Health insurance providers

Care levels [Pflegegrad]

If a person requires nursing care within the meaning of the Social Security Code [Sozialgesetzbuch], the person giving care will receive benefits from the social long-term care insurance of the person requiring care. The person giving care can be a home care service or a private individual or family member.

The basis for this is the Eleventh Book of the Social Security Code [elftes Buch des Sozialgesetzbuches (SGB XI)].

To receive benefits from this insurance, it is initially necessary to determine a need for care. This examination is performed by the Medical Service of the Health Insurance Funds [Medizinischer Dienst der Krankenversicherungen, MDK]. If the MDK has determined a need for care, the person requiring care is classified into one of five care levels. The care level determines what benefits the person requiring care is entitled to.

More detailed information on the topic of care levels is available here.

To obtain a care level, an informal application must first be made with the responsible health insurance provider of the person requiring care. The health insurance provider then sends the relevant forms. After these have been filled out and submitted, the MDK will be involved and the assessment process will begin.

Experience has shown that whenever insurance benefits are claimed, it is advisable to first read the "GTCs" of the insurance company and then report the "claim."

This also applies to long-term care insurance. One should be thoroughly prepared when the MDK inspector visits. It is important to see one's own situation from a neutral perspective and be completely familiar with the inspector's criteria. An inspector naturally has a certain scope of discretion, but the criteria that an inspector must adhere to are defined in the Social Security Code.

For general information and preparation for the assessment, the "Pflegebibel" (care guide only available in German) is recommended.