Sickness benefit: when you start getting it and how to apply for it

 As soon as the employer no longer pays wages in the event of a prolonged illness, the statutory health insurance system steps in. However, the payment of sick pay is always a source of trouble. What you should know if you are ill for several weeks.

The essentials in brief:

• Sickness benefit is a benefit provided by statutory health insurance. The amount depends on your regular income. It is 70 percent of the gross salary (with further restrictions).
• In most cases, the health insurance company pays sick pay from the seventh week after the first sick leave, because the employer is still stepping in until then.
• Employees, trainees and recipients of unemployment benefit I are entitled to sickness benefit. The self-employed, on the other hand, have to take care of their own insurance.

Who receives sick pay?

Sickness benefit is paid for

• workers
• trainee
• Recipients of unemployment benefit I

As a student, on the other hand, you usually do not get any sick pay - not even if you work a little while you are studying and are not insured. That only turns around when you place more emphasis on work than on study for a longer period of time. This means: If the job is your main occupation, you are insured and receive sick pay. The most important question is: Do you work more than 20 hours in a typical week?

In the event of an accident at work or an occupational disease, you will not receive sick pay. In these cases, the accident insurance company or the trade association is responsible instead.

As an employee, when am I entitled to sick pay?

As soon as your doctor has given you sick leave, i.e. has certified that you are unable to work, you are entitled to sick pay. This also applies from the first day of an inpatient stay in a hospital or in a prevention or rehabilitation facility of the health insurance company. Sickness benefit is also paid under certain conditions if you look after a sick child.

However, most employees are entitled to continued payment of wages by their employer during the first six weeks of illness. The health insurance company only steps in from the seventh week and pays sickness benefit.

The sick note from your doctor is usually called a "certificate" or "yellow certificate" - actually it is a "certificate of incapacity for work". You need to

• Tell your employer immediately that you are ill. If you are ill for more than three days at a time, you must also present the doctor's certificate to the employer. This must be submitted by the fourth day at the latest. The employer can also request this earlier.
• Submit them to the health insurance company within a week of the start of your inability to work - you are still responsible for this yourself, your employer will not do it for you.
• each time your incapacity to work is extended, you can provide your employer and the health insurance company with a follow-up certificate that you are still ill.

From 2021, the electronic certificate of incapacity for work (eAU) will be gradually introduced for those with statutory health insurance. The doctor treating you then sends the medical certificate digitally to the health insurance company. For medical practices, however, electronic transmission is only mandatory from October 1, 2021. As long as the following applies: If you are on sick leave, clarify with your treating doctor whether the certificate can be sent digitally. If it is not yet possible, you are responsible for sending it to the health insurance company yourself.

Attention: For privately insured people, however, everything remains as usual.

New sick note via video

Since October 2020, doctors have also been able to write their patients off sick in a video consultation. The corresponding guideline was adapted accordingly by the Federal Joint Committee (G-BA).

Prerequisites for the AU certificate via video:

• It is only possible for patients who are already known in practice from previous treatments and whose incapacity to work can be assessed with sufficient certainty via video transmission.
• An initial certificate can be issued via video  for a maximum of seven days . After that, the patient has to go to the practice if they continue to be ill.
• Subsequent certificates can only be issued by video  if you have previously visited the practice and the doctor has determined that you are unable to work due to the same illness through a personal examination.
• The patient must also be informed before the video consultation about the limited possibilities for findings in this way .

Patients are not entitled to sick leave during a video consultation: the doctor decides whether, in certain cases, he will also issue a sick leave certificate after an online visit.

In general, if it is not possible to assess the incapacity to work with sufficient certainty via video consultation, a personal examination must be carried out in the practice.

In addition, the inability to work must not be issued solely on the basis of an online questionnaire, a chat survey or a telephone call.

Are the self-employed also entitled to sick pay?

There is no statutory entitlement to sick pay for the self-employed. However, you have three different options for insuring yourself in the event of illness:

1. You submit an election declaration to the health insurance company and pay a higher contribution to the statutory health insurance, which also includes the right to payment of sick pay.
2. You conclude an optional tariff for sick pay with the statutory health insurance.
3. Alternatively, you can take out private daily sickness benefit insurance .

How much sick pay is paid?

Sickness benefit is paid for each calendar day that you are on sick leave. It depends on the amount of your regular income:

• Sickness benefit is 70 percent of gross income, but no more than 90 percent of net income.
• One-off payments such as Christmas bonuses are taken into account.
• Sickness benefit is limited to a statutory maximum of EUR 112.88 per day (value for the year 2021).

Contributions to pension, unemployment and long-term care insurance are deducted from sick pay. You do not have to pay health insurance contributions if you receive sick pay.

For most, that means you'll have slightly less cash on hand with sick pay than you would have while you're working.

If you are unable to work for months and you have to pay a large proportion for medication and aids yourself or if you have to remodel your home because of the illness, things can get tight financially. Additional protection against this risk is offered by some disability insurance policies , which also pay for long-term incapacity to work. If you are looking for an appropriate insurance, you can pay attention to this clause. The insurance usually steps in after six months of illness and pays a pension over a longer period of time.

How long is sick pay paid?

Insured persons receive sick pay for the same illness for a maximum of 78 weeks in any three-year period. This is calculated from the day on which the inability to work begins. The time during which wages are continued to be paid by the employer is included in the calculation.

You will only receive continuous sickness benefit if your doctor writes you unfit for work without interruption. Retroactive sick leave is not possible.

That means: You have to go back to your doctor no later than the working day after the sick note expires! If the certificate of incapacity for work ends on a Friday, it is sufficient if the further sick leave is issued on the following Monday.

What happens if I don't submit a medical certificate in time?

If you are ill for a long period of time, you must regularly obtain new certificates from the doctor and send them to the health insurance company and your employer. If you don't do this, there may be gaps in sick pay. The insurance companies do not pay as soon as there is no longer a valid certificate.

In the event that the employment relationship ends during sick leave, you now have one month from the end of the last certified incapacity to submit a follow-up certificate. Here, too, the entitlement to sick pay is suspended until a corresponding certificate is submitted later.

If you are a few days late with a follow-up certificate, you will lose some money. The entitlement to sick pay is suspended for this period. If a certificate then arrives at the health insurance company, they will continue the payments.

On the other hand, it can be worse if the gap lasts longer than a month because of the same illness. Give yourself more time to submit a new certificate to the health insurance company, you are risking your insurance cover!

You should therefore absolutely not leave any gaps in the first place and forward the follow-up certificate to the health insurance company immediately after the end of the last AU certificate.

Can I go on holiday if I receive sick pay?

Approval from the health insurance company is not required for travel within Germany . You do not have to inform the health insurance company about such a trip. All you have to do is take part in medical treatments and examinations. If no treatment is planned during the time of the trip, you can drive inland without any problems.

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