Degrees of care & your entit­le­ment to paid mobility

In this article, you will find out to what extent groups of people with different care levels are entitled to patient transportation.

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Doc­tor holds a board on which all five care levels are writ­ten down. 

Many peo­ple in Ger­many have to rely on pati­ent trans­por­ta­tion in their ever­y­day lives. These jour­neys can be pre­scri­bed by a doc­tor and the costs covered by health insu­rance based on various requi­re­ments, such as cer­tain care levels.
In this article, you can find out which care levels entitle you to this.

For more infor­ma­tion on the pre­scrip­tion of pati­ent trans­por­ta­tion, you can read our article on this topic here

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Back­ground: blue sky with clouds
Fore­ground: 3 street signs with the names “Pfle­ge­stär­kungs­ge­setze“, “Pfle­ge­re­form“ and “Pfle­ge­grade“

Care levels — con­ver­sion to care grades

The second Care Streng­thening Act in 2017 chan­ged the 4 care levels (0–3) that had been known for years to 5 care gra­des. Above all, this ensu­red that peo­ple with demen­tia were given grea­ter con­side­ra­tion. From now on, peo­ple with demen­tia and those in need of phy­si­cal care are equally entit­led to bene­fits from the long-term care insu­rance fund.

Which care levels entitle you to pati­ent transportation?

As alre­ady descri­bed, groups of peo­ple with dif­fe­rent care levels are entit­led to pati­ent trans­por­ta­tion with sub­se­quent assump­tion of costs by the health insu­rance fund.
This applies to the fol­lo­wing care levels:

  • Care level 3 (with addi­tio­nal proof of per­ma­nent mobi­lity impairment)
  • Care level 4
  • Care level 5

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Close-up of a text pas­sage on which the defi­ni­ti­ons of care levels 3–5 are shown. 

For these groups, there is no addi­tio­nal aut­ho­riza­tion requi­re­ment. This means that prior appr­oval of the trans­port by the health insu­rance com­pany is not neces­sary.

But who belongs to care levels 3, 4 & 5?

Strictly spea­king, it is not pos­si­ble to assign dif­fe­rent impairm­ents to care levels at a glance. This is done by spe­cial asses­sors with the help of the “NBA” assess­ment pro­ce­dure.
The asses­sors assign points to 6 cate­go­ries, each of which con­ta­ins dif­fe­rent ques­ti­ons. The total num­ber of points is then cal­cu­la­ted, weigh­ted and sub­se­quently assi­gned to a care level.

These 6 cate­go­ries are tes­ted in the assess­ment process:

  • Mobi­lity
  • Cogni­tive and com­mu­ni­ca­tive abilities
  • Beha­vi­oral and psy­cho­lo­gi­cal problems
  • Self-care
  • Coping and inde­pen­dent hand­ling of ill­ness- or the­rapy-rela­ted demands and stresses
  • Orga­niza­tion of ever­y­day life and social contacts

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Doc­tor holds a board with the term “degree of care“, which is in the cen­ter of the board. The con­tents of the 6 cate­go­ries are writ­ten on the outside. 

Howe­ver, in order to pro­vide a rough over­view of the dif­fe­ren­ces bet­ween the care levels, all care levels have been defi­ned. In addi­tion to the defi­ni­ti­ons, the total score of the assess­ment pro­ce­dure is also given, which is decisive for the allo­ca­tion to the care levels.

Care level 3: “severe impair­ment of inde­pen­dence”, bet­ween 47.5 and less than 70 points
Care level 4: “most severe impair­ment of inde­pen­dence”, bet­ween 70 and under 90 points
Care level 5: “most severe impair­ment of inde­pen­dence with spe­cial requi­re­ments for nur­sing care”, bet­ween 90 and 100 points

Addi­tio­nal pay­ment for trans­por­ta­tion costs

If you or someone close to you can claim pati­ent trans­por­ta­tion, you should also take this into account.
If jour­neys are covered by health insu­rance, insu­red per­sons are unfort­u­na­tely still obli­ged to pay part of the costs for each jour­ney them­sel­ves. This also applies to child­ren and young people.

What you need to know about payment:

  • Pay­ment of 10% of the tra­vel costs per trip (mini­mum five euros and maxi­mum ten euros per trip)
  • Dri­vers receive the money directly after transportation
  • if the bur­den limit accor­ding to § 62 SGB is excee­ded, insu­red per­sons can be exempted from the payments
    • 2% of the gross income
    • 1% of gross income for the chro­ni­cally ill (if the ill­ness requi­res long-term treatment)

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6 dice with various sym­bols from the health sec­tor are arran­ged in a pyra­mid. The top die is tur­ned by a per­son and is the only die to show 2 sym­bols (hos­pi­tal cross and money coins). 

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