Household help after surgery: how to apply to your health insurance fund, step by step

When health insurance pays for household help after surgery

Before you apply, it is worth taking a quick look at the requirements under § 38 SGB V. Your health insurance fund pays if you cannot keep your household running after an operation and no one else in the household can take over. This applies after a hospital stay as well as after outpatient surgery.

If no child lives with you, up to 4 weeks are possible, and only if you do not have a care level (Pflegegrad) of 2 to 5. With a child under 12 or a child with a disability who depends on help in the household, it can be up to 26 weeks. What household help covers in everyday life is explained on our page household help after an operation. For an overview of all options without a care level, see our guide household help without a care level.

Applying for household help: the steps at a glance

From planning to extension, there are seven steps. We explain the most important ones in more detail in the sections below.

1. 1

   Plan before surgery

   Before the operation, work out who can run the household afterwards and how long you are likely to be limited. Contact a provider early so that the help can be planned properly.

2. 2

   Get a medical certificate

   Your doctor certifies that household help is necessary (ärztliche Bescheinigung). It should state why you cannot run your household yourself.

3. 3

   Apply to your health insurance fund

   Submit the certificate together with your application to your health insurance fund, ideally before the household help starts.

4. 4

   Wait for approval

   The fund reviews your application and tells you whether and for how long it will cover household help.

5. 5

   Find a provider

   If you do not have one yet, choose a provider that is approved for domestic support and bills your fund directly.

6. 6

   Billing and co-payment

   The provider bills your fund. From the age of 18, your share is the statutory co-payment (Zuzahlung).

7. 7

   Extend if needed

   If the approved period is not enough, apply for an extension in good time before it ends. Ask your doctor to confirm that you still need the help.

Before surgery: what to clarify in good time

With a planned operation you have one advantage: time. Use the weeks beforehand to answer three questions.

• Who else lives in your household? If another person in the household can keep it running, there is no entitlement. If they cannot, for example because they work, explain this in your application.
• Do children live with you? A child under 12 or a child with a disability who depends on help extends the possible period from 4 to up to 26 weeks.
• Do you have a care level? Without a child in the household, household help under § 38 SGB V is only available if you do not have care level 2 to 5. With care level 2 to 5, your long-term care insurance fund (Pflegekasse) is the right contact.

Also talk to your doctor about household help before the operation, and ask whether the certificate can be issued in advance. Get in touch with a provider early, too. That way you can find out whether household help is available near you at the time you need it.

After an accident or emergency surgery

In this case there is no time to plan. Apply as soon as possible, even from hospital. Family members can help you with this, and so can we.

Your application to the health insurance fund: the documents you need

Ask your health insurance fund in what form it would like to receive your application for household help. What goes into it follows from the requirements: the fund needs to see why you cannot run your household, from when and for roughly how long, and why no one in the household can step in.

Have these documents and details ready:

• the medical certificate stating that household help is necessary
• your insurance number (it is printed on your health insurance card)
• the date of the operation or of your discharge from hospital
• who lives in your household, including the ages of any children
• a short explanation of why no one in the household can keep it running
• whether you have a care level
• if already known: the provider who will deliver the household help

Keep copies of everything you submit and make a note of when you sent the application. This helps if the fund has any questions.

After approval: finding a provider and billing

Your health insurance fund reviews your application and tells you whether it will cover household help and for what period. If you need to plan the start, ask your fund about the status.

Finding a provider

The simplest option is a provider approved for domestic support (hauswirtschaftliche Versorgung) under § 132 SGB V. Alltagsdienst Sperling is approved by all statutory health insurance funds and bills them directly, so you do not have to pay in advance. Note that the fund does not pay relatives up to the second degree as household help. At most it reimburses their travel costs and loss of earnings.

Billing and co-payment

From the age of 18 you pay a co-payment under § 61 SGB V: 10 percent of the daily costs, at least 5 euros and at most 10 euros per day. So with daily costs of up to 50 euros it is 5 euros, and from 100 euros it stays at 10 euros. The provider bills the rest directly to your fund. If you need more hours than the fund covers, you can book them privately with us.

If the time is not enough: applying for an extension

Is your recovery taking longer than expected? Then talk to your doctor in good time before the approved period ends. Ask for confirmation that household help is still needed and apply to your fund for an extension.

The statutory maximum is 4 weeks, or 26 weeks with a child under 12 or a child with a disability who depends on help in the household. Beyond that, the fund only pays if its statutes (Satzung) provide for more. Ask about this before the time runs out.

If it becomes clear that you will need everyday help on a permanent basis, household help from your health insurance fund is no longer the right route. In that case, an application to your long-term care insurance fund is worthwhile. Our guide applying for a care level explains how.

How we help you with your application

You do not have to do this alone. In a free initial phone call we check whether you are entitled to household help and which documents your fund needs. We support you with the application and agree the start date with you. After a first meeting at your home, a household helper permanently assigned to you comes to you, and we bill your fund directly.

Call us on 07121 159 10 58, Monday to Friday from 8:00 am to 2:00 pm, ideally before your operation. Outside these hours, our AI phone assistant Vera takes your request. Or write to us using our contact form.

Frequently asked questions

Sources

• § 38 SGB V: household help (Haushaltshilfe)
• § 61 SGB V: co-payments (Zuzahlungen)

This article reflects the legal situation on the date given and is not legal advice. We review the amounts every year at the turn of the year.