Learn about sick pay in Germany. Receive up to 90% of your net salary for 72 weeks if you’re on sick leave due to the same medical condition. Find out how the self-employed can insure sick pay voluntarily.

Key Takeaways

• Your statutory health insurance pays sickness benefits if you’re on sick leave for more than six weeks due to the same medical condition. Before that, you will receive a full salary from your employer.
• You will receive a maximum of 90 percent of your net salary as sick pay – as an employee for a maximum of 72 weeks.
• The self-employed can voluntarily insure sick pay.
• In German culture, employers and doctors recommend staying at home until recovered.

How can you apply for sickness benefits in Germany?

• Send the sick note immediately to your insurance company and your employer.
• You should file an objection if your health insurance refuses to pay you for the time you were sick.

Table of content

After a severe injury like a broken arm or a car accident, work is the last thing you think about. But still, you need money to put food on the table.

Lucky you, you are in Germany.

In Germany, as an employee, you don’t have to worry about your finances during your recovery time.

Your employer continues to pay you a full salary for the first six weeks. After that, the health insurance company steps in with the sick pay.

Germans prefer to stay at home when they are sick. They believe it’s better to recover 100% than drag the sickness for long.

Also, when you are sick, you cannot work efficiently and risk infecting your colleagues. Thus, stay home until recovered.

Who is entitled to sick pay?

To get sickness benefits in Germany, you must fulfill two conditions.

• You are a member of the German statutory health insurance (Gesetzlichen Kran­ken­ver­si­che­rung (GKV))
• You have acquired a right to sick pay.

If you meet the above conditions, you will get sick pay by your health insurance under the following situations (§ 5 Para. 1 No. 1 SGB V).

• You do not receive a salary from your employer and are getting treatment as an inpatient in a hospital or rehabilitation facility.
• You are unable to work for more than six weeks due to the same illness, and your employer no longer pays ( § 3 Continued Pay Act ).
• You started a new job and got sick in the first four weeks. In this situation, your employer does not have to pay your salary. Instead, the health insurance company pays you sick pay.
• You receive unemployment benefit 1 (Ar­beits­lo­sen­geld 1) and are ill for more than six weeks. The Employment Agency (Agentur für Arbeit) continues to pay unemployment benefits for the first six weeks. After that, the health insurance company takes over to pay sickness benefits.

You must get a certificate of incapacity for work (Ar­beits­un­fä­hig­keits­be­schei­ni­gung) from a doctor within a week. Otherwise, the health insurance company will not pay the sick pay.

And worst, you may lose your entitlement to sick pay (Section 49 (1) No. 5 SGB V).

Not everyone receives paid sick leave in Germany.

The following people are not entitled to sickness benefits in Germany.

• Spouses and children who are co-insured in the statutory family health insurance.
• Interns
• Students
• Recipients of unemployment benefit II (Ar­beits­lo­sen­geld II). If you draw unemployment benefit II (aka Hartz IV), you will continue to receive basic security during your sick days.

In certain cases, the health insurance company can suspend your entitlement to sick pay. The pause is for a certain period only.

For example, you won’t receive sick pay during parental leave. Instead, you will get parental benefits.

Self-employed persons in statutory health insurance have to take care of themselves.

Self-employed people are responsible for taking adequate insurance policy that covers them during illness.

As a self-employed person in Germany, you have four options:

1. Option 1: You pay a reduced contribution of 14 percent to the statutory health insurance (Gesetzlichen Kran­ken­ver­si­che­rung (GKV)). On top of it, you contribute a Zusatzbeitrag, which is roughly 1.3 percent. This additional amount depends on your income and health insurance company. In this case, you do not receive any paid sick leave.
2. Option 2: You pay the standard contribution rate, i.e., 14.6 percent of gross income plus the Zusatzbeitrag. In this case, you’ll get sickness benefits after 6 weeks of illness.
3. Option 3: You took an optional sickness benefit tariff. You can take this as an add-on to your existing health insurance. Under this tariff, you receive sickness benefits immediately without waiting for six weeks. Your health insurance tariff decides when and how much sick pay you will receive.
4. Option 4: You take out private daily sickness benefits insurance (Kran­ken­ta­ge­geld­ver­si­che­rung). Private health insurances offer more services as compared to public health insurance in Germany. However, you must check this carefully before opting for private health insurance. The reason is once you enroll in private health insurance, returning to public health insurance is tough.

What should you consider when writing sick notice?

The entitlement to paid sick leave begins when your doctor determines that you cannot work ( Section 46 sentence 1 no. 2 SGB V ).

Normally, doctors in Germany do not issue sick notes (Arbeitsunfähigkeitsbescheinigung) for long periods.

Thus, your doctor must issue a new sick note from the day your last sick note ended to maintain your entitlement to sick pay.

For example, your sick leave ends on Tuesday. Then, you have to see the doctor by Wednesday.

Otherwise, there will be a gap in the period you were ill. And it may lead the health insurance company to stop your sick pay.

However, since 2016, the doctor’s note for sick leaves don’t have to overlap. As a result, fewer people lose their entitlement to paid sick leave due to formal errors.

The gap in sick leave

As a rule, your doctor cannot give you a backdated sick leave certificate.

However, there may be exceptions.

For example, you contacted your doctor well in time and booked an appointment. But the doctor postponed the meeting.

Then, the doctor can write you a sick leave certificate for up to three days in the past. With this backdated medical certificate, you won’t lose your entitlement to sick pay (as per the judgment on March 26, 2020, Az. B 3 KR 10/19 R ).

The German government also introduced a special regulation by the Appointment Service and Care Act.

Under this act, you have one month to get a new sick note after the last sick leave ends. And during this time, you will continue to receive the sickness benefits.

Don’t know when you’ll be able to work?

There is a field on the medical certificate in which the doctor must enter how long you will be unable to work. The doctor usually issues the sick leave certificate for no more than two weeks.

But if the end of the disease is not yet foreseeable, some doctors leave this field empty. And others write “until further notice (bis auf Weiteres).“

The best part is that the health insurance companies must continue paying the sickness benefits.

What do you have to do to get sick pay?

You do not have to submit a separate application to receive sick pay.

Here is what the process looks like:

1. The employer sends proof of earnings to your health insurance company

Your health insurance company will request an “earnings certificate”(Verdienstbescheinigung) from your employer at the end of six weeks.

It uses the earnings certificate to calculate your sick pay.

Under German law, the employer must send all the required information to your health insurer to calculate your sick pay.

2. Get a sick note from your doctor

Since 2016 there is a single document, sick note (Ar­beits­un­fä­hig­keits­be­schei­ni­gung), that you can use for both sick leave and sick pay.

The doctor certifies your incapacity to work on the document. Then, you submit this document to your employer to take sick leaves until you are fit and have sick pay for six weeks.

You submit the same document to your health insurance company. And after six weeks, you become eligible to get the sickness benefits.

3. Who submits the incapacity for work certificate?

The short answer is you are responsible for making sure that your insurer gets the certificate on time.

But, since October 2021, your doctor should send the certificate of incapacity to work to your statutory health insurance company electronically.

However, many medical practices do not have the necessary technology. Thus, they continue to give the certificate in paper form.

If your doctor cannot submit the certificate to your health insurance, you must send it yourself.

You can submit the certificate online, via mobile app, or by registered mail. However, I prefer submitting the incapacity to work certificate digitally, as it is fast and hassle-free.

4. Verification and payment of sickness benefits

You will receive sick pay as soon as your health insurance company receives and processes the “incapacity for work” certificate.

The insurance company pays the sickness benefit in retrospect to the first day of your incapacity to work. The doctor mentions your first day of illness in the sick note.

5. Send a sick note to your employer

Send a sick note to your employer as soon as you get one. It is required by the employer to pay you a full salary for the first six weeks.

You should continue informing your employer after six weeks about your illness.

Even if the employer no longer pays the salary, they need to know if and when you can work again.

If you are unemployed and receive unemployment benefits I (ALG I), you must inform the employment agency.

How much is the sick pay in Germany?

German law regulates sickness benefits. According to the law, sick pay is 70 percent of gross earnings but no more than 90 percent of net earnings (Section 47 SGB V ). So, the lower of these two values is the gross sick pay.

The health insurance company deducts social security from the gross sick pay and pays the rest.

Tip: Here is a sick pay calculator by T.K. You can use it to calculate the net sick pay you will receive.

Example of sick pay calculation

Item	Amount (Monthly)
Gross Salary	3000 €
Net Salary (Income tax class III, 1 Child)	1977 €
70% of the gross salary	2100 €
90% of the net salary	1779 €
Gross sick pay	1779 €
Social Security	​
Pension Insurance (9,3 %) (Ren­ten­ver­si­che­rung)	165 €
Unemployment Insurance (1,20 %) (Arbeitslosenversicherung)	21 €
Long-term Care Insurance (1,525 %) (Pfle­ge­ver­si­che­rung)	27 €
Net sick pay	1557 €

Source: Finanztip

The insurance company also considers one-time payments like Christmas (Weinachtsgeld) or Holidays (Uralubsgeld) allowance while calculating the sick pay (Section 47 (2) sentence 6 SGB V).

These one-time payments increase the amount of sick pay you will get.

Sick pay for high earners

The law limits the amount of sick pay to 70 percent of the contribution assessment ceiling (Beitragsbemessungsgrenze). As a result, you can get a maximum of 120.75 € gross sick pay per day in 2024 or 3622.5 € per month.

Net sick pay is not enough to cover your expenses.

You may need more than the sick pay if you are a high earner and have high monthly expenses. In this situation, you can take private sick pay insurance (Krankengeldversicherung) to cover the difference.

Another option is to ask your employer.

Some employers in Germany supplement sick pay to cover the difference in your net salary and net sick pay.

How long is the paid sick leave period?

You can avail sickness benefits for 78 weeks within three years per illness (§ 48 SGB V).

You don’t have to be on continuous sick leave; the health insurance company adds the periods you were ill.

However, the waiting period of six weeks occurs only once in these three years. And as you already know, you receive wages from your employer during this time.

Here are some rules that apply when you are on paid sick leave

• You will receive sick pay immediately if you get additional sick leave due to the same illness.
• The same rule applies if you are self-employed and are entitled to sick pay. However, some health insurance companies do not follow this rule. So, discuss it with your health insurance partner before signing the contract.
• The health insurance company will not extend the sickness benefit period if you catch another illness during your sick leave. The benefit period will remain the same, i.e., 78 weeks ( § 48 Para. 1 Sentence 2 SGB V ).
• 78 weeks of sickness benefit period includes the sick leave paid by your employer. That means the first six weeks; your employer pays you the wages. And the health insurance company covers the rest of the period, i.e., 72 weeks (§ 49 Para . 1 No. 1 SGB V, § 146 Para . 1 Clause 1 SGB III ).
• You don’t get sick pay during parental leave, as you get parental allowance during that period.

What happens if you catch the same sickness after three years?

After three years, everything starts anew.

So, if you catch the same illness in a new three-year period, your sickness benefits start over again.

But, you must fulfill the following conditions to receive sickness benefits.

• You must be in the statutory health insurance scheme.
• You must either be employed or be looking for a job.
• No doctor gave you sick leave for the same disease for at least six months.

Is sick pay tax-free?

The answer to this question is yes and no.

Yes, you don’t pay taxes on sick pay when you receive it. However, it is subject to the progression proviso.

As a result, the tax office adds the sickness benefit to the total taxable income of that year.

So, you don’t pay tax when you receive sick pay. But, you may end up paying tax when you file the tax return for that year.

This way tax office ensures fair tax calculation for people who received sick pay and those who didn’t.

Hence, people who received sickness benefits may not have a lower tax rate than people who didn’t.

Resolving trouble with your health insurance company?

It is your right to receive paid sick leave. But your health insurance company can get in the way.

So, it’s essential to know how you can defend yourself against common problems:

Unsolicited calls from health insurance

Patient advice centers (Beratungsstelle) report that many insured people feel pressured by their health insurance company on the phone.

Sometimes, health insurance companies advise their customers to quit their jobs and apply for unemployment benefits.

One of the motivations behind this suggestion is health insurers don’t have to pay sickness benefits if you register yourself as unemployed.

But you should never respond to such suggestions.

In principle, the health insurance company can call you for individual advice on sick pay. But only if they have your written consent.

And you can revoke your consent at any time ( § 44 Para. 4 SGB V ).

If you feel harassed by your health insurance company, feel free to tell them that you do not want telephone advice.

Also, mention that you are happy to answer any necessary questions in writing only.

Please note that you have certain obligations to cooperate ( § 60 to 67 SGB I ) with the health insurer. So you cannot refuse to provide information.

However, you can provide the required information in writing instead of on the telephone.

Get your health checked by “Medizinischen Dienst.”

“Medizinischen Dienst” checks your incapacity to work, not the health insurance company.

So, your health insurance company can request “Medizinischen Dienst” to check your incapacity to work. However, in this check, your insurer can ask only these two questions (in writing):

1. Is it possible to know by when you can work again? If yes, what is the tentative date?
2. Are there any treatments planned that prevent you from returning to work?

You can also agree to provide this information on the telephone. But in this case, the health insurance company must create a protocol for the call.

There could be situations when you are unsure what to tell the health insurance company.

In such scenarios, you can contact an advice center (Beratungsstelle) for guidance.

Every city has multiple advice centers run by NGOs or the government. You can find them by searching “Beratungsstelle” on Google.

The health insurance company issues a letter to stop paying sickness benefits.

The health insurance company can tell you they’ll stop paying the sick pay as you are healthy and can work. Many people in Germany have received such a letter.

But, to issue this letter, the insurance company needs the expert opinion of the medical service (Medizinischen Dienst).

The Medical Service (M.D.) judges your health based on your medical reports. However, they may also ask for a personal examination in exceptional cases.

But, an assessment based on the medical records alone does not always hold in court.

In a similar situation, the Hessische Landessozialgericht (State Social Court) ruled in favor of a civil engineer.

As per its ruling, the health insurance company must conduct extensive investigations into the state of health before it stops paying sickness benefits.

The ruling applies especially in the case of a mental illness.

Thus, the health insurance company should conduct your examination before concluding anything.

On top of it, they must request your medical records from your doctor to learn more about your health condition (judgment of October 18, 2007, Az. L 8 KR 228/06 ).

What can you do if the health insurance company wants to stop paying sick pay?

If the insurer wants to stop paying sick pay, you should do the following.

• Request the M.D.’s report as soon as possible.
• File an objection within one month to the health insurance company. Add the note that you will submit the reason for the objection later, for example, within 14 days after you have received the M.D.’s report.
• Ask your physician to apply for a second opinion from the health insurance company ( § 6 Disability Directive ).

But your doctor might refuse to apply for a second opinion.

In this case, list all the doctors who can treat you in your objection letter and add a note:

“for the medical justification of the objection, please contact the doctors mentioned in the list.”

If the health insurance company contacts any of the doctors from your list for an opinion, doctors are legally bound to answer.

Of course, they can bill the health insurance company for their service.

Many times the second opinion changes the decision of the health insurer. And you continue to receive the sickness benefits.

You should apply for rehab.

The health insurance company may ask you to apply for rehabilitation via your pension insurance.

The German law allows health insurers to do this if they believe you are at risk of disability ( § 51 Para. 1 SGB V ).

Here are a few things that you should know about applying for rehab.

• As per law, you have ten weeks to submit your rehab application. And the health insurance company cannot set a shorter deadline.
• We recommend sending the rehab application by registered mail, as it proves that you applied on time.
• It’s vital to send the rehabilitation application within ten weeks, as the insurance company may stop paying sick pay.
• You have the right to appeal against the request for rehabilitation.
• If in doubt, contact an advice center near you for guidance.
• You have the freedom to choose the rehab center.
• During rehabilitation, you will not receive sick pay but a transitional allowance (Übergangsgeld in German).
• Transitional allowance is paid by your pension insurance when you are in rehab. It is 68 percent of the last net salary if you have no kids and 75 percent if you do.
• The paid sick leave continues if you are unable to work after rehab.

But, if the physician determines that you cannot work long-term, your rehab application will convert into a disability pension application.

Once the disability application is approved, you will no longer receive sick pay.

Vacation is allowed when you are on paid sick leave

German law allows you to go on vacation when you are on paid sick leave. But the holiday should not impair your recovery.

You don’t need the health insurance company’s approval to go on a vacation as long as you travel within Germany.

But, if you decide to travel outside of Germany, you will need your insurer’s approval. However, according to the Federal Social Court ruling, health insurance companies must approve the travel if it’s within E.U. ( Az. B 3 KR 23/18 R ). At least in most cases.

Things to do if you plan to travel abroad during paid sick leave.

• Get a note from your physician stating the trip will not interfere with your recovery.
• Inform your health insurance company several weeks before the trip.

By applying early, you’ll have the time to file an objection if your insurer does not approve your travel.

Get help from a counseling center.

I recommend taking help from the advice center when in need. They can help you with the following.

• Resolving conflicts with your health insurance company.
• Explain your rights.
• Guide you based on the situation.
• Help you write an objection against the health insurer.

Here are some of the entities that provide counseling.

• Independent patient advice service (UPD)
• Consumer advice centers
• Social organizations such as the VDK.

Take legal action if the objection is unsuccessful.

If your objection is unsuccessful, you can still take legal action before the social court.

German government waived the court fees to make it easier for the general public to take legal action. However, it makes sense to get help from a lawyer specializing in social law.

You have to pay the fee of the lawyer yourself if you lose the case. So weigh the cost before taking any legal action, especially if you don’t have legal expense insurance (Rechanwaltsversicherung in German).

What happens after paid sick leave ends?

The following applies if you cannot work after 78 weeks of paid sick leaves.

• You won’t get sick pay after the 78th week.
• You may be entitled to a disability pension (Er­werbs­min­de­rungs­ren­te in German).
• Your health insurance company will ask you to apply for medical rehabilitation. The insurer must do so no later than three months before your sickness benefits expire.

The doctor checks whether rehab can restore your ability to work within three to six months. If it can’t, your application for rehabilitation converts into a disability pension application.

German pension bureau may take months to evaluate your application for a disability pension. So your sickness benefits may expire before you start receiving a disability pension.

Hence, you should inform the employment agency also about your condition at least three months before your sick leave ends.

This way, you can claim unemployment benefits (§ 145 SBG III) until you get a disability pension.

Frequently asked questions about sick leave

How much sick pay is there?

The amount of sick pay is prescribed by law: 70 percent of gross earnings but no more than 90 percent of net earnings (Section 47 SGB V). The employee’s share of statutory social insurance is deducted from the lower of these two values. You will then receive the remaining amount as sick pay.

How long is paid sick leave?

Sickness benefit for the same illness runs for 78 weeks or 19.5 months within three years (§ 48 SGB V). You don’t have to be on sick leave in one go. The periods are added together.

What do you have to do to get sick pay?

You do not have to submit a separate application to receive sick pay. Your health insurance company will contact you to coordinate further procedures.