Long-term care insurance
Our services in case of care
BKK EWE's long-term care insurance benefits serve to provide financial support in the event of a need for long-term care and are provided upon application. A distinction is made between home care and full inpatient care in a care facility. In order to receive benefits from the nursing care insurance fund, a pre-insurance period of two years within the last ten years must first be fulfilled for both home and full inpatient care.
When care is needed
Persons in need of care are those who, due to illness or disability, require assistance with the "usual and regularly recurring activities of daily living" for an expected period of at least 6 months. In order to do justice to the varying severity of the need for care, it is divided into care degrees. The exact classification is made in cooperation with the Medical Service. The MD doctors visit the insured person in his or her living quarters to determine the extent of the need for care.
The five degrees of care
The prerequisite for access to care services is the existence of care degrees 1 to 5. The care degree is determined with the help of an assessment instrument based on care expertise.
- Care level 1: minor impairment of independence
- Care level 2: considerable impairment of independence
- Care level 3: severe impairment of independence
- Care level 4: most severe impairment of independence
- Care level 5: most severe impairment of independence with special requirements for nursing care
Looking for a suitable care facility?
Are you looking for an adequate care facility? Then use the BKK Care Finder.
Professional nursing advice from spectrumK
Our long-term care insurance offers all insured persons and their relatives qualified and comprehensive long-term care counseling if there is a need for individual counseling. The care consultation can take place both by telephone and in the home.
If you would like a nursing consultation, please feel free to contact the nursing hotline of our cooperation partner spectrumK.
Contact
Phone: 0800 7237267
E-mail: pflegeberatung@spectrumK.de
Caregiver leave and family caregiver leave
To care for a close relative, you can take time off from work in whole or in part.
Online nursing courses
Are you caring for a relative? We would like to support you in this responsible activity with our online care courses.
Care services
Outpatient care
Care level 1
Care advice
- Consultation in the patient's own home by a nursing service,
- additional benefits for persons in need of care in outpatient assisted living groups,
- Supply of nursing aids,
- financial subsidies for measures to improve the individual or shared living environment,
- additional care and activation in inpatient care facilities,
- Caregiving courses for family members and volunteer caregivers.
- In addition, the nursing care insurance fund grants a relief amount of €125.00 per month. For care level 1, this can also be used for benefits in kind from the care service (basic care), which is not possible for other care levels.
- In the case of full inpatient care, a subsidy of €125.00 is paid.
- Caregiver security benefits are not provided for Care Level 1.
Care level 2-5
Care benefits in kind
Benefits in kind can be claimed if approved outpatient care services provide care in the home. The costs for this are settled directly by the care service with the care insurance fund.
The following amounts are available each month for billing the nursing service, depending on the level of care:
- Care level 2: up to €761.00
- Care level 3: up to € 1,363.00
- Care level 4: up to €1778.00
- Care level 5: up to € 2200.00
Care allowance
Care allowance can be claimed if the person in need of care is cared for by a private caregiver (e.g. spouse, relatives, friends,...) in the home.
Depending on the level of care, the following amounts are paid monthly:
- Care level 2: € 332.00
- Care level 3: € 573.00
- Care level 4: € 765.00
- Care level 5: 947.00 €
It is required that for care levels 2 and 3, a counseling session is conducted every six months by an approved outpatient care service. For care grades 4 and 5, this consultation must be carried out on a quarterly basis. We will bear the costs for this on your behalf.
Combination power
It is possible to claim benefits in kind in addition to the care allowance ("combination benefit"). In this case, a percentage of the care allowance is paid out after the outpatient care service has settled its accounts.
Partial/full inpatient care
Part day and night care
Day and night care refers to temporary accommodation during the day/night in a semi-inpatient facility. Here, the care-related expenses are covered by our long-term care insurance.
Costs for room and board must be borne by the patient, but may be reimbursed via the care and respite benefits. Day and night care can also be claimed in addition to the care allowance. The entitlement to care allowance remains unaffected.
The following amounts are available:
- Care level 2: up to € 689.00
- Care degree 3: up to 1298,00 €
- Care degree 4: up to 1612,00 €
- Care degree 5: up to 1995,00 €
Full inpatient care
For full inpatient care in an approved nursing home, we pay a flat monthly amount for you. This covers part of the costs for nursing, care and education. You bear the remaining part, as well as the costs for meals, accommodation, investments and comfort services.
Most nursing homes also offer extensive care and activation measures for residents. The costs for these are settled directly with us.
We pay the following flat monthly amounts to nursing homes:
- Care degree 2: 770,00 €
- Care degree 3: 1262,00 €
- Care degree 4: 1775,00 €
- Care level 5: 2005,00 €
From January 1, 2022, in addition to the monthly lump sum, the long-term care insurance will pay a supplement for the personal contribution to care-related expenses and training allowances. This supplement increases with the length of stay in a fully inpatient care facility. In the first year of full inpatient care, the care insurance fund pays 15% of the care-related personal contribution, 30% in the second year, 50% in the third year and 75% thereafter.
Short-term and preventive care
(Entitlement with care degree 2 to 5)
Short-term care
If home care is not possible, not yet possible or not possible to the extent required and day-care is not sufficient, there is a temporary entitlement to full inpatient care (e.g. following inpatient treatment or in other crisis situations). During the use of short-term care, half of the care allowance continues to be paid.
Short-term care can be claimed for up to 8 weeks. The benefit amount is € 1774.00, whereby the increase by the funds of the prevention care is possible.
Persons with care level 1 can have costs of short-term care reimbursed via the entitlement to respite care, provided that the budget for this is sufficient.
If you need short-term care, please contact our nursing care insurance company.
Preventive care
If a caregiver is prevented from providing care due to a vacation, illness or other reasons, the costs for necessary substitute care are covered for 6 weeks and a maximum of € 1612.00 per calendar year. Preventive care can also be extended to the entire calendar year, provided that it is provided on an hourly basis (less than 8 hours per day). Preventive care can be provided by a private substitute, a licensed nursing service, a full inpatient care facility and relatives.
The prerequisite for preventive care is that the person in need of care has been cared for in his or her home environment for 6 months prior to the first prevention. You are entitled to continued payment of half of the care allowance for the period during which you receive preventive care.
Special regulation for respite care §39 Para. 4 SGB XI
For people in need of care who have not yet reached the age of 25 and receive care benefits in accordance with care degree 4 or 5, the costs for necessary replacement care are covered for 8 weeks up to a maximum of €1612.00 per calendar year. A pre-care period is not required under this special regulation.
Should you wish to make use of preventive care, please contact our nursing care insurance company.
Care and relief services
Costs associated with the following services may be reimbursed as additional care and respite services:
- Day, night and short-term care (e.g. for accommodation, meals, investment costs)
- Special offers of general guidance and care or offers of domestic care from approved outpatient care services
- Low-threshold care and respite services
People in need of care can claim additional care and respite benefits of up to €125.00 per month.
Those who do not fully exhaust their entitlement to outpatient care benefits in kind can additionally use the amount not used for the receipt of outpatient care benefits in kind - but no more than 40% of the benefit amount earmarked for this purpose - for low-threshold care and respite services.
Pension and unemployment insurance obligation for caregivers
Under certain conditions, we assume the contribution payments for pension and/or unemployment insurance for the caregivers. The amount of the contributions depends on the respective care degree of the person in need of care and the weekly care hours.
Published on: 22.02.2022 - Last modified on: 02.01.2024
