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What Spitex costs does my supplemental insurance cover?

The services covered by your supplemental insurance vary depending on your health insurance provider and policy. That’s why, as part of the needs assessment , SpitexCare works with you to determine which services in your specific case may be partially covered by your supplemental insurance.

Supplemental insurance can be important if you need Spitex services whose costs are not covered by basic insurance or the government. These services are referred to as “non-insurance-covered services.”

SpitexCare has compiled a clear list of all the non-insurance-covered services we offer. If you do not have supplemental insurance, you are responsible for the full cost of these services. You can find the current hourly rates under Rates.

Home Economics

Housekeeping services are not covered by basic insurance. Depending on your supplemental insurance plan, you may be eligible for coverage of services such as cleaning, laundry, grocery shopping, or cooking.

Support

Care services are not covered by health insurance. Depending on your supplemental insurance plan, coverage may be available for care, companionship, assistance with daily living, or relief for family members.

Support

Depending on your supplemental insurance plan, coverage for escort services may be available—for example, for doctor's appointments, shopping, or other outings.

Recovery After a Hospital Stay

After a hospital stay, you may temporarily need additional support at home. Depending on your supplemental insurance, you may be eligible for coverage for certain support services.

Additional Spitex Visits

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Household Assistance in Case of Illness or Accident

Some supplemental or accident insurance policies cover household help in the event of illness or an accident, subject to certain conditions. Whether costs are covered—and to what extent—depends on the specific insurance policy.

Desired Services

Optional benefits are additional services that are not covered by basic insurance. Depending on the supplemental insurance plan, you may be eligible for a cost-sharing arrangement.

The policy is key

Just because you have supplemental insurance doesn’t mean that all costs are automatically covered. What matters is always what’s specified in your individual policy.

As a rule, a benefit cannot be reimbursed twice. If the basic insurance or the government covers the cost, the supplemental insurance may not be able to cover it again.

There are several things to keep in mind when purchasing supplemental insurance:

  • What benefits are included?

  • Is a doctor’s prescription required?

  • Are there daily or annual limits?

  • Does the service provider have to be approved?

  • Are there waiting periods?

  • Are there any exclusions?

  • Has the service already been paid for by another entity?

Documents for Supplemental Insurance

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Before reviewing or reimbursing costs, insurance companies require documentation. The following are often required:

  • Proof of service

  • Invoice for the service

  • Details of the service provided

  • Doctor’s prescription or confirmation

  • Insurance number / policy details

It is best to check directly with your supplemental insurance provider before the service begins to determine which documents are required.

Coverage of Costs in the Event of an Accident

If assistance is needed following an accident, accident insurance may cover the costs. For employees, this is typically handled through the employer.

In this case, you should first check with your employer to determine which accident insurance provider is responsible. You should also clarify which benefits are covered and how to file a claim for reimbursement.

The rules may vary depending on the situation—for example, for self-employed individuals, retirees, or people without accident insurance through their employer.

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Frequently Asked Questions About Coverage Under Supplemental Insurance

Which Spitex services does my supplemental insurance cover?

Depending on your insurance plan, costs for housekeeping, care, or assistance may be covered. Additional support following a hospital stay may also be covered. The specific benefits covered by your supplemental insurance depend on your individual policy.

Does my supplemental insurance cover a housekeeper?

Some supplemental insurance policies cover part of the costs of household help, such as cleaning, laundry, or grocery shopping. Whether you are eligible for this coverage and how much the insurance will contribute depends on the terms of your policy.

Does the supplemental insurance also cover care and assistance?

Yes, depending on your supplemental insurance, coverage for home care or assistance with doctor’s appointments may be available. Relief for family caregivers may also be covered under certain conditions. It all depends on what benefits your policy includes.

Who pays for home care after a hospital stay?

After a hospital stay, certain care services may be covered by your basic health insurance. If you need additional help with household chores or personal care, your supplemental insurance may cover some of the costs, depending on your policy.

Does my supplemental insurance cover the full cost of Spitex services?

Not necessarily. Supplemental insurance policies may exclude certain benefits or limit coverage. Often, there are maximum amounts per day or per year. Therefore, before you begin your assignments, check to see how much your insurance actually covers.

Do I have to pay for Spitex services myself if I don't have supplemental insurance?

You are generally required to pay for services not covered by health insurance—such as personal care and housekeeping—out of pocket unless you have appropriate supplemental insurance. Recognized long-term care services, on the other hand, are partially covered by basic health insurance and the government, provided the legal requirements are met.

Do I need a doctor's prescription for the costs to be covered?

That depends on your supplemental insurance and the services you need. Some insurance companies require a doctor's prescription or confirmation before they will cover the costs. It's best to clarify this requirement before your first Spitex visit.

What documents does my supplemental insurance require for reimbursement?

Insurance companies often require an invoice and proof of the services provided. Depending on the policy, a doctor’s prescription or additional information may also be necessary. Check with your insurance company in advance to find out what documents they need. SpitexCare will provide you with the necessary documentation for the services rendered.

Who covers the costs of home health care after an accident?

After an accident, accident insurance may cover certain care and support services. For employees, the employer’s accident insurance generally applies. Which costs are covered depends on your insurance coverage and the services you need.