🩺 Sickness benefit: 78 weeks, end of entitlement (Aussteuerung) and request to apply for rehabilitation
In brief
For the same illness you receive sickness benefit for at most 78 weeks within three years. After that it ends. This is called Aussteuerung.
If your capacity to work is at risk, the health insurance fund can ask you to apply for rehabilitation. It sets a deadline of 10 weeks for this. If you miss the deadline, the sickness benefit lapses.
Plan for the end early. Talk to your health insurance fund, doctor and advice centre before the sickness benefit runs out.
Step by step
- Ask when sickness benefit endsAsk the health insurance fund for the Aussteuerung date.
- Read the requestRead letters from the health insurance fund setting a deadline immediately.
- Clarify rehabilitation or pension applicationHave someone check which application makes sense now.
- Prepare to register as unemployedClarify in good time whether unemployment benefit under the Nahtlosigkeit rule is possible afterwards.
Deadlines
- After the deadline under § 51 SGB V expires, sickness benefit lapses. If the application is submitted later, the entitlement revives from the date of application.
- A second illness during the first period of incapacity for work does not extend the 78 weeks.
- Periods in which sickness benefit is suspended or refused count towards the 78 weeks. Periods without entitlement do not.
- Only the request to apply for a pension due to full reduction in earning capacity is tied to residence or stay abroad (§ 51 Abs. 1 S. 2 SGB V, deadline 10 weeks; alternative: rehabilitation application). Regardless of place of residence, the health insurance fund can set a deadline of 10 weeks under § 51 Abs. 2 SGB V for an application for the standard old-age pension. A forced rehabilitation application can count as a pension application (§ 116 Abs. 2 SGB VI).
In depth · legal basis, figures and practice – for advisers and professionals
Duration under § 48 SGB V
Insured persons receive sickness benefit without time limit, but in case of incapacity for work due to the same illness for at most 78 weeks within each three years, counted from the day incapacity for work begins. The three-year period runs by calendar from the start of incapacity for work. Under § 48 Abs. 2 SGB V, a new entitlement arises in a new three-year period if, on renewed incapacity for work, the insured persons are insured with entitlement to sickness benefit and in the meantime for at least six months were not incapacitated for work because of this illness and were working or were available to the employment service.
Amount (§ 47 Abs. 1 SGB V)
Sickness benefit is 70 percent of the regular gross earnings achieved (Regelentgelt), at most 90 percent of net earnings.
Request under § 51 SGB V
If earning capacity is significantly at risk or reduced, the health insurance fund can set a deadline of ten weeks to apply for benefits for medical rehabilitation and for participation in working life. If insured persons do not submit the application within the deadline, the entitlement to sickness benefit lapses when the deadline expires. If the application is submitted later, the entitlement revives on the day of application. Only the request to apply for a pension due to full reduction in earning capacity is tied to residence or stay abroad (§ 51 Abs. 1 S. 2 SGB V, deadline 10 weeks; alternative: rehabilitation application). Regardless of place of residence, the health insurance fund can set a deadline of 10 weeks under § 51 Abs. 2 SGB V for an application for the standard old-age pension.
Not checked
Exemption from contributions, individual cases on pension applications, case law on Aussteuerung and reporting duties to the health insurance fund and employer were not checked in a primary source.
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