Applying for home nursing care for people with statutory health insurance

If you need qualified nursing care at home or at another suitable location due to an illness, you can apply for home nursing care from your statutory health insurance provider. You will need a doctor's prescription for this.

Your doctor can prescribe home nursing care if you need support after an operation or serious illness, for example, or if it is necessary to ensure that the medical treatment objective is achieved.

If you have statutory health insurance, home nursing care must be approved in advance by your health insurance provider. You can then - with the help of your health insurance company if you wish - choose a suitable nursing service that is a contractual partner of your health insurance company.

Home nursing care can take place in your home, with your family or at another suitable location. These include, for example, assisted living facilities as well as schools and kindergartens for children and young people.

Home nursing care can include

• Basic care: this includes, for example, personal hygiene, nutrition and mobility.
• Treatment care: Treatment care helps to cure the illness or prevent it from getting worse. This includes, for example, administering medication or wound care.
• Domestic care: This is help in the household, for example shopping, washing or cleaning the home.

Supportive care

Supportive care is necessary

• if you have a serious illness,
• an illness worsens acutely
• and you need support, particularly after a stay in hospital, an outpatient operation or outpatient hospital treatment.

Supportive care usually includes basic care and housekeeping. The statutory health insurance funds cover supportive care for up to 4 weeks for each case of illness. An extension for medical reasons is possible.

Backup care

If home nursing care ensures the success of medical treatment, your statutory health insurance will pay for so-called back-up care. This covers treatment care for as long as it is medically necessary.

Some health insurance companies have stipulated in their statutes that basic care and domestic care can also be paid for in addition to treatment care.

Hospital avoidance care

You receive so-called hospital avoidance care

• if treatment in hospital is not possible,
• home nursing care allows you to return home earlier after hospital treatment,
• or hospital treatment can be avoided altogether by providing home nursing care.

Hospital avoidance care includes treatment care and - if necessary - additional basic care and housekeeping. Hospital avoidance care is covered by statutory health insurance for up to 4 weeks per case of illness. An extension for medical reasons is possible.

• Medical prescription

• You have been prescribed home nursing care by a doctor.
• There is no one in your household who could care for you to the extent required.
• for supportive care: you are not in need of care with care level 2, 3, 4 or 5
  

• Objection
• Action before the social court
  

To receive home nursing care, you normally proceed as follows:

• Your doctor prescribes home nursing care for you.
• You choose a nursing service that is a contractual partner of your health insurance company. If you wish, your health insurance company will help you choose a suitable provider.
• You present the doctor's prescription to the care service. As a rule, the care service will take care of the application to your health insurance company. Alternatively, you can also submit the doctor's prescription directly to your health insurance company. You can submit the application by post or - with many statutory health insurance companies - online or in person at the office.
• Your health insurance company will check whether you can receive home nursing care.
• If your health insurance company has approved the application, the care service will bill your health insurance company directly.

You do not have to observe any deadlines. You or your care service must submit the doctor's prescription to your health insurance fund.

If you are already receiving home nursing care or wish to receive it immediately, the health insurance company will only cover the costs of the services provided by the nursing service until a decision is made on approval if the prescription is received by the health insurance company no later than 4 working days after the prescription is issued.

Adults pay EUR 10.00 for each prescription and 10 percent of the costs as a statutory co-payment. This applies for the first 28 days per calendar year.

The statutory co-payment does not apply if you are exempt from the statutory co-payment obligation.