Cost coverage of health insurance for Home help

The assumption of costs for home help by health insurance in Switzerland can be a valuable support if you are unable to run the household yourself due to illness or accident. However, it is important to find out about home help in good time and take the necessary steps to apply for cost coverage. With the right preparation and the right information, you can ensure that you receive home help.

Home help health insurance
18.05.2024  |  Reading time: 0 Minute

What is meant by domestic help?

Domestic help refers to assistance with everyday household tasks that cannot be carried out independently due to illness, accident or other health impairments. This includes activities such as

  • Cleaning the flat
  • Washing and ironing laundry
  • Shopping
  • Cooking
  • Childcare

These services are designed to ensure that those affected can remain in their familiar surroundings without neglecting their household.

Requirements for the assumption of costs

Certain conditions must be met for the health insurance fund to cover the costs of domestic help. These are usually

  1. Doctor's prescription: The home help must be prescribed by a doctor. The doctor must confirm that the assistance is necessary and that the patient is unable to perform the household tasks themselves due to their health situation.

  2. No other means of assistance: There must be no other means of obtaining the required assistance. This means that there must not be anyone living in the household who could take over the tasks.

  3. Health insurance cover: The patient must have compulsory health insurance, which is required by law in Switzerland.

Scope and duration of cost coverage

The exact duration and scope of cost coverage can vary. As a rule, the health insurance company covers the costs for a limited period of time, which is determined by the doctor. This may be for the duration of an acute illness or convalescence after an operation, for example.

The assumption of costs may also be limited to a certain number of hours per week. It is therefore important to obtain detailed information from your health insurance provider in advance and to clarify the details of cost coverage.

How do I apply for cost coverage?

The process for applying for household help usually involves the following steps:

  1. Obtain a doctor's prescription: Have your doctor issue a prescription for home help. This should clearly state the necessity and expected duration of the assistance.

  2. Inform your health insurance company: Submit the doctor's prescription to your health insurance company. This can be done by post or online, depending on the options available to your health insurance company.

  3. Application: If necessary, complete any additional forms required by your health insurance fund. These forms are used to collect further information about your situation.

  4. Wait for approval: Wait for your health insurance provider to approve the assumption of costs. In some cases, this can take some time, so it is advisable to submit the application early.

Tips for choosing a domestic help

When choosing a suitable domestic help, you should consider a few important points:

  • Qualification: Make sure that the home help has the necessary qualifications and, ideally, experience in caring for people with health restrictions.
  • Trustworthiness: Make sure that the domestic help is trustworthy. It can be helpful to ask for references or find out from a recognised placement agency.
  • Clarify cost coverage: Clarify in advance whether the costs for the chosen home help will be fully covered by your health insurance or whether you will have to pay a contribution yourself.

What happens if the health insurance company rejects the application for home help?

A rejection of the application for home help by the health insurance fund is not the end of the road. By carefully examining the reasons for the rejection, consulting the doctor treating you, appealing against the decision and utilising alternative support options, you can continue to try and obtain the help you need.

Can household help also be provided by a family member?

Yes, in Switzerland household help can also be provided by a family member, but there are certain conditions and regulations that must be met for the health insurance company to cover the costs. Here are the most important points:

  1. Doctor's prescription: The need for household help must be certified by a doctor. The doctor must confirm that the patient is unable to perform household tasks themselves due to their health situation.

  2. Authorisation by the health insurance fund: The health insurance fund must agree that the household help is provided by a family member. This is often subject to certain conditions, such as the qualifications and availability of the family member.

  3. Contractual regulations: It may be necessary for the family member to conclude a formal contract that specifies the tasks, working hours and remuneration. This contract also serves the purpose of transparency and verifiability vis-à-vis the health insurance company.

Who bears the costs if the authorised number of hours is exceeded?

As a rule, the health insurance fund does not cover the costs of exceeding the authorised number of hours of home help. Insured persons should therefore be well informed about the authorised number of hours and, if necessary, plan measures in advance to cover the costs of additional hours. Options such as applying for an extension, utilising social assistance or taking out private supplementary insurance can provide additional support.

Can household help be applied for retroactively if the need already existed?

A retroactive application for household help is generally possible, but is subject to certain conditions and careful justification. It is important to communicate with the health insurance fund at an early stage, enclose all the necessary evidence and clearly explain the reasons for the late application. Careful preparation and, if necessary, the support of counselling centres or legal advisors can improve the chances of success of your application.

How can I extend the home help if I still need it?

A timely and well-prepared application for an extension of household help is crucial to ensure continuous support. You can increase the likelihood of a successful extension by making contact at an early stage, providing a detailed medical certificate and making a careful application. Should difficulties arise, there are various counselling and support options available to help you assert your concerns.

What should I do if I am dissatisfied with the domestic help's performance?

Dissatisfaction with the performance of domestic help can have various causes and requires a careful and structured approach. You can try to improve the situation through direct communication, reviewing written agreements, liaising with intermediary agencies and, if necessary, formal complaints processes. Documentation and advice from external agencies can be helpful in effectively addressing your concerns and finding appropriate solutions.

Which supplementary insurances cover the costs of home help?

In Switzerland, some supplementary insurance policies offer benefits that go beyond the basic cover provided by compulsory health insurance and also cover the costs of household help. It is important to check the exact conditions and scope of cover of the individual supplementary insurance policies, as these can vary. Here are some options and points to consider:

Supplementary insurance for outpatient services

  • These insurance policies generally cover additional outpatient services that are not covered by basic insurance. This may also include home help, especially if it is necessary in connection with an illness or accident.

Supplementary hospital insurance

  • Some supplementary hospitalisation insurance policies offer extended benefits for the period after a hospital stay, which can also include home help. This is particularly useful for aftercare or rehabilitation.

Supplementary long-term care insurance

  • Supplementary long-term care insurance policies are specially designed to provide benefits that are needed in the event of long-term care. These can also cover household help, care at home and support with everyday activities.

Some well-known providers of supplementary insurance in Switzerland that may offer benefits for home help are:

  • Swica
  • CSS
  • Helsana
  • Concordia
  • Sanitas
  • Groupe Mutuel
  • KPT
  • Sympany

How are the costs for domestic help settled?

In some cases, billing takes place directly between the home help or the agency providing it and the health insurance fund. This is often the case if the home help is provided by a recognised agency that works together with the health insurance fund.

In other cases, the patient must first pay the costs of the home help themselves and then apply to the health insurance fund for reimbursement.

There are also models where the health insurance company covers part of the costs directly and the patient has to pay a co-payment. This can be the case, for example, with certain supplementary insurance policies or limited hourly quotas.

Who is liable if the domestic help causes damage?

If the domestic help is self-employed or freelance, they can be held directly liable for the damage caused. In such cases, the domestic help should have their own liability insurance to cover such damage.

If the domestic help is employed through a placement agency, the agency may be liable as an employer. In this case, the agency should have liability insurance that covers damage caused by its employees.

It can be useful to have your own personal liability insurance to cover damage caused by people in your household. This is especially true if you employ the domestic help yourself.

Are home help services also available during pregnancy and the puerperium?

Yes, home help services are also available during pregnancy and in the postnatal period. If a pregnant woman needs support in the household due to health problems, complications or particular stress, the doctor can prescribe home help. This prescription is the basis for applying to the health insurance fund for the costs to be covered.

In addition to home help, a midwife can also provide support. The midwife's services are usually covered by basic insurance and include visits during the postnatal period, during which she provides medical and nursing support.

Can I keep my home help if I change my health insurance company?

If the domestic help is employed through an agency, you should check whether the contract with the agency remains in force even after a change of health insurance provider.

If the home help is necessary for medical reasons and this has been confirmed by a doctor, there is a good chance that the new health insurance company will also recognise the necessity and cover the costs.

Changing health insurance provider does not necessarily mean that you will lose your existing home help. With careful planning, timely communication and complete documentation, you can ensure that the new health insurance company recognises the need for home help and covers the costs.

Which health insurance company pays the most for home help in Switzerland?

Compulsory health insurance (basic insurance) usually only covers medically necessary services, and support from home help is often limited to special situations. To find out which health insurance company pays the most for home help, you can compare health insurance companies.

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