Receive sick pay for health insurance holders

Prerequisites

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

Documents required

Please ask your health insurance provider which documents you need to submit.

Please note

• The insurance relationship existing at the time the entitlement to sickness benefit arises determines who is entitled to sickness benefit and to what extent.
• In order to compensate for the difference between sick pay and net wages, private health insurance companies offer daily allowance insurance.
• As soon as you receive a pension due to total incapacity for work or incapacity for work, a full old-age pension, a retirement pension or early retirement benefit or comparable benefits, your entitlement to sickness benefit ends from the start of these benefits.
• An overview of the health insurance companies can be found on the website of the GKV-Spitzenverband (see "Links" section).
• Self-employed people who are voluntarily insured in the statutory health insurance scheme can protect themselves against loss of income due to illness (from the seventh week of incapacity to work) by taking out insurance with a claim to sick pay in accordance with Section 44 of the Social Security Code (SGB V) or - if the health insurance company provides for an optional sick pay tariff in its statutes - by taking out this optional tariff. By taking out this optional tariff, the insured person is bound to the health insurance company for three years.
• For example, insured persons who are insured under family insurance or persons who receive unemployment benefit II, as well as compulsorily insured students or trainees on internships are not entitled to sick pay.

Deadlines

• Reporting incapacity for work: Inform your health insurance company immediately, at the latest within one week of the medical diagnosis.


• Entitlement to sickness benefit: arises from the start of hospital treatment or treatment in a preventive and rehabilitation facility, and otherwise from the day on which the incapacity to work is medically established.


• You are entitled to sickness benefit for a maximum of 78 weeks within a period of three years in the event of incapacity to work due to the same illness. If another illness occurs during the period of incapacity to work, the benefit period is not extended. After the three years have passed, you can only receive sickness benefit again for the same illness if you were able to work and employed for at least six months in the meantime or were available to the job centre.

Procedure

• While you are still sick and your 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 sick pay from your health insurance company by presenting your current certificate of incapacity to work.
• Sick pay is calculated per calendar day. If you are entitled to sick pay for a whole calendar month, this is calculated as 30 days. If you are only entitled to part of a month's sick pay, you will be paid for the days that have actually accrued.
• The sickness benefit is reduced by the contributions for the insured person's share of pension, unemployment and nursing care insurance, if there is compulsory insurance in these. The additional contribution for childless persons in nursing care insurance is borne solely by the sickness benefit recipient.

Processing time

The processing time depends on the individual case.

Fees

No

Legal remedies

• contradiction


• lawsuit before the administrative court

Legal basis

§§ 44 to 53 Book V of the Social Security Code (SGB V) – sick pay


http://www.gesetze-im-internet.de/sgb_5/