Sickness benefit: How long do you optimally protect your income during illness?
22 Apr 2025
5
Minutes
Katrin Straub
CEO at nextsure
A prolonged illness can quickly lead to financial difficulties if income is lost. Find out how long sickness benefits are paid and how you can effectively protect yourself. This article explains the differences between statutory sick pay and private sickness benefits and provides you with specific recommendations for action.
The topic in brief and concise terms
Statutory sick pay is paid for a maximum of 78 weeks within a three-year period for the same illness, with the first six weeks counting as continued salary payment.
Private daily sickness benefit is typically paid indefinitely as long as incapacity for work exists and there is no occupational disability.
The amount of private daily sickness benefit should cover the net income to close financial gaps during prolonged illness.
Statutory Sick Pay: Understanding the 78-Week Limit
Statutory insured individuals receive sickness benefit from their health insurance after six weeks of continued salary payment by the employer. This entitlement exists for the same illness for a maximum of 78 weeks within a period of three years, as stipulated by § 48 SGB V. The six weeks of continued salary payment are counted towards these 78 weeks, so effectively up to 72 weeks of sickness benefit are paid. Note that the sickness benefit amounts to only about seventy percent of the gross income, but a maximum of ninety percent of the net income. A distinction from the daily sickness allowance is important here. This regulation forms the basis, but for many, it is not sufficient to maintain their standard of living.
Private daily sickness allowance: Individual coverage without time limit?
Unlike statutory sickness benefits, private daily sickness allowance insurance usually has no time limitation on the duration of benefits, as long as the inability to work persists. This means that payments can potentially continue beyond the 78 weeks. You can agree on the amount of private daily sickness allowance individually to secure your net income as completely as possible. This is essential especially for self-employed and freelancers, who often experience income loss from the first day of illness. For employees with an income above the contribution assessment ceiling, a sensible daily sickness allowance insurance is often indispensable. The payment starts after an agreed waiting period, for example, after 42 days.
Case study: Calculating income gaps during long-term illness
Imagine an employee with a monthly gross income of 4,000 euros and a net income of 2,500 euros falls ill for an extended period. After six weeks of continued salary payment, they receive sick pay. Seventy percent of 4,000 euros gross is 2,800 euros, ninety percent of 2,500 euros net is 2,250 euros. Therefore, they receive 2,250 euros in sick pay, from which social security contributions are deducted, leaving around 1,950 euros net. This creates a monthly shortfall of 550 euros. Over the maximum period of 72 weeks of sick pay, this shortfall amounts to 9,900 euros. A private daily sickness benefit insurance can cover this gap. An adjustment of the daily sickness benefit for salary changes is important.
Here's how to secure yourself:
Determine your current net income.
Check the amount of statutory sick pay (approx. 70% gross, max. 90% net).
Calculate the difference – this is your insurance need.
Take out a private daily sickness benefit insurance in this amount.
Ensure an appropriate waiting period, usually starting from the 43rd day.
This calculation illustrates how quickly a significant financial burden can arise.
Expert depth: What happens after the cessation of sickness benefit?
When the entitlement to statutory sick pay ends after 78 weeks, this is referred to as being out of benefit. However, the employment relationship does not automatically end. Those affected should contact the employment agency early to check their entitlement to unemployment benefit I. At the same time, an application for a disability pension can be submitted to the pension insurance. Our expert tip: Continue to obtain sick notes even after being out of benefit to avoid gaps in your pension account. A private daily sickness benefit insurance usually continues to pay as long as incapacity for work exists and no occupational disability has been determined. If you experience problems with the payment of daily sickness benefits, you should act immediately. The distinction from occupational disability insurance is crucial here.
Special cases and important clauses regarding sickness benefit
The conditions for the payment of daily sickness allowance can vary depending on the contract. Pay attention to clauses on occupational disability: the payment of daily sickness benefit usually ends when occupational disability occurs. For self-employed individuals, a daily sickness allowance insurance for the self-employed is often possible and sensible with a very short waiting period, e.g., from the eighth or 15th day. Some tariffs also offer a daily sickness allowance insurance without a waiting period. Our expert tip: Check the conditions for partial incapacity for work and gradual reintegration. Not every tariff provides full coverage here. The question of whether private disability pension and sickness benefit simultaneously can be claimed is also relevant.
Important aspects when choosing a tariff:
Amount of the insured daily allowance (should cover net income).
Waiting period (time until the first payment).
Duration of benefits (usually unlimited in private daily sickness benefits for occupational incapacity).
Definition of incapacity for work and occupational disability.
Regulations for partial incapacity for work.
Waiver of the insurer's ordinary right of termination.
Guarantees for additional insurance to adjust the amount.
A careful review of these points ensures you optimal protection.
Design tips for comprehensive coverage
To avoid financial difficulties during a prolonged illness, proactive planning is crucial. Start with a thorough analysis of your income and expenses. Determine the actual amount you would need in case of illness. Choose a daily sickness benefit that covers your net income but does not exceed it, as insurers usually do not pay more than the last net income. Pay attention to the correct waiting period: for employees, this is usually the 43rd day; for self-employed individuals, an earlier time might be sensible. Also, consider the possibility of taking out a daily sickness benefit insurance with specific providers, if you are already insured with them. Regularly reviewing and adjusting your daily sickness benefit insurance, for example, in the event of salary increases or changes in life circumstances, is essential.
Conclusion: Proactive planning secures your income in the long term
The duration of sickness benefits payment heavily depends on whether you are legally or privately insured and what individual agreements you have made. While statutory sickness benefits are limited to 78 weeks, private sickness benefit insurance often offers unlimited protection in case of incapacity for work. A precise analysis of your financial situation and tailored insurance coverage are crucial to avoid income gaps. Do not underestimate the financial risk of a prolonged illness. Take control of your own precautionary measures. We at nextsure are here to help you find the right solution and secure your financial future.
Request an individual risk analysis now: Have your insurance situation checked for free and receive concrete optimization suggestions.
More useful links
Wikipedia provides a comprehensive overview of sickness benefits, an important service of statutory health insurance.
The Federal Ministry of Health provides official information on sickness benefits, explaining the legal foundations.
gesund.bund.de, a German government portal for health information, offers detailed explanations on sickness benefits.
FAQ
How is the duration of sickness benefit calculated?
Statutory sickness benefit has a maximum duration of 78 weeks within a three-year block period for the same illness, including continued payment of wages. Private sickness benefit is paid according to the individual contract terms, often without a time limit in the case of ongoing incapacity for work.
Can I determine the amount of my daily sickness allowance myself?
Yes, with a private daily sickness allowance insurance, you can usually choose the amount of the daily allowance up to the level of your net income. Statutory sick pay is limited to approximately 70 percent of gross income or 90 percent of net income.
What is a waiting period for sickness daily allowance?
The waiting period is the time from the start of incapacity for work during which no sickness benefit is paid. For employees, payment often begins after six weeks (42 days), coinciding with the end of continued salary payment. Self-employed individuals can choose shorter waiting periods.
Does the daily sickness benefit insurance also cover incapacity to work?
No, the sickness benefit insurance provides coverage in case of incapacity to work. If occupational disability occurs, the obligation of the sickness benefit insurer typically ends. In this case, a separate occupational disability insurance is necessary.
Do I have to pay tax on sickness benefit?
Private daily sickness allowance is tax-free. Statutory sick pay is also tax-free, but it is subject to the progression clause, which means it can increase the tax rate applied to other income.
What does regulation of sick pay mean?
Aussteuerung means that the maximum entitlement to statutory sick pay has been reached after 78 weeks, and the health insurance company stops payments. Those affected must then seek alternative benefits such as unemployment benefits or a disability pension.
