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Apply for domestic help from the statutory health insurance


If you have statutory health insurance, you can get support from a domestic helper in certain cases. You can apply for domestic help from your health insurance fund if, for example, you

  • due to hospital treatment,
  • preventive medical care for mothers or fathers, or
  • because of medical rehabilitation

temporarily unable to continue running your household yourself.

Entitlement to domestic help exists if:

  • there is a child in your household who
    • younger than 12 years of age at the start of domestic help, or
    • is disabled and in need of help,
  • there is no other person living in the household who can manage the household.

This entitlement to domestic help is not limited in time.

In addition, under certain conditions, you can get temporary domestic help if you:

  • are recovering at home from surgery, therapy or a serious illness,
  • there is no other person living in the household who can manage the household,
  • You are not in need of long-term care – in this case, however, domestic help may be considered for the care of a child living in the household

The domestic help will support you for a maximum of 4 weeks. If you have a child with a disability who is dependent on assistance, your entitlement is up to 26 weeks.

Some statutory health insurance companies also pay for domestic help in other cases or if you have older children. You can find out more about this in the statutes of your statutory health insurance company.

In principle, you must apply for domestic help from the health insurance company before making use of it. To apply to your health insurance company, you need a medical certificate. Your doctor will confirm the need for domestic help and provide information on the extent to which you are likely to need domestic help and for how long. In addition, the doctor should indicate when the need for support arises and what illness-related impairments exist.

If your statutory health insurance company agrees to your application, it will put you in touch with a domestic help from a nursing service or a comparable organisation. If the health insurance company is unable to provide domestic help or if there is a reason not to do so, you can organise the household help yourself and will be reimbursed for the costs in an appropriate amount. However, there may be regional differences.

If your parents, siblings or other close relatives help you in the household, your health insurance company cannot pay them any compensation. However, it can reimburse travel expenses and, in some cases, loss of earnings. Find out more about this from your statutory health insurance company.

Process flow

You can apply for household help by post or – in the case of many statutory health insurance companies – hand it in in person at the office or submit it online.

  • Fill out the application form of your statutory health insurance company and submit it to your health insurance company together with the medical certificate on the necessity and duration of household help.
  • Your health insurance company will check your entitlement to domestic help and advise you on suitable providers. Alternatively, you can choose a domestic helper yourself, provided that she is a contractual partner of your health insurance company.
  • You hire the domestic helper.
     

Requirements

You must meet the following requirements if you need a domestic help during a hospital stay, a medical care for mothers or fathers or
apply for medical rehabilitation:

  • You have statutory health insurance.
  • You have received a medical certificate stating the need for and duration of domestic help.
  • There is a child in your household who
    • younger than 12 years of age at the start of domestic help, or
    • disabled and in need of assistance.
  • There is no other person living in your household who could continue it.

You must meet the following requirements if, due to a serious illness, after a hospital stay or
apply for domestic help for 4 weeks after an operation:

  • You have statutory health insurance.
  • You are not in need of care with care level 2, 3, 4 or 5 (note: in this case, however, domestic help may be an option for the care of the child).
  • You have received a medical certificate stating the need for and duration of domestic help.
  • There is no other person living in the household who could continue it.
  • The entitlement is extended to up to 26 weeks if:
    • there is a child in your household who
      • younger than 12 years of age at the start of domestic help, or
      • disabled and in need of assistance.
         

Which documents are required?

  • medical certificate attesting to the necessity and duration of a domestic help

What are the fees?

The domestic help usually settles the costs directly with your health insurance company. For each day of domestic help, you make a co-payment if you are over 18 years old. The co-payment is 10 percent of the costs, but at least EUR 5.00 and a maximum of EUR 10.00 per day.

The statutory co-payment does not apply if

  • You need domestic help because of pregnancy or childbirth.
  • You are exempt from the statutory obligation to make additional payments.
     

What deadlines do I have to pay attention to?

You must apply for domestic help from your health insurance fund before claiming the benefit. If you have hired a domestic helper without the consent of your health insurance company, the costs can only be reimbursed in exceptional cases.

Processing duration

It usually takes about 1 to 15 business days to process.
In order to process and make a decision quickly, your health insurance company must have the necessary information and, if necessary, documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed in order to protect patients' rights.
Please note that the stated processing time is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or records are sent to you or your health insurance company by post.
If necessary, the medical service must be involved. This will take up to an additional 5 weeks to process your request.
 

Applications / forms

- Forms: yes

- Online procedure possible: Many statutory health insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no
 

Appeal

  • Contradiction
  • Appeal to the Social Court
     

Technically approved by

Federal Ministry of Health
 

Professionally released on

25.10.2021

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)