Eight points you should know about daily sickness benefits

Sometimes everything goes smoothly in life, 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 with the one or other curve also the accident risk increases, is to be seen these days not only with the Tour de France. A compound fracture of the leg caused by a bicycle accident, for example, is not only painful – prolonged sick leave can also have financial implications.

Although employees initially receive continued payment of their wages from their employer. At some point, however. In the case of self-employed persons, the 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 therefore all the more important that you always know exactly what your insurance cover is.

1. From when do you receive daily sickness benefits?

When taking out the contract, you can help determine the start of payment of the daily sickness benefit. Usually you have the choice between different waiting periods from a few days up to several months. The waiting period is the time between the onset of incapacity for work. The first day of daily sickness benefits.

Employees usually have daily sickness benefit insurance with payment from the age of 43. day of incapacity for work, as most employers continue to pay wages for six weeks in the event of illness. However, you can of course also choose a later start. The only thing that is not possible is that you receive wages and daily sickness benefits at the same time. For the self-employed, income often ceases at the onset of an illness. Therefore, the daily sickness allowance can start earlier in this case, z. B. 4 and above. or 22. Day of incapacity for work.

Important: Every insured person should make the decision about 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 allowance?

Do you still know how much your daily sickness benefit is?? For those with statutory insurance, the amount of their daily sickness allowance is fixed: 70 percent of gross income, but no more than 90 percent of net income, whereby income is only paid 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. "Almost free" because the amount is limited to your net income. The average net income of the past twelve months is relevant here, whereby self-employed persons should check in individual cases which income is taken into account in the calculation of daily sickness benefits. Whether you maintain your full net income during incapacity for work or limit yourself to 90, 80, … percent of it – that is entirely up to you. In this case, your daily sickness benefit 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 looks at what you earned in the last 12 months before you became incapacitated for work or in the last 12 months before you became incapacitated for work. have earned an average salary before applying for daily sickness benefits. Finally, your daily allowance must not exceed your net income. – Of course, you can also apply for 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 check for this purpose. Most insurers also offer an increase on their own initiative at regular intervals. If you meet certain requirements (e.g. B. If you do not meet the requirements of the insurance policy (e.g., the insurance periods), the health check is not usually required. Usually, insurers also waive this requirement if you submit the application after a salary increase within a period specified in the contract.

3. How does your daily sickness benefit premium come about??

The amount of your daily sickness benefit contribution depends on:

– Amount of the daily sickness benefit – 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 daily sickness benefits. The insurance company can then levy a risk surcharge. If you fall ill after taking out the insurance, on the other hand, this has no effect on your premium – no matter how frequently you fall ill, if necessary. Receive daily sickness benefit. If an illness for which you are paying a risk surcharge has been cured, you can ask your insurer to review it.

Important: Always pay your premium. If you do not fulfill your obligation to pay contributions, your insurance company is also not obliged to pay benefits, d. h. You do not receive daily sickness benefits. In addition, the insurer can terminate your contract if you continue to be late with payments.

4. What you should bear in mind if you change your profession?

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

5. When should you report your incapacity for work?

Insurers do not recognize a retroactive determination of incapacity for work. Therefore, have your incapacity for work confirmed by a doctor in good time 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. Most of the time it is identical with the waiting period. If your inability to work extends over a longer period of time, your insurance company will require 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 in the event of incapacity for work, you are no longer subject to compulsory insurance under the statutory pension insurance scheme. To ensure that these periods are also taken into account for your pension, you can take out compulsory insurance for up to 18 months – provided that you were last subject to compulsory pension insurance for at least one year. To do this, you must submit an application to the relevant pension insurance institution. You can finance the contributions for 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 covered for pension insurance without any gaps. If you apply later, you will only be subject to insurance again from the day after the application is received.

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

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

The daily sickness allowance is a benefit for an unlimited period of time. Only when you are no longer completely incapacitated for work, the insurance company will end the payment. There can be two reasons for this: You have recovered to such an extent that you can return to work at least partially – or your state of health will not improve in the foreseeable future. This is because the payment of the daily sickness allowance requires that you Temporary are unable to pursue their occupation. 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 incapable of working, you should check whether you are incapable of working. 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. This is intended to support reintegration into working life (Hamburg model). Even if this benefit is not provided for in the terms of the collective agreement, companies often pay a reduced daily allowance on a voluntary basis. In case of doubt, you should therefore always check with your insurer.

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