Daily sickness benefit: How long can you optimally protect your income in the event of illness?
22.04.25
7
Minutes
Katrin Straub
Managing Director at nextsure
A long-term illness can quickly lead to financial shortfalls if your income stops. Find out how long sickness benefit is paid and how you can protect yourself effectively. This article explains the differences between statutory sick pay and private sickness benefit and gives you concrete recommendations for action.
The topic in brief and concise terms
Statutory sick pay is paid for a maximum of 78 weeks within three years for the same illness, with the first six weeks of continued pay being counted towards this.
Private sickness daily allowance is generally paid for an unlimited period, as long as incapacity for work continues and there is no occupational disability.
The amount of private sickness benefit should cover net income to close financial gaps during prolonged illness.
Statutory sickness benefit: understanding the 78-week limit
People insured under the statutory health insurance scheme receive sickness benefit from their health insurer after six weeks of continued salary payments by their employer. Under Section 48 of Book V of the German Social Code (SGB V), this entitlement applies for the same illness for a maximum of 78 weeks within a three-year period. The six-week continued salary payment is counted towards these 78 weeks, meaning that sickness benefit is effectively paid for up to 72 weeks. Please note that sickness benefit amounts to only around seventy per cent of gross income, but no more than ninety per cent of net income. A distinction from sick pay allowance is important here. This rule forms the basis, but for many people it is not sufficient to maintain their standard of living.
Private sickness benefit: individual cover without a time limit?
In contrast to statutory sick pay, private daily sickness benefits insurance generally has no time limit on the benefit period, as long as incapacity for work continues. This means payments can potentially continue beyond the 78 weeks. The amount of private daily sickness benefit can be agreed individually, so that your net income is protected as fully as possible. This is particularly essential for self-employed people and freelancers, who often suffer a loss of income from the first day of illness. For employees with an income above the contribution assessment ceiling, an appropriate daily sickness benefits insurance is often indispensable. Payment begins after an agreed waiting period, for example after 42 days.
Case study: Calculating the income gap in the event of long-term illness
Imagine an employee with a gross monthly income of €4,000 and a net income of €2,500 falling ill for a longer period. After six weeks of continued salary payment, they receive sickness benefit. Seventy per cent of €4,000 gross is €2,800, ninety per cent of €2,500 net is €2,250. So they receive €2,250 in sickness benefit, from which social security contributions are still deducted, leaving around €1,950 net. This creates a monthly shortfall of €550. Over the maximum benefit period of 72 weeks of sickness benefit, this shortfall adds up to €9,900. Private daily sickness benefit insurance can offset this difference. Adjusting the daily sickness benefit when your salary changes is important.
This is how you protect yourself:
Determine your current net income.
Check the amount of statutory sickness benefit (approx. 70% of gross, max. 90% of net).
Calculate the difference – this is the level of cover you need.
Take out private daily sickness benefit insurance at this level.
Make sure the waiting period is suitable, usually from the 43rd day.
This calculation shows how quickly a significant financial burden can arise.
Expert insight: What happens after sickness benefit ends?
When entitlement to statutory sickness benefit ends after 78 weeks, this is known as benefit exhaustion. This does not automatically end the employment relationship. Those affected should contact the Employment Agency at an early stage to check their entitlement to unemployment benefit I. At the same time, an application for a reduced earning capacity pension can be submitted to the pension insurance provider. Our expert tip: Even after benefit exhaustion, continue to obtain medical certificates of incapacity for work to avoid gaps in your pension record. A private daily sickness benefit insurance policy usually continues to pay as long as incapacity for work exists and no occupational disability has been established. If there are problems with the payment of sickness daily allowance, you should act immediately. The distinction from occupational disability insurance is crucial here.
Special cases and important clauses in daily sickness benefit
The conditions for payment of daily sickness benefit can vary depending on the contract. Pay attention to clauses relating to occupational disability: the benefit of daily sickness benefit usually ends when occupational disability occurs. For the self-employed, a daily sickness benefit insurance policy for self-employed people is often possible and worthwhile even with a very short waiting period, e.g. from the eighth or 15th day. Some tariffs also offer daily sickness benefit insurance without a waiting period. Our expert tip: Check the conditions for partial incapacity for work and gradual return to work. Not every tariff provides full cover here. It is also relevant whether a private occupational disability pension and sick pay can be received at the same time.
Important aspects when choosing a tariff:
Amount of the insured daily benefit (should cover net income).
Waiting period (time until the first payment).
Benefit period (for private KTG usually unlimited in the event of incapacity for work).
Definition of incapacity for work and occupational disability.
Provisions for partial incapacity for work.
Waiver of the insurer's ordinary right to terminate.
Guaranteed insurability options to adjust the amount.
A careful review of these points ensures you optimal protection.
Design tips for comprehensive protection
To avoid financial difficulties during a long illness, forward planning is crucial. Start with a detailed analysis of your income and expenditure. Determine the level of cover you actually need in the event of illness. Choose a daily sickness benefit amount that covers your net income, but does not exceed it, as insurers usually pay no more than your last net income. Pay attention to the correct waiting period: for employees, this is usually the 43rd day; for the self-employed, an earlier point may make sense. Also find out about the option of taking out daily sickness benefit insurance with specific providers if you are already insured with them. Regular review and adjustment of your daily sickness benefit insurance, for example following pay rises or changes in personal circumstances, is essential.
The duration of sick pay benefits depends greatly on whether you are statutorily or privately insured and on the individual arrangements you have made. While statutory sickness benefit is limited to 78 weeks, private daily sickness benefit insurance often offers unlimited cover in the event of incapacity for work. A precise analysis of your financial situation and tailored cover are essential to avoid income gaps. Do not underestimate the financial risk of a prolonged illness. Take charge of your provision yourself. We at nextsure support you in finding the solution that is right for you and securing your financial future.
Request an individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific suggestions for improvement.
More useful links
Wikipedia offers a comprehensive overview of daily sickness allowance, an important benefit of statutory health insurance.
The Federal Ministry of Health provides official information on sick pay, explaining the legal basis.
gesund.bund.de, a German government portal for health information, offers detailed explanations of sick pay.
FAQ
How is the duration of daily sickness benefit calculated?
Statutory sickness benefit is paid for a maximum of 78 weeks within a three-year qualifying period for the same illness, including continued payment of salary. Private daily sickness benefit is paid in accordance with the individual policy conditions, often without a time limit if incapacity for work continues.
Can I choose the amount of my daily sickness benefit myself?
Yes, with private daily sickness benefit insurance, you can usually choose the amount of daily benefit freely up to the level of your net income. Statutory sick pay is limited to around 70 per cent of gross income or 90 per cent of net income.
What is a waiting period for sickness daily allowance?
The waiting period is the period from the start of incapacity for work during which no daily sickness benefit is paid. For employees, payment often begins after six weeks (42 days), matching the end of continued pay. Self-employed people can choose shorter waiting periods.
Does sickness daily allowance insurance also pay out in the event of occupational disability?
No, sickness daily allowance insurance pays benefits in the event of incapacity for work. If occupational disability occurs, the insurer’s obligation to pay under the sickness daily allowance insurance usually ends. In this case, separate occupational disability insurance is necessary.
Do I have to pay tax on sickness benefit?
Private sickness daily allowance is tax-free. Statutory sick pay is also tax-free, but it is subject to the progression proviso, so it can increase the tax rate for other income.
What does ‘Aussteuerung’ mean when it comes to sickness benefit?
Exhaustion means that the maximum entitlement to statutory sickness benefit has been reached after 78 weeks and the health insurance fund stops the payments. Those affected must then seek alternative benefits such as unemployment benefit or a reduced earning capacity pension.
