Apply for sickness benefit in the compulsory health insurance

Sickness benefit is intended to compensate the insured person for loss of earnings. The duration of the entitlement and the amount of sickness benefit are prescribed by law.

In the event of illness, you as an employee will continue to be paid your wages in accordance with labor law regulations (continued payment of wages in the event of illness is usually granted for six weeks). After this period, those insured with a compulsory health insurance provider may be entitled to sick benefit 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 benefit amounts to 70% of gross wages/income (insofar as they are subject to the calculation of premiums) up to a maximum of 90% of net wages/income. A person is entitled to sickness benefit for a maximum of 78 weeks within each 3-year period if the incapacity for work is due to the same illness.

If another illness is added during the incapacity for work, the benefit entitlement period is not extended. After the 3-year-period has expired, you can only receive sickness benefit again for the same illness if you have been able to work and were gainfully employed for at least 6 months in the meantime or have been available for job placement through the Federal Employment Agency.

Attention! 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 sickness benefit and net wages, private health insurance providers offer daily allowance insurance schemes.

As soon as you start receiving a pension due to a complete disability to work, old-age pension, an early retirement pension or comparable benefits, the entitlement to sickness benefits ends.

Point of contact

Compulsory health insurance (Krankenkasse)

–> Krankenkassenliste
Datenbank des GKV-Spitzenverbandes

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Service details

Prerequisite

  • You must have health insurance coverage with entitlement to sickness benefit.
  • Your period of entitlement to continued payment of wages in the event of illness has expired.
  • You must report the inability to work to the health insurance provider without delay.
  • Recipients of unemployment benefit, alimony payments or reduced hours compensation are also entitled to sickness benefit. 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 the incapacity for work due to the illness.
  • Mainly self-employed persons who are voluntarily insured under the compulsory 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 provider for three years.

Persons insured under the family insurance scheme or recipients of unemployment benefit II or compulsorily insured students or trainees are not entitled to sickness benefit.

Procedure

  • While you are ill and your employer continues to pay your wages, you must send a copy of the certificate of incapacity for work to your health insurance provider.
  • If you are still unable to work after the period of entitlement to continued wage payments has expired, apply for sickness benefit from your health insurance provider 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.

Required documents

Ask your health insurance provider which documents you need to submit.

Deadlines

  • Notification of incapacity for work: inform your health insurance provider immediately, at the latest within one week of receiving the medical diagnosis.
  • Entitlement to sickness benefit: arises from the first day of hospital treatment or treatment in a preventive care and rehabilitation facility, otherwise from the day of the medical determination of incapacity for work.

Release note

Saxon State Ministry for Social Affairs and Social Cohesion. 17.06.2020