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How to get Postpartum Support paid by your Health Insurance?

In Germany, support from a Mütterpflegern (postpartum doula) during pregnancy and after childbirth is unfortunately not yet a state-funded benefit automatically available to all women. However, if you are covered by statutory health insurance, you can claim the legal entitlement to household assistance during childbirth or illness. In this post, you will learn more about who is eligible for the coverage or cost sharing of a Mütterpflege by health insurance.

The service of a Mütterpflegerin is (still) requested and billed as household assistance by health insurance companies. However, a Mütterpflegerin is much more than just a household helper, as she is specifically trained to support families during this special phase of life around childbirth. In addition to household tasks such as cooking, cleaning, shopping, etc., she also takes care of children and serves as a mindful conversation partner and point of contact for worries and uncertainties in everyday life with the baby. The scope, duration, and specific tasks are always individually tailored to each family.

Who is eligible?

In principle, any woman (and also any man) can apply for such professional household assistance through a Mütterpflegerin if the legal requirements under § 24h SGB V or § 38 SGB V are met at the time of application. Health insurance companies differentiate here between household assistance during pregnancy and childbirth (§ 24h SGB V) and in case of illness (§ 38 SGB V). The insured person must meet certain requirementsto be able to apply for household assistance.

Eligibility Requirements

The requirements to claim household assistance as a health insurance benefit are as follows:

  • at least 1 child under 12 years of age living in the household (for some health insurance companies, the age is 14, and there are generally no age restrictions for disabled children).

  • statutory health insurance coverage (for private health insurance, the coverage must be requested separately).

  • no other person living in the household who can continue to manage the household during the requested period (husband working from home is acceptable, but no parental leave or partner's vacation during the entitlement period).Die Voraussetzungen um Haushaltshilfe als Krankenkassenleistung in Anspruch zu nehmen sind die Folgenden:

Haushaltshilfe bei Schwangerschaft und Entbindung

If the need for support is related to pregnancy (e.g., strict bed rest or extreme pregnancy sickness) or childbirth, or is attributable to it (e.g., birth injuries, cesarean section, recurrent milk congestion), then § 24h SGB V applies. In this case the service is free of charge for the insured person.

§ 24h Household Assistance

The insured person receives household assistance if, due to pregnancy or childbirth, she is unable to continue managing the household and no other person living in the household can continue the household [...]

To apply for support directly after childbirth it should be sufficient for the midwife to certify the necessity. However, unfortunately, many health insurance companies require a diagnosis and a medical certificate from a doctor for the approval of household assistance.

Household Assistance in Case of Illness

In the specific case of illness, such as hospital treatment, severe illness, or rehabilitation measures, or if the illness cannot be explicitly attributed to pregnancy and childbirth, then § 38 SGB V applies, and the costs for a Mütterpflegerin are subject to co-payment by the insured person. However, the amount of the co-payment, which is 10% per day (minimum 5 € and maximum 10 € per day), is relatively low.

§ 38 Household Assistance

(1) Insured persons receive household assistance if they are unable to continue managing the household due to hospital treatment or due to a service under § 23 (2) or (4), §§ 24, 37, 40, or § 41. Furthermore, a child must live in the household who has not yet reached the age of twelve at the beginning of the household assistance or who is disabled and in need of assistance. In addition, insured persons receive household assistance if they are not dependent on care with care levels 2, 3, 4, or 5 within the meaning of the Eleventh Book and if they are unable to continue managing the household due to serious illness or due to an acute exacerbation of an illness, especially after a hospital stay, after outpatient surgery, or after outpatient hospital treatment, but for a maximum of four weeks. If a child lives in the household who has not yet reached the age of twelve at the beginning of the household assistance or who is disabled and in need of assistance, the entitlement under sentence 3 is extended to a maximum of 26 weeks. The need for care of insured persons does not preclude household assistance under sentences 3 and 4 for the care of the child.

(2) The statute can stipulate that the health insurance fund provides household assistance in cases other than those mentioned in paragraph 1 if insured persons are unable to continue managing the household due to illness. It may deviate from sentences 2 to 4 of paragraph 1 and determine the scope and duration of the service.

(3) The entitlement to household assistance exists only if a person living in the household cannot continue managing the household.

(4) If the health insurance company cannot provide household assistance or if there is reason to refrain from doing so, the insured persons shall be reimbursed for the costs of a household assistant procured by themselves to an appropriate extent. No costs will be reimbursed for relatives and in-laws up to the second degree; however, the health insurance company may reimburse the necessary travel costs and loss of earnings if the reimbursement is in reasonable proportion to the costs otherwise incurred for a replacement.

(5) Insured persons who have reached the age of 18 shall pay a contribution per calendar day of service utilization in accordance with the amount determined in accordance with § 61 sentence 1 to the health insurance fund.

Finding a Mütterpflegerin (Household Assistance)

For the application for household assistance, there are forms that can be downloaded either from the internet or the health insurance portal or can be requested to be sent by a health insurance company employee. Once the application ist filled out with the neccessary information the insured person then sends it to their health insurance company. Some health insurance companies have lists of contractual partners for household assistance where one can try their luck, or one can find their own Mütterpflegerin, e.g., via the internet or recommendation from other women. Through a power of attorney and assignment declaration, the Mütterpflegerin can not only support in the (successful) application process or take over the process with the health insurance company but also handle the payment directly with them. This way, the insured person does not have to deal additionally with the paperwork and processing of the application for household assistance in addition to their situation.

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