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Good news for people in need of care and their relatives – many small but necessary services can now be billed and applied for anew. With the new Care Strengthening Act, as of January 1, 2015, even those in need of care who do not meet the requirements of §45a SGB XI receive additional care and relief services amounting to €104 per month.
Policyholders with significantly limited everyday competence (mentally ill, disabled, or people with dementia) are entitled to the care allowance. These so-called "low-threshold relief services" can even be granted, depending on care needs, with the increased amount of €208.
| Care level | Services per month up to |
| Care level I, II, or III (without significantly reduced everyday competence) | 104 euros |
| Care level 0, I, II, or III (with permanently significantly limited everyday competence, which entitles the person to claim the basic amount) | 104 euros |
| Care level 0, I, II, or III (with permanently significantly limited everyday competence, entitling to claim the increased amount) | 208 euros |
What are low-threshold care and relief services?
- Hourly care for dementia patients
- Maintaining Social Contacts
- Care of individuals in need of care in their own homes
- Family-relieving and supportive services such as visiting a cemetery, a zoo or concert, public events, excursions
- Relieving the family in dealings with authorities and doctor visits
- Support in the household and domestic care (household-related services)
- Support with shopping planning and shopping
- Individual Assistance for Organizing and Managing Daily Life
- Supervised Holiday
- Promotion of Hobbies and Activities
- Reading books, newspapers, etc.
The possible services are roughly divided into three groups:
- Household relief (e.g., cleaning, shopping, taking out the trash, making beds, watering flowers)
- Care support (e.g., accompaniment during walks, public events, therapeutic services, doctor visits, or home care)
- Organizational relief (e.g., prescription orders from the doctor, trip to the pharmacy, applications with the health insurance, arrangement of hairdresser, foot care, physical therapy)
Utilization of the service and transfer of claims:
The benefit is available to every insured person, and no special application is required. The benefit can only be claimed as a service and cannot be paid out. Benefits not claimed from the current year are carried over to the following year. They can then be claimed until June 30th of the following year. The new entitlements from the current year are accordingly transferred to the second half of the year or again to the following year.
The legislator has also created the legal conditions allowing the entitlement to outpatient care services, which is not fully utilized, to be used for low-threshold care and relief services. However, this is limited to a maximum of 40%. So far, this has not yet been practically implemented by the payers and providers; negotiations are ongoing. We will promptly inform you on this page about the innovations.
How to apply for the provision of the amount for additional care and relief services?
- Call your nursing care fund, they will assist you further.
- Keep the insurance number, last name, first name, and date of birth ready.
- You can also directly contact an outpatient care service that provides support and relief services and takes care of everything else.
How is the billing done?
This is a so-called reimbursement benefit. This means that the outpatient care service bills you directly, and you submit the invoice for reimbursement to the nursing care fund. Alternatively, you can agree with the care service that it receives a so-called assignment declaration from you, with which the care service can bill the nursing care fund directly.
If there is no remaining balance from previous months or the previous year, only the monthly entitlement of €104 or €208 can be reimbursed. Amounts exceeding this must be borne by the insured and will be directly billed as a personal contribution by the care service to the insured, or the insurance will reimburse only the monthly entitlement for submitted bills.
Who can provide the domestic services?
Ambulatory care services or providers with the appropriate approval can conclude a contract as a service provider (e.g., a home care service) with the service recipient (caregiver or a caring relative) and then provide the services. In some federal states, such as North Rhine-Westphalia, these services may also be provided by private individuals. A prerequisite for billing with the care fund is a 40-hour course that must be completed by the person who wishes to provide the service. Any more questions about this? Call us, we will be happy to provide more detailed information.
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