Anyone who requires ongoing support in their daily life – for example, with washing, dressing, or household tasks – can apply for a care level assessment. This is a prerequisite for benefits from long-term care insurance, such as care allowance, in-kind benefits, or assistance with day care. The application process is simple, but there are a few important things to keep in mind. This article explains how to apply for a care level assessment – step by step.
1. Submit an application to the long-term care insurance fund.
The first step is informal and straightforward: You (or a family member) need to submit an application for a care level assessment to the long-term care insurance fund. The long-term care insurance fund is the long-term care insurance branch of your health insurance company.
Here's how:
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A quick call to the long-term care insurance provider is all it takes.
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Alternatively, you can also submit the application in writing or online.
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You will then receive an application form by post.
Tip: The application can also be submitted by authorized relatives or caregivers.
2. Assessment by the Medical Service
After the application has been submitted, the long-term care insurance fund commissions the Medical Service (for those with statutory insurance) or Medicproof (for those with private insurance) to carry out an assessment.
Process:
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An expert will announce their visit by telephone or in writing.
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The assessment usually takes place in the applicant's home.
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The aim is to assess independence and care needs.
Important: Please have your medical documents ready – e.g., doctor's reports, medication plans, diagnoses, or rehabilitation reports. Family members should be present at the appointment if possible.
3. What is being checked?
The assessment is conducted according to the so-called New Assessment Procedure (NBA) . The following areas of life are evaluated:
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mobility
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Cognitive and communicative skills
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Behavioral and psychological problems
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Self-sufficiency
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Dealing with illness-related demands
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Structuring daily life and social contacts
Points are awarded depending on the degree of impairment. The total number of points then determines the care level.
4. Await notification from the long-term care insurance fund.
After the assessment, the Medical Service prepares a report and sends it to the long-term care insurance fund. Based on this report, the fund decides on the level of care required and sends you a written notification.
Processing time: Usually about 4–6 weeks after application.
5. Care level too low? – File an appeal
If you disagree with the decision of the long-term care insurance provider, you can file a written appeal within one month. You should include medical or nursing-related justifications with your appeal.
Tip: Consultation with care support centers or care advisors can be very helpful here.
6. After approval: Use the benefits
After your care level has been approved, you can take advantage of various benefits:
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Care allowance for home care provided by relatives
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Care benefits in kind when supported by a care service
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Relief amount (125 € per month)
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Day and night care
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Subsidies for care aids
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Home modifications