Care benefits of statutory health insurance

If someone needs care support or help at home for a short time for health reasons, they can apply to their health insurance fund to cover the cost. This may happen, for example, if an illness becomes severe or when someone has had a recent operation. Medical treatment in a hospital is not always necessary in these cases, but support at home is.

People in these situations are often not entitled to long-term care insurance benefits to cover this type of short-term care support. That’s because long-term care insurance benefits only apply if the need for care is likely to last for at least six months.

The following health insurance benefits can help in these situations:

• support in the form of home nursing
• support in the form of home help
• short-term care without a care grade
• transitional care

Co-payments

Insured persons usually need to cover some of the costs themselves. Gather all the paperwork. If the costs exceed your personal contribution limits, you may be released from your obligation to contribute to the cost with a co-payment. Sometimes you can also include the costs as an extraordinary expense in your tax declaration.

You can find out how to be exempted from co-payments on the consumer advice center website.

Home nursing involves everyday care support. This includes post-treatment care (for example, changing wound dressings), basic care (such as help with personal hygiene), and household assistance (for example, shopping), where required. Doctors can only prescribe home nursing for an initial period of 14 days. Follow-up prescriptions can be issued for a longer period. However, the doctor must provide a reason in this case. 

The health insurance fund will only approve home nursing if there is nobody in the household who can provide the required level of care.

The patient must themselves pay 10 euros per support service prescribed by a doctor, and a maximum of 10 percent of the total costs for home nursing. Co-payment is limited to 28 days per year. Children and adolescents up to the age of 18 are exempt from co-payment. In addition, co-payment does not apply to home nursing due to a pregnancy or birth.

Home help covers activities in the home that do not relate to care. These include, for example, laundry, cleaning, shopping, and cooking. These activities are also known as household-related services. People can apply for home help for a maximum of 4 weeks per case of illness. 

If the household includes children below the age of twelve or children with a disability, who also need help, home help can also provide support by taking care of the children. In these cases, the home help can be extended to a maximum of 26 weeks.

The health insurance fund will only approve home help if there is nobody in the household who can provide the required level of care.

The insurance holder must contribute 10 percent of the costs of home help each day, but a minimum of 5 euros and a maximum of 10 euros per day. Co-payment does not apply if home help is needed in the context of a pregnancy or birth.

If home nursing or home help are not sufficient, the health insurance fund will cover the cost of a temporary stay in a residential care facility. The nursing care, support and post-treatment care provided during a stay like this is subsidized to a maximum of 1,774 euros per year for 8 weeks at most. The patient themselves has to pay for all costs incurred above and beyond this, as well as the cost of accommodation and meals (also referred to as “hotel costs”).

The health insurance fund will only approve short-term care if there is nobody in the household who can provide the required level of care.

If anyone, with or without an assigned care grade, needs further support immediately after hospital treatment, they can be looked after in that hospital for a maximum of a further 10 days. This applies to each individual hospital treatment.

This benefit covers accommodation, food, basic and post-treatment care, provision of medicines and medical aids, as well as medical treatment, where necessary.

The health insurance fund will only cover the cost of transitional care if care at home, short-term care, or medical rehabilitation are not possible or present significant difficulty.

Adults are required to contribute 10 euros per day for transitional care in hospital. Co-payment is limited to 28 days per year.

If you need temporary support for health reasons, contact the doctor who is treating you.

As these benefits generally need to be applied for from the health insurance fund, a doctor’s prescription is required. The prescription must indicate the diagnosis and impairments that are the reason why temporary support is needed, as well as the length of time for which it is required and the scope of the support involved.

Your health insurance fund can advise you on possible entitlements to benefits and on how to proceed. The social service at the hospital can also provide assistance on request.

Contact your doctor or your health insurance fund if you become aware that the benefits available for temporary care and the potential extensions of the periods for which they are available are inadequate in your case. It may also be a good idea to apply for a care grade from the care insurance fund. The care fund will then check whether there is a need for care so that you may be able to access the benefits available with long-term care insurance.

If your health insurance entitlements have been used up and you are in financial need, it may be possible to apply for help with care costs from the social welfare office.

You can get more information from the relevant social welfare office in your town or district.

If you need support as a result of a work accident, the relevant accident insurance provider may also cover the costs of home nursing and care measures.

The German Social Accident Insurance (DGUV) helpline will tell you who to contact in such cases. The helpline is available free of charge from 8:00 am to 6:00 pm, Monday to Friday, on 0800 60 50 404.