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Applying for sickness benefit as an insured person


The sickness benefit is intended to compensate the insured person * 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 labour law regulations (continued payment of remuneration in the event of illness usually for six weeks). After expiry of this period, persons with statutory health insurance may be entitled to sickness benefit in the event of permanent incapacity for work or if they are treated as an inpatient in a hospital or in a preventive or rehabilitation facility.

Sickness benefit amounts to 70 percent of gross earnings (insofar as they are subject to contribution calculation) to a maximum of 90 percent of net earnings. The entitlement to sickness benefit exists for a maximum of 78 weeks within 3 years in the event of incapacity for work due to the same illness.

If another illness occurs during the period of incapacity for work, the duration of the benefit will not be extended. At the end of the three years, you can only receive sickness benefit for the same illness again if you have been able to work and work for at least six months in the meantime or have been available to the employment agency.

Attention! The insurance relationship existing at the time the entitlement to sickness benefit arises determines who is entitled to sickness benefit and to what extent.

To compensate for the difference between sick pay and net earnings, private health insurance companies offer daily allowance insurance.

As soon as you receive a total disability or incapacity pension, a full old-age pension, a retirement pension or an early retirement allowance or similar benefits, your entitlement to sickness benefit ceases from the start of these benefits.

*) In order to remain comprehensible, we limit ourselves to the generalized names of persons, they always refer to each gender – ed.

Contact point

Statutory health insurance (health insurance)

–> list of health insurance companies
Database of the National Association of Statutory Health Insurance Funds

Process flow

  • While you are still ill and your employer continues to pay your salary, you must send a copy of the certificate of incapacity for work to your health insurance company.
  • If you are still unable to work, apply for sickness benefit from your health insurance company by presenting 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 a whole calendar month, it is set at 30 days. If you are only partially entitled to sickness benefit in a month, you will be paid 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 there. The premium supplement for childless persons in long-term care insurance is borne by the recipient of sickness benefit alone.
  • Check with your health insurance company for more details.

Competent authority

In Germany, sickness benefit is a compensation benefit provided by the statutory health insurance. An overview of the health insurance companies can be found on the website of the National Association of Statutory Health Insurance Funds:

Requirements

  • There must be health insurance with entitlement to sickness benefit.
  • The deadline for continued payment of wages in the event of illness has expired.
  • You must report your incapacity for work to the health insurance company without delay.
  • Recipients of unemployment benefit, transitional allowance or short-time work allowance are also entitled to sickness benefit. This is granted from the first day of incapacity for work.
  • Since sickness benefit has the function of replacing earnings, it can in principle be claimed in the case of voluntarily insured persons as a substitute for the income that the insured person received as remuneration or income from work before the onset of incapacity for work and which ceases to exist due to the illness.
  • Full-time self-employed persons who are voluntarily insured in the statutory health insurance can insure against loss of income due to illness (from the seventh week of incapacity for work) by insuring themselves with an entitlement to sickness benefit in accordance with § 44 SGB V or - if the health insurance fund provides for an optional sickness benefit tariff in its statutes - by taking out this optional tariff. By taking out this optional tariff, the insured person is bound to his health insurance company for three years.

For example, insured persons who are insured under family insurance or recipients of unemployment benefit II or compulsorily insured students or trainees are not entitled to sickness benefit.

Which documents are required?

Check with your health insurance company to find out what documents you need to provide.

What are the fees?

None

What deadlines do I have to pay attention to?

  • Notification of incapacity for work: Inform your health insurance company immediately, at the latest within one week of the medical diagnosis.
  • Entitlement to sickness benefit: in the case of hospital treatment or treatment in a preventive and rehabilitation facility, arises from the beginning of the treatment or from the day on which the incapacity for work is medically determined.

Technically approved by

The Senator for Health, Women and Consumer Protection

Professionally released on

01.12.2020

Author

The text was automatically translated based on the German content.

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