Apply for sickness benefit

In the statutory health insurance, certain members (e.B. employees, recipients of unemployment benefit I) and in the health insurance of farmers the assisting family members who are subject to pension insurance are entitled to sickness benefit if the illness makes them unable to work or if they are treated inpatient in a hospital, a preventive care or rehabilitation institution at the expense of the health insurance funds. Sickness benefit amounts to 70 % of the regular salary earned, insofar as this is subject to the calculation of contributions (standard salary). However, it may not exceed 90 % of the net salary. Contributions to pension and unemployment insurance are payable from sickness benefit. For assisting family members of an agricultural entrepreneur who are not subject to pension insurance, the sickness benefit for the calendar day is one eighth (if necessary according to the statutes up to one quarter) of the contribution assessment limit of the statutory health insurance.

Certificate of incapacity for work Declaration on the payment of sickness benefit If necessary, further documents may be required.


Preconditions
You have statutory health insurance with entitlement to sickness benefit The deadline for continued payment of remuneration has expired (6 weeks). You must report your incapacity for work to the health insurance company without delay. Recipients of unemployment benefit, maintenance allowance or short-time working allowance are also entitled to sickness benefit. Full-time self-employed workers can insure sickness-related loss of income (from the seventh week of incapacity for work) if their health insurance company provides for statutory provisions for a sickness benefit choice tariff. By concluding this optional tariff, the insured person is bound to his health insurance for three years. Not entitled to sickness benefit Insured persons who are insured under family insurance Recipients of unemployment benefit II compulsorily insured students or interns.

Hints
Entitlement is suspended to the extent and for as long as the insured person receives contributory wages or income from work during the illness or receives sickness benefit, injured person's allowance, transitional allowance, maintenance allowance or short-time working allowance. Likewise, the payment is suspended as long as the insured person takes parental leave under the Federal Parental Allowance and Parental Leave Act, the insured person receives maternity benefit or unemployment benefit I or the entitlement to benefits under the Employment Promotion Act is suspended due to a blocking period. This also applies if the sickness benefit is higher than one of these benefits.
While you are 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. After six weeks, your attending physician will also confirm your further incapacity for work with a certificate of incapacity for work, which you must immediately send to your health insurance companies. If you are still sick for a longer period of time and can therefore not work, you must regularly submit the further certificates of incapacity for work to the health insurance company. In addition, you must complete a "Declaration on the payment of sick pay" at most health insurance companies. The sickness benefit will be transferred to the account you specify in the application form for the previous period of incapacity for work. 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. important: The inability to work must be fully proven. For complete proof of the existence of incapacity for work, it is sufficient if the incapacity for work that continues to exist due to the same illness is medically determined on the working day following the last previously certified day of incapacity for work and accordingly a follow-up certificate of incapacity for work is issued on the day after the previous end of the incapacity for work. If this day does not fall on a working day (Saturday is not considered a working day in this respect), it is sufficient if the further incapacity for work due to the same illness is determined by a medical judge on the working day following the previous attested end of the incapacity for work.

Responsible for the content
MSAGD

Last update or date of publication
02.10.2019