What costs for Spitex services do I have to pay and how much?
Good, professional care costs money. And although outpatient Spitex care is significantly cheaper than inpatient care, it can quickly add up to several thousand francs a month. Understandably, people in need of care or their relatives are therefore concerned about the costs incurred and, above all, who has to bear what proportion of these costs. The decisive factor here is the exact type of services involved, but the canton also plays a role in the distribution of costs.
In this blog post, we will explain the different types of benefits and who bears what proportion of their costs. In the next blog post, we will give you a few tips on what financing options you have if the costs are too high and when you can claim financial support.
Roughly speaking, there are two types of benefits when it comes to costs:
- services prescribed by a doctor and therefore covered by health insurance
- Services that are not covered by health insurance
Medically prescribed services that are covered by health insurance
What is meant by this?
All services prescribed by a doctor in accordance with the KLV (Health Care Services Ordinance) are subject to compulsory health insurance. It therefore makes no difference whether you receive these services from a public or private Spitex organization - the costs are charged identically and you pay exactly the same for both. Private Spitex organizations such as SpitexCare are therefore not more expensive for these services, but they do have some advantages, which we have listed and explained in this blog post. The only important thing is that the Spitex organization in question has the appropriate cantonal approval and is therefore recognized by health insurance companies - like SpitexCare.
These services, which are subject to compulsory health insurance, are financed in varying proportions by the respective health insurance company, the Spitex clients themselves and the public sector, i.e. the cantons and municipalities. These services include the actual care, but also the necessary prior needs assessment. The rates for these services are set by the Federal Council in the Health Care Services Ordinance (KLV) and are the same for all cantons. However, a further distinction is made between two financing categories for these services subject to compulsory health insurance:
- outpatient care without acute/transitional care
- outpatient acute/transitional care
What is outpatient care without acute/transitional care?
This basic financing category basically includes all services that do not fall into the special second financing category of outpatient acute/transitional care. According to the Health Care Benefits Ordinance (KLV), compulsory health care insurance pays the following statutory contributions per hour:
- CHF 54.60 for basic care (eating and drinking, washing, dressing, mobilization, etc.)
- CHF 65.40 for examination and treatment (administering medication, wound care, blood pressure measurement, etc.)
- CHF 79.80 for clarification and advice (care planning, instructions on taking medication, etc.)
These services are always billed in units of 5 minutes, but are always charged at a minimum of 10 minutes per service.
Who pays what for outpatient care without acute/transitional care?
In addition to your individual deductible and co-payment, you pay a cantonal patient contribution, sometimes also known as a patient contribution, for outpatient care services without acute/transitional care that are subject to compulsory health insurance. However, this patient contribution may only amount to a maximum of CHF 15.95 per day or CHF 5821.75 per year - regardless of the canton in which you live. The remaining costs are then borne by the respective canton or municipality.
What is outpatient acute/transitional care?
The financing category of outpatient acute/transitional care only covers outpatient care services that have been directly prescribed by a hospital doctor for a maximum of 14 days following a hospital stay, subject to certain criteria. In accordance with the KLV, these services are then fully covered by the compulsory health insurance and the cantons or municipalities.
Who pays what for outpatient acute/transitional care?
You only pay the co-payment and your deductible for these mandatory outpatient acute/transitional care services. All other costs are covered by health insurance and the public purse.
How high is the patient contribution in the Canton of Zurich?
In accordance with the Care Act of the Canton of Zurich, the patient contribution is CHF 8 per day, in addition to your individual deductible and the respective excess.
How high is the patient contribution in the canton of Aargau?
Since January 2013, the patient contribution in the canton of Aargau has been 20% of the contributions stipulated by law in the KLV for the whole of Switzerland, which we have listed above. Here too, you pay the patient contribution in addition to your individual deductible and excess. However, this 20% patient contribution to the costs is capped at a maximum of CHF 15.95 per day or CHF 5821.75 per year. Children and adolescents are also exempt from this patient contribution until they reach the age of 18. The patient contribution is also waived in the case of invoices for disability insurance (IV), military insurance (MV) and accident insurance (UV).
Benefits not covered by health insurance
What is meant by this?
Services that are not covered by health insurance include all care and housekeeping services that are not prescribed by a doctor, do not require special training and are therefore very often provided by relatives. Examples of these non-nursing services are shopping and cooking, cleaning, washing and ironing, accompanying to medical appointments etc. as well as night watches. However, certain care services that are not listed in the KLV are also included.
Who pays what for services not covered by health insurance?
Unfortunately, you generally have to pay for these uncovered services yourself. However, there are private supplementary insurances and financial support tools from the federal government and municipalities that can at least reduce these costs. It is best to find out about your current insurance cover for this as early as possible. If it is worth changing your supplementary health insurance, you should do so as soon as possible, but make sure you are aware of any blocking periods for your benefits immediately after the change. On Comparis.ch you will find further information on changing or canceling your supplementary health insurance as well as a helpful health insurance comparison.
We will be happy to answer your questions!
In our free and non-binding initial consultation, we will work with you to clarify your individual situation and the options for professional, friendly and affordable care for you or your relatives. Simply talk to us:
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