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Apply for sick pay for a caregiver during inpatient treatment of people with disabilities

You may be admitted as a caregiver if a person with a disability is receiving inpatient treatment at a hospital. In that case, you will stay overnight at or near the hospital and receive your meals there as well. For the duration of your stay as a caregiver, if you have public health insurance, you may be eligible for sick pay under certain conditions if your income is reduced as a result of your inpatient stay.

The hospital decides whether a caregiver is medically necessary.

Both you and the person you are accompanying must have public health insurance.

In addition, the person with a disability you are accompanying must meet the following requirements:

  • They receive integration assistance benefits. They are not accompanied by staff from an integration assistance service provider for inpatient hospital treatment.
  • Benefits for accompaniment during inpatient hospital treatment are not already being provided as part of social participation benefits

As a caregiver for a person with a disability, you must also meet the following requirements for the health insurance provider to pay sick pay:

  • You are a close relative as defined by the Care Leave Act, or
  • You are a person from the individual’s immediate personal circle, and
  • you do not provide integration assistance services to the person you are accompanying in exchange for payment.

You must submit the application for sick pay as a caregiver to your statutory health insurance provider.

You will receive sick pay for the entire duration of the inpatient stay. Full-day accompaniment is also considered equivalent to an inpatient stay. Full-day accompaniment is defined as when the time you spend at the hospital, combined with the time spent traveling to and from the hospital, totals at least 8 hours.

Employees: As a rule, the statutory health insurance provider will reimburse you, as an accompanying person, 70 percent of your gross wages, up to a maximum of 90 percent of your net wages. 

Full-time self-employed individuals: Your sick pay amounts to 70 percent of your earned income from the past 12 months.
 

  • Reimbursement for lost wages when accompanying people with mental or physical disabilities during inpatient hospitalization Granting
  • If a person with a disability is receiving inpatient treatment at a hospital, a caregiver may be admitted with them
  • The caregiver may receive sick pay for the duration of the inpatient stay, provided that:
    • Accompanying a person with a disability is medically necessary
    • the person with a disability receives integration assistance benefits
    • No benefits are already being provided for accompanying the person during inpatient hospital treatment as part of social participation benefits
    • the inpatient stay results in a loss of earnings 
    • Both the person with a disability and the caregiver must have statutory health insurance
    • The accompanying person is a close relative or someone from the person’s immediate personal circle
    • The time required for the medically necessary presence at the hospital, plus the companion’s travel to and from the hospital, amounts to at least 8 hours per day
    • A certificate from the hospital stating that the inpatient accommodation of an accompanying person is medically necessary, as well as a certificate from the hospital regarding the days of presence
  • The amount of sick pay for the duration of the companion’s inpatient stay is generally limited for
    • Employees:
      • 70 percent of gross wages, but
      • up to 90 percent of net pay
    • Full-time self-employed individuals:
      • 70 percent of the income from work earned over the past 12 months
  • Proof: A certificate from the hospital stating that the inpatient admission of an accompanying person is medically necessary, as well as a certificate from the hospital specifying the days of presence 
  • Responsible party: The accompanying person’s statutory health insurance provider 

  • Certificate from the hospital confirming the medical necessity of inpatient admission 
  • Confirmation from the hospital regarding the number of days spent there

If applicable, proof of income or proof of loss of income. For employees, the employer typically reports the required income data.

Note: In special cases, additional documents may be required. Please check with your health insurance provider for more information.
 

  • You and the person with a disability whom you are accompanying are covered by public health insurance.
  • The person you are accompanying is receiving inpatient treatment at the hospital.
  • Your admission to the hospital as an accompanying person is medically necessary. Full-day accompaniment is considered equivalent. This means that the time you spend at the hospital, including your travel time to and from the hospital, must total at least 8 hours.
  • You have suffered a loss of earnings.
  • You are a close relative or part of the person’s immediate circle.
  • The person you are accompanying receives integration assistance benefits. You will not receive sick pay from your health insurance provider if, for example, you are accompanying the person with a disability as a personal assistant and are paid for this work. If you are accompanying the person with a disability as part of integration assistance, the costs are covered by the integration assistance providers.
  • Benefits are not already provided for accompanying the person during inpatient hospital treatment as part of social participation benefits. 

There are no costs involved.

You can submit your application for sick pay as a caregiver by mail, in person at the office of many statutory health insurance providers, or online.

  • Have the hospital issue you a certificate confirming the medical necessity of the accompaniment.
  • Have the hospital certify the periods of inpatient care or full-day accompaniment. 
  • Submit the proof of the medical necessity of the care and the certification of your hours of presence, along with the other required documents, to your statutory health insurance provider.
  • Notify your employer of your absence.
  • The statutory health insurance provider will review your application and the documents and will contact you if they have any questions.
  • The health insurance provider will pay you sick pay. 
    • For employees: Your health insurance provider will not pay your sick pay until your employer has provided the necessary information regarding your wages to the health insurance provider.

Processing time: 4 - 9 Working days
To ensure prompt processing and a decision, you must provide your health insurance company with all necessary information and, if applicable, any required documents—in a complete and clear manner.
 
The health insurance company will decide on applications in a timely manner, while adhering to the statutory processing deadline to protect patients’ rights. 

Please note that the processing time indicated is an average across all health insurance providers. It may vary in individual cases.

The exact processing time also depends on the complexity of the individual case and may be extended accordingly. The same applies if documents or records are sent by mail to you or your health insurance provider.

If necessary, the Medical Service must be involved. This may take up to five additional weeks to process your request.
The health insurance provider decides on applications in a timely manner, while adhering to the statutory processing deadline to protect patients’ rights. 
Please note that the processing time indicated is an average across all health insurance providers. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be extended accordingly. The same applies if documents or records are sent by mail to you or your health insurance provider.
If necessary, the Medical Service may need to be involved. This service requires up to five additional weeks to process your request.

There is no deadline.

  • Appeal
  • Lawsuit before the Social Security Court

Many public health insurance providers offer forms. Please check with your health insurance provider for more information.

GKV-Spitzenverband 


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The text was automatically translated based on the German content.

Source: Serviceportal Saarland