Working Life > Social Insurance > Health Insurance > Statutory Health Insurance > Sick Benefit

Sick Benefit

Definition, Explanation

In Germany, employees who are insured in the statutory health insurance are legally entitled to being paid sickness benefit. Legal basis is $ 44 of the Sozialgesetzbuch SGB V und § 45 SGB V.

Statutory-health-insured are entitled to being paid the sick benefit when

• they are unable to work (working-inability of the employee)
• they are medically treated in hospitals or in institutions providing preventive or rehabilitation treatment
• they are caring for children below the age of 12 if no other person in the household can take over the child care
• they are in induced termination of pregnancy or in sterilisation

People who are not entitled to sick benefit are:

• dependently insured, via family members
• students
• persons who are being prepared for occupations in institutions of youth welfare
• persons who are exerting occupations that are part of professional practical trainings provided in study regulations and examination regulations

The entitlement to sick benefit is suspended or dropped:

• during continuing remuneration payment in the first 6 weeks of employment
• during parenting period
• while the employee is receiving maternity benefit, support sick benefit, injury benefit, bridging money, unemployment benefit 1, subsistence money or short workers money
• while the employee is receiving pension or reduced pension for reduced earning capacity

Amount of the sick benefit

• 70 % of the regular pre-tax working-remuneration that is liable to social insurance contributions
• maximum 90 % of the after-tax working-remuneration
• The pre-tax remuneration taken into account is additionally limited by the contribution assessment ceiling of 3,750 Euros (2010). What results is a maximum sick benefit of 87.50 Euros per day
• in the determination of the working-remuneration, one-time payments like Christmas money and vacation money are considered pro-rata
• start of payment with the first day of a hospital or equivalent treatment, or one day after certification of working-inability
• duration of payment maximum 78 weeks within 3 years, for the same disease. The 78 weeks do not necessarily have to be a continuous period
• For another disease occurring within the period of working-inability, the duration of sickness benefit payment is not extended
• times during which sick benefit payment is suspended or dropped for any of the above reasons, are in all other respects treated like times during which sickness benefit is paid
• Unemployed are paid sickness benefits in the amount of their unemployment benefits. The health insurance takes over the total payment of social insurance contributions
• A calendar month is considered to be virtually 30 days, for calculation of paid amounts
• During times of sick benefit being paid, the insured is still obliged to pay contributions to pension-, unemployment- and nursing-care- insurance. The health insurance takes over paying those contributions to social insurance during sick benefit being paid
• Sick benefit for the care for a child is paid for maximum of 10 days per year per child, for single parents 20 days

Tips, Checklist

• Have your working-inability diagnosed and by a doctor and get a written certificate. The certificate has to be sent to the employer immediately, and to the health insurance within one week
• The entitlement to sick benefit arises from the day after the day of doctor’s certification, respectively exactly on the day of a hospital treatment
• As a self-employed, artist or publicist and as a short-term-employee, you can get entitled to sick benefit from the 7th week from your health insurance by a sick-benefit-optional-tariff, or by additionally contracting a private health insurance. Check the conditions and prices which differ across insurances
• When contracting a sick-benefit-optional-tariff, mind that you will be bound to that tariff for at least 3 years
• Attend consultations and examinations ordered by the medical office of the health insurance, and do not refuse to participate in rehabilitation treatment. Otherwise, you violate the so-called “duties of collaboration” and put your entitlement to sick benefit at risk

Last update: 04/01/2010