Sickness benefit for insured persons Grant to the policyholder Unfortunately this specification of service has not yet been completely translated.
The sickness benefit is intended to compensate the insured * 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 the 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, legally insured persons 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.
The sick pay 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 each in the event of incapacity for work due to the same illness.
If another illness occurs during the incapacity for work, the duration of the benefit is not extended. At the end of the three years, you can only receive sick pay 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 service.
Attention! The insurance relationship existing when the sickness benefit entitlement 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 pension for full disability or incapacity for work, a full pension due to old age, a pension or early retirement benefit or comparable benefits, your entitlement to sickness benefit ends from the beginning of these benefits.
*) In order to remain understandable, we limit ourselves to the generalizing personal designations, they always refer to each gender ed.
Statutory health insurance (health insurance)
Database of the GKV-Spitzenverband
Check with your health insurance company to find out which documents you need to present.
- 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 working allowance are also entitled to sickness benefit. This is granted from the first day of incapacity for work.
- Since sickness benefit has a pay-replacement function, 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 is no longer applicable due to the illness.
- Full-time self-employed workers who are voluntarily insured in the statutory health insurance can insure the 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 a sickness benefit choice tariff in its statutes - concluding this optional tariff. By concluding this optional tariff, the insured person is bound to his health insurance for three years.
For example, insured persons who are insured under family insurance or recipients of unemployment benefit II or students or interns who are compulsorily insured are not entitled to sick pay.
§§ 44 to 53 Fifth Book of the Social Code (SGB V) Sickness benefit
- 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, then apply for sick pay from your health insurance company on presentation of the current certificate of incapacity for work.
Payment of sickness benefit
- The sickness benefit is calculated per calendar day. If you are entitled to sickness benefit for a whole calendar month, this is set at 30 days. If you are only partially entitled to sick pay in one month, you will be paid for the days actually incurred.
- 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 supplement for childless persons in long-term care insurance is borne solely by the recipient of sickness benefit.
Responsible for the content
The Senator for Health, Women and Consumer Protection
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