Hallesche sickness benefits: Optimize income protection in case of incapacity for work
22 Jun 2025
4
Minutes
Katrin Straub
CEO at nextsure
A prolonged illness can threaten your financial livelihood if your income suddenly stops. The Hallesche daily sickness benefit provides important protection in this situation. Find out how you can maintain your standard of living even in the event of illness.
The topic in brief and concise terms
Hallesche daily sickness allowance covers the income gap that occurs after six weeks of continued salary payment due to the lower statutory sick pay.
Hallesche offers plans with simplified health questions and a fair moratorium clause that can also cover known pre-existing conditions after two years.
For self-employed individuals, daily sickness allowance is essential, as they often do not have an automatic entitlement to statutory sick pay; Hallesche offers special tariffs for this, starting from the 22nd day.
Laying the foundation: Understanding the necessity of sickness benefit
Many employees underestimate the financial gap after the six-week period of continued salary payments ends. Statutory sick pay often covers only about seventy percent of the gross income. For self-employed individuals, this basic coverage often doesn't apply at all, making private insurance indispensable. Hallesche's daily sickness allowance aims to bridge this gap and secure ongoing costs such as rent or loans. A thorough review of one's personal insurance situation is the first step.
The amount of the daily sickness allowance should not exceed the average net income of the past twelve months. With Hallesche, for example, a daily rate of up to 30 euros can be insured, which corresponds to 900 euros per month. This helps to close the gap with the statutory insurance's sick pay, which in 2025 will be a maximum of around 129 euros per day. The correct adjustment of the daily sickness allowance is crucial.
Hallesche offers specific rates for different professional groups. These include the KT rate for employees and self-employed individuals, FKT for freelancers, MKT for doctors and dentists, and KTAR for managing directors of limited liability companies. The start of benefit payments varies, for employees it is often the 43rd day, for the self-employed it can start earlier, such as from the 22nd day. This flexibility allows for individualised coverage.
Check conditions: Mastering the start of benefits and health questions with Hallesche
Hallesche offers simplified health questions for its daily sickness allowance, such as the product Krankengeld.plus. Primarily, besides height and weight, it asks if there has been a continuous inability to work for more than 21 days in the last two years. This makes access easier for many applicants. A BMI between 17 and 30 is a prerequisite for acceptance through the simplified process.
A so-called moratorium clause is also part of the conditions. This states that no benefits will be paid for inability to work within the first two years of the insurance start if there is a causal connection with an illness that was treated within the last two years before the application and led to inability to work. However, after these two years, full insurance coverage is provided for these original diagnoses, as long as no new inability to work arises due to them. It is important to understand the difference between sick pay and daily sickness allowance.
The general waiting times are usually three months but are waived in cases of accidents. For psychotherapy and dental treatments, special waiting times of eight months may apply. An advantage is Hallesche's waiver of the ordinary right of termination, which gives you additional security. The question of how long daily sickness allowance is paid is also contractually regulated.
Target audience in focus: Finding tailored solutions for employees and the self-employed
For employees in statutory health insurance (GKV), Hallesche's daily sickness allowance is an important supplement. It fills the gap that arises after the six weeks of continued salary payment due to the lower sickness benefits from GKV. The Krankengeld.plus tariff from Hallesche is specifically designed for GKV-insured employees and offers a daily rate of up to 30 euros. A key benefit is the coverage for a child's illness, provided the GKV also pays for it.
Self-employed individuals and freelancers often do not have a statutory entitlement to sickness benefits or must actively choose this and pay higher contributions. For them, private daily sickness allowance insurance is essential. Hallesche offers special tariffs like KT or FKT, with benefits starting often as early as the 22nd day. The amount of insurable daily allowance is based on the pre-tax profit of the last twelve months. For the self-employed, daily sickness allowance is a necessity.
Hallesche allows for an adjustment of daily sickness allowance without a renewed health examination within two months in case of income increases. This is particularly relevant for employees. The tariffs are designed so that unexpected premium jumps in old age due to step models are not to be feared, as they are calculated with age reserves. This ensures better cost planning over many years.
Optimising the scope of services: Consider important details and exclusions
The daily sickness allowance from Hallesche is also paid on Sundays and public holidays, as soon and as long as there is entitlement to sickness benefits from the health insurance or injury benefits. An important aspect is that the payout of the daily sickness allowance is tax-free. Hallesche provides benefits for partial incapacity to work within the framework of reintegration for up to eight weeks, if certain conditions are met. This applies to employees with full insurance coverage from Hallesche.
The alcohol clause is not applied by Hallesche, so work incapacity due to alcohol is generally covered. Benefits can be provided for inpatient withdrawal measures if the insurer has approved them in advance. Please note that in the case of cures and rehabilitation measures, the daily sickness allowance is often only paid after a prior work incapacity lasting at least four weeks. If the private health insurance does not pay the daily sickness allowance, prompt action is required.
No ordinary termination rights by Hallesche.
Contract can be cancelled monthly without a minimum term.
Benefits also provided when caring for a sick child under the tariff Krankengeld.plus.
Adjustment without health check when income increases (within two months, for employees).
Worldwide insurance coverage is provided in case of temporary stay in Europe for acute illnesses requiring inpatient treatment.
Premiums are calculated with age reserves, which prevents large increases in premiums as you age.
Insurance coverage typically ends with the commencement of pension benefits, and at the latest upon reaching the age of 65, although there may be options to extend until the age of 70. A combination with a disability insurance is often advisable.
Leverage expert knowledge: Understand legal framework conditions and current judgments
The Insurance Contracts Act (VVG) forms the legal basis for daily sickness benefits. An important principle is the prohibition of enrichment according to § 200 VVG, which states that insurance benefits must not exceed the previous net income. Nevertheless, the daily rate once agreed upon is generally binding. For freelancers, § 18 paragraph 1 number 1 Income Tax Act (EStG) is relevant when it comes to defining insurable professional groups in the FKT tariff.
Current judgments, such as that of the Federal Court of Justice (BGH) on 12 March 2025 (Case No.: IV ZR 32/24), strengthen the rights of the insured. The BGH decided that insurers may not retroactively reduce daily sickness benefits without express agreement, even if income has decreased. Clauses that allow unilateral reductions have often been classified as non-transparent and ineffective.
Our expert tip: Check your insurance terms carefully, especially when changes are made to the contract. If your daily sickness benefit has been unjustly reduced in the past, there may be claims for redress (note prescription periods!). A daily sickness benefit insurance without waiting periods is rare, but conditions vary.
Hallesche waives the ordinary right of termination. This is an important point because some insurers could cancel after a claim. The tariffs of Hallesche, such as Krankengeld.plus, are also often cancellable monthly, which gives you flexibility. These customer-friendly regulations offer additional security and planning reliability for your financial future.
Recommended Actions: Your path to optimal health insurance coverage with Hallesche's daily sickness benefit
Carefully analyze your individual needs. Calculate the difference between your net income and the expected statutory sick pay. Take into account all ongoing expenses. For self-employed individuals, securing the lost profit is crucial. A daily rate of 30 euros can already be an important support.
Compare the various tariffs of Hallesche (KT, FKT, MKT, KTAR, Krankengeld.plus) regarding the start of benefits, the amount of the daily allowance, and specific conditions for your professional group. Pay attention to the health questions and the significance of the moratorium clause. An honest answer to the health questions is essential for the later entitlement to benefits.
Consider the possibility of a simplified health check, as is offered, for example, with the Krankengeld.plus tariff. This can significantly ease the process of agreement if you meet the prerequisites (e.g. no incapacity for work for more than 21 days in the past two years). Use the option to adjust the daily sickness allowance according to salary increases to ensure you are always optimally covered.
Seek advice from an independent source to find the solution that's right for you. We at nextsure are happy to help you analyze your individual situation and design the optimal protection through a daily sickness allowance from Hallesche or another provider. Comprehensive advice can help you avoid pitfalls and achieve long-term financial security. Remember, that good protection keeps you free to fully concentrate on your recovery in case of an emergency.
More useful links
Wikipedia provides basic information on sickness benefits.
The Federal Statistical Office offers official data on sickness absence in Germany.
Statista delivers statistics on the number of sick days, broken down by diagnosis.
The Techniker Krankenkasse (TK) offers its health report on sickness absence for the year 2023.
The German Economic Institute (IW) analyses the sickness absence rates in Germany in a detailed article.
Statista presents statistics on the main causes of sickness absence.
The BKK Dachverband publishes monthly statistics on sickness absence rates.
The Federal Institute for Occupational Safety and Health (BAuA) provides information on the costs of sickness absence.
Wikipedia explains health benefits in Germany.
Wikipedia offers details on continued pay in the event of illness.
FAQ
What amount should I insure my daily sickness allowance with Hallesche for?
The sickness benefit should bridge the gap between your net income and statutory sickness allowance. It should not exceed your average net income over the past twelve months. An accurate calculation of your fixed costs and income is recommended.
What are the waiting times for Hallesche daily sickness benefits?
The general waiting times are usually three months, but they do not apply in the case of accidents. Special waiting times of eight months may apply for certain treatments such as psychotherapy.
What is the moratorium clause in the Hallesche's daily sickness allowance?
The moratorium clause stipulates that no benefits will be paid for incapacity to work due to pre-existing conditions treated in the two years before the contract commenced and which led to incapacity to work, within the first two years of the contract. After that, full coverage is provided.
Can I adjust the daily sickness allowance from Hallesche in the event of a salary increase?
Yes, in the event of salary increases, you can usually adjust the daily sickness benefit with Hallesche within two months without a new health assessment, especially as an employee.
Does Hallesche provide sick pay abroad?
Yes, during a temporary stay in European countries, daily sickness benefits are paid for the duration of medically necessary inpatient treatment in a public hospital in the event of acute illnesses or accidents.
What happens to the Hallesche daily sickness allowance when receiving a retirement pension?
Sickness benefit generally ends with the receipt of an old-age pension, or at the latest upon reaching the age of 65. There may be options to extend it until the age of 70.
