Domestic help (social benefit)

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Household help is a social benefit that can be covered in Germany by the social insurance and social assistance agencies .

Legal bases

The following rules regulate the right to domestic help:

In the statutory pension and unemployment insurance , Section 74 of Book IX of the Social Code regulates the right to domestic help if it is not possible to continue the household or look after the children due to a service for medical rehabilitation or a service for participation in working life ( vocational rehabilitation ). The entitlement to domestic help is based on Section 38 of the Social Code Book V. However, the cost bearer of the domestic help is the cost bearer of the rehabilitation measure.

Special regulations apply according to the law on old-age insurance for farmers (ALG), operational and household help in the event of illness-related incapacity for work, pregnancy and cure are regulated in Section 36 ALG.

Responsibility of the statutory health insurance

Forms of domestic help

Domestic help includes all activities that are part of running a household, such as B. child care, food preparation, apartment cleaning, clothes care, etc. The scope of the service depends on the individual, actual need for help. If the household can still be partially continued or if the household can be managed by another person at certain times (e.g. weekend, vacation of the partner), the benefits can only be granted to a limited extent.

Household help can be provided in various forms by the health insurance companies. The first option, which is rarely used in practice, is for the health insurance company to provide household help in the form of a substitute worker. These can be special employees of the health insurance company or employees of institutions with which the health insurance company has concluded contracts in accordance with Section 132 of the Social Code Book V. In individual cases, the costs for a self-procured replacement worker will be reimbursed to a reasonable extent ( Section 38 (4) SGB V). Costs of € 8 per hour or € 64 per day (2009) are considered reasonable. A domestic help is provided for a maximum of 8 hours and in special exceptional cases (household manager = sick person is a single parent) for max. Approved 10 hours per day. Except for domestic help due to pregnancy or childbirth, there are additional payments per day.

For relatives and by-laws up to the second degree, no costs are reimbursed (unless the health insurance company's statutes expressly provide for such reimbursement). In these cases, however, the health insurers assume the necessary travel costs if these are above the reasonable daily flat rate and a possible loss of earnings, e.g. B. in the case of unpaid leave of the partner, this is in practice the most common type of domestic help. The reimbursement of costs in these cases is regulated by the statutes of the health insurance company; the reimbursement is usually limited to the maximum amount of the costs for a given worker (€ 64 per day).

The statutes of the health insurance company regulate how many days the health insurance company is obliged to provide household help. Any need beyond the days stipulated in the articles of association will be examined by a medical commission according to medical necessity. The Commission then determines how to proceed.

Domestic help with hospital treatment or rehabilitation

Performance basis is § 38 SGB V . Entitlement to domestic help can exist due to hospital treatment , medical preventive services, a medical rehabilitation measure or due to a mother-child cure , if one of these services makes it impossible to continue the household. Even if it is necessary to take a child with you to hospital for medical reasons , you are entitled to domestic help.

The prerequisite is that a child under the age of 12 lives in the household and no other person living in the household can continue to run it. An exception to this are children who are disabled and dependent on help, in these cases the age limit does not apply. According to Section 38 (2), the health insurance company can provide more generous provisions in its statutes (e.g. an age limit of 14 years).

There is basically no entitlement to benefits in the case of outpatient treatment .

In its statutes, the health insurance company can stipulate that household help is granted in other cases based on a medical certificate, e.g. B. in the event of illness (without hospitalization) or after outpatient operations . In contrast to the control power, however, this differs from fund to fund.

The duration of the service is determined by the duration of the service causing it, e.g. B. the length of the inpatient hospital stay.

Since January 1, 2004, an additional payment has to be made in addition to the costs of using domestic help . This amounts to 10% of the costs per service day, but at least € 5 and a maximum of € 10 per day. This only applies to insured persons of legal age.

Domestic help with pregnancy and childbirth

The legal basis for this service is § 24h SGB ​​V (formerly: § 199 RVO ). The benefit is granted if it is not possible to continue the household due to pregnancy or childbirth and no one else in the household can continue to do so. In contrast to domestic help according to Section 38 SGB ​​V paragraph 1 or 2, in these cases it is not a prerequisite that another child lives in the household.

The co-payment regulation according to § 38 Abs. 5 SGB V does not apply either, i. H. an additional payment for household help due to pregnancy or childbirth is not required (note: this was already the case under § 199 RVO, by circular, paragraph 5.3).

The law (§ 199 RVO ) requires (e) as a prerequisite for the entitlement of the pregnant or giving birth to domestic help, to have a household and to have managed it himself. In addition, pregnancy or childbirth must be the cause of the benefits; in the case of other causal illnesses, pregnant women and mothers also receive benefits according to SGB V. Since pregnancy itself is only causal in exceptional cases (e.g. when bed rest is prescribed by a doctor) , the more common benefit case is childbirth.

Domestic help can be granted for inpatient delivery as well as for a home birth .

Domestic help during pregnancy or childbirth is not subject to any time limit; it is provided for as long as the doctor or midwife deems it necessary. Even after childbirth, there is a fundamental entitlement if the woman is still weakened by the consequences of the childbirth and is unable to continue the household.

There is no general upper limit for the duration of domestic help in accordance with Section 199 RVO for home births . For an assessment of the benefit entitlements, the respective individual circumstances are decisive, which may have to be checked by a socio-medical assessment by the medical service of the health insurance (MDK). For the upper limit of the length of stay, the DRG flat rate (O60D) is the point of contact for the individual performance review. This is currently 3.3 days.

Domestic help as a service provided by the statutory long-term care insurance

Domestic help is referred to in long-term care insurance as "domestic care". According to Section 14 (4) No. 4 SGB XI, household services include help with shopping, cooking, cleaning the apartment, washing up, changing and washing laundry and clothes and heating the apartment. The entitlement to benefits is linked to the existence of a care level, whereby the need for help is at the same time partly one of the reasons for a care level ( § 15 SGB ​​XI). The assistance is part of the care in kind according to § 36 SGB ​​XI, which is usually provided by outpatient care services. The assistance is specifically defined in framework contracts at the state level in accordance with Section 75 of Book XI of the Social Code. The remuneration is based on agreements in accordance with Section 89 SGB ​​XI, which are concluded between the care services and the care funds.

Home help as part of social assistance

Social assistance knows several types of domestic help. The small household help according to § 27 Abs. 3 SGB XII is only possible for people who 1. are not able to work and 2. are not in need of help within the meaning of SGB XII, but need support with housekeeping. The major domestic help according to Section 70 of Book XII of the Social Code only comes into consideration if other family members live in the household who would have to be housed as inpatients without domestic help.

Otherwise, domestic help is usually provided as part of the care assistance in accordance with Section 63 SGB ​​XII i. V. m. § 65 SGB ​​XII granted, need for care in the sense of long-term care insurance is expressly not required for this. ( Section 61, Paragraph 1, Sentence 2, SGB XII) Recipients of unemployment benefit II can also make use of domestic help via the care assistance.

Web links

Wiktionary: Household help  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ BSG, December 11, 2007, AZ B 8 / 9b SO 12/06 R