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 sickness benefit 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, you may be entitled to sickness benefit for persons with statutory health insurance in the event of permanent incapacity for work or if you are being treated as an inpatient in a hospital or in a preventive or rehabilitation facility.
The sickness benefit amounts to 70 percent of the gross salary (insofar as it is subject to the calculation of contributions) up to a maximum of 90 percent of the net salary. 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 incapacity for work, the benefit period 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 gainfully employed for at least six months in the meantime or have been available to the employment agency.
Attention! The insurance relationship existing at the time of entitlement to sickness benefit determines who is entitled to sickness benefit and to what extent.
In order to compensate for the difference between sickness benefit and net earnings, private health insurance companies offer daily allowance insurance.
As soon as you receive a full disability pension, a full old-age pension, a pension or an early retirement allowance or similar benefits, your entitlement to sickness benefit ends from the start of these benefits.
*) In order to remain understandable, we limit ourselves to the generalizing designations 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 the 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 your 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 contribution surcharge for childless persons in long-term care insurance is borne solely by the recipient of sickness benefit.
- Check with your health insurance company for more details.
Competent authority
In Germany, sickness benefit is a compensation benefit from 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 a function of replacing earnings, it can in principle be claimed in the case of voluntarily insured persons as compensation for the income that the insured person received as remuneration or income from work before the onset of the incapacity for work and that ceases to exist due to the illness.
- Full-time self-employed persons who are voluntarily insured in the statutory health insurance can cover loss of income due to illness (from the seventh week of incapacity for work) by insuring themselves with a claim to sickness benefit in accordance with § 44 SGB V or - if the health insurance company 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 interns 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: accrues in the case of hospital treatment or treatment in a preventive and rehabilitation facility from the beginning of the treatment, otherwise from the date of the medical determination of incapacity for work.
Legal basis
§§ 44 Fifth Book of the Social Code (SGB V)
§ 44a of the Fifth Book of the Social Code (SGB V)
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.
