Deutsche Rentenversicherung Knappschaft-Bahn-See
Regionaldirektion Nord
Millerntorplatz 1
20359 Hamburg

Andreas Matthies
Phone: +49 40 30 388-51 21
Mobile: 0151 19 61 52 48

Webcode for this Content: 16404066

Benefits of long-term care insurance

Scope of the statutory nursing care insurance

The statutory nursing care insurance has to ensure that its members receive the required nursing care. It arranges for basic care and housekeeping and reimburses related expenses. The legal basis is volume eleven of the German Social Insurance Code (SGB XI). Responsibility rests with the nursing care funds which have been established by all statutory health insurance funds.

The three care levels

Statutory nursing care insurance is focused on persons in need of nursing care. Need of nursing care means having to rely to a considerable extent, permanently or long-term, on support for everyday routines (meals, grooming, mobility and housekeeping) due to a physical, mental or psychological illness or handicap.

The medical service of the health insurance acts also on behalf of the nursing insurance funds and assesses on application the degree of need for care. The assessment is performed by the medical service in the home of the applicant. The medical service decides after a thorough evaluation on the care level needed. There are three care levels and the benefits from the nursing insurance fund increase with the level:

  • Care level 1 (considerable need of care):
    Persons in need of support for at least two routines per day (e.g. getting up, getting dressed) for not less than 90 minutes; thereof not less than 45 minutes for basic care.
  • Care level 2 (substantial need of care):
    Persons in need of support for grooming, meals or mobility at least at three different times per day for not less than three hours; thereof not less than two hours for basic care.
  • Care level 3 (extreme need of care):
    Persons in need of support for grooming, meals or mobility at any time for not less than a total of five hours per day; thereof not less than four hours for basic care.

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Benefits of nursing care insurance

The benefits of nursing care are listed in the following table:

Kind of care Benefits

home care

  • In kind benefits: Assumption of the cost of suitable professional caregivers at home
  • Nursing care benefits: Assumption of the cost of a privately engaged caregiver, who may also be a relative.

In kind benefits and nursing care benefits can be combined. The nursing care benefit will be reduced accordingly.

If a home caregiver is prevented from care due to leave, illness or other reason, the insurance fund may pay for a substitute. This is possible for up to 4 week per year and within financial limits.

  • Aids for care: the insurance fund pays for aids which facilitate ease of care, alleviation of afflictions or a more self reliant life, as long as these are not to be financed by other funds (e.g., health insurance). The nursing care insurance fund will assess if there is a need for such aids.

Part-time institutional care

Persons in need of nursing care are entitled to part time institutional care, if home care can not be provided sufficiently. It is provided in designated institutions, either as daytime or night time care and includes also transportation between home and centre. The amount of benefits depends on the care level.

short-time care

Short-time care can be granted for a transitional period after an in-patient treatment or in other situations in which home care or part-time institutional care is not possible or sufficient. It is provided at an institution designated to full-time care for a maximum of four weeks per calendar year. The amount of reimbursement is limited.

full-time institutional care

Persons in need of nursing care are entitled to full-time institutional care, if home care or part-time institutional care is not possible. Only costs of care are covered, accommodation, subsistence and other agreed services (if any) are to be paid for by the patient.

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Nursing care abroad

If a member or a relative covered by the nursing care insurance is permanently domiciled in a foreign European country, they have to choose between either financial benefits or in kind benefits, while a combination of both is not possible.

If a member of the German nursing care insurance is entitled to benefits from the social security system of his foreign state of residence, benefits from the German insurance are put on hold.

When assessing the degree of need for care the same standard applies in Germany and abroad. Abroad, the medical service in Germany cooperates with a partner organization in the state of residence for such assessment. The assessment report is forwarded to the German medical service which evaluates it, accepts or rejects the need for care and finally informs the responsible nursing care insurance fund.

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