Daily sickness allowance

Definition of daily sickness allowance: a fixed amount that you receive from your daily sickness allowance insurance in case of incapacity to work because of illness.

The most important facts about daily sickness benefit

  • The daily sickness allowance (Krankentagegeld) secures the income of a working person in the event of incapacity to work due to illness.
  • Daily sickness allowance is usually paid from the 43rd day of illness.
  • The daily sickness allowance is paid until you are able to work again. There is no maximum benefit period in case of illness.
  • The amount of the daily rate is individually selectable, up to the amount of the net income.
  • Civil servants do not need to be insured for the daily sickness allowance. They are covered by their employer "Dienstherren".
  • The daily sickness allowance is tax-free and does not have to be declared in the tax return.

What is the daily sickness allowance?

Whether it is a broken arm or Lyme disease from a tick bite - so many things can cause you to be unable to work. In the event of illness, an employee normally receives regular pay for six weeks. If you are sick longer or are unable to work due to an accident, you may lose your earnings. Now it is no longer the employer's responsibility, but the health insurance.

Definition:

  • In short: The doctor says you are not able to work right now.
  • More precicly: You are considered unfit for work when you are no longer able to work in your job with a medical certificate and you are not doing any other paid work.

Definition:

  • In short: The doctor says you can only work by the hour. f.e. 2 hours per day
  • More precicly: You are considered to be partially incapacitated for work if you have a doctor's certificate stating that you are only able to work to a limited extent in your job as part of a gradual / step by step reintegration process, and that you are not doing any other paid work.

Definition:

  • In short: The doctor says you will probably not be able to work fully for a very long time.
  • More precicly: You are considered to be disabled if the doctor determines that you are more than 50% disabled in your current profession for the foreseeable future.
Header Krankentagegeld B

Do I really need the daily sickness allowance?

  • The statutory health insurance (GKV) includes the daily sickness allowance for 78 weeks. The GKV pays 80% of your net income during this time.
  • A private additional insurance makes sense in the GKV so as to close the 20% gap of your net income.
  • Privately insured persons should in any case take out a daily sickness allowance insurance to continue to cover their monthly expenses from the 43rd day.

The daily sickness allowance insurance covers you in case of inability to work. The occupational disability insurance (BU) only takes effect if you are expected to be at least 50% unable to work forever or for a very long period (at least six months). In case of a broken bone or a longer illness, it is often foreseeable that you will work in your profession again.

It often takes several months before the incapacity is determined and recognized by the BU. This time has to be bridged financially.

Daily sickness allowance necessary as a privately insured person?

As a privately insured person, you have the choice when it comes to daily sickness allowance. However, this should not tempt you to save in the wrong place. Ask yourself honestly: Do I have so many financial reserves that I can bridge several months of loss of earnings in case of doubt? Only if you can say yes with a clear conscience and want to spend the money painlessly, you don't need a daily sickness allowance insurance. In all other cases, it is part of the compulsory program.

Difference between daily sickness allowance and sick pay

  • Sick pay is paid by the statutory health insurance, and daily sickness allowance is paid by a private insurance
  • Sick pay can only be received by those insured by the statutory health insurance. 
  • Privately insured persons do not receive sick pay, and for this reason they absolutely need a daily sickness allowance insurance.

And what is a daily hospital allowance?

  • An additional insurance that can be taken out if a longer stay in a hospital is coming / on the way.

Daily sickness allowance insurance with ottonova

The basic requirement for daily sickness allowance insurance is a full health insurance policy taken out with ottonova. The amount of the daily sickness allowance depends on your income or, in the case of self-employed persons, on your profession and the number of employees. Within this framework, you can determine the amount yourself, but the maximum amount is 300,-€ per day. This amount will only be paid out after the specified waiting period. In most cases the waiting period is 42 days.

We define a waiting period as a period during which no daily sickness allowance is paid despite the inability to work. After that you will receive it daily, even on Sundays and holidays. If you are reintegrated (partially incapacitated for work), you are entitled to daily sickness allowance for a maximum of three months. The daily sickness allowance is tax-free, so it is paid net.

Daily sickness allowance insurance covers incapacity to work in these cases:

  • Illnesses and accidents not caused intentionally
  • Treatments and examinations due to pregnancy

Self-employed women with KTS42 (daily sickness allowance for self-employed persons from the 43rd day of incapacity for work) receive daily sickness allowance regardless of whether they are incapacitated for work during periods of statutory maternity protection.

In these cases you cannot receive a daily sickness allowance:

  • For salaried employees: During the period of legal maternity protection, i.e. 6 weeks before and 8 weeks after the date of delivery (during this period the employer pays the salary)
  • In case of transfer of the habitual residence abroad, unless it is a neighbouring country of Germany

In any case, you need a medical certificate of incapacity to work.

ottonova distinguishes between daily sickness allowance for employees and for self-employed persons (this also includes managing partners and board members of companies).

Daily sickness allowance for employees

Employees can choose between three pay scale levels, which differ in their waiting periods:

  • 42 days (KTA43)
  • 91 days (KTA92)
  • 182 days (KTA183) 

KTA stands for daily sickness allowance for employees - the number determines the waiting period. The KTA43 takes effect after six weeks, i.e. usually from the point at which salaried employees no longer receive continued pay. Contributions become cheaper if you choose a longer waiting period and bear the loss of earnings in the meantime yourself. If your salary increases, you can apply for a corresponding increase in the daily sickness allowance.

Daily sickness benefit for self-employed persons

For self-employed persons there is only one tariff stage with a waiting period of 42 days:

KTS42 (daily sickness allowance for self-employed persons from the 43rd day of incapacity for work).
We have decided to do this because for this group, a loss of earnings exceeding 42 days is often not bearable.

During maternity leave, the waiting period does not apply, you will receive a salary replacement immediately.

Which daily sickness benefit should I choose?

The amount of the daily sickness allowance should be based on your personal needs. Calculate carefully how much money you need each month for fixed costs plus living expenses. At the very least, your basic living should be covered by the daily sickness allowance. The statutory health insurance pays a maximum of about 100 € per day. You should not fall below this value.

A longer waiting period is advisable if you have your own financial reserves, or if you have agreed with your employer to continue to pay your salary for a longer period. This also allows you to reduce your monthly contribution. An additional occupational disability insurance (Berufsunfähigkeitsversicherung) is useful in most cases. In Germany, occupational disability insurance is only available from a life insurer.

Important: If you take out private daily sickness allowance insurance with several providers, they may not be obliged to pay out the full daily sickness allowance.

Everything okay?

It is important to us that you understand exactly what the daily sickness allowance is all about. If you are still unsure, we will be happy to help you. Just write us a message and let us advise you personally.
Is there a maximum limit for the daily sickness allowance?

The daily sickness allowance may not exceed the net income.

Who benefits from a daily sickness allowance insurance?

Employees as well as self-employed persons and freelancers benefit from a daily sickness allowance insurance because in case of illness the loss of earnings is bridged.

When does the daily sickness allowance insurance pay, when not?

The insurance pays:

- after the end of the waiting period (2 weeks as a self-employed person, 7 weeks as an employee in the GKV)

- for the duration of the medically certified inability to work or the statutory maternity leave periods

- all days of the week

The insurance does not pay:

- in case of occupational disability

- for service interruptions

- in case of incapacity to work during a stay at a health resort or sanatorium

- for rehabilitation treatments that are covered by the pension insurance

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