Long-term care insurance covers the financial risk of the need for care. It is intended to enable the person who needs care to nonetheless lead a self-determined life. Thus, long-term care insurance is not a full-fledged insurance. Rather, it provides basic social security in the form of supportive assistance that does not however preclude the participation of the insured and other agencies.
The competent care insurance fund first examines which services are potentially required for the medical rehabilitation of the insured in order to overcome or minimise his need for care, or to prevent his condition from worsening.
The decisive factor determining which benefits are received is the degree of need. This is determined by the medical service of the health insurance fund. In order to take into account varying needs, three care categories have been established by law. These also establish the maximum amount of benefits provided through long-term care insurance:
Long-term care insurance provides either benefits-in-kind or cash benefits used to finance basic personal care and help with household chores. A combination of cash allowance and non-cash benefits is possible. In addition, the following services are provided:
If a person claims care benefits on an outpatient basis - i.e. for home care - he will receive a cash allowance of 225 € in Care Category I, 430 € in Care Category II or 685 € in Care Category III.
Assistance can also be supplied by professional caregivers (e.g. social services or a home care agency), whose work will be covered by the care insurance funds as a so-called benefit-in-kind. For this care option, those in Category I are entitled to 440 €, in Category II to 1,040 € and those in Category III to 1,510 €. Those whose ability to care for themselves is especially impaired (so-called "hardship cases") can receive up to 1,918 € per month.
When home care is not adequate, care can also be provided in semi-inpatient or full inpatient facilities. For full inpatient care, basic personal care and treatment as well as household assistance are covered in the amount of 1,023 € in Category I, 1,279 € in Category II, 1,510 € in Category III, and for hardship cases 1,825 €. Costs for food and board in the nursing home must be financed by the patient.
When relatives or friends provide care, they receive a monthly care allowance and automatic pension and accident insurance for the duration of their care activities. However, these volunteer caregivers must assist the person requiring care for a minimum of hours per week to qualify for these benefits.
A person is entitled to long-term insurance benefits only after he has been insured for at least two years.