Statutory sick pay and sickness benefit: Optimising financial security in the event of incapacity for work
05.05.25
8
Minutes
Katrin Straub
Managing Director at nextsure
A longer illness can quickly lead to financial shortfalls. Many people are not exactly clear on the difference between statutory sick pay and sickness daily allowance. This article explains the details and shows how you can optimise your cover.
The topic in brief and concise terms
Sickness benefit is a benefit provided by statutory health insurance, while daily sickness benefit is a private supplementary benefit for bridging income gaps.
Statutory sickness benefit amounts to approx. 70% of gross income, up to a maximum of 90% of net income, and is limited to 78 weeks.
Private sickness benefit insurance is particularly important for higher earners and self-employed people in order to secure their standard of living.
Sick pay and daily sickness benefits: the key differences at a glance
The fundamental difference between sickness benefit and daily sickness benefit lies in the provider and the type of cover. Sickness benefit is a benefit provided by statutory health insurance (GKV) for its members. It is usually paid after the employer's six-week continued pay period has ended. Daily sickness benefit, on the other hand, is a benefit from private supplementary insurance. Both those insured under statutory schemes and those with private insurance can take out this cover to bridge the gap to their net income. Private cover often offers more flexible options for tailoring. Understanding this basic information is the first step towards optimal provision.
Statutory sickness benefit: understanding entitlement, amount and duration
Employees insured under statutory health insurance are entitled to sickness benefit after six weeks of continued remuneration. Self-employed people in the statutory health insurance scheme (GKV) can also receive sickness benefit under certain conditions, often by choosing an appropriate tariff. The amount of sickness benefit is seventy per cent of gross income, but no more than ninety per cent of net income. There is a contribution assessment ceiling that caps the maximum sickness benefit; in 2025, the maximum sickness benefit is 128.63 euros per day. For the same illness, sickness benefit is paid for a maximum of 78 weeks within three years, with continued remuneration taken into account. Please note the exact basis for calculation to avoid any surprises. A suitable daily sickness benefit insurance can be effective here. The precise rules can be found in Book Five of the Social Code (SGB V). These statutory framework conditions form the basis of your cover.
Private sickness benefit: closing individual insurance gaps
Private daily sickness benefit is designed to close the financial gap between statutory sickness benefit and your actual net income. This cover is particularly relevant for higher earners whose income exceeds the contribution assessment ceiling, as statutory sickness benefit often does not suffice in such cases. Self-employed people and freelancers, who have no entitlement to statutory sickness benefit or only a limited one, also use this to protect themselves against existential financial risk. The amount of the insured daily sickness benefit and the point at which payments begin (e.g. from the 43rd day of illness) can be agreed individually. It is important that the daily sickness benefit, together with statutory sickness benefit, does not exceed your previous net income (no overcompensation rule). The cover for self-employed people requires particular attention. The following points should be considered when choosing daily sickness benefit:
Amount of the daily rate: based on net income.
Benefit start date: usually after the end of continued pay.
Waiting periods: some tariffs have initial waiting periods.
Scope of cover: check insurance cover abroad.
Flexibility: option to adjust in the event of salary increases.
Health assessment: honest declarations are essential.
Careful selection of the tariff is crucial for optimal protection.
Example calculations: This is how the difference affects you financially
An employee with a gross monthly salary of EUR 4,000 and a net salary of EUR 2,500 receives statutory sickness benefit after six weeks of illness. This amounts to seventy per cent of EUR 4,000, i.e. EUR 2,800 gross, but no more than ninety per cent of EUR 2,500, i.e. EUR 2,250 net. Social security contributions are then deducted from this, so the actual payout is lower, for example around EUR 1,950. This creates a monthly shortfall of around EUR 550. A self-employed person without entitlement to statutory sickness benefit would have no income at all from the seventh week onwards without private cover. These examples illustrate the need for additional cover. The adjustment of daily sickness benefit when income changes is an important aspect. The specific calculation can be complex, so a careful review is worthwhile. These figures show how important individual planning is.
Expert tips: What you should look out for when choosing your cover
When deciding whether or not to take out private sickness allowance insurance, you should carefully analyse your personal circumstances. Take your monthly fixed costs and your income into account. Our expert tip: Check the terms of your sickness daily allowance tariff carefully, especially with regard to health questions and possible exclusions. Make sure the daily allowance is sufficiently high so that you can maintain your standard of living. For those with statutory insurance, it is important to know how long sickness daily allowance is paid. The following aspects are particularly relevant:
Net income protection: the sickness daily allowance should close the gap to net income.
Waiting period: choose the benefit start date to match the duration of your continued salary payments.
Contribution stability: find out how premiums develop in later life.
Waiver of the ordinary right to terminate: the insurer should not be able to cancel without good reason.
Guaranteed option to increase cover: the possibility of increasing it without a new medical assessment in certain circumstances.
Expert advice can help you avoid pitfalls and find the best cover. This way, you secure your financial position in the long term.
Keeping an eye on legal fundamentals and current developments
The statutory provisions on sickness benefit can be found primarily in Book Five of the Social Code (SGB V), in particular Sections 44 to 51. These set out the requirements, amount, duration and calculation of sickness benefit. For private daily sickness allowance, the insurer’s respective policy conditions and the Insurance Contract Act (VVG) apply. Our expert tip: Keep up to date with current court rulings, for example on the question of when occupational disability exists and payment of daily sickness allowance can be stopped. Sometimes situations arise in which the private health insurer does not pay the daily sickness allowance. It is important to understand the differences between daily sickness allowance and occupational disability. The legal situation can change, so it is advisable to stay up to date. This ensures that your insurance cover is always up to date.
The difference between Krankengeld and Krankentagegeld is significant and has a direct impact on your financial security in the event of illness. While statutory Krankengeld provides basic cover for those insured under GKV, often at around seventy percent of gross salary, private Krankentagegeld closes the remaining income gap. A careful analysis of your personal situation and tailored cover are essential. Take the opportunity to shape your financial future proactively. With the right knowledge, you can make informed decisions. Request your personal risk analysis now: have your insurance situation checked free of charge and receive concrete suggestions for optimisation.
More useful links
The Federal Ministry of Health provides comprehensive information on sickness benefit.
The EU Equal Treatment Office explains sickness benefit in connection with working conditions in Germany.
The Health Knowledge Foundation provides information on how you can apply for sickness benefit.
The VdK sets out the most important rules on sickness benefit.
The Federal Administration provides information on benefits in the area of sickness benefit.
The AOK provides information on benefits in the event of incapacity for work and sickness benefit.
FAQ
Who pays sickness benefit and who pays daily sickness allowance?
Sickness benefit is paid by statutory health insurance (GKV). Sickness daily allowance is a benefit of private health insurance or private supplementary insurance.
How much is the sickness benefit?
Sickness benefit amounts to 70 per cent of regular gross earnings, but no more than 90 per cent of net earnings. There is a statutory upper limit.
Is sickness daily allowance important for self-employed people?
Yes, for self-employed people, sickness daily allowance insurance is often essential, as they generally have no entitlement to continued pay or statutory sickness benefit, or it is not sufficient.
Can I receive sickness benefit and daily sickness allowance at the same time?
Yes, the sickness allowance is intended to bridge the gap between statutory sick pay and your net income. However, the two benefits together must not exceed your previous net income.
From when is sickness daily allowance paid?
The start of benefits for sickness daily allowance can be agreed individually, usually after the expiry of the statutory continued payment of wages for six weeks, i.e. from the 43rd day of incapacity for work.
Is sickness benefit taxable?
Sickness benefit is tax-free, but it is subject to the progression clause. This means it is taken into account when determining your tax rate and can increase it.
