Applying for a care degree: what you need to know
Anyone applying for a care degree should be well prepared for the visit from the Medical Service of the health insurance funds.
People in need of long-term care are entitled to benefits from long-term care insurance. In order to receive these benefits, the person in need of care (or a relative) must submit an application to their long-term care insurance - a department of their health insurance company. If a need for care is established, the benefits are paid retroactively up to the date of application. It is therefore important to submit the application as soon as possible.
The long-term care insurance then commissions the Medical Service of the Health Insurance Funds (MDK) to draw up an expert opinion on the extent of the need for long-term care. For this purpose, an assessor visits the person in need of care.
The right preparation for a visit from the medical service
A great deal depends on this visit, as the MDK's report is the basis for the care insurance company's decision on whether and what benefits the person in need of care will receive. Relatives and patients should prepare well for this appointment (which must be announced well in advance). For example, it is advisable to keep a care diary for several days in which all care activities that are relevant for the care insurance are noted. It also makes sense to talk to the patient in advance about their need for help in everyday life. Particularly important: Even if patients understandably want to present themselves in a good light, they should clearly demonstrate their need for help at the assessment appointment and not gloss over the situation in any way.
You should have these documents ready
- Reports from the family doctor, specialists or the discharge report from the hospital, if available.
- Current medication plan.
- If a care service comes, care documentation.
- Care diary, in which you note down in advance all care activities that are relevant for care insurance.
Compensation possible in the event of delay
The long-term care insurance funds are bound by a deadline when processing applications. A maximum of 25 working days may elapse between the MDK's visit and the decision. If it takes longer, people in need of care or their relatives can claim compensation of 70 euros per week or part thereof. However, this regulation does not apply if the person in need of care lives in a care home and already has at least care level two. Or has no care level been approved at all? In such cases, people in need of care and their relatives can lodge an appeal against the decision. If this is also unsuccessful, there is always the option of going to the social court.
Appeal against the MDK's decision - how to do it
If the Medical Service rejects the application for a care degree, or if the classification is lower than expected, you can lodge an appeal within 28 calendar days. You can also lodge several appeals. If the appeal is rejected twice, the social court will decide.
- Ask for a reason for the rejection and use this to formulate your objection.
- The long-term care insurance fund examines the appeal and sends an expert again.
- If the new assessment is positive, you will receive benefits from long-term care insurance retroactively from the date of the first application.
- If you are not yet in need of care to the extent that a care degree is approved, you can submit a new application after a certain period of time.
- You can also submit a new application for long-term care insurance benefits if your state of health changes significantly.
"A lot depends on the visit from the medical service. We recommend that people in need of care and their relatives prepare well for this appointment."
Jürgen Griesbeck, Product Manager Homecare-Eldercare, pme Familienservice Group
pme Familienservice Group - Your EAP provider since 1991
On behalf of more than 900 employers, the pme Familienservice Group supports employees in achieving a successful work-life balance and being able to work with a clear head.
The pme Familienservice Group supports employees in crises, e.g. conflicts at work, addiction or partnership problems. With a homecare eldercare service, it relieves the burden on professionals in organizing and financing care services and offers psychosocial support. The pme Academy offers seminars, workshops and coaching on the topics of personnel management and development.
You can find out more about the pme Familienservice Group here: www.familienservice.de/wer-wir-sind
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