Sickness benefits are paid for a maximum of 78 weeks or 19.5 months within a three-year period starting from the first sick leave certificate. The sick leave period does not have to be continuous; the periods are added together. However, it must always be... the same disease The reason for incapacity for work must be listed. Sickness benefits are also paid during periods when one is in hospital or a rehabilitation facility and the employer does not pay a salary.

After the first six weeks, the employer must notify the health insurance company. The health insurance company then requests a certificate of earnings from the employer so that the claim can be verified and the amount of sick pay calculated.

If your earnings are below the contribution assessment ceiling of €4,687.50 per month (as of 2020), sick pay amounts to 70% of your gross income, but no more than 90% of your net income. The maximum daily rate is €109.38 (maximum €2,877 per month, as of 2020), meaning that sick pay is capped based on the contribution assessment ceiling. From the lower of these two amounts, the employee's share of statutory social security contributions (approximately 12% for pension, unemployment, and long-term care insurance) is deducted. No health insurance contributions are paid during the period of sick pay. The remaining amount after social security contributions is then paid out as sick pay. This money is generally tax-free, but is subject to the progression clause for income tax purposes, meaning that sick pay is included when determining the tax rate. Many health insurance companies offer a sickness benefit calculator on their websites. It makes sense to create such a calculation as a precaution, to know how much money you would actually receive in the event of a prolonged illness.

It is important to check the difference between the maximum sick pay and ongoing expenses. Even for those with statutory health insurance, taking out a daily sickness allowance insurance policy makes sense if the difference is too large. Especially for sick people whose earnings exceed the contribution assessment ceiling, the financial gap can be significant due to the cap on benefits.

To receive sick pay, it is crucial that the patient ensures they send the required follow-up sick notes (AU certificates) to their health insurance provider in a timely manner. The doctor must issue the sick note no later than the working day after the last day of illness indicated on the previous sick note (Saturdays are not included in this calculation; meaning if the previous sick note ends on a Friday, a new one must be obtained by the Monday of the following week). The doctor cannot issue a sick note retroactively! These follow-up sick notes must also reach the health insurance provider within one week. Failure to ensure continuous sick leave results in the loss of entitlement to sick pay.

Some employers offer to subsidize the difference between net pay and sick pay when an employee is receiving sick pay. It's worth asking whether this offer is available.

If you are an employee with private health insurance, you will not receive sick pay after the six weeks of continued salary payment. It is therefore extremely important to take out a daily sickness allowance insurance policy that pays out from the 43rd day and covers monthly expenses. Important: Most daily sickness allowance insurance policies – like statutory health insurance companies – require a complete record of sick leave certificates!

As a self-employed individual, you can choose whether or not to receive sick pay from your health insurance provider when you sign your contract. The amount of your health insurance contributions depends on this choice. This must be stipulated in the contract. If you opt for sick pay, it amounts to 70% of your regular earnings, up to a maximum of €109.38 per day (as of 2020). You must be able to live off your savings for the first six weeks. If this isn't possible, you can opt for a supplementary insurance plan to receive sick pay starting in the fourth week of illness.

Taking out a private daily sickness allowance insurance policy, which may even kick in before the end of the sixth week of illness, is also an option. The earlier the benefit is paid, the more expensive the insurance premium will be.

Furthermore, it should be noted that a health check is required to take out a daily sickness allowance insurance policy. Daily sickness allowance, on the other hand, is paid regardless of how good or bad one's health was at the time the health insurance contract was concluded.

It is essential to take out private daily sickness allowance insurance, see „Self-employed, legally insured“.

Sickness benefit insurance is generally unnecessary because the employer usually continues to pay wages indefinitely. The issue of occupational disability, potential retraining or early retirement in the event of prolonged incapacity for work, and the possibility of occupational disability insurance in such cases is very complex and will not be discussed here.

If you are still unable to work after 78 weeks of sick leave, your health insurance provider will usually request that you apply for medical rehabilitation no later than three months before your sick pay ends. The health insurance provider will then assess whether rehabilitation is likely to restore your ability to work (rehabilitation before retirement). If this is not possible, you must apply for a disability pension. The review process by the German Pension Insurance (Deutsche Rentenversicherung) can take anywhere from several months to several years.

Therefore, it is important to register with the employment agency at least three months before the end of sick pay in order to receive unemployment benefit I during the waiting period, provided the requirements are met. As a special case, there is the option of receiving so-called unemployment benefit during incapacity for work while, for example, the German Pension Insurance is reviewing the application for a reduced earning capacity pension.

The application form and other necessary documents for applying for a reduced earning capacity pension can be obtained online from the German Pension Insurance (Deutsche Rentenversicherung) or sent upon informal request. You can also receive free assistance with the formalities from a German Pension Insurance advice center, or from organizations such as the VdK (Social Association of Germany) or other social welfare associations. This is advisable, as several documents are required and the process is quite complex.

If medical or vocational rehabilitation cannot restore the ability to work to the point where the individual can earn a living, the next step involves assessing, based on one or more expert opinions, the extent to which, i.e., how many hours per day, the patient can still work. The previously held occupation is not considered; rather, virtually all jobs on the labor market are deemed reasonable. Only for those born before 1961 does the actual occupation play a role.

This determines whether one is entitled to a pension due to full (less than 3 hours of daily work capacity) or partial incapacity for work (3 to 6 hours of work capacity per day). The partial incapacity pension is half the amount of the full incapacity pension.

The disability pension is paid until the standard retirement age is reached, after which one receives an old-age pension (Note: This is reduced for life by up to 10.8 %, because one was not employed until reaching the retirement age!)

A pension is only granted to those who have paid into the statutory pension insurance for at least five years before the start of their incapacity for work; in addition, at least three years of insured employment (with payment of mandatory contributions) must be proven within the last five years.

The exact regulations are complicated. For advice in tricky cases, a personal consultation appointment, e.g. with the VdK, is worthwhile.

In cases of partial disability, the affected person is expected to support themselves by working part-time. However, if no part-time job can be found on the labor market, an appeal should be filed against the partial disability pension. Under certain circumstances, this can then be converted into a full disability pension.

The basis for calculating the pension amount (individual pension entitlement) is the number of years paid into the pension insurance scheme, the amount of contributions paid (the earnings points accrued), and how long one would still have to work until the regular retirement age. For very young people who become unable to work, so-called creditable periods apply to prevent them from receiving an extremely low pension. The pension statement, which is sent annually by the German Pension Insurance, also shows the amount of the expected full disability pension in case of disability.

The amount of the disability pension is never generous. (In 2017, the average disability pension for new applications was €716.) It should also be noted that, as with the old-age pension, an individual deduction is applied if the retirement age has not yet been reached. This deduction amounts to a maximum of 10.8%.

Often, the reduced earning capacity pension falls below the level required for basic social security. Therefore, it is advisable for those insured under the German pension insurance scheme to take out occupational disability insurance in good time (if possible) to close any gaps in coverage.

The pension insurance provider regularly reviews whether an individual remains entitled to a reduced earning capacity pension or whether they are once again fully or partially capable of working. This means that the reduced earning capacity pension is generally initially granted for a limited period, and a renewal application must be submitted in good time (approximately six months before the expiry date).

To earn additional income, activities must not exceed the time limits (maximum three hours per day for full disability, maximum six hours for partial disability). In total, no more than €6,300 per year may be earned in addition to the pension for those with full disability; otherwise, the pension will be reduced.

Determining the maximum earnings limit for partial disability pensions is more complex. It is calculated individually. The pension notification states the limit for the initial period of partial disability, but this value changes over time. Therefore, it is necessary to regularly inquire with the pension insurance provider about how much additional income can be earned without risking pension reductions. The minimum annual earnings limit is €15,138.90 (as of 2020).

Calculating the individual earnings limit without deductions is very complicated. Here too, consulting the pension insurance provider before accepting a job makes sense.

If the application for a reduced earning capacity pension is rejected (this happens in approximately 40 cases), an appeal must be filed within one month (send it by registered mail). Professional assistance is advisable in this case (e.g., legal advice from the VdK, a lawyer specializing in social law).

For self-employed individuals or employees not subject to mandatory contributions to the statutory pension insurance scheme, or for example, members of a professional pension fund, occupational disability must be covered by private occupational disability insurance and/or an alternative through the pension fund. Even with pension funds, lengthy processing times and protracted assessment procedures are generally to be expected when an application for occupational disability benefits is submitted. Many contracts only provide occupational disability benefits if one is completely unable to perform any work whatsoever, and not simply if one is no longer able to work in their own profession. In such cases, consulting a specialist lawyer can be helpful.

Disability insurance (BU), on the other hand, typically pays out benefits when you are no longer able to work in your original profession. It does not offer "alternative suggestions" for potentially still possible jobs. Furthermore, the assessment of disability is not as lengthy as with pension funds. However, it is important to note the maximum age limit for the disability insurance policy – you must be able to bridge any potential financial gap until you reach retirement age.