Eight points about the daily sickness allowance that you should know

"Sometimes everything in life goes smoothly, provided you have a bicycle," sings Max Raabe in his current feel-good hit "Fahrrad fahr’n" ("Ride a bicycle"). The fact that in life the risk of an accident increases with every bend in the road can be seen these days, and not only in the Tour de France. A complicated leg fracture caused by a bicycle accident, for example, is not only painful – a longer period of sick leave can also have financial consequences.

Although employees initially receive a salary continuation payment from their employer. But at some point it ends. In the case of the self-employed, income is reduced from the first day of illness and, in case of doubt, is completely eliminated. That is why employees and self-employed persons take out private daily sickness benefits insurance in addition to their private comprehensive health insurance: Like the sickness benefit of the statutory health insurance (GKV), the private daily sickness benefit is paid if you no longer earn any income from your gainful employment as a result of an illness or accident. The benefits are thus a living wage. It is all the more important that you always know exactly what you are covered for.

1. When will you start receiving sick pay?

When you take out a policy, you can help determine when the daily sickness allowance will be paid out. Usually you have the choice between different waiting periods from a few days up to several months. Waiting period is called the time between the onset of incapacity for work and the first day of daily sickness benefits.

Employees usually have daily sickness benefit insurance with payment from the age of 43. day of incapacity, since most employers continue to pay wages for six weeks in the event of illness. But of course you can choose a later start. The only thing that is not possible is that you receive wages and daily sickness benefits at the same time. In the case of the self-employed, income is often lost as soon as an illness begins. That’s why daily sickness benefits can start earlier here, z. B. from the 4. or 22. Day of incapacity for work.

Important: Each insured person should decide on the start of payment depending on his or her own financial situation: How long can I get by without an income?? In case of doubt, a higher insurance premium due to earlier payment of daily sickness benefits is easier to shoulder than a longer period without income. In principle, it is also possible to change the waiting period. Ask your insurer about this.

2. How much is your daily sickness benefit?

Do you still know how much your daily sickness benefit is? For those with statutory insurance, the amount of their sickness benefit is fixed: 70 percent of gross income, but no more than 90 percent of net income, whereby income is only taken into account up to the income threshold for assessing contributions (2018: 4.425 euros/month) is taken into account.

In private health insurance, on the other hand, you are almost free to agree the amount of your daily sickness allowance with your insurance company at the start of the insurance policy. "Almost free" because the amount is limited to your net income. The average net income of the past twelve months is relevant; self-employed persons should check in each individual case which income is taken into account when calculating the daily sickness allowance. Whether you retain your full net income or limit yourself to 90, 80, … percent of it in the event of incapacity for work – that is entirely up to you. Your daily sickness allowance is not set in stone, but the amount can also be changed.

Important: If your income decreases permanently – for example due to a change of job – you should inform your insurer and agree on a lower daily sickness allowance with a correspondingly lower premium. When paying out, your insurer namely looks at what you earned in the last 12 months before your incapacity for work or. have earned on average before applying for daily sickness benefits. Finally, your daily allowance must not exceed your net income. – Of course, you can also request an increase in the insurance benefit if you feel that this is necessary or desirable.

Since an increase in the daily sickness allowance is an extension of benefits, your insurer will generally require a health examination for this purpose. Most insurers also offer an increase on their own initiative at regular intervals. If you meet certain requirements (e.g. B. Deadlines) are met, there is usually no need for a health check. Usually, insurers also waive this if you submit the claim after a salary increase within a period specified in the contract.

3. How does your contribution to the daily sickness allowance insurance come about??

The amount of your daily sickness benefit insurance premium depends on:

  • the amount of the daily sickness allowance
  • Start of payment
  • Your age when you took out the insurance
  • Your state of health when you took out the insurance.

Pre-existing conditions may increase the imputed risk that you will need to claim per diem sickness benefits. The insurance company may then levy a risk surcharge. If you fall ill after taking out the insurance, this will have no effect on your premium – regardless of how often you are insured, if necessary. Receive daily sickness benefit. If an illness for which you are paying a risk surcharge has been cured, you can request your insurer to review this.

Important: Always pay your premium. If you do not meet your obligation to pay contributions, your insurance company is also not obliged to pay benefits, d. h. You do not receive a daily sickness allowance. In addition, the insurer may terminate your policy if you continue to be in arrears with payments.

4. What you should consider if you change your profession?

The payment of the daily sickness allowance is linked to the occupation you have declared. Therefore, you must inform your insurer if you change your profession. This also applies if you continue to do the same job but switch from self-employment to employment or vice versa. Since a change of job usually also means a change of income, it is a good idea to inform the insurer of both facts at the same time. How to avoid conflicts in case of doubt.

5. When should you report your inability to work?

Insurers do not recognize any retroactive determination of incapacity for work. Therefore, have your incapacity for work confirmed by a doctor at an early stage and report it in good time. The waiting period begins on the day on which a doctor has determined in writing that you are unable to work. The period within which you must inform your insurer of this is specified in your insurance conditions. In most cases, it is identical to the waiting period. If your incapacity for work extends over a longer period of time, your insurance company will ask you to provide regular evidence in the form of medical certificates.

6. Why you should think about your pension when you are unable to work?

As soon as you no longer receive continued payment of wages when you are incapacitated for work, you are no longer subject to compulsory insurance under the statutory pension insurance scheme. In order for these periods to be counted towards your pension, you can take out compulsory insurance for up to 18 months – provided you were last subject to compulsory pension insurance for at least one year. You must submit an application for this to the relevant pension insurance institution. You can finance the contributions for the pension insurance with your daily sickness allowance.

Important: You should apply for continued pension insurance within three months of the start of your incapacity for work, so that you are insured without any gaps in your pension insurance. If you apply later, you are not subject to compulsory insurance again until the day after the application is received.

By the way, during the period of daily sickness benefits, you are liable to pay unemployment insurance contributions as an employee, but you do not have to worry about this. Your insurance company pays the premium directly to the Federal Employment Agency on your behalf.

7. How long does the insurance pay you daily sickness benefits??

The daily sickness allowance is a benefit without time limit. Only when you are no longer completely incapacitated for work does the insurance company stop paying out benefits. There can be two reasons for this: you have recovered to such an extent that you are able to work again, at least partially – or your state of health will not improve in the foreseeable future. This is because payment of the daily sickness allowance requires that you temporarily you are not able to pursue your profession. If, on the other hand, your doctor determines that you will not be able to work for the foreseeable future, i.e permanently, If you are unable to work, you should check whether you are incapacitated for work. Insurance is also important for this case.

8. Is it possible to return to work part-time with daily sickness benefits??

Traditionally, daily sickness allowance insurance only pays out in the event of 100 percent incapacity for work. In the meantime, however, more and more tariffs also provide for partial payment of the daily allowance if the insured person is able to work again to a limited extent. In this way, the reintegration into working life (Hamburg model) should be supported. Even if this benefit is not provided for in the tariff conditions, the companies often pay a reduced daily allowance on a voluntary basis. In case of doubt, you should therefore always check with your insurer.

If there are any problems with your daily sickness allowance insurer, you can contact the PKV ombudsman, who is available free of charge.

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