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. Image description 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 Image description 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 Image description 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 Image description 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) Image description 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). Folgen Sie uns auch gerne auf LinkedIn!
