Health insurance guide

Household help without a care level: your options

You can get household help without a care level (Pflegegrad) if an illness, an operation or a pregnancy temporarily stops you from running your home. In that case it is usually your health insurance fund (Krankenkasse) that pays, not your long-term care insurance fund (Pflegekasse). This guide explains the options and what you need for each.

By Alexander Sperling · Updated: 6 October 2026 · 8 min read

Household help without a care level: who pays?

When it comes to household help, many people think of the long-term care insurance fund first. Its benefits, however, require a care level. If you do not have one, you are still not on your own: when your household is left undone because of an illness, an operation or a pregnancy, your statutory health insurance fund is often the one responsible.

Without a care level there are four ways to get household help:

Illness, surgery or accident: household help from your health insurance fund under § 38 SGB V
Pregnancy and childbirth: household help from your health insurance fund under § 24h SGB V
Extra benefits (Satzungsleistungen): additional benefits your fund offers beyond the legal minimum
Paying privately: if no fund is responsible or you need more hours

Both statutory routes share one basic rule: there must be no one else in your household who can keep it running. In both cases you also need a medical certificate (ärztliche Bescheinigung) and an application to your health insurance fund.

After surgery, an accident or serious illness: § 38 SGB V

Your health insurance fund covers household help if you cannot keep your household running because of a serious illness or a sudden worsening of an illness. Typical situations are the time after a hospital stay, after outpatient surgery or after outpatient hospital treatment, for example following an accident.

As a rule: up to 4 weeks

The fund pays for household help for up to 4 weeks. Important: if no child lives with you, this entitlement only applies if you do not have care level 2 to 5. With no care level at all, or with care level 1, it is therefore possible.

With a child under 12: up to 26 weeks

If a child under 12 lives in your household, or a child with a disability who depends on help, the entitlement extends to up to 26 weeks. For families this is a real relief when one parent is out of action after an operation.

Co-payment and relatives

From the age of 18 you pay a co-payment (Zuzahlung) under § 61 SGB V: 10 percent of the daily costs, at least 5 euros and at most 10 euros per day. Relatives up to the second degree, such as parents, children, grandparents, grandchildren or siblings, are not paid as household help by the fund. At most it reimburses their travel costs and loss of earnings.

What household help looks like in everyday life is explained on our page household help after an operation. How to apply step by step is covered in our guide applying for household help after surgery.

During pregnancy and after the birth: § 24h SGB V

Expectant and new mothers do not need a care level for household help either. Your health insurance fund pays if you cannot keep your household running because of the pregnancy or the birth and no one else in the household can take over. Typical reasons are:

premature labour
bed rest ordered by your doctor
a high-risk pregnancy
the time after the birth, including after a caesarean section

Unlike household help due to illness, there is no co-payment and no fixed maximum duration. Household help continues for as long as your doctor certifies it is needed. We bill your fund directly. You can find out more on our page household help during pregnancy.

Extra benefits: when your fund offers more

The rules in § 38 SGB V describe the minimum every statutory health insurance fund must provide. Beyond that, each fund can decide in its statutes (Satzung) to cover more when it comes to household help. What that means in practice differs from fund to fund.

If you are looking for household help from your health insurer without a care level, it is worth asking about these extra benefits as well. This is especially useful if the statutory routes do not apply to you or the maximum duration is not enough. Ask your fund directly: do you pay for household help in my situation, and if so, for how long?

Paying privately: flexible, but at your own cost

Sometimes no fund is responsible. For example, if you would like help at home without being ill, if someone in your household could step in, or if the maximum duration has been used up. In that case, paying privately is the remaining option. You decide how often and for how long the household help comes.

With us, you can book additional hours privately if your fund covers fewer hours than you need. You can also book us entirely privately, without any insurance fund involved. We discuss the cost with you beforehand.

If you have private health insurance, whether household help is covered depends on your policy. We are happy to advise you on your individual case.

When it is worth applying for a care level

Household help from your health insurance fund is meant for temporary situations. If it becomes clear that you will need everyday support on a permanent basis, even after you have recovered, for example due to age, a chronic illness or declining strength, it is worth applying for a care level.

From care level 1 you are entitled to the relief allowance (Entlastungsbetrag) of 131 euros a month (§ 45b SGB XI). You can use it for recognised everyday support services (Angebote zur Unterstützung im Alltag), for example regular household help from us. From care level 2, further benefits from the long-term care insurance fund are added.

The application is informal: a phone call to your long-term care insurance fund is enough. Benefits are paid from the month in which you apply. After that, the Medical Service (Medizinischer Dienst) assesses you, usually at home. How to prepare is explained in our guide applying for a care level.

Bear in mind: with care level 2 to 5 and no child in the household, the entitlement to household help under § 38 SGB V no longer applies. Instead, the long-term care insurance fund then helps with the cost of support at home, through the relief allowance and other benefits. We are happy to go through your situation with you.

How we support you

Alltagsdienst Sperling is approved by all statutory health insurance funds as a provider of domestic support (hauswirtschaftliche Versorgung) under § 132 SGB V. We bill your fund directly and help you with the application. In a free initial phone call we work out which route suits you.

Call us on 07121 159 10 58, Monday to Friday from 8:00 am to 2:00 pm, or write to us using our contact form.

Frequently asked questions

Does health insurance pay for household help without a care level?

Yes, if you cannot keep your household running because of a serious illness, after an operation, or because of pregnancy and childbirth. In addition, there must be no one else in the household who can take over. You need a medical certificate and an application to your health insurance fund.

How long will my health insurance fund pay for household help?

In case of illness or after an operation for up to 4 weeks, or up to 26 weeks if a child under 12 or a child with a disability who depends on help lives in your household. During pregnancy and after the birth there is no fixed maximum duration. Your fund may offer more under its statutes.

What do I have to pay myself?

For household help due to illness, you pay 10 percent of the daily costs from the age of 18, at least 5 and at most 10 euros per day. During pregnancy and after the birth there is no co-payment. We bill the rest directly to your health insurance fund.

I have care level 2. Can I still get household help after surgery?

If no child lives in your household, there is no entitlement under § 38 SGB V with care level 2 to 5. Benefits from your long-term care insurance fund may apply instead, such as the relief allowance. We will advise you free of charge on the options you have.

My partner lives with me. Am I still entitled?

That depends on whether your partner can keep the household running. The fund decides this case by case. So explain clearly in your application why your partner cannot step in.

Sources

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.