To receive benefits from the care insurance it is essential to have a care degree. This level depends on how severely a person's independence is restricted and varies from 1 to 5. The higher the care level, the more extensive the benefits that can be claimed.
Apply for a care level with the care insurance fund
If you are permanently and significantly dependent on assistance in everyday life and would like to claim long-term care insurance benefits, you must apply for a care degree. To do this, you submit an informal application to your care insurance provider. You will then receive a detailed form which you must complete, sign and return.
After the application for long-term care, the long-term care insurance then commissions the preparation of a long-term care assessment, for which an assessor visits you at home or alternatively carries out an assessment by telephone or video call. This assessment is based on a fixed points system and forms the basis for the decision on your care level, which is ultimately awarded by the long-term care insurance company. If necessary, it will also obtain further information
You will receive the care degree decision in writing together with the expert opinion. If you do not agree with the result, you can lodge an appeal. If your care level is recognized, you are entitled to care services (outpatient care, home help, everyday assistance, cleaning assistance, care aids) retroactively from the date of application.
Where can I apply for a care degree?
To apply for a care degree, contact your care insurance provider directly. If you have statutory insurance, your long-term care insurance is usually part of your health insurance. Therefore, you can simply contact your health insurance company to obtain information about the relevant long-term care insurance fund.
It is important to know for people who are privately insured: If you would like to apply for a care degree, you must contact your private compulsory long-term care insurance (PPV) directly. Even if you have also taken out supplementary long-term care insurance, the compulsory long-term care insurance company is responsible for processing the long-term care degree application.
The choice of expert service also depends on your form of insurance: those with statutory insurance are assessed by an expert from the Medical Service (MD) while privately insured persons are visited by an assessor from Medicproof or another private service.
When do you apply for a care degree?
It is basically a wise decision to apply as soon as possible, as your entitlement is retroactive from the date of application. The longer you wait, the more benefits you will lose in both financial and material terms.
There are two possible situations:
1. initial application: If you did not previously have a care degree.
2. upgrading: If the current care level is no longer appropriate.
Initial application - Applying for a care degree for the first time
It is advisable to submit an initial application for a care degree if you assume that you will probably be dependent on support in everyday life for longer than six months. Even if it is only for minor assistance with household chores, shopping or coping with everyday life, it makes sense to apply for a care degree.
Taking the step to actively ask for help often means giving up some of your independence, which is not easy for many people. Unfortunately, many of those affected wait too long until it is practically unavoidable before applying for care services.
It is important to understand that care benefits should not cause shame. They are insurance benefits that you should be entitled to if you need them. It is not necessary to already be bedridden to be considered in need of care.
Upgrading - when the care level is no longer appropriate
If your state of health deteriorates and your current care level no longer seems appropriate, it is time to apply for a upgrade of the care level because there are 5 different care levels (formerly care levels) into which people in need of care can be classified.
The process is similar to the initial application: you inform your care insurance company about the changes in your condition and apply for an increase in the care level. If your descriptions are convincing, the insurance company will arrange for a new assessment by an expert and, if necessary, adjust the care level accordingly.
Checklist: Apply for the right care level
Before submitting the application and determining the need for care, it should be determined who will care for the person in need of care. Family caregivers and/or an outpatient care service can be considered for home care. Alternatively, hiring a Polish caregiver could also be considered. If care is to be provided on a part-time or full-time inpatient basis, a suitable care facility must be found.
Expert opinions, x-rays, etc. should be collected and kept in order to prove limited independence. The attending physician should be informed of the application, as he or she may be able to provide documents certifying the need for care.
The next step is to submit an informal application to the health insurance fund, which can be submitted in writing or by telephone. When submitting the application, you should start keeping a care diary, as this can be used as a basis for argumentation during the review meeting.
As soon as the application has been received by the care insurance fund, an assessor from the Medical Service of the Health Insurance Fund (MDK) is commissioned to assess the care degree. During a personal visit, the assessor uses the New Assessment Assessment (NBA) to check the remaining independence and the care situation. The appointment for the home visit is arranged in writing and/or by telephone with the applicant/carer.
It is important to ensure that the applicant (the person in need of care) does not attend this appointment alone, as many people embellish their situation during the assessment, which can have a negative impact on the determination of the care level. It is best if the person responsible for the care is also present. The duration of the home visit can vary and usually lasted up to one hour until the end of 2016.
Once the assessment has been completed, the assessor will send the results of the assessment to the long-term care insurance fund. After checking the result, the long-term care insurance fund will inform you of the result in the form of the degree of care you have received. The entire application process can take up to a maximum of 5 weeks, whereby this period begins with the receipt of the application by the fund and ends with the date of issue of the assessment result.
Urgent application for a care degree
In some situations, the usual period of up to 25 working days is not appropriate, especially if a person is still in hospital and it is foreseeable that they will be dependent on care at home after discharge. In such cases, it is possible to submit an urgent application for a care degree.
An urgent application enables a faster classification through a shortened assessment. Initially, it is only checked whether there is a need for care and whether at least care level 2 is achieved. A detailed assessment is then carried out as soon as possible. Urgent applications are often submitted when the applicant is still in hospital. In such cases, it is advisable to contact the hospital's social services department, as these employees are familiar with urgent applications for care and fast-track classifications and can offer support and care advice.
There are three admissible grounds for an urgent application:
- Continued care after hospitalization or rehabilitation is not guaranteed.
- The carer agrees care leave or family care leave with their employer.
- The person in need of care is receiving palliative care.
Unsecured further care after an inpatient stay
If someone is currently in hospital or in an inpatient rehabilitation clinic and care after discharge can only be ensured through an assessment, it is possible to submit an urgent application.
In such situations, the assessment must take place no later than the fifth day after the application is submitted. This enables a quick provisional decision on the degree of care, which ensures that further care and its financing can be guaranteed.
Care leave or family care leave for the carer
If the person providing care has agreed care leave or family care leave with their employer, it is also possible to submit an urgent application. However, this is only possible if a corresponding care degree already exists. This issue should therefore often be clarified before the person is discharged from hospital or an inpatient rehabilitation clinic.
There are two possible cases:
- If the person in need of care is currently in hospital or in an inpatient rehabilitation clinic, the assessment must take place no later than the fifth working day after the application is submitted.
- If the person in need of care is at home and does not receive palliative care, the assessment must take place no later than the tenth working day after the application is submitted.
Palliative care
Even if a person is receiving palliative care, an urgent application can be made, regardless of whether the care is provided at home or in a hospice. In this case, an assessment must be carried out within five days of the application being made.
How do I apply for a care degree?
There are various ways to apply for a care degree. You can do this over the phone by calling your care insurance provider. Alternatively, you can submit the application in writing by post or email. Many long-term care insurance companies now also offer online application forms. Another option is to submit the application in person at a care support center near you.
Regardless of the method chosen, the content of the application remains the same. You inform your long-term care insurance company that you wish to apply for a care degree or apply for benefits from the long-term care insurance.
If you do not yet have a care degree, an application for care services is also an application for a care degree.
Notes on the care degree form
Below you will find tips and information on filling out the care degree form:
Type of application
You must decide whether it is a first-time application (if the person concerned has not received any long-term care insurance benefits to date), an upgrade of the existing care level (if the person concerned already has a recognized care level but the restrictions have worsened and you are applying for a higher care level) or an adjustment of the care benefits (if the type of benefits is to change, e.g. from family carers to a care service).
Personal details
In the application, you must provide information about the person in need of care and, if applicable, the authorized person. This includes, among other things: Name, address, contact details, date of birth and policyholder number.
Service types
Depending on the level of care 2, 3, 4 or 5 the following types of benefit can be applied for: Care allowance, care benefits in kind, day care, night care, combination benefits and full inpatient care.
Type of care
You indicate whether you would like to receive outpatient care (from relatives or a care service) or inpatient care in a nursing home.
Information on other service providers:
Indicate whether there are any causes for the need for long-term care, such as an accident or illness (e.g. stroke), and whether you are already receiving benefits from other providers.
Final data:
Finally, enter your account details and the details for making an appointment with the Medical Service of the Health Insurance (MDK) for the care assessment and agree to the data protection guidelines.
Can I apply for a care degree by telephone?
A telephone application for care services is a direct and uncomplicated way to start the process and clarify initial questions. After the phone call, you will usually receive an application form by post or be directed to an online form. It is important to note that the day of the call is the official application day.
Apply for a care level online
Many long-term care insurance companies offer online forms on their websites for direct application or at least provide application forms for download. You can simply search for a corresponding offer on the website of your long-term care insurance company or alternatively use a search engine to find the form you need.
Apply for a care degree at the care support center
If you prefer the most personal approach, you can contact a care support center in your federal state directly. There you will receive comprehensive information and can fill out an application for a care degree together with the specialists.
A visit to a care support center offers the opportunity to clarify open questions and to be encouraged by the personal contact. However, you should not waste any time when applying for a care degree. If the appointment at the care support center could cause a delay, it is advisable to choose a different route for the application.
How can I prepare for the Medical Service assessment?
Where does the assessment take place?
As a rule, both the initial and any follow-up assessments are carried out in the applicant's home. This regulation applies to applications for home care as well as applications for full inpatient care.
Overcoming communication barriers
If the person in need of care who is to be assessed has difficulty communicating in the official language German, they and their relatives can be supported by other relatives or acquaintances with sufficient language skills or by a translator for the duration of the assessment. The assessor must ensure that communication is barrier-free and that any necessary aids are available.
Who should be present at the assessment?
With the consent of the applicant, caregiving relatives, partners or other persons or services involved in the applicant's care should also be interviewed. It is therefore important to ensure that not only the senior citizen who is to be classified into a care degree attends the appointment, but also the caregiver and, if available, another person of trust.
If an authorized representative or legal guardian is known, they must also be notified in good time.
Preparation
It is helpful to make a note of examples of special or particularly complex care situations from everyday care that can be mentioned during the expert's visit. A checklist can help to prepare important information:
- What causes difficulties in everyday life?
- What activities do you need support with in everyday life?
- Is there a current medication or treatment plan? You should have these to hand.
- Medical reports, discharge reports from a treatment facility and other medical documents should also be available.
- If a care service is involved, inform them in good time and have the care documentation ready.
What happens after the assessment
After the expert from the Medical Service of the Health Insurance Fund (MDK) has carried out the personal examination, the result of the assessment will be processed by your long-term care insurance fund. You should receive notification from the long-term care insurance fund within five weeks.
In most cases, the care assessment is sent by post. This determines the level of care you have achieved. If you are not satisfied with the result, you have the option of appeal to lodge an appeal.
What services can you expect?
The 2017 long-term care reform [mfn]Pflegereform 2017[/mfn] made it easier to be classified as needing long-term care and to receive benefits and money from long-term care insurance. It is important to note that the long-term care insurance funds apply the principle of "outpatient care before inpatient care", which has an impact on the benefits granted. Compared to 2016, benefits relating to home care were increased, while benefits for (semi-)inpatient care were reduced.
