Working Life > Social Insurance > Nursing Care Insurance

Nursing Care Insurance

Definition, Explanation

One component of the social insurance is the statutory nursing care insurance. It is connected to the health insurance. That is, since Jan 1995, everybody who gets health-insured, be it in the statutory or in a private health insurance, automatically becomes a member of the social nursing care insurance. Only clerks who are not insured in statutory health insurance must contract an extra, private nursing care insurance. In these cases, their financial aids from their employers are then complemented by a residual-costs-insurance that pays all nursing care expenses that are not covered by the health insurance. Legal basis is the Gesetz zur sozialen Absicherung des Risikos der Pflegebedürftigkeit (Nursing care insurance Act, PflegeVG), SGB XI.

By paying contributions to the nursing care insurance, the insured becomes entitled to be supported in case of need of nursing care. The support covers body care, mobility and housekeeping assistants.

Insured are:

• Compulsorily insured
  • Compulsorily insured of statutory health insurance, being employees, apprentices, getters of unemployment benefit I and II, university students, farmers, disabled, interns as well as artists and publicists in the artists social insurance, pensioners in statutory pension insurance
  • Persons with residence in Germany who are entitled to medical treatment
  • Voluntarily insured of a health insurance. You can also get freed from the obligation to be insured if you are in a private nursing care insurance
• Dependently insured, via family members
  • Spouses and children of insured who are not obliged to be insured and are not insured in a private nursing care insurance
  • with a total annual income of less than 400 Euros
• Voluntarily continuingly insured
  • after ceasing of family-members-dependent insurance
  • after end of obligation to be insured, if at least insured for 12 months in statutory nursing care insurance

Contributions, contribution rates

• Insured in social nursing care insurance pay a basic contribution of 1.95 % of their pre-tax working-income or pension, up to the contribution assessment ceiling of monthly 3,750 Euros (2010)
• Childless persons from the age of 24 on pay additional 0.25 % with their contribution
• Insured who are entitled to financial aid by the employer, or to governmental support for medical care, pay 0.975 %
• In the federal state of Sachsen, employees pay 1.475 %
• Self-employed, pensioners and students pay 1.95 %
• Employees pay only 0.975 % of the contribution to statutory health insurance. The other half of the contribution is paid by the employer
• Contributions to private nursing care insurance are calculated based on individual risks. Here, there is no extra premium for childless. The employers pay an extra amount corresponding to the employer's share of contributions to statutory nursing care insurance
• Getters of sick benefit also pay contributions based on 80 % of the working-income on which amounts of sick benefits are based

Contributions:

• Need of nursing care is given, in general, if, due to physical or mental illness or disablement of longer duration (6 months minimum), the person cannot manage the basic necessities without assistance more than once a week
• as regarding to:
  • Body care: washing, dental care, defecation and urination
  • Feeding
  • Mobility: Getting up and into bed, dressing / undressing, leaving and re-entering the domicile
  • Housekeeping: Shopping, cooking, cleaning, laundry
• depending on the degree of nursing-care need:
  • degree I: considerable need of nursing care
  • degree II: severe need of nursing care
  • degree II: most severe need of nursing care
  • hardship case degree

Kinds of benefits:

• Benefits for home care
  • Home care benefits: Support for financing nursing care personnel working in full-time. Extent depends on degree of nursing-care need
  • Nursing care support for nursing personnel of own recruitment
  • Home care when the caring person is unavailable (e.g. illness, vacation)
  • Care utilities as they are not financed by health insurance
• Out-patient care and short-term care
  • if home care cannot be guaranteed
  • Day- or night-care in respective facilities, including transport
  • Short-term care: Nursing care in in-patient facilities for a bridging period or in crisis situations, limited to 4 weeks per year
• In-patient care
  • if home care or out-patient care is not possible
  • Expenses up to 1.432 Euros per month
  • The person cared for has to pay board and lodging on her own

Procedure:

• The insured must apply for the benefits. Entitlement is given since the month of application, and when the duration of prior insurance has been at least 5 years within the last 10 years
• Medical department of the health insurance determines need of nursing care and its severance degree
• Medical department of the health insurance examines extent and kinds of measures apt to reduce the severance of need of nursing care

Tips, Checklist

• Request a copy of the health insurance medical department report. It contains the reasons why you have been rated that degree, and you possibly can object to it
• If you find the health insurance medical department rating of your degree of need of nursing care not justified, you can take legal action at the social court
• As a private-insured, your legal action requires you to have a counter-report filed which you have to pay on your own. Therefore, try to sort out dissension with your insurance otherwise

Last update: 12/28/2009