Health insurance funds

Care level

If a person requires nursing care within the meaning of the Social Security Code, the person giving care will receive benefits from the social nursing care insurance of the person requiring care. The person requiring care can be an outpatient care service or a private individual or family member.

The basis for this is the Eleventh Book of the Social Security Code (SGB XI).

To receive benefits from this insurance, it is initially necessary to determine a need for care. This examination is performed by the MDK, Medical Service of the Health Insurance Funds. If the MDK has determined a need for care, the person to be cared for is classified in one of 3 care levels. The benefit claims then arise from this nursing care category.

If the care is provided by an outpatient care service, the benefits are presently between EUR 440 and EUR 1,510 (in serious cases EUR 1,918) per month, depending on the care category level.

If the care is provided by a relative, depending on the care level, a care benefit in the amount of EUR 225 to EUR 685 can be claimed.

A combination of outpatient services and care by a relative are possible.

To obtain a care level, an informal application must first be made with the responsible health insurance fund of the person requiring care. The health insurance fund then sends the relevant forms. After these have been filled out and submitted, the MDK will be instructed and the assessment process will begin. An example for initial information can be found here and here.

Experience has shown that whenever benefits are claimed from insurance, it is advisable to first read the "GTCs" of the insurance company and then report the "claim".

This is no different with the care insurance. One should be thoroughly prepared when the MDK inspector visits. It is important to see one's own situation from a neutral perspective and be precisely aware of the inspector's criteria. An inspector naturally has a certain scope of discretion, but the criteria that an inspector must adhere to are defined in the Social Security Code.

For general information and preparation for the assessment, the „Care Bible“ is recommended.