🏦 Sickness benefit for longer-lasting exhaustion
In brief
If you are unable to work for longer than six weeks because of an exhaustion illness, continued pay by the employer ends and the statutory health insurer pays sickness benefit. It amounts to 70% of your gross income, capped at a maximum of 90% of your net income. Sickness benefit is not paid indefinitely, however: for the same illness there is a maximum of 78 weeks of sickness benefit within each period of three years (counted from the first day of the relevant incapacity for work) – after that, people colloquially speak of "Aussteuerung" (end of entitlement).
For exhaustion illnesses it is particularly important whether a renewed sick note counts as the "same" or a "new" illness, as this decides on the rest of your 78-week allowance.
Step by step
- Apply for sickness benefit in good timeYour health insurer usually needs an application as well as the continuous certificates of incapacity for work without a gap.
- Make sure sick leave is continuousHave the follow-up certificate issued if possible before the previously certified incapacity for work expires, otherwise the entitlement for the gap may lapse.
- Keep an eye on the block periodAsk your health insurer how many of the 78 weeks within the current three-year period have already been used up.
- Get informed in good time before the 78 weeks run outThe health insurer and the German Pension Insurance (Deutsche Rentenversicherung) are meant to point out rehabilitation options early (rehab before pension) – ask actively if this does not happen.
- If the end of entitlement is looming, check alternativesThese include rehab measures, a possible reduced earning capacity pension or – if you become unemployed afterwards – unemployment benefit (Arbeitslosengeld) (see Wegweiser for the unemployed).
Deadlines
- Whether renewed incapacity for work concerns the "same" or a "new" illness is often hard to determine clearly for exhaustion illnesses and can significantly affect the remaining entitlement period – if in doubt, ask the health insurer and your doctor.
- Do not let a gap arise between two sick notes: if even one day is missing and no follow-up certification takes place at the latest on the next working day, the entitlement to sickness benefit for the period afterwards may lapse.
- After the 78 weeks have run out ("Aussteuerung"), the entitlement to sickness benefit for this illness ends regardless of whether you are still unable to work – find out early about rehab or pension options and about the duty to register with the Agentur für Arbeit (employment agency).
- The exact amount of individual sickness benefit depends on your gross income and the contribution assessment ceiling and is deliberately not stated here with an example amount, as it changes every year – have your health insurer calculate the specific amount.
In depth · legal basis, figures and practice – for advisers and professionals
Entitlement and amount (§§ 44, 47 SGB V)
Under § 44 SGB V, insured persons who are unable to work because of illness are entitled to sickness benefit as soon as continued pay by the employer ends (or from the start if there is no duty of continued pay). Under § 47 SGB V, sickness benefit amounts to 70% of the regular gross pay earned before the incapacity for work, but not more than 90% of the corresponding net pay, and is additionally capped by the contribution assessment ceiling in statutory health insurance.
Block period and maximum duration (§ 48 SGB V)
Under § 48 Abs. 1 SGB V, sickness benefit for the same illness is paid for a maximum of 78 weeks within each period of three years (so-called block period). This three-year period begins on the first day of incapacity for work because of the relevant illness – regardless of whether sickness benefit was already being paid at that time or continued pay was still running. The first six weeks of continued pay also count towards the 78 weeks. Under § 48 Abs. 2 SGB V, a new entitlement to sickness benefit for the same illness only arises once the insured person has not been unable to work because of it for at least six months and was fit for work during that time.
Continuous certification (§ 46 SGB V)
The entitlement to sickness benefit arises from the day following the day of medical certification of the incapacity for work (§ 46 Satz 1 SGB V). To prevent a late follow-up certificate from interrupting the entitlement, § 46 Satz 2 SGB V provides that the entitlement is preserved where the incapacity for work continues if the follow-up certification takes place at the latest on the next working day after the end of the incapacity for work last certified.
After the end of entitlement: what then?
Once the maximum duration of 78 weeks is reached, the entitlement to sickness benefit for this illness ends. Depending on your individual situation, medical rehabilitation, a reduced earning capacity pension (see separate topic page) or – if none of these benefits applies and the employment relationship ends – unemployment benefit I (Arbeitslosengeld I) come into consideration; anyone who remains unable to work must register specially with the Agentur für Arbeit for this. More on unemployment in the Wegweiser for the unemployed.
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