Child sickness benefit Germany: Which regulations should you know?

Eight to ten infections per year are actually normal for young children, because their immune system is still inexperienced. But what happens when you can't work so you can look after your child? Are there children's sick days in private health insurance and do those with private insurance also receive children's sick pay if your child is sick?

How much is the benefit for a sick child?

The entitlement to children's sick pay is regulated in the fifth social security code (SGB V). The statutory health insurance funds pay legally insured persons 90 percent of the net salary from the first day of the child's illness. However, in the case of very good earnings, a cap applies: not more than 116.37 euros per day are covered by the public health insurance. According to SGB V, a maximum of 10 days per child are taken into account per parent and child. A prerequisite for the payment of sick pay is that the children are also legally insured under the family insurance scheme.

Are privately insured persons entitled to children's sick pay?

No, private health insurance does not reimburse so-called "non-insurance benefits". A compensation payment for sick children like in the public health insurance is therefore not possible. However, it is possible for the employer to continue to pay wages for a certain number of days if the child is ill. 

A ruling of the Federal Labor Court states that the employer must continue to pay wages for at least five days per year if the child is younger than 8 years. However, a longer period for such continued payment can of course be specified in the employment contract.

The statutory health insurance (SHI or German GKV) can also only pay it because it receives subsidies from the federal government. So, it is the taxpayers who end up paying for children's sick pay, not the insured themselves. The private health insurers do not receive any corresponding subsidies and therefore do not usually offer the children's sick pay.

But as the saying goes, there is no rule without exception. Occasionally, there are daily sickness allowance tariffs that provide for daily sickness allowance for children as a benefit extension.

How is the child sickness benefit regulated in private health insurance?

The few private health insurances where you can apply for children's sick pay have very individual regulations. Some are based on the statutory health insurance funds.

Some private health insurance companies pay daily sickness allowance for children if:

• the parents are released from work to care for the sick child, but do not receive continued pay from the employer.
• the child is under 12 years old (there is no limit for disabled persons in need of assistance).
• there is no grandmother or other relative living in the household who could take care of the sick child.
• the doctor considers the care necessary and has issued an appropriate certificate.
• the child falls ill outside the vacation period.
  

One parent has statutory insurance, the other private insurance: Who pays when the child is sick?

Whether you are entitled to child sick pay depends on the situation. Let's look at two examples.

Father Florian is carpenter and has statutory insurance, as does their son Leo. Mother Sabine is a self-employed hairdresser, earns around €60,000 and has opted for the benefits of private health insurance. Since the child is covered by statutory insurance, Florian receives children's sick pay from the insurance fund when he cares for him at home.

However, the scenario is often different: If one parent is privately insured and earns more than 69,300 Euro per year, the child often is, too, since non-contributory family co-insurance is not an option. And after all, dad and mom also want the best benefits for their offspring. So, what about children's sick pay - do privately insured persons receive benefits for the care of their sick child?

One parent and child privately insured, the other publicly insured: What happens if the child is sick?

Let's assume father Fritz is a lawyer and has been in private health insurance for 10 years. His wife Stefanie is a salaried clerk and insured in the statutory health insurance. If the two of them have now decided to insure their daughter Paula privately, the statutory health insurance does not pay child sickness benefits.

However, Stefanie may receive support from other sources in this case. Her employer may be able to help her.

Is there continued payment of wages when the child is sick?

If the child is sick, the continued payment of wages usually depends on what has been agreed with the employer. In the case of loss of earnings, it is less important whether you have statutory or private insurance.

Employees

In principle, employed parents who have to care for their sick child at home are entitled to time off. The regulation applies to children under 12 years of age and for a maximum of 10 working days per year. If you have more than one child, it is 25 days. If you stay at home to care for your child during this period, you will continue to receive your salary. You receive continued pay for caring for your child regardless of whether you have statutory or private insurance. After all, your employer is responsible for this.

However, there is a catch: In some employment contracts, this ideal scenario is excluded. Then the contract says something like: "Payment of wages is only made for work actually performed." Sounds nice at first, but it means you won't see a dime from your employer if you take care of your sick child instead of working. Statutorily insured persons receive children's sick pay from the health insurance fund in this case.

By the way, your employer could also arrange the continued payment of wages as they see fit. For example, they could limit it to a certain amount. Whether you are entitled to unpaid leave is also regulated individually. It's best to talk to your employer or check what your contract says.

➜ Discover the ottonova tariffs for employees here.

Self-employed

Since self-employed persons do not have an employer, there is of course no one to pay wages in case of illness. Self-employed persons who have voluntary statutory insurance are entitled to sick pay for their child from the statutory health insurance fund.

➜ Discover the ottonova tariffs for the self-employed here.

Civil servants

Federal civil servants and judges can take a maximum of four days of special leave to care for their child. The same applies to many state civil servants. It is best to check the regulation that applies in your federal state. If in doubt, just ask at the personnel office and find out.

Summary: Who pays if the child has private insurance and is ill?

All the regulations are a bit complicated. So, let's briefly summarize what support you can count on.

Privately insured people get money for the care of their sick child if:

• one parent is employed, and the employer provides continued payment of wages.
• the private health insurance provides daily allowance for children (which is usually not the case).
• one parent is a civil servant and receives state benefits.

Special regulation Corona pandemic (no longer valid): Day-care or school is closed due to a lockdown and the child must be cared for at home (whether sick or healthy is irrelevant here).

A sick child is a challenge for most parents. After all, they may also have to get their job and household in order. This is a good opportunity to practice composure and improve your time management.