After sick pay when the health insurance fund no longer pays stiftung warentest

If employees are sick for a very long time, sick pay also ends. We show three ways how it can continue afterwards: Hamburger Modell, ALG 1, reduced earning capacity pension.

1. The most important facts in brief 2. What happens after sick pay 3. Variant 1: Back to work 4. Option 2: Continue to be ill – apply for ALG 1 5. Variant 3: Permanently ill – reduced earning capacity pension 6. Interview: "The employment agency can help"

The most important facts in brief

What is possible when sick pay ends

Sick pay. If you are ill for a longer period of time, your employer will continue to pay your salary for six weeks. After that, you will receive up to 72 weeks of sick pay from your health insurance fund. Work. Approach your employer if you can return to work in the foreseeable future. There are various measures that can make your return to work easier. Continue to be sick . If you are still on sick leave after your sick pay has expired, contact the employment agency. It is the right contact. Permanently unable to work. If you are permanently unable to work, you will receive a reduced earning capacity pension. Consultation. Social welfare associations such as VdK, SoVD and the statutory pension insurance will advise you individually.

What happens after sick pay

Sickness benefit runs for a long time, but not indefinitely. Payment ends after 78 weeks. "Ausgesteuert" is what health insurers call it in their jargon. People who receive sick pay should act beforehand. Otherwise they may lose health insurance coverage in addition to the payment.

Become active before the end of the time

Sick pay protects employees who are sick for a long time. In the first six weeks, you continue to receive a salary from your employer. After that, the health insurance fund will step in and pay sickness benefit for those with statutory health insurance. In private health insurance, sick pay is an additional benefit that policyholders can add at extra cost via the "daily sickness allowance" module. You return to your job. Are supported by their employer. – You are still sick and receive benefits from the employment agency or job center. You are permanently too sick to work. Receiving a pension for reduced earning capacity.

Take care in time

"Insured persons should definitely take care while they are still receiving sick pay," appeals Dorothee Czennia, social policy officer at the VdK social association. Many things can be clarified with the employer, so that a return to work is possible. However, this takes time. "If you wait, it will get hectic after a good year and a half."

Application for severe disability

The expert recommends also considering an application for severe disability status in the event of prolonged illness. The severely disabled status at least gives them a "disadvantage compensation" such as special protection against dismissal in the job. In addition, they can retire on average two years earlier than planned, with deductions even earlier.

Tip: More information in our detailed special on statutory sick pay.

Option 1: Back to work

Sick or fit for work? In order to find out how capable someone is, the employment agency can initiate rehabilitation, which affected persons are not allowed to refuse. © Getty Images

In any case, the best option is to get well and go back to work. Those who are still receiving sick pay can plan a gradual return to work, colloquially known as Hamburg model called.

Hamburg model: gradual return to working life

Insured people are still on sick leave in the Hamburg model while they go back to work by the hour. In most cases, the number of hours they spend at work increases over several months. A step-by-step plan for this is determined together with the doctor; the employer must agree to it. Important: The Hamburg model is also possible for privately insured persons. What is possible for them is regulated by the benefit module for daily sickness benefits.

BEM: Support from the employer

Gradual re-entry into the job can also be made possible under the Operational integration management (BEM) take place. BEM is intended to support employees in their return to work and to help prevent longer periods of illness in the future through various measures.

Employers are obliged to offer BEM to all employees who have been ill for more than six weeks. Together they discuss what support is possible. BEM measures include, for example, modifications such as handicapped-accessible entrances or the purchase of special hearing aids. Such assistance is independent of sick pay and can also benefit employees who only return to work after they have finished receiving it.

Bridge part-time: Temporarily reduce working hours

Another option: Since 2019, employees can reduce their working hours as so-called bridge part-time for a fixed period of time. It is worth exploring this option for a slow return to work.

Variant 2: Continue to be ill – apply for ALG 1

If your state of health does not yet allow you to return to work, the Employment Agency is the right contact – even if you are still employed. "For someone who still has a job and is on sick leave, this sounds strange at first," says Christian Schultz, an employee in the Social Policy and Communications Department at SoVD Schleswig-Holstein. His colleagues often have to deal with such cases in the consultations (see interview).

Take care three months in advance

Here, too, the following applies: You should not only contact the employment agency when the sickness benefit has expired, but already beforehand. Normally, the health insurance company informs the insured that it will soon stop paying sickness benefits. If you have not received this letter two or three months before you are due to leave the company, you should ask your insurance company about it. Affected persons must go to the employment agency with this letter. Apply for unemployment benefit 1 (ALG 1). Anyone who has been employed for at least twelve months and is subject to compulsory insurance is entitled to this benefit. As a rule, ALG 1 amounts to 60 percent of net pay. Those who still receive child benefit receive 67 percent.

Money for transitional periods

ALG 1 is often available for sick employees under the so-called seamlessness regulation. Whether it applies is decided by the medical service of the employment office – and on the basis of the files. The regulation can apply, for example, if someone has already applied for a reduced earning capacity pension, but it has not yet been approved, because that can take months.

Unemployment benefit 1 can be received even if the seamlessness regulation does not apply. But then things often get complicated: This is because employees who are ill must make themselves available to the labor market within their remaining capacity so as not to jeopardize payments, even though they are still ill.

It may happen that the employment agency sends claimants to rehab to check whether they are still fit for work. You must comply with this request in order not to jeopardize the payments.

Variant 3: Permanently ill – reduced earning capacity pension

The general ability to work is decisive for whether a reduced earning capacity pension is granted. If, for example, a nursery school teacher can no longer work in a daycare center because of a mental illness, but can still work in a call center, she would not receive a reduced earning capacity pension. It is therefore optimal to take out private disability insurance in good time, which pays a pension in an agreed amount if someone is permanently unable to work in their last profession for health reasons.

Anyone who can work less than three hours a day due to illness or accident receives the full reduced earning capacity pension. If it is between three and six hours a day, the payment is reduced by half.

An average of 835 euros a month

A full reduced earning capacity pension is much lower than the net income. It is often barely enough to cover basic living costs. On average, it is currently 835 euros per month net before taxes. With partial reduction in earning capacity the pension is accordingly lower. There are also requirements: The minimum insurance period in the statutory pension insurance is five years. Insured persons must have paid compulsory contributions for at least three years in the last five years. In addition to employment subject to social insurance contributions, periods of child-rearing and care are also considered compulsory contribution periods.

Around 40 percent of applications are rejected by the pension insurance fund. Insured persons can file an objection

Interview: "The employment agency can help"

Christian Schultz is an expert on social policy at the German Social Association (SoVD). © Olaf Bathke

If sick pay runs out, the employment agency is often responsible for sick employees. But many of them end up at the job center. Then receive less financial support. Expert Christian Schulz explains why it pays to be persistent.

If the seamlessness regulation does not apply

Sick leave and nevertheless to the employment agency, that sounds at first strangely.

This is also difficult to understand for laypersons. If the seamlessness regulation does not apply, those affected must make themselves available to the labor market within the scope of their possibilities. Only then there is also ALG 1.

Does that work in practice?

Again and again, we experience that applicants are sent away by the employment agency because their employees are of the opinion that they are not responsible for the matter.

Do not be put off

What do you advise then??

It is important to remain persistent, not to let yourself be sent away. You have to explicitly tell the employees of the employment agency that you are entitled to ALG 1 – and that you are working full time, otherwise you will not receive the full unemployment benefit. That takes energy that sick applicants often don't have.

What else happens?

Those affected often report to the job center out of necessity. Instead of ALG 1, there is then only ALG 2, also called Hartz 4. That is not only lower, besides with the purchase income of the partner and own savings are also taken into account. This should be avoided at all costs.

Reject job offers in case of doubt

How often do those affected actually receive job offers??

As a rule, you don't get any offers then. If it occurs nevertheless, affected persons can reject this with view of the health problems.

Is it necessary to continue to be on sick leave??

If you do not fall under the seamlessness regulation, it is a tightrope walk. Strictly speaking, you would have to continue to be sick leave for the employment agency. This often causes problems. If you are sick, you are not available for placement, they say. We recommend that you do not pass on the sickness notification. Incidentally, the health insurance fund no longer needs the certificate. You should ask your employer: Often, however, he no longer wants the yellow slip of paper.

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