Crisis assistance required: urgent appeal!
In Germany, public health insurance companies may provide financial assistance for a household helper, also known as "haushaltsnahe Unterstützung" or "Verhinderungspflege," when a family member is ill or injured. This support is subject to specific requirements and conditions.
To qualify, the ill or injured family member must have a recognized care level (Pflegegrad), assessed by the Medical Service of Health Insurance (MDK). This care level reflects the need for support in daily activities, including household help. The household helper service must be necessary to maintain the care recipient's well-being at home and to support their care and recovery.
The costs must be related to care or necessary assistance, not just regular cleaning or maintenance tasks. Eligible tasks include help with shopping, cooking, cleaning, or assisting the patient with personal hygiene or mobility. The household helper can be a professional service provider or, under certain conditions, a non-professional (e.g., a neighbor or family friend), but the expenses must be invoiced formally.
The family member must apply for these benefits, often through the Pflegekasse (care insurance fund), which is part of the health insurance provider. There are caps and monthly allowances for such services depending on the recognized care level.
Notably, pregnant or recently delivered women whose application has been approved do not have to make any co-payment. Patients over 18 years old pay 10% of the costs of a household helper per day, which is usually at least five, but no more than ten euros.
The application process requires the household helper's tasks to be specified by the treating doctor, who issues a medical necessity certificate stating the period and number of hours for which a household helper is needed. The application is submitted directly to the health insurance company.
It is essential to note that this support is primarily offered under long-term care insurance (Pflegeversicherung), rather than standard health insurance. However, if the helper’s services are part of prescribed medical or nursing care following illness or injury, funding may be possible through health insurance specifically.
The legislator stipulates that the application must be processed within three weeks. For exact requirements, one must refer to the Pflegeversicherung provisions under the German Social Code Book XI (SGB XI) and consult the Pflegekasse handling the case.
In addition, if a person requires household help due to a hospital stay, treatment for their child, or preventive or rehabilitation measures, and their health insurance is covering the costs, they can also claim household help. The service must be necessary to maintain the care recipient's well-being at home and to support their care and recovery.
Private health insurance may have different or more limited provisions for household helpers. In summary, health insurance (particularly in the public system) can finance a household helper for an ill or injured family member only if the family member has a recognized care need (Pflegegrad) and the helper performs medically or nursing-related household support, with formal application and approval by the care insurance (Pflegekasse).
- In specific situations where a family member requires assistance due to illness or injury, the family can potentially seek financial aid from health insurance, even using a non-professional caregiver, such as a neighbor or family friend, under the condition that the caregiver's services are necessary for the care recipient's well-being, and the expenses are formalized through invoices.
- Beyond regular cleaning or maintenance tasks, health-and-wellness support for family members can be covered under long-term care insurance or health insurance, depending on the care recipient's recognized care need (Pflegegrad) and the performer's medically or nursing-related roles, such as help with shopping, cooking, cleaning, or assisting the patient with personal hygiene or mobility.
