Applying for a care level: Insights from MDK and long-term care insurance funds
In today's blog post, we would like to offer you a comprehensive overview of how to apply for a care level. For this purpose, we conducted an exclusive interview with expert Mario Dibra, who has specialized in the application process for emergency call systems. Furthermore, we gained direct insights from the Medical Service of the Health Insurance Funds (MDK) as well as various long-term care insurance funds.
The aim of this post is to provide you with valuable insights and practical tips on how to successfully apply for a care level. We are convinced that Mario Dibra's expertise and the information we have received directly from the relevant institutions will help you better understand and successfully navigate the application process.
So stay tuned as we present valuable insights and advice on applying for a care level in the following sections.
In Germany, people with health impairments have access to various support services to cover their care needs. One of the most important steps on this path is applying for a care level. The care level is determined by the Medical Service of the Health Insurance Funds (MDK) and forms the basis for the allocation of care benefits and care allowance. In this guide, you will learn how to successfully apply for a care level.
1. Understand the different care levels
Before applying, it is important to understand the different care levels. In Germany, there are five care levels, which are based on the degree of independence and impairment of self-care. The care levels range from 1 (minor impairment) to 5 (most severe impairment).
2. Check your care needs
Before submitting your application, you should check your individual care needs. Make a list of your daily activities and consider which ones you need support with. This can include washing, dressing, eating, but also mobility or taking medication.
3. Collect relevant documents
For the application, you will need various documents that document your need for care. These include medical certificates, medical records, medication plans, reports from therapists, and other relevant documents. The more information you can provide, the better it is for the assessment of your care needs.
4. Contact your long-term care insurance fund
To apply for a care level, you must contact your long-term care insurance fund. There you will receive the necessary application forms and can seek advice. The staff of the long-term care insurance fund will also help you compile the required documents and fill out the application correctly.
5. Fill out the application carefully
Care is important when filling out the application. Provide all relevant information completely and correctly. Also, observe the deadlines for submitting the application to avoid delays.
6. Wait for the assessment
After submitting your application, an expert from the MDK or Medicproof will visit your home to assess your care needs. It is important to be honest and open during this assessment and to answer all questions from the expert.
7. Decision on the care level
After the assessment, you will receive a decision on your care level. This decision will also contain information about which benefits you are entitled to and the amount of care allowance that will be set.
We will go into more detail on the topic of applying for a care level later and involve long-term care insurance funds and the MDK. But first, let's look at applying for an emergency call system.
Interview with Mario Dibra, expert on applying for an emergency call system
Hello Mr. Dibra, thank you for taking the time to answer some important questions about applying for an emergency call system. You already have expertise in applying specifically for the Gardia emergency call wristband. We look forward to benefiting from your experience.
Please introduce yourself first.
M. Dibra: Hello, I am Mario Dibra and have been working for Microsynetics GmbH, which developed the Gardia emergency call system, since 2020. I work in product management. Gardia and the possibility of realizing a modern home emergency call system fascinated me from the start. My goal is to further develop our product and provide our customers with functions that enable them to live a safe and self-determined life, as easily accessible as possible for everyone. Therefore, it quickly became clear that we wanted to work on a solution that would enable our customers with a care level, in particular, to use Gardia quickly and cost-effectively. We are proud that we succeeded in having the costs covered by long-term care insurance funds and that it has been possible to apply for cost coverage of the Gardia subscription since April 23, 2024.
After intensive tests, studies, and certification programs last year, we were finally able to put our concept for realizing billability into practice.
What requirements must be met for someone to apply for an emergency call system with the long-term care insurance fund?
M. Dibra: For the application for an emergency call system to be submitted to the long-term care insurance funds, at least care level 1 must first be present. I will explain it using the example of the Gardia emergency call system. In addition, the person should live alone for a large part of the day and not be able to make a call for help themselves.
What is needed for the application besides a care level? Are there specific documents?
M. Dibra: The name of the long-term care insurance, the long-term care insurance fund number & insured person number should be readily available. These can be found on a letter from the long-term care insurance fund and the insurance card.
Do I have to fill out the application for cost coverage completely?
M. Dibra: Yes, a complete application is necessary. The wristband is first purchased for a fee. The monthly subscription costs for the Gardia emergency call wristband can be covered by the long-term care insurance fund if a care level is present. For this, an application for cost coverage is necessary, which must be approved by your long-term care insurance fund.
So the purchase price for the wristband is not covered?
M. Dibra: Whether the purchase price is covered by the long-term care insurance depends on various factors. You are welcome to try to claim reimbursement for this from your long-term care insurance fund. However, Micrsynetics Gmbh cannot guarantee that the costs will be covered by the long-term care insurance fund.
How do I apply as a new customer and as an existing Gardia customer?
M. Dibra: You will receive an e-mail with the link to the application. With this link, you can create a Gardia account. Then you can start the application process. Alternatively, you can wait until you have received the Gardia wristband and carry out the configuration and application independently in the My Gardia App. The application process can take up to 3 weeks. As an existing customer, you can do this at any time in the My Gardia App. For both cases, there is a video for explanation.
How does the cost coverage work?
M. Dibra: After a successful application and review, the long-term care insurance funds cover the full costs for the PflegePlus subscription with all the benefits of the basic package and the NotfallPlus subscription. You can find out more about this on the www.gardia.net website.
Where can I see the current status of my application?
M. Dibra: You can view the current status of your application in the web client, via the link previously sent by e-mail, and in the My Gardia App. In addition, we will inform you about the successful application, as well as the acceptance or rejection of the application by e-mail.
What happens if a care level has been applied for, but has not yet been approved?
M. Dibra: Please wait until your care level has been approved. Only then submit an application for cost coverage.
How can I change my home emergency call provider?
M. Dibra: If you already receive a home emergency call service through your long-term care insurance fund, you can request a change to the Gardia emergency call system from them.
What happens if my application is rejected?
M. Dibra: You will be informed of the rejection of the application by e-mail. You then have 7 days to decide whether to book the subscription at your own expense. If this is not done, the service will be discontinued after 7 days.
We have now focused heavily on the Gardia emergency call system. Now we would like to know more about it.
What advantages does it have over the classic home emergency call system?
M. Dibra: We have listed some advantages over the home emergency call system. It is best if you link them here.
Is it possible to store health data?
M. Dibra: We recommend that you use the My Gardia App and store your health-relevant information. This will be forwarded to the 24/7 emergency call center in an emergency and can be helpful in an emergency situation.
How accurate is the localization and fall detection?
M. Dibra: The localization accuracy of the wristband can vary and depends on various factors, such as the availability of mobile networks and GPS signals. Basically, however, it is very accurate. The wristbands are equipped with a fall sensor that can automatically trigger an emergency call when a fall is detected. The fall accuracy is 96%. You can find out more about the emergency call system on the website www.gardia.net
We thank Mr. Dibra for the detailed interview and have also inquired with the MDK and long-term care insurance funds about what is necessary to apply for a care level.
Apply for the Gardia emergency call wristband with your long-term care insurance fund now.
The Gardia emergency call system automatically triggers an alarm on the wristband in the event of a fall or with a short press of a button and quickly sends help.
To the application
Applying for a care level
Applying for a care level is the first step to subsequently applying for the emergency call system. We have gathered important insights from the MDK and long-term care insurance funds on this.
What does the MDK do?
MDK assessors evaluate whether the quality of an examination, treatment or care service corresponds to the recognized standard of medicine and care. For the long-term care insurance funds, the MDK assesses the need for care of patients and determines which care level exists. The assessment is carried out by specially trained nursing staff at home or in the nursing home. The MDK informs the respective long-term care insurance fund about the result of the assessment and the care level.
What exactly are long-term care insurance funds?
Long-term care insurance funds are the providers of statutory and private long-term care insurance. They are affiliated with the respective health insurance funds and are responsible for financing benefits for insured persons with recognized care needs from insurance contributions.
Who applies for care benefits?
MDK: You can apply for care benefits for yourself or, on behalf of another person, with their long-term care insurance fund, provided you are authorized to do so.
Where is the application submitted?
MDK: The application must be submitted to the responsible long-term care insurance fund. Members of a statutory health insurance fund are automatically members of the corresponding long-term care insurance fund. Any written or telephonic notification to the responsible long-term care insurance fund with the wish for regulated care benefits is considered an application. The time of application is crucial for the start of benefits. The benefit decision is issued by the long-term care insurance fund.
What happens next?
MDK: If you have applied for care benefits with your long-term care insurance fund, they will commission the Medical Service to prepare an expert opinion. The Medical Service will then contact you in writing or by telephone to arrange an appointment for a care assessment.
It is particularly helpful if people who support you with care also participate in the care assessment. These can be relatives, friends or neighbors. If you are legally supervised, this person should also be present.
Please prepare – if available – reports from your family doctor, specialists, or the discharge report from the hospital. Please have your current medication plan ready. If a nursing service visits you, please also have the nursing documentation ready.
How does a care assessment proceed?
MDK: The assessment usually takes place as a personal interview with an assessor from the Medical Service. This can be a home visit or a telephone interview. During this, the assessor determines how independently you can manage your daily life and where you need help. The assessment also identifies what aids, rehabilitative, or preventative measures could help you to support you in managing your daily life as independently as possible. The assessment can last up to an hour.
What determines what benefits I receive?
MDK: The entitlement to benefits results from the care level, which is calculated based on a point system: The six areas (1) mobility, (2) cognitive and communicative abilities, (3) behaviors and psychological problems, (4) self-care, (5) coping with illness-related demands, (6) shaping daily life each contain individual criteria, for example, for self-care: eating or drinking. Points are awarded and added up for the assessed criteria. The areas are weighted differently according to their importance for daily life, for example, self-care: 40 percent, mobility: 10 percent. The care level is derived from the total score. The higher your care level, the higher your entitlement to benefits.
When and from whom do I receive the notification of the care level?
MDK: The assessor from the Medical Service summarizes the results of the assessment in an expert opinion, which is sent to the care insurance fund.
If aids, rehabilitative or preventive measures could strengthen your independence, this information is also given to the care insurance fund with your consent.
You will then receive the notification of the care level and benefits from the care insurance fund, as well as the expert opinion from the Medical Service if desired.
It usually takes up to 25 working days from the application to the notification.
Objection: What can I do if I disagree with the care level?
MDK: If you disagree with the decision of the care insurance fund, you can file an objection with the care insurance fund within one month of receiving the notification.
How do I get a higher care level?
MDK: Care needs can change over time. If your care needs (or those of a relative) have increased, you can apply to the care insurance fund for an upgrade. The application is necessary to trigger a new care assessment by the Medical Service. As with the initial application, the Medical Service will suggest an appointment at which an assessor will gain a comprehensive overview of your current support needs and your independence in a personal interview.
Who can advise me on care benefits?
MDK: As soon as you have applied for care benefits, your care insurance fund will offer you and your relatives care advice within two weeks, to which you have a legal right. Your care insurance fund will support you in putting together benefits from the care insurance according to your needs and wishes and can give you valuable tips on organizing care and other advisory services.
Apply for the Gardia emergency call system now
Conclusion
Applying for a care level can be a complex process, but with the right preparation and support, it is manageable. By carefully examining your care needs, gathering relevant documents, and diligently filling out the application, you increase your chances of a successful application. Remember that the care level not only offers you financial support but also provides access to important care services that can help you manage your daily life as best as possible.
