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Applying for household help from statutory health insurance

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)

Service Description

If you are temporarily unable to manage your household on your own due to serious illness, a cure or during a stay in hospital, you are entitled to household help under certain conditions. You can apply for this from your statutory health insurance fund.

If you have statutory health insurance, you can receive support from a home help in certain cases. You can apply for household help from your health insurance fund if, for example

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

temporarily unable to continue running your household yourself.

You are entitled to household help if

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

This entitlement to household help is not limited in time.

Under certain conditions, you can also receive temporary home help if you

  • are recovering at home from an operation, therapy or a serious illness,
  • there is no other person living in the household who can take care of the household,
  • you are not in need of long-term care - in this case, however, household help may be available to care for a child living in the household

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

Some statutory health insurance funds also pay for household help in other cases or if you have older children. You can find out more in the statutes of your statutory health insurance fund.

You must always apply to your health insurance fund for home help before claiming it. You will need a doctor's certificate to apply to your health insurance fund. In this certificate, your doctor confirms the need for domestic help and states the extent and duration of the domestic help you are likely to need. The doctor should also state the date from which the need for assistance arises and which illness-related impairments are present.

If your statutory health insurance fund approves your application, it will arrange a home help from a care service or a comparable organization. If the health insurance company is unable to provide domestic help or there is a reason not to do so, you can organize domestic help yourself and receive a reasonable reimbursement of the costs. However, there may be regional differences.

If your parents, siblings or other close relatives help you with household chores, your health insurance company cannot reimburse them. However, it can reimburse travel costs and, in some cases, loss of earnings. Please contact your statutory health insurance fund for more information.


Process flow

You can submit your application for household help by post or - with many statutory health insurance funds - in person at the office or online.

  • Fill in the application form from your statutory health insurance fund and submit it to your health insurance fund together with the medical certificate confirming the necessity and duration of the home help.
  • Your health insurance company will check your entitlement to home help and advise you on suitable providers. Alternatively, you can choose a home help service yourself, provided it is a contractual partner of your health insurance fund.
  • You hire the home help.
Requirements

You must meet the following requirements if you are applying for household help during a stay in hospital, medical care for mothers or fathers or
because of medical rehabilitation:

  • You have statutory health insurance.
  • You have received a medical certificate confirming the necessity and duration of the home help.
  • There is a child living in your household who
    • is younger than 12 years of age at the start of the home help or
    • disabled and dependent on help.
  • There is no other person living in your household who could continue to run it.

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

  • 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, home help for the care of the child may be possible).
  • You have received a medical certificate confirming the necessity and duration of the home help.
  • There is no other person living in the household who could continue to do so.
  • The entitlement is extended to up to 26 weeks if
    • a child lives in your household who
      • is younger than 12 years of age at the start of the home help or
      • disabled and dependent on help.
Which documents are required?
  • Medical certificate confirming the necessity and duration of domestic help
What are the fees?

The home help usually settles the costs directly with your health insurance company. If you are over 18 years of age, you will have to make an additional payment for each day of home help. The co-payment is 10 percent of the costs, but at least EUR 5.00 and at most EUR 10.00 per day.

The statutory co-payment does not apply if

  • you need home help due to pregnancy or childbirth.
  • you are exempt from the statutory co-payment obligation.
What deadlines do I have to pay attention to?

You must apply for domestic help from your health insurance fund before you make use of the service. If you have hired domestic help yourself without the consent of your health insurance fund, the costs can only be reimbursed in exceptional cases.

Processing duration

Processing normally takes around 1 to 15 working days.
In order to process and decide quickly, your health insurance fund must have the necessary information and any required documents in a complete and meaningful form.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated 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 may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
The Medical Service may need to be involved. It may take up to an additional 5 weeks to process your request.

Legal basis
Appeal
  • Objection
  • Action before the social court
Applications / forms

- Forms: yes

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

- Written form required: no

- Personal appearance necessary: no

Weiterführende Informationen
Author
Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

Teaser

If you are temporarily unable to manage your household on your own due to serious illness, a cure or during a stay in hospital, you are entitled to household help under certain conditions. You can apply for this from your statutory health insurance fund.

Process flow

You can submit your application for household help by post or - with many statutory health insurance funds - in person at the office or online.

  • Fill in the application form from your statutory health insurance fund and submit it to your health insurance fund together with the medical certificate confirming the necessity and duration of the home help.
  • Your health insurance company will check your entitlement to home help and advise you on suitable providers. Alternatively, you can choose a home help service yourself, provided it is a contractual partner of your health insurance fund.
  • You hire the home help.

Requirements

You must meet the following requirements if you are applying for household help during a stay in hospital, medical care for mothers or fathers or
because of medical rehabilitation:

  • You have statutory health insurance.
  • You have received a medical certificate confirming the necessity and duration of the home help.
  • There is a child living in your household who
    • is younger than 12 years of age at the start of the home help or
    • disabled and dependent on help.
  • There is no other person living in your household who could continue to run it.

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

  • 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, home help for the care of the child may be possible).
  • You have received a medical certificate confirming the necessity and duration of the home help.
  • There is no other person living in the household who could continue to do so.
  • The entitlement is extended to up to 26 weeks if
    • a child lives in your household who
      • is younger than 12 years of age at the start of the home help or
      • disabled and dependent on help.

Which documents are required?

  • Medical certificate confirming the necessity and duration of domestic help

What are the fees?

The home help usually settles the costs directly with your health insurance company. If you are over 18 years of age, you will have to make an additional payment for each day of home help. The co-payment is 10 percent of the costs, but at least EUR 5.00 and at most EUR 10.00 per day.

The statutory co-payment does not apply if

  • you need home help due to pregnancy or childbirth.
  • you are exempt from the statutory co-payment obligation.

What deadlines do I have to pay attention to?

You must apply for domestic help from your health insurance fund before you make use of the service. If you have hired domestic help yourself without the consent of your health insurance fund, the costs can only be reimbursed in exceptional cases.

Processing duration

Processing normally takes around 1 to 15 working days.
In order to process and decide quickly, your health insurance fund must have the necessary information and any required documents in a complete and meaningful form.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated 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 may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
The Medical Service may need to be involved. It may take up to an additional 5 weeks to process your request.

Legal basis

Appeal

  • Objection
  • Action before the social court

Applications / forms

- Forms: yes

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

- Written form required: no

- Personal appearance necessary: no

Weiterführende Informationen

Author

Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

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