Private compulsory long-term care insurance
Insurance Product Information Document
Company: Hallesche Krankenversicherung a. G.
This fact sheet provides you with an overview of your coverage under private compulsory long-term care insurance. Please note that this information is not exhaustive. We will provide you with details in the form of the insurance conditions for private compulsory long-term care insurance, consisting of the MB/PPV and the PVN tariff, customer information and the insurance policy. For comprehensive information, please read all the documents.
What type of insurance is this?
It is a private long-term care insurance that replaces the coverage provided by the statutory social insurance system and fulfills the statutory obligation to insure. It protects you against the financial risk of needing long-term care.
What is insured?
- Costs of home care, day and night care, full inpatient care, care courses, improvements to the living environment, payment of care allowance, insofar as the benefits are sufficient, appropriate and cost-efficient in terms of reason and amount.
- Nursing aids are usually provided on loan.
- Contributions to pension and unemployment insurance for nursing staff.
- Subsidies for compulsory health and long-term care insurance of nursing staff during the care period.
- The benefits are equivalent in type and scope to those provided by social long-term care insurance.
What is not insured?
- Special additional services
- Costs for accommodation and meals
- Calculable investment and other required operational costs.
Are there any restrictions on cover?
- The reimbursement of expenses is limited in amount in each case.
- The amount of insurance benefits depends on the tariff level of the insured person.
- The amount of insurance benefits also depends on the care level the insured person has been assigned to.
- Benefits are limited to the level of care and costs of social long-term care insurance.
Where am I covered?
- The insurance covers contract benefits in the Federal Republic of Germany.
- Under certain conditions, some contract benefits can also be claimed abroad.
What are my obligations?
- A medical examination is carried out before the contract is concluded. Therefore, you must truthfully provide all the information requested by the insurer regarding all your previous and current ailments and illnesses.
- To receive benefits, you must file an application. To determine your need for and the degree of care, you will usually be assessed in your living environment.
- In order for benefits to be paid, you must provide the required proof.
- You must notify the insurer immediately in writing of the occurrence, cessation and any reduction in the need for care.
- Notification must be given of changes in the person and scope of care activities of nursing staff for whom the insurer provides social security benefits or benefits during the care period.
- You are obliged to pay the premiums in full and on time. In case of delay, you may be charged additional costs. If you are in default of six or more months of premiums, your insurer must report you to the Federal Office for Social Security and you may be subject to fine proceedings.
- In the period from January 1st, 2022 to December 31st, 2022 you are also obliged to pay a corona surcharge. This was introduced by the legislature in order to finance the statutory additional expenditure on long-term care insurance to finance the corona pandemic.
When and how do I pay?
- The premium will be debited from your account on a monthly basis or as a one-time payment according to the agreed payment method when due. Unless otherwise agreed, you must pay the first premium immediately upon expiration of two weeks after receipt of the insurance policy.
- If the fee is monthly, it is due on the first day of each month.
When does the cover start and end?
- The start of coverage is specified in the insurance policy. However, the insurance shall not commence before the insurance contract is concluded, the first premium is paid and the waiting period of two years has expired.
- The contract is valid for an indefinite period.
- The insurance coverage ends – also for pending claims – with the termination of the insurance contract.
How do I cancel the contract?
- You can terminate the contract if the obligation to insure under private compulsory long-term care insurance ends, e.g., due to the entry of the obligation to insure in Germany’s compulsory long-term care insurance system, or upon termination of your private health insurance.
- If the obligation to insure continues, your termination will not take effect until you prove to your insurer within the notice period that the insured person is covered by a new insurer without interruption.