Does Swiss health insurance pay for household help?

What basic health insurance pays

Basic health insurance does not pay for household help. It strictly distinguishes between nursing care and housework. Nursing care concerns your body and your health, housework your home and your everyday life. Only nursing care is a benefit of basic health insurance (Art. 25a para. 1 of the Federal Health Insurance Act, KVG).

Art. 7 para. 2 of the Health Care Benefits Ordinance (KLV) lists exhaustively which nursing care is covered: assessment, advice and coordination; examination and treatment, such as wound care or preparing medicines; and basic care, such as help with personal hygiene, dressing and undressing, eating and drinking. Cleaning, cooking, laundry, shopping or childcare are not on the list.

The contributions apply to nurses and to organisations for nursing care and help at home, i.e. nursing care at home (Spitex). Billing is in units of 5 minutes, with a minimum of 10 minutes (Art. 7a para. 2 KLV). The canton of residence pays part of the costs above these contributions; at most 20 % of the highest nursing care contribution set by the Federal Council may be passed on to you (Art. 25a para. 5 KVG). The details are regulated by the canton.

The same separation applies after a birth. For maternity, basic health insurance pays for the midwife’s home visits after the birth: within the 56 days after the birth, up to 16 visits after a premature birth, a multiple birth, a caesarean section or for a first child, otherwise up to 10 (Art. 16 para. 1 let. c KLV). These visits serve to care for and monitor mother and child and to give advice, not to help in the household. More on this in the guide Midwife.

What supplementary insurance pays

For household help itself, only a voluntary supplementary outpatient insurance comes into question. The law does not oblige any supplementary insurance to cover household help. Before you sign the contract, the insurer must inform you about the scope and limits of the cover (Art. 3 of the Insurance Contract Act, ICA). Common provisions in the general terms and conditions:

• an amount per day or per hour and a maximum amount per year or per event,
• a maximum duration, for example a certain number of days after a hospital stay or after a birth,
• a doctor’s confirmation that you cannot run your household yourself,
• recognised providers: only Spitex organisations, or also private providers and people you know,
• waiting periods, especially for maternity benefits.

We are building a comparison of supplementary products under Supplementary insurance. What counts are the general terms and conditions and the information from your insurer.

Conditions

Different requirements apply to nursing care through basic health insurance and to household help through other routes.

• Doctor’s order and needs assessment: Nursing care under basic health insurance is based on a needs assessment and, for examination and treatment, on a medical instruction or prescription (Art. 7 para. 1 and Art. 8 KLV). This is valid for at most nine months and must then be renewed.
• Recognised service providers: Basic health insurance pays for nursing care by approved nurses, Spitex organisations and nursing homes (Art. 7 para. 1 KLV).
• Separate invoices: If Spitex provides both nursing care and housekeeping, it must issue two separate invoices for the services covered by basic health insurance and for the other services (Art. 59 para. 2 of the Health Insurance Ordinance, KVV). The invoice for the household goes to you or to your supplementary insurance.
• Co-payment: The deductible and a 10 % retention fee apply to nursing care (Art. 64 para. 2 KVG), plus any cantonal patient contribution. The midwife’s home visits after the birth are maternity benefits for which no co-payment is charged (Art. 64 para. 7 KVG).
• Supplementary insurance: Which proof it requires for household help is set out in the general terms and conditions. Clarify this before the help starts.
• Supplementary benefits: If you receive annual supplementary benefits to the old-age and survivors’ insurance or invalidity insurance, the canton reimburses proven costs for help, nursing care and support at home (Art. 14 para. 1 let. b of the Federal Act on Supplementary Benefits, ELG). The canton decides which costs are reimbursed (Art. 14 para. 2 ELG). For single people living at home, the cantonal maximum for such costs of illness and disability may not be lower than CHF 25,000 per year, for married couples CHF 50,000 (Art. 14 para. 3 ELG).

Sample calculation

Example with fictitious people, an assumed hourly rate and an assumed contract benefit. Ruth, 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. We assume an hourly rate of CHF 45 for the household help and a benefit of CHF 60 per day from her supplementary insurance (contract example). The contribution for basic care is the statutory value from Art. 7a KLV.

How to proceed

1. Plan ahead: Before a planned operation or before the birth, clarify who will help in the household and who will pay.
2. Read the general terms and conditions: Check whether your supplementary insurance includes household help, how high the amount per day is, how long it pays and which providers it recognises.
3. Get a doctor’s confirmation: Many contracts require confirmation that you cannot run your household yourself.
4. Have the invoices separated: Make sure that nursing care and household help are invoiced separately, and submit each invoice to the right place.
5. Check supplementary benefits: If you receive supplementary benefits, ask the supplementary benefits office of your canton which costs it reimburses.

Common mistakes

• Treating Spitex as the same as household help. Spitex offers both, but basic health insurance only pays for the nursing care.
• Only asking after the operation. Clarify benefits and proof beforehand, otherwise confirmations will be missing or the provider will not be recognised.
• Taking out supplementary insurance shortly before the birth. Waiting periods for maternity benefits can rule out the contribution.
• Forgetting supplementary benefits. If you receive supplementary benefits, you are entitled to reimbursement of proven costs for help at home within the cantonal rules.

You will find more on nursing care at home in the guide Spitex and further benefits in the overview What does health insurance cover?. You can compare basic health insurance premiums in the premium calculator, key figures are in the health insurer profiles; you can plan a change of insurer under Switching.