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Apply for sickness benefit as an insured person/insured person


The sickness benefit is intended to give the insured person * to compensate for the loss of earnings. The duration and amount of sick pay are prescribed by law.

In the event of illness, you as an employee will continue to be paid your salary in accordance with labor law regulations (continued payment of remuneration in the event of illness generally for six weeks). After this period, those insured by law may be entitled to sick pay if they are unable to work for an extended period or if they are treated as an inpatient in a hospital or in a preventive care or rehabilitation facility.

Sick pay amounts to 70 percent of gross pay (insofar as it is subject to the calculation of contributions) up to a maximum of 90 percent of net pay. The entitlement to sickness benefit exists for a maximum of 78 weeks within each 3-year period in the event of incapacity for work due to the same illness.

If another illness is added during the incapacity for work, the benefit period is not extended. After the three years, you can only receive sickness benefit again for the same illness if you have been able to work and gainfully employed for at least six months in the meantime or have been available to the employment service.

Caution.The insurance relationship existing when the entitlement to sickness benefit arises determines who is entitled to sickness benefit and to what extent.

To make up the difference between sick pay and net pay, private health insurance companies offer daily allowance insurance.

As soon as you start receiving a pension due to full reduction in earning capacity or disability, a full pension due to old age, a retirement pension or an early retirement pension or comparable benefits, the entitlement to sick pay ends from the start of these benefits.

*) In order to remain comprehensible, we limit ourselves to the generalized designations of persons; they always refer to each gender - d. Red.

Contact

Statutory health insurance (Krankenkasse)

->List of health insurance companies
Database of the GKV-Spitzenverband

Check with your health insurance company to find out what documentation you need to submit.

  • There must be health insurance with entitlement to sick pay.
  • The deadline for continued payment of wages in the event of illness has expired.
  • You must report the inability to work to the health insurance fund without delay.
  • Also recipients of unemployment benefits, transitional allowance or short-time allowance are also entitled to sick pay. This is granted from the first day of incapacity for work.
  • As sickness benefit is a substitute for remuneration, it can be claimed by voluntarily insured persons as a substitute for income that the insured person received as remuneration or income from work prior to the onset of incapacity for work and which is lost due to the illness.
  • Full-time self-employed persons who are voluntarily insured under the statutory health insurance scheme can cover loss of income due to illness (from the seventh week of incapacity for work) by taking out insurance with a claim to sickness benefit in accordance with Section 44 of the German Social Code, Book V, or - if the health insurance scheme provides for an optional sickness benefit tariff in its articles of association - by taking out this optional tariff. By taking out this optional tariff, the insured person is bound to his or her health insurance fund for three years.

For example, insured persons who are insured under the family insurance scheme or recipients of unemployment benefit II or compulsorily insured students or interns are not entitled to sick pay.

None

  • While you are still ill and the employer continues to pay your remuneration, you must send a copy of the certificate of incapacity for work to your health insurance fund.
  • If you are still unable to work, apply for sickness benefit from your health insurance fund by submitting the current certificate of incapacity for work.

Payment of sickness benefit

  • Sickness benefit is calculated per calendar day. If you are entitled to sickness benefit for an entire calendar month, this is calculated as 30 days. If you are only partially entitled to sickness benefit in a month, payment will be made for the days actually accrued.
  • The sickness benefit is reduced by the contributions for the insured person's share of pension, unemployment and long-term care insurance, if insurance is compulsory in these areas. The supplementary contribution for childless persons in the nursing care insurance is borne by the sick pay recipient alone.
  • Check with your health insurance company for more details.
  • Notification of incapacity for work: inform your health insurance fund immediately, at the latest within one week of the medical determination.
  • Entitlement to sickness benefit: arises in the case of hospital treatment or treatment in a preventive care and rehabilitation facility from its beginning, otherwise from the day of the medical determination of incapacity for work.

The text was automatically translated based on the German content.

The Senator for Health, Women and Consumer Protection

01.12.2020

Sick pay In Germany, sickness benefit is a payment in lieu of remuneration provided by the statutory health insurance. An overview of the health insurance funds can be found on the website of the GKV-Spitzenverband:

Responsible authorities


GKV-Spitzenverband

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)