Ordinance on the Act on Supplementary Benefits to the AHV and IV (Supplementary Benefits Ordinance, ELV BL) - Assertion of the Claim (ELV)

1. The entitlement to a supplementary benefit is asserted by submitting the completed and signed application form along with the required documents and identification to the municipal branch of the cantonal compensation office at the place of residence of the entitled person.

2. Authorized to submit the application form are the beneficiary, the legal representative, the spouse, the registered partner, blood relatives in the ascending and descending line, siblings, as well as social welfare authorities and child and adult protection authorities.

3. The municipal branches forward the application to the cantonal compensation office after reviewing the personal and economic circumstances of the insured person.

4. The cantonal compensation office makes a decision by issuing an order.

**1. The municipal branch office shall, if necessary, assist the person claiming a supplementary benefit for themselves or a third party in completing the application form.**

**2. If the municipal branch office at the residence of the entitled person becomes aware of changes in personal circumstances, significant changes in economic circumstances, or changes of address of the entitled person or the family members who are included in the calculation of the supplementary benefit, it shall independently report these to the cantonal compensation office.**

1. The Cantonal Compensation Office issues the publications required for the implementation of the law and prepares the official forms.

1. The Inheritance Office provides the Compensation Fund, upon written request, in the event of the death of a recipient of supplementary benefits or in the event of the death of a widowed spouse of a former recipient of supplementary benefits, with the following data

a. a list of heirs including any representatives of the heirs;

b. the inventory, provided the estate exceeds CHF 40,000 or includes real estate.

2. The Inheritance Office provides the Municipality, upon written request, in the event of the death of a person whose death results in a claim for reimbursement of additional contributions according to the municipal regulations, with the following data

a. a list of heirs including any representatives of the heirs;

b. the inventory, provided the estate exceeds the exemption limit stipulated in the respective municipal regulations or includes real estate.

3. The data is provided after the expiration of the deadline for renunciation. If this deadline has not expired within 10 months after the death of the deceased, the data already collected will be provided.

4. The Inheritance Office provides any rectified inventory to the Compensation Fund and the Municipality.

5. The Compensation Fund and the Municipality may exclusively use the data according to paragraphs 1, 2, and 4 for the reimbursement of supplementary benefits and additional contributions.

6. The Compensation Fund and the Municipality are neither bound by the existence nor the valuation of the recorded assets and liabilities.

1. Claims arising from supplementary benefits take precedence over claims arising from additional contributions.

1. The decision of the Social Insurance Institution serves to clarify the entitlement to assisted living.

2. For persons who have not yet received supplementary benefits, the Social Insurance Institution shall issue a decision for persons living at home after registration.

3. The assessable income and, if applicable, the supplementary benefits from the supplementary benefits decision are used by the municipality to verify the entitlement and to determine the extent of the contributions.

1. The eligible home care costs according to § 2a of the Supplementary Benefits Act to the AHV (Old Age and Survivors' Insurance) and IV (Disability Insurance) are limited for accommodation and care as follows

a. in the year 2018 to CHF 200.- per day;

b. in the year 2019 to CHF 190.- per day;

c. in the year 2020 to CHF 180.- per day;

d. * in the year 2021 to CHF 170.- per day;

e. * from the year 2022 to CHF 160.- per day.

2. The cost share of the persons according to paragraph 1 for care services is fully eligible.

1. The funding gap for the supplementary contributions according to § 2abis of the Supplementary Benefits Act to the AHV and IV corresponds to the difference between, on the one hand, the recognized expenses pursuant to Art. 10 paras. 2 and 3 of the ELG without considering the upper limit according to § 4a and, on the other hand, the sum of the eligible income pursuant to Art. 11 and Art. 11a of the ELG and the determined amount of supplementary benefits pursuant to Art. 9 para. 1 of the ELG.

2. The data communication according to § 6 para. 3 of the Supplementary Benefits Act to the AHV and IV from the cantonal compensation fund to the municipal communities includes the sending of copies of the supplementary benefit decisions to them.

1. The application for additional contributions in accordance with § 2abis of the Supplemental Benefits Act to the AHV and IV must be submitted together with the application for supplemental benefits to the municipal branch office.

2. The municipal branch office forwards the application for additional contributions to the municipal council.

3. The municipal council decides on the additional contributions based on the supplemental benefits decision of the cantonal compensation office.

1. The additional contributions are paid to the person residing in the residential and nursing home or in the hospital. Subject to paragraphs 2 and 3.

2. The person may authorize the municipality to pay the additional contributions to the residential and nursing home or the hospital.

3. The municipalities may stipulate in the regulations that the additional contributions are paid directly to the residential and nursing home or the hospital.

1. The allowable amount for personal expenses for individuals living in homes or hospitals is CHF 360.- per month.

1. Sections 7-24 regulate the costs that are reimbursed according to Article 14, paragraph 1 of the Federal Act of October 6, 2006, on Supplementary Benefits to Old Age, Survivors' and Disability Insurance (ELG).

2. The cantonal compensation office determines and issues the reimbursements.

3. Before determining the reimbursements, it conducts a needs assessment and may involve external experts for this purpose.

1. Specified medical, disability, and auxiliary costs are reimbursed for the calendar year in which they were incurred.

1. Costs pursuant to § 7 shall be reimbursed if

a. the claim for reimbursement is made within 15 months after invoicing; and

b. the costs were incurred during a period in which there was an entitlement to supplementary benefits.

1. For the costs of illness and disability eligible for compensation in addition to the annual supplementary benefits, the maximum amounts shall be those specified in the federal legislation on supplementary benefits to old-age, survivors', and disability insurance.

1. Right to Reimbursement of Costs under Article 14 ELG only exists within the framework of a simple, economical, and appropriate performance of services and on the condition that no other insurances cover the costs.

2. From the recognized costs for care according to §§ 19a-19d, the monthly helplessness allowances of the AHV/IV and the accident insurance as well as the monthly assistance contribution of the IV are deducted.

2bis No deduction pursuant to paragraph 2 is made if the helplessness allowance has been deducted from the cantonal contributions in accordance with the disability assistance legislation.

3. If the health insurance has credited the helplessness allowance of the IV or the accident insurance for its reimbursement of home care and support costs, the helplessness allowance is not deducted from the verified costs to the extent of the credit.

4. In the application of Article 14 paragraph 5 ELG, paragraph 3 applies accordingly.

1. Medical, disability, and assistive device costs incurred in Switzerland shall be reimbursed.

2. Costs incurred abroad shall be exceptionally reimbursed if they become necessary during a stay abroad or if the medically indicated measures can only be carried out abroad.

3. Costs incurred abroad for spa treatments and convalescent stays shall not be reimbursed.

4. If an assistive device not meant to be loaned is purchased abroad, the price predetermined in Switzerland shall apply, provided it is evidently lower.

1. The participation pursuant to Article 64 of the Federal Act of March 18, 1994, on Health Insurance (KVG) in the costs for services covered by the compulsory health care insurance, as well as the cost share of the insured person for outpatient care services according to Article 25a paragraph 5 KVG, shall be reimbursed.

1. If an insurance with a higher deductible is chosen in accordance with Article 93 of the Ordinance of 27 June 1995 on Health Insurance (KVV), a cost participation will be reimbursed, which per year does not exceed the sum of the ordinary deductible and the co-payment according to Article 103 paragraph 2 KVV.

1. Costs for simple, economical, and appropriate dental treatments will be reimbursed. Paragraph 3 is reserved.

2. For the reimbursement, the Accident, Military, and Disability Insurance Tariff (UV/MV/IV-Tariff) for the compensation of dental services and the UV/MV/IV-Tariff for dental technical work are decisive.

3. If the costs of a dental treatment (including laboratory) are expected to exceed CHF 3,000, a cost estimate must be submitted to the cantonal compensation office before the treatment.

4. Cost estimates and invoices must be submitted according to the tariff positions of the UV/MV/IV-Tariff.

1. Expenses for medically prescribed, essential diets for individuals who do not live in a nursing home or hospital are considered medical expenses.

2. They are reimbursed as an annual flat rate of CHF 2,100.-.

1. Costs for medically prescribed convalescent treatments are reimbursed after deducting a reasonable amount for living expenses, provided that the treatment is carried out in a home or hospital.

2. If a canton has limited the costs for staying in a home or hospital pursuant to Art. 10 para. 2 lit. a ELG, this limitation shall apply mutatis mutandis to convalescent treatments.

1. Costs for doctor-prescribed spa treatments are considered after deducting a reasonable amount for subsistence, provided that the insured person was under medical supervision during the spa stay.

**1. Costs for Household Assistance are Reimbursed if the Assistance is Provided:**

a. * by a directly employed person who does not reside in the same household;

b. * ...

c. * by another service provider.

**2. The Reimbursements Amount to per Household:**

a. * up to CHF 27.90 per hour;

b. * ...

c. * ...

d. * a maximum of CHF 5,500 per calendar year.

3. ...

4. ...

5. ...

6. ...

7. ...**

1. Costs for care provided at home shall be reimbursed in accordance with Sections 19a-19c.

2. ...

1. If care is provided according to § 19 by a family member, the costs will only be reimbursed if the person

a. is not included in the old-age and survivors' insurance (EL) calculation; and

b. suffers a long-term, substantial loss of earnings due to providing the care.

2. The costs will be reimbursed to the extent of the loss of earnings, but at most according to the maximum insurable salary as per the accident insurance legislation[15].

1. If care is provided in accordance with § 19 by a directly employed caregiver, beneficiaries of an allowance for severe or moderate helplessness shall be reimbursed for the costs according to reasonableness, but only for the part of the care that cannot be provided by a home care organization.

1. If care is provided under § 19 by a provider other than those specified in §§ 19a or 19b, the costs will be reimbursed based on reasonableness.

1. Costs for care provided in day or night facilities shall be reimbursed according to reasonableness.

1. Costs for care provided by a service provider recognized under § 27 of the Disability Assistance Act will be reimbursed to the extent of non-personal services.

a. * ...

b. * ...

2. No reimbursement will be made if the costs are covered by cantonal contributions under the disability assistance legislation.

3. The maximum amount according to Art. 14 para. 3 let. a num. 1 ELG is CHF 60,000.-.

1. Costs for care in institutions recognized under the Federal Act of October 6, 2006, on Institutions for the Promotion of the Integration of Disabled Persons (IFEG) are reimbursed if

a. the care services are provided by a service provider recognized by the Health Insurance Act (KVG);

b. the costs have been excluded from disability assistance; and

c. the services are necessary due to age, disability, accident, or illness.

1. Documented transport costs are reimbursed to the extent they arise in Switzerland due to an emergency transport or a necessary transfer.

2. Also reimbursed are documented costs for transports to the nearest location for medical treatment. The reimbursed costs correspond to the prices of public transport for direct route journeys. If the insured person is dependent on using another means of transport due to their disability, these costs will be reimbursed.

3. Day structures according to § 21 are considered equivalent to medical treatment locations as stipulated in paragraph 2.

4. For persons with disabilities in recognized homes who are dependent on private providers for disabled transport to and from workshops and day centers, these costs are reimbursed, provided there is an authorization for benefit receipt according to § 14 BHG for the stay in the workshop or day center. In these cases, the maximum amount according to Art. 14 para. 3 letter b ELG is increased to CHF 25,000.

1. Recipients of supplementary benefits are entitled under Art. 14 para. 1 let. f of the Supplementary Benefits Act (ELG) to reimbursement for the acquisition or rental costs of aids or assistive devices (nursing aids and treatment devices) listed in the annex. Only rental costs are reimbursed for aids and assistive devices marked with an asterisk (*) in the annex.

2. Recipients of supplementary benefits are also entitled to reimbursement of one-third of the cost contribution by the AHV for aids,

a. that are listed in the annex to the Ordinance of August 28, 1978, on the provision of aids by the Old Age Insurance; and

b. to which the AHV has made a cost contribution.

3. Costs for spare parts and accessories used in the context of a surgical procedure are also reimbursed.

4. A claim for reimbursement of costs exists only insofar as the aids are not provided based on the provisions of the AHV, the IV, or health insurance. The assistive devices according to the annex are provided on loan for home care only.

5. The acquisition or rental costs are reimbursed, provided that the design of the aid is simple and appropriate.

6. The provisions of the Disability Insurance apply mutatis mutandis to the reimbursement of repair, adjustment, renewal, and use training costs.

1. Where it is doubtful whether an aid or auxiliary device is necessary, or whether its design is simple and appropriate, the insured person must provide a certificate from a doctor, a specialist center for disability assistance, or an occupational therapy center.

2. In the case of hearing aids, the necessity and appropriateness of the device must be certified by an expert recognized by the disability insurance for the evaluation of hearing aids.

3. The costs for the evaluations are considered costs within the meaning of Art. 14 para. 1 letter f ELG.

1. The following are repealed

a. The Regulation of December 23, 1997, on the Introduction of an Allowance for Self-Occupied Properties in the Asset Calculation Concerning the Clarification of the Right to Supplementary Benefits,

b. The Regulation of March 2, 1999, on the Supplementary Benefits Act for AHV and IV.

1. This regulation shall enter into force on January 1, 2008.