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Benefits provided by the nursing-care insurer

Nursing-care insurers pay nursing allowances and nursing benefits in kind in keeping with the nursing care grade involved. Nursing allowances are paid to your family member if he or she is cared for by you or by a volunteer. As with nursing care provided e.g. by an outpatient nursing-care service, nursing benefits in kind are directly settled with the nursing-care insurer. A combination of nursing allowances and nursing benefits in kind is possible. If the amount of nursing benefits in kind is not entirely exhausted, it can be paid out to the individual requiring care on a pro rata basis in the form of a nursing allowance.

Nursing allowances and nursing benefits in kind

Care grade I:

  • Nursing benefits in kind: 0€
  • Nursing allowances: 0€

Care grade II:

  • Nursing benefits in kind: 689€ 
  • Nursing allowances: 316€

Care grade III:

  • Nursing benefits in kind: 1.289€
  • Nursing allowances: 545€

Care grade IV:

  • Nursing benefits in kind: 1.612€
  • Nursing allowances: 728€

Care grade V:

  • Nursing benefits in kind: 1.995€
  • Nursing allowances: 901€

Additional nursing-care insurance benefits

Supplemental assistance benefits

For Care grades I, II; III, IV and V, the person requiring nursing care receives supplemental assistance and relief benefits in a monthly amount of 125 EUR. This amount may be used for care but not for basic care. It is disbursed to the person in need of care and only upon presentation of proof of utilization of the care service(s) in question. These supplemental assistance services may only be performed by approved service providers of the nursing-care insurers.

Care aids

The health or nursing-care insurer pays or provides a supplement for aids that facilitate in-home care and improve the lifestyle of the person in need of care, such as nursing beds. In
the event, the individual requiring care must pay a share of ten percent, but no more than €25, for the cost of a care aid. Technical care aids of a larger scope are often rented; there is no
co-pay obligation in this case. The costs of consumable products are reimbursed by the nursing-care insurer up to an amount of €40 per month. The costs of any wheelchairs, walkers
or incontinence items prescribed by a physician are paid by the health insurer. For every aid from the area of the health insurer, a co-pay falls due in the amount of 10% of the cost, at
least €5 and no more than €10.

Housing adaptation

Upon application, and regardless of the level of nursing care assigned, the nursing-care insurer provides a subsidy of up to 4.000 EUR for restructuring of the home setting – bathroom alteration, installation of a stair lift – to ensure care in the home.

Partially inpatient nursing care (day care and night care)

This is considered if a sufficient level of in-home care is not provided: In the case of day care, the individual needing nursing care sleeps in his or her personal surroundings and spends the day, or certain days of the week, in a daytime-care facility recognized by the nursing-care insurer. In the case of night care, the individual needing nursing care spends the night, or certain nights of the week, in a nursing home and is returned to his or her personal surroundings in the morning.

In addition to outpatient nursing benefits in kind and the nursing allowance, the nursing-care insurers assume the costs of day and night care up to a monthly amount of:

  • Care grade II: 689 €
  • Care grade III: 1.298 €
  • Care grade IV: 1.612 €
  • Care grade V: 1.995 €

Care by a subsitute (Section 39 of Title XI of the Social
Insurance Code)

If illness or vacation prevents the private caregiver from providing nursing care for the individual in need of it, the nursing-care insurance assumes the cost of (a) substitute caregiver(s) for up to six weeks, for an amount not to exceed 1,612 EUR per calendar year. Care by a substitute in the home setting can be used in its entirety or for individual days of assistance. A prerequisite for this is a duration of care of at least six months. Short-term care and care by substitutes can also be combined. As a result, up to 50% of the benefit amount for short-term care (up to €806) can be used to compensate care provided by a substitute caregiver. The amount utilized is offset against the amount of benefits for short-term nursing care.

Short-term nursing care (Section 42 of Title XI of the the Social Insurance Code)

If the private caregiver is on vacation or ill, the nursing-care insurer assumes the expenses for the provision of nursing care, social care and nursing care associated with medical treatment by a substitute caregiver in a nursing home for up to four weeks, for an amount not to exceed €1,612 per calendar year. Unused benefits for substitute nursing care can also be used to pay for services provided within the framework of short-term care. As a result, the benefits amount for short-term care can, at a maximum, be doubled, and the duration of claim extended to not more than eight weeks per calendar year.

Full-time inpatient nursing care (nursing home)

If in-home care is no (longer) possible, consideration is given to care in a nursing home. In the event, individuals requiring nursing care receive “around-the-clock” assistance in single- and double-bed rooms. The nursing-care insurer pays in keeping with the level of nursing care involved. The costs of accommodations and meals, along with supplemental services, must be paid by the resident him- or herself, or by the relevant welfare agency. The benefits paid by the nursing-care insurer are:

  • Care grade I: 125€
  • Care grade II: 770 €
  • Care grade III: 1.262 €
  • Care grade IV: 1.775 €
  • Care grade IV: 2.005 €

Questions?

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