Household help

What is household help?

Household help supports you with the tasks of everyday life: cooking, cleaning, laundry, shopping, changing the beds and sometimes childcare. In health insurance, this is about situations in which you temporarily or permanently cannot do these tasks yourself, for example after an operation, during a serious illness, after an accident or after giving birth.

The distinction between nursing care and household tasks is important. Nursing care concerns your body and your health: dressing wounds, preparing medicines, helping you wash and get dressed. Household help concerns your home and your daily life. Basic health insurance only pays for nursing care. This also applies if the same Spitex organisation provides both: it must issue two separate invoices for basic health insurance benefits and for other services.

Who pays for household help therefore depends on your situation:

• Supplementary insurance. Some supplementary outpatient insurance policies include a contribution towards household help, usually linked to conditions such as a doctor’s certificate, a maximum duration or an amount per day. The rules are in your contract.
• Supplementary benefits. If you receive supplementary benefits to old-age and survivors’ insurance (AHV) or invalidity insurance (IV), the canton reimburses proven costs for help, care and support at home.
• Paid yourself. In all other cases, you bear the costs yourself. In some circumstances, they may count as medical expenses in your tax return; the tax authorities set the rules for this.

The same applies after giving birth. In the case of maternity, basic health insurance covers care by the midwife and doctor, but not help in the household.

How it works

If you need help at home after a hospital stay or during an illness, the process is usually as follows:

1. Assess the need. During a home visit, Spitex assesses what nursing care you need. This needs assessment is mandatory for nursing care paid by basic health insurance.
2. Nursing care through basic health insurance. For nursing care, basic health insurance pays fixed contributions per hour: CHF 76.90 for assessment and advice, CHF 63.00 for examination and treatment, CHF 52.60 for basic care. Of the nursing costs not covered, at most 20% of the highest care contribution set by the Federal Council may be passed on to you; the rest is governed by the canton’s financing of long-term care.
3. Household help separately. Spitex or a private organisation bills help in the household separately. You submit this invoice to your supplementary insurance if it covers household help.
4. Enclose proof. Ask your supplementary insurance whether it requires a doctor’s certificate confirming that you cannot run your household yourself.

The conditions of supplementary insurance policies vary greatly. Some only pay after a hospital stay, others also for outpatient treatment. Some only recognise Spitex organisations, others also private providers or people you know. Read the conditions before you hire anyone.

Legal basis

In basic health insurance, Art. 25a of the Federal Health Insurance Act (KVG) governs nursing care in the event of illness. The insurance pays a contribution towards nursing care provided on an outpatient basis or in a nursing home on the basis of a proven need for care. Under Art. 25a para. 5 KVG, at most 20% of the highest care contribution set by the Federal Council may be passed on to the insured person from the nursing costs not covered; the cantons regulate the remaining financing.

Which nursing services are included is listed exhaustively in Art. 7 para. 2 of the Health Care Benefits Ordinance (KLV): measures for assessment, advice and coordination, for examination and treatment, and for basic care, such as help with personal hygiene, dressing and undressing, eating and drinking. Housework such as cleaning, cooking or laundry is not listed. Art. 7a para. 1 KLV sets the contributions per hour: CHF 76.90, CHF 63.00 and CHF 52.60. Under Art. 59 para. 2 of the Health Insurance Ordinance (KVV), separate invoices are required for basic health insurance benefits and for other services.

For recipients of supplementary benefits, Art. 14 para. 1 let. b of the Federal Act on Supplementary Benefits (ELG) applies: the cantons reimburse proven costs for help, care and support at home and in day-care structures. For single people living at home, the cantonal maximum amounts for such costs of illness and disability may not be lower than CHF 25,000 a year, and for married couples CHF 50,000 (Art. 14 para. 3 ELG).

There is no legal obligation for supplementary insurance to cover household help. What applies is set out in the contract; under Art. 3 of the Insurance Contract Act (ICA), the insurer must inform you about the scope and limits of cover before the contract is concluded.

Example: ten days of help after an operation

Ruth is 67, lives alone and comes home after a knee operation. Spitex comes for ten days: one hour of basic care and two hours of help in the household every day. The hourly rate for household help of CHF 45 and the supplementary insurance benefit are assumptions for illustration; the basic health insurance contributions are the statutory values.

What this means for you

Plan help in the household before you need it, for example before a planned operation or before a birth.

1. Check your contract. Look in your supplementary insurance policies to see whether household help is included, under what conditions and up to what amount. You can compare the insurers’ benefits under compare supplementary insurance.
2. Have invoices split. Make sure nursing care and household help are billed separately. Only then can each insurance cover its share.
3. Note waiting periods. Supplementary insurance can have waiting periods, for example for maternity benefits. A new policy taken out shortly before the event will not help then.
4. Look into supplementary benefits. If your income is tight, ask the supplementary benefits office of your canton.

Basic health insurance remains the foundation. You can compare its premiums in the premium calculator and find the insurers under health insurers. Which supplementary insurance covers additional outpatient benefits is explained under supplementary outpatient insurance.

Common mistakes

• Equating Spitex with household help. Spitex offers both, but basic health insurance only pays for the nursing care.
• Only asking after the operation. Clarify beforehand what your supplementary insurance pays and what proof it requires.
• Hiring private help without checking. Some contracts only recognise certain providers. Ask before you pay someone you know.
• Forgetting supplementary benefits. If you receive supplementary benefits, you are entitled to reimbursement of proven costs for help at home. Ask the supplementary benefits office of your canton.

We explain how we build our examples under how we calculate.