Applying for sickness benefit as an insured person

If you as an employee are unable to work for a longer period of time, you can receive sickness benefit to cover the loss of earnings.

If you fall ill as an employee, you will continue to receive your salary for a certain period of time. This usually lasts for 6 weeks.

After this period has expired, you can receive sickness benefit as a person with statutory insurance, which takes the place of your salary.

For example, you can receive sickness benefit in the following cases

• prolonged incapacity to work
• Prolonged inpatient stay in a hospital
• Treatment in a preventive care or rehabilitation facility

If you stay in hospital or a preventive care or rehabilitation facility, you are entitled to sickness benefit from the very first day.

Sickness benefit amounts to 70 percent of your gross salary, insofar as it is subject to the calculation of contributions, up to a maximum of 90 percent of your net salary. You will receive sickness benefit for a maximum of 78 weeks in any 3-year period if you are unable to work due to the same illness.

The amount of sickness benefit you ultimately receive depends on the insurance relationship you have when you apply for sickness benefit. This means, for example

• Your health insurance tariff
• Your health insurance affiliation

Private health insurance companies offer daily allowance insurance to make up the difference between sickness benefit and net pay.

If another illness occurs during your incapacity for work, your sickness benefit will not be extended. At the end of the 3-year period, you can only receive sickness benefit again for the same illness if you have been fit for work and gainfully employed or available to the employment agency for at least 6 months in the meantime.

You can no longer receive sickness benefit if you receive one of the following benefits:

• Pension due to full reduction in earning capacity or disability
• Full pension due to old age
• Pension or early retirement benefit
• Comparable benefits

However, you can receive sickness benefit if you receive the following benefits

• Unemployment benefit
• transitional allowance
• Short-time allowance

You will receive this from the first day of incapacity for work.

For voluntarily insured persons:

If you are voluntarily insured, you can generally receive sickness benefit as compensation for the income that is lost due to your inability to work.

For persons with voluntary statutory insurance who are also self-employed:

• Even if you have statutory insurance and are also self-employed as your main occupation, you can protect yourself against loss of income due to illness. You can insure yourself with an entitlement to sickness benefit (so-called optional sickness benefit) by submitting a declaration of choice. If the health insurance company also provides for an optional sickness benefit tariff in its statutes, you can also take out this optional tariff and thus supplement your entitlement to sickness benefit. By taking out this optional tariff, you are bound to the health insurance company for 3 years.
• It is also possible to take out the optional tariff instead of the optional sickness benefit. This can, for example, compensate for loss of income during the first 6 weeks (42 days) of incapacity for work. For example, there are optional tariffs where the health insurance company pays from the 8th, 15th or 22nd day of incapacity for work. It is also possible to increase the amount of sickness benefit.

• Medical certificate of incapacity for work
• If necessary, further documents, depending on the health insurance company

• You have health insurance and are entitled to sick pay.
• The period for continued payment of wages in the event of illness has expired.
• You have reported your incapacity to work to the health insurance fund without delay.

• Contradiction
  • You will find further information on how to lodge an appeal in the notification of your application for sickness benefit.
• Appeal to the administrative court

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

Payment of sickness benefit:

• The health insurance fund calculates the sickness benefit per calendar day. If you are entitled to sickness benefit for a whole calendar month, it will calculate this as 30 days. If you are only entitled to sickness benefit for part of a month, you will receive it for the days actually taken.
• The sickness benefit is reduced by the contributions for the insured person's share of pension, unemployment and long-term care insurance if you are subject to compulsory insurance. In this case, you are solely responsible for the contribution surcharge for childless persons in long-term care insurance.

Notification of incapacity for work: Inform your health insurance fund without delay, at the latest within one week of the medical diagnosis.

The exact processing time depends on the respective health insurance company.

There are no costs.

The following persons cannot receive sickness benefit:

• Insured persons who are covered by family insurance
• recipients of unemployment benefit II
• compulsorily insured students or interns