Home help from the health insurance fund: who is entitled to it?

More people are entitled to home help than most people think. Regardless of whether they have a chronic illness, are recovering, pregnant or need care from care level 1, all of these groups have one thing in common: their entitlement to household help paid for by their health insurance. In this guide you will find all the important information about home help and everyday companions at a glance!

What is a home help?

A domestic help is a person who works in private households for a fee and performs various tasks there. These can include

1. Cleaning work: Cleaning, dusting, floor mopping, window cleaning, etc.
2. Laundry care: washing, ironing, folding clothes, etc.
3. Shopping assistance: getting groceries and other daily necessities.
4. Food preparation: cooking meals, preparing snacks, etc.
5. Childcare: looking after children, taking them to and from school, helping with homework, etc.
6. Support for elderly or sick people: Help with everyday activities, accompanying to doctor's appointments, administering medication, etc.

Some domestic helpers are permanently employed by a family or individual and work full-time, while others work on an hourly basis or for several employers. There are also agencies that place domestic helpers, such as the Agentur für Haushaltshilfe, who provide care for people in their homes nationwide.

Home help paid for by the health insurance fund: In these cases, household help is available with cost coverage

In Germany, people with statutory health insurance can receive household help from their health insurance fund under certain conditions. It doesn't matter whether you are insured with Techniker Krankenkasse, AOK, Barmer or one of the many other health insurance companies. Here are the most common cases in which this is possible:

1. Hospitalization: If you have to go to hospital and there is no one in your household to look after your children under the age of 12 or a disabled child who needs help, the health insurance fund can pay for household help.
2. Illness: Even if you are not hospitalized, the health insurance fund can pay for household help if you are unable to run the household due to illness and there is a child under the age of 12 or a disabled child at home who needs help.
3. Pregnancy and childbirth: If a pregnant woman is unable to run the household for health reasons, the health insurance fund can cover the costs of a home help. This also applies after childbirth if the mother is unable to run the household or look after other children living in the household due to complications, for example.

Requirements and restrictions

• The need for domestic help must be proven by a medical certificate.
• As a rule, it is expected that solutions are first sought within the family before external domestic help is financed.
• The duration and scope of the support provided by the health insurance company may vary.

It is important to contact your own health insurance company directly and find out about the exact conditions and possible scope of support. Other social benefits or support may also be possible.

Home help from the health insurance fund during pregnancy and after the birth

During pregnancy and after childbirth, situations may arise in which a woman is unable to run the household herself. In such cases, women with statutory health insurance in Germany can apply for household help, which is financed by the health insurance fund. Here is the most important information on the subject:

1. Prerequisites: You can apply for household help if
   • the expectant or new mother is unable to continue running the household due to her pregnancy or after giving birth,
   • there is a child living in the household who has not yet reached the age of twelve when the household help begins or who is disabled and dependent on help, and
   • no other person living in the household can manage the household.
2. Duration: The duration for which household help is granted depends on the individual situation. After childbirth, it is common for support to be granted for the duration of the hospital stay and a few days beyond. However, support can be extended in the event of complications or special situations.
3. Application: Household help should be applied for from the health insurance fund as early as possible. A medical certificate confirming the need for household help is required. The health insurance company will then decide on the application.
4. Cost coverage: If the requirements are met, the health insurance company will cover the costs of home help. However, there may be a personal contribution or an additional payment, depending on the regulations of the respective health insurance company.
5. Self-organization: In some cases, the person concerned can organize the home help themselves and then have the costs reimbursed by the health insurance fund. In this case, it is important to clarify the details with the health insurance company in advance.

It is advisable to contact your own health insurance company at an early stage in order to obtain all the necessary information and submit the application in good time. This will ensure that support is available in good time if necessary.

 Home help after an operation via health insurance

If you are temporarily unable to run your own household due to illness, you may be entitled to household help financed by the statutory health insurance fund under certain conditions. Here is the most important information about household help in the event of illness:

1. Prerequisites:
   • The insured person is unable to run the household due to his/her illness.
   • There is at least one child living in the household who has not yet reached the age of twelve when the household help begins or who is disabled and dependent on help.
   • There is no other person in the household who is able to take over the household.
2. Duration: The duration of domestic help is generally limited to the period of incapacity for work or illness. However, in exceptional cases and for special medical reasons, the period may be extended.
3. Application: An application for household help should be submitted to the relevant health insurance fund. A medical certificate confirming the need for household help is usually required.
4. Cost coverage: If the requirements are met, the health insurance company will cover the costs of home help. However, depending on the health insurance company, there may be a co-payment or a deductible.
5. Self-organization: It is possible for the person concerned to organize the home help themselves and have the costs reimbursed by the health insurance company. In this case, it is important to clarify the cost limits and modalities with the health insurance company in advance.
6. Choice of domestic help: There are professional services that are recognized and provided by health insurance companies. In some cases, however, a private person, such as a neighbor or relative, can also be used as a home help.
7. Private health insurance: Different regulations often apply to privately insured persons. It is important to contact the private health insurance company directly to clarify the details.

To ensure that all requirements are met and no misunderstandings arise, those affected should contact their health insurance company at an early stage and provide all the necessary documents.

From care level 2: Finance a home help with the conversion entitlement from outpatient care benefits in kind

With the support of the Conversion of outpatient benefits in kind in accordance with Section 45a SGB XI, you will receive further financial support in addition to your entitlement to relief amounts - provided you have a care level 2 to 5.

You can use up to 40 percent of your budget for care services to cover the costs of a home help for a home help. The amount of the care benefit in kind depends on your care level.

As with the relief amount, the respective provider of home help must be recognized by the care insurance fund according to the respective state law (varies from state to state) so that you are entitled to a conversion of outpatient benefits in kind. If you have any questions, our customer service team will be happy to advise you. Please feel free to contact us by telephone on +49 (0)2131 / 760 100or by e-mail at anfrage@agentur-fuer-haushaltshilfe.de or conveniently via our contact page.