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Source: BUS Sachsen-Anhalt (Linie6PLus)

Applying for domestic help for those with health insurance

Description

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

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

temporarily unable to continue to run your household yourself.

The right to domestic help exists if:

  • there is a child living in your household who
    • at the beginning of the domestic help younger than 12 years or
    • is handicapped and dependent on help,
  • there is no other person living in the household who can run the household.

This entitlement to domestic help is not limited in time.

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

  • recover at home from surgery, therapy or a serious illness,
  • there is no other person living in the household who can run the household,
  • You are not in need of permanent care – but then the domestic help can be eligible for the care of a child living in the household

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

Some statutory health insurance companies also pay a domestic help in other cases or if you have older children. You can find out more 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 a domestic help and provide information on the extent and for how long you are likely to need the domestic help. In addition, the doctor should indicate when the need for support exists and which disease-related impairments are present.

If your statutory health insurance company approves your application, it will provide you with a domestic help from a nursing service or a comparable organisation. If the health insurance companies can not provide a domestic help or if there is a reason to refrain from doing so, you can organize the domestic help yourself and receive the costs reimbursed 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 remuneration. However, it can reimburse travel expenses and, in some cases, loss of earnings. Please contact your statutory health insurance company for more information.

You can submit the application for domestic help by post and – with many statutory health insurance companies – hand it in personally at the office or submit it online.

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

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

  • You have statutory health insurance.
  • You have received a medical certificate of the necessity and duration of the domestic help.
  • In your household lives a child who
    • at the beginning of the domestic help younger than 12 years or
    • is handicapped and dependent on help.
  • There is no other person in your household who could continue it.

You must meet the following requirements if you are suffering from a serious illness, after a hospital stay or
after an operation, apply for a domestic 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: then domestic help can be considered for the care of the child).
  • You have received a medical certificate of the necessity and duration of the domestic help.
  • There is no other person in the household who could continue it.
  • The entitlement is extended to up to 26 weeks if
    • there is a child living in your household who
      • at the beginning of the domestic help younger than 12 years or
      • is handicapped and dependent on help.
         
  • medical certificate of the necessity and duration of a domestic help

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 additional 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 is not applicable if

  • You need domestic help because of pregnancy or childbirth.
  • You are exempt from the statutory obligation to pay co-payments.
     

You must apply for domestic help from your health insurance company before you take advantage of the service. If you have independently commissioned a domestic help without the consent of your health insurance company, the costs can only be reimbursed in exceptional cases.

Processing usually takes about 1 to 15 business days.
For a quick processing and decision, your health insurance company must have the necessary information and, if necessary, necessary documents completely and meaningfully.
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 stated processing time is an average value of 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 documents are sent by post to you or your health insurance company.
If necessary, the medical service must be involved. This takes up to 5 weeks to process your request.
 

- Forms: yes

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

- Written form required: no

- Personal appearance required: no
 

The text was automatically translated based on the German content.

Federal Ministry of Health
 

No authority found