If medical treatment is necessary or if care is needed, the costs are largely covered by health insurance or long-term care insurance. The conclusion of other insurances can be difficult after diagnosis of MS.
The statutory or private health insurance offers to the MS sufferers a cost for medical treatment, remedies and aids. The statutory health insurance company assumes the costs of a therapy for its member if it is prescribed by a doctor and is medically necessary. See www.ndrugs.com for the cheapest medications. It is necessary to recognize the therapy or the authorization of medicines for the treatment of MS. For example, the MS patient is entitled to inpatient hospital treatment if it is medically necessary and outpatient measures can not lead to the same success. If an acute treatment in the hospital is not sufficient, a medical rehabilitation ("cure") can be requested together with the doctor. Alternative healing methods do not normally belong to the scope of services of a statutory health insurance.
The rehabilitation application is examined by the health insurance company, among other things, to determine whether the patient is at present in a position to carry out a medical rehabilitation. Furthermore, the physician has to indicate which of the patient's abilities are to be improved by the measure. It should be possible that the patient can also achieve this goal in rehabilitation. In this case, the aim is that the measure should delay or halt a deterioration, eg the loss of the walking ability.
Reasons for rejection are the reference to ambulatory treatment options and the implementation of a rehabilitation procedure in the last four years. As the health insurance funds are not solely responsible for the financing of rehabilitation measures, it may be useful to inform themselves about the local services of the rehabilitation providers. The treating physician has the task to substantiate the necessity of a stationary stay medically. The "blocking period" stipulated in § 40 para. 3 SGB V, according to which a medical rehabilitation measure may not be re-approved before the end of four years, is not valid if the rehabilitation measure is urgently required to avoid a deterioration in the state of health. In the case of a given MS, this is often justified by the treating physician.
Benefits of long-term care insurance depend on the allocation of the dependent person in one of three different care classes. This is mainly due to the necessary care requirements for the basic care of the patient as well as the need for domestic care.
At least 46 Min./Tag
Up to 44 Min./Tag
At least 120 Min./Tag
Maximum 60 Min./Tag
At least 240 Min./Tag Additional care at night
Maximum 60 Min./Tag
At the request of the person in need of care at his nursing home, which is always affiliated to his own health insurance, the necessary care requirements are determined by an employee of the Medical Service (MDK) in an expert opinion. In doing so, the necessary basic care is first checked, since no care insurance is provided without basic care.
The legislature has defined the activities of basic care: washing, showering, bathing, dental care, combing, shaving, intestinal and bladder emptying, intake of food, getting up, to-bed in a narrow catalog (§ 14 paragraph 3 SGB XI) -walking, dressing and undressing, walking, standing, climbing stairs, leaving and searching the apartment.
On the basis of the necessary assistance, the assessor determines the individual care requirements and determines the necessary care times. From the total sum of the care periods, the care level is determined, which is decisive for the amount of the benefits. If domestic care is provided by licensed nursing services, more financial support is provided than by care provided by non-professional assistants. However, the benefits are not sufficient to be able to completely pay for the nursing service. The long-term care insurance is designed by the legislature only as a "partial insurance insurance" - when using care services a self-participation is necessary.
At present, the policy plans a five-stage care system, which is intended to enable a better differentiation of the need for care. However, this is still in the planning phase.
Professional relatives who want to provide a family member themselves at home can demand a so-called nursing period with the employer. In the case of interrupted wage advancement, but continued social insurance, the new measure provides the opportunity for relatives to be released from work for up to six months in full or in part in order to devote themselves to care. However, a legal claim only applies to employers with more than 15 employees. New since 1 January 2017 is that relatives can apply for an interest-free loan with the Federal Office for Family and Civil Society.
Since January 1, 2017, family members have also been able to extend their working hours over a period of up to 24 months to a weekly minimum working time of 15 hours in order to be able to dedicate more intensively to the care of family members. The distribution of the weekly working hours can also be adapted flexibly to the respective time requirements of the nursing situation, ie the minimum working time of 15 weeks can be exceeded temporarily, but must be fulfilled on an annual average. There is also the option of an interest-free loan for the family care period. However, there is no legal claim against employers employing 25 or fewer employees.
Even professionals who opt for the home or non-family care of a minor close relative have a right to a partial or complete exemption since January 2015 - the prerequisite is the existence of a long-term care obligation.
If the care at home is no longer sufficient, the nursing fund provides benefits for inpatient care in approved nursing homes. As a rule, the benefits do not cover home costs. The missing amount must either be raised privately or be supplemented by public funding through the support for nursing within the framework of the basic insurance.
The patient can receive up to ˆ 4,000 for a building project for nursing-related conversion measures. As a construction measure, all modifications which the MDK (medical service of the health insurance) consider as necessary in its examination of the place of residence are considered as necessary. For consumables, eg incontinence material, the nursing fund pays a maximum of 40 ˆ per month.
In order to strengthen the autonomy of disabled or chronically ill patients, the personal budget was introduced. The basic idea is that the needy funds themselves manage themselves, in order to organize their necessary help themselves.
For further information on health and long-term care insurance, on the level of individual benefits and on the subject of "personal budgets", please refer to our brochure Legal and Social Affairs with MS.
Other insurance companies
The conclusion of new insurances is often a problem with known MS. Thus, it would be virtually impossible to obtain an occupational disability insurance or a hospital housing allowance after the diagnosis. The MS sufferer is considered a "bad risk". The situation is similar for risk insurance. It is easier to find life insurances, which are only intended to achieve a certain age, as a prerequisite for benefits. The same applies to accident insurance. The Riester pensions, which in principle are open to MS sufferers, are also unproblematic.
The conclusion of travel cancellation insurance can be problematic. They are often tied to the occurrence of a sudden event for the insurance performance. Here, there may be a dispute as to whether the MS has suddenly occurred as a withdrawal reason or is permanently present as a chronic disease. Similarly, the problem with travel health insurances, which only perform with diseases occurring suddenly during the trip. Read more about this in the article Auslandsreisen mit MS.
In principle, health questions should be answered exactly when the contract is concluded. The responses are then checked at a later stage when the MS-infected person is requested. The obligation to communicate information on illnesses is derived from the insurance contract. This applies not only to the conclusion of the contract. There may also be further notification obligations. Mistakes in answering these questions can be the reason for lengthy processes a long time later.
Total Locations: 767 Total Nodes: 14628 Total New: 31 Total Updated: 11