Krankengeld

Krankengeld (sickness benefit) is the German statutory health insurance benefit that replaces a portion of lost income when a worker is unable to work due to illness for more than 6 weeks. It is anchored in SGB V §§ 44-51 (Social Code Book V, on statutory health insurance) and is paid by the Krankenkasse (statutory health insurance fund), not the employer.

The benefit sits within a layered income protection system that begins on day one of illness:

• Day 1-42 (6 weeks): Lohnfortzahlung — full salary paid by the employer (Entgeltfortzahlungsgesetz, EntgFG).
• Day 43 onward: Krankengeld — sickness benefit from the Krankenkasse, replacing about 70% of gross income (capped).
• Up to 78 weeks per illness — Krankengeld pays for a maximum of 78 weeks within a 3-year period for the same illness.
• Beyond 78 weeks: transition to either return-to-work or Erwerbsminderungsrente (reduced earning capacity pension).

Coverage:

• Statutory health insurance (gesetzlich versichert) employees and most self-employed who voluntarily insure with Krankengeld coverage — eligible.
• Private health insurance (privat versichert) employees — pay for Krankentagegeld separately as part of their PKV contract.
• Self-employed (Selbstständige) in GKV — can opt into Krankengeld via the Wahlerklärung at extra premium.
• Mini-job workers (Minijobber) — not eligible for Krankengeld via GKV (they have family coverage).
• Civil servants (Beamte) — covered by Beihilfe and private insurance, not Krankengeld.

Krankengeld is fundamentally different from Pflegegeld (care allowance), Erziehungsgeld/Elterngeld (parental allowance), and Arbeitslosengeld (unemployment benefit) — these are different benefit streams under different legal bases.

The Krankenkasse decides eligibility based on the Arbeitsunfähigkeitsbescheinigung (AU certificate, also called gelber Schein or eAU). Since 2021, the certificate is largely electronic (eAU), with the doctor's office transmitting directly to the Krankenkasse and employer.

For migrant workers in Germany, Krankengeld is one of the most important practical benefits: it ensures financial security during illness, an event that can otherwise quickly destabilize an immigrant household. About 1.2 million workers received Krankengeld in any given month in 2024, accounting for €15 billion in annual statutory health insurance payouts.

Five conditions must be met to receive Krankengeld:

1. Statutory health insurance member with Krankengeld entitlement. This includes most employees (Pflichtversicherte), voluntarily insured (freiwillig Versicherte) with the option chosen, and recipients of Bürgergeld.
2. Inability to work due to illness (Arbeitsunfähigkeit) confirmed by a doctor.
3. Existing employment relationship when the illness began (not a job that has already ended).
4. Illness began during the insurance period (not before coverage started).
5. Properly submitted certificates (AU/eAU) to both employer and Krankenkasse.

Who has automatic entitlement:

• Employees with statutory health insurance (most workers earning under €69.300/year in 2026 are automatically GKV) — full entitlement.
• Statutory-insured employees earning above €69.300/year — still entitled, but can switch to private insurance (PKV) which has different sick-pay rules.
• Apprentices and dual students — full entitlement during their training.
• Recipients of Arbeitslosengeld I (unemployment benefit 1) — full Krankengeld while ill.
• Self-employed with GKV and the optional Krankengeld coverage — full entitlement after a 21-day waiting period.

Who is NOT entitled to GKV Krankengeld:

• Mini-jobbers under €538/month — covered through family insurance (Familienversicherung), not eligible for Krankengeld.
• Family-insured spouses and children without separate income — covered for medical care but not Krankengeld.
• Civil servants (Beamte) — covered by Beihilfe + private insurance.
• Self-employed without the optional GKV Krankengeld coverage — they would need PKV Krankentagegeld.
• Privately insured (PKV) employees — receive Krankentagegeld from their PKV plan, on different terms.

For migrant workers and refugees:

• Asylum seekers (Gestattung) under § 4 AsylbLG receive only emergency medical care — no Krankengeld during the asylum process.
• Recognized refugees (Asylberechtigt, Flüchtling, Subsidiärer Schutz) — full Krankengeld entitlement as soon as employed.
• Ukrainian war refugees under §24 AufenthG — full GKV access, full Krankengeld when employed.
• EU nationals working in Germany — full entitlement under EU regulations.
• Third-country workers with valid residence and work permits — full entitlement.

Common pitfalls:

1. Insurance gap: if a worker is between jobs and didn't continue voluntary insurance, Krankengeld can be denied for an illness that begins during the gap. Always continue Krankenkasse coverage during job transitions.
2. Illness that began before employment: if you fell ill in the previous job (or pre-employment) and the new contract hasn't yet activated GKV coverage, Krankengeld may be denied.
3. Probationary period (Probezeit): Lohnfortzahlung is technically not guaranteed in the first 4 weeks, but Krankengeld kicks in. Many migrant workers misunderstand this.
4. Missed eAU submission: even with electronic transmission, if your doctor's office hasn't sent the eAU to your Krankenkasse, your benefit can be delayed. Check with the Krankenkasse app.

Krankengeld replaces a portion of the worker's gross income, but the calculation is more complex than a simple percentage:

Formula:

• Gross calculation: 70% of the worker's gross earnings, but capped at 90% of net earnings.
• Calculation base: average daily gross earnings in the last full pay period before the illness began.
• Maximum cap: there is an absolute monthly maximum based on the contribution ceiling. For 2026, the calculation ceiling (Beitragsbemessungsgrenze) for GKV is €5.512.50 per month, which translates to a maximum Krankengeld of approximately €4.013/month gross.

Step-by-step calculation:

1. Take gross monthly salary (Bruttoarbeitsentgelt).
2. Divide by 30 to get daily gross.
3. Multiply by 0.7 = daily Krankengeld gross.
4. Compare to 90% of net daily — take the lower.
5. Subtract worker's portion of social insurance contributions (~21%).
6. Net Krankengeld = roughly 70% of net income.

Example calculations for 2026:

• Worker earning €2.500 gross/month → daily gross €83.33 → Krankengeld gross daily €58.33 → minus contributions → net daily ~€46 → monthly net ~€1.380.
• Worker earning €3.500 gross/month → daily gross €116.67 → Krankengeld gross daily €81.67 → net daily ~€65 → monthly net ~€1.950.
• Worker earning €5.000 gross/month → at GKV calc ceiling → maximum Krankengeld gross daily €128.63 → net daily ~€102 → monthly net ~€3.060.
• Worker earning €6.500 gross/month (above GKV ceiling) → still capped at the same maximum (€3.060 net/month).

Duration:

• Maximum 78 weeks (546 calendar days) within 3 years for the same illness.
• If multiple illnesses overlap, the 78-week cap applies to all of them combined for the 3-year period.
• Holiday days, weekends, public holidays are all counted toward the 78 weeks.
• Within a single sickness episode, periodic interruptions (e.g., short return to work) do not reset the clock.

After 78 weeks (or earlier discharge from doctor):

• Worker returns to work — full salary resumes from the employer.
• Worker is permanently unable to work — application for Erwerbsminderungsrente.
• Worker still ill but Krankengeld exhausted — Arbeitslosengeld I if employable in some capacity, or Bürgergeld if not.

Tax treatment:

• Krankengeld is tax-free, but subject to Progressionsvorbehalt — it raises the family's tax rate. Higher-earning spouses often see a small additional tax bill (~€300-1.000/year).
• Krankengeld counts as income for Bürgergeld, Wohngeld, and Kinderzuschlag eligibility calculations.

The first 6 weeks of illness are covered by the employer through Lohnfortzahlung (continued wage payment, EntgFG). From day 43 onward, the Krankenkasse takes over with Krankengeld.

Lohnfortzahlung (Days 1-42):

• Employer pays 100% of regular salary for up to 6 weeks.
• Applies to all employees who have been with the employer at least 4 weeks.
• During Probezeit (first 4 weeks of employment), Lohnfortzahlung is not automatically guaranteed — but in practice most employers pay it.
• For Apprentices (Auszubildende) — Lohnfortzahlung is guaranteed from day 1 of training.

Transition (Day 43):

• Employer stops paying salary on day 43.
• Krankenkasse starts paying Krankengeld from day 43.
• Worker must submit a new AU/eAU before day 43 to ensure no interruption.
• Important: the calculation of Krankengeld uses the gross monthly salary from the last pay period before the illness — not from a longer averaging period.

Reset rules:

• If the worker returns to work for 6+ months between illnesses, Lohnfortzahlung restarts at 100% × 6 weeks for the next sickness.
• If the new illness is the same as the previous one and starts within 6 months, Lohnfortzahlung is not granted; the worker goes directly into Krankengeld.

Practical tips for migrant workers:

1. Submit your AU/eAU to your employer on the first day of illness (or by day 3 at the latest).
2. Keep digital copies of all AU certificates — Krankenkasse may request them later.
3. Around day 35-40, request a follow-up appointment with your doctor to assess whether continued illness is expected — this gives time for the eAU to be transmitted before day 42.
4. Open a direct deposit (SEPA) instruction with Krankenkasse to avoid delays.
5. If you don't speak fluent German, use the Krankenkasse's multilingual support — most large funds offer Turkish, Polish, Arabic, Russian, English.

After long-term sickness (typically 6+ weeks within 12 months), the employer must offer Betriebliches Eingliederungsmanagement (BEM) — corporate reintegration management. The legal basis is SGB IX § 167 Abs. 2.

BEM goals:

• Identify causes of repeated or prolonged sickness.
• Develop a plan to safely return to work.
• Find alternative tasks if old work is no longer feasible.
• Coordinate medical, occupational health, and HR support.

BEM process:

1. Employer invites the worker to a BEM meeting (written, voluntary).
2. Worker decides whether to participate (no consequences if declines).
3. Meeting involves HR, often Schwerbehindertenvertretung (if applicable), Betriebsarzt (company doctor), and possibly external rehab counselor.
4. Plan developed: gradual return-to-work (Wiedereingliederung), workplace adjustments, medical rehab, vocational retraining.

Gradual return to work (Stufenweise Wiedereingliederung):

• Worker returns part-time (e.g., 2-4 hours/day) for a defined period (usually 4-12 weeks).
• During Wiedereingliederung, the worker is still on Krankengeld (not yet on regular salary).
• The Krankenkasse pays the difference between part-time work and full Krankengeld.
• Plan must be agreed by doctor, employer, Krankenkasse, and worker.

Worker rights during BEM:

• Confidentiality: information shared in BEM cannot be used as basis for termination.
• Participation is voluntary; declining does not justify dismissal.
• Severely disabled workers (Schwerbehinderte) have additional protections under SGB IX.
• Workers can bring a confidante (e.g., union rep, family member).

For migrant workers:

• BEM meetings are typically conducted in German. Worker has the right to request an interpreter, but employer is not legally obligated to provide one. In practice, large companies (DAX firms, public sector) often provide; SMEs may not.
• Buronia.com can help workers prepare for BEM meetings in their native language.
• Caritas, Diakonie, and AWO migration counselling can accompany BEM meetings for migrant workers.
• If BEM identifies workplace bullying (Mobbing) or discrimination tied to the worker's illness, the worker can also pursue AGG (anti-discrimination) protection.

Several special situations affect Krankengeld eligibility and calculation:

1. Pregnancy and maternity:

• From 6 weeks before to 8 weeks after birth: Mutterschutzgesetz — full salary via Mutterschaftsgeld (paid by Krankenkasse, capped at €13/day) + employer Zuschuss to bring it up to net salary.
• If pregnancy complications make work impossible before Mutterschutz starts: Krankengeld can apply, but it's complex — Beschäftigungsverbot (work prohibition) issued by gynecologist often replaces Krankengeld with full salary continuation.

2. Child illness (Krankheit eines Kindes):

• Parents have the right to Kinderkrankengeld when a child under 12 is sick: up to 15 days per parent per child per year (with maximum 35 days per parent, 70 days per family).
• 2026 rate: 90% of net daily income, capped at €128/day.
• For single parents: up to 30 days per child, max 70 days total.
• For 2026, the temporary COVID-era increase to 30/60 days has been adjusted; check the latest rules.

3. Self-employed Krankengeld:

• Self-employed (Selbstständig) in GKV can opt into Krankengeld coverage.
• Standard 6-week waiting period before Krankengeld starts (instead of starting day 43 for employees).
• Optional shorter waiting periods (3 weeks, 1 week) available at higher premium.
• Calculation based on the income reported during the previous tax year.

4. Work-related illness or accident:

• If illness or accident is due to work conditions: Berufsgenossenschaft (statutory accident insurance) takes over, not the Krankenkasse.
• Verletztengeld replaces Krankengeld for work-related injuries — paid at higher rate (80% of regular salary, no Krankengeld cap).

5. Combination with other benefits:

• Krankengeld + Wohngeld: Krankengeld counts as income; Wohngeld may be reduced.
• Krankengeld + Kindergeld: independent, both received in parallel.
• Krankengeld + Elterngeld: cannot be received at the same time; Elterngeld takes precedence during parental leave.
• Krankengeld + Bürgergeld: only if Krankengeld is insufficient (below Bürgergeld floor); the difference is paid as Bürgergeld.

6. Workers with cross-border situations:

• Cross-border commuters (Frontaliers) — typically receive Krankengeld from the country where they pay social contributions, regardless of where they live.
• Workers temporarily abroad — Krankengeld continues if illness occurs during a documented business trip or short vacation.
• Workers returning to home country during illness — Krankengeld may be paid for up to 6 weeks abroad with prior Krankenkasse approval.

Krankengeld for cross-border workers is governed by EU regulation 883/2004 for EU/EEA/Swiss workers, and by bilateral agreements for third-country workers.

Scenario 1: Worker in Germany, family in another EU country.

• Worker pays GKV contributions in Germany → entitled to Krankengeld from German Krankenkasse.
• Family in another EU country covered through Familienversicherung in Germany.
• Polish, Romanian, Bulgarian, Hungarian, Czech, Slovakian, Croatian, Greek, Spanish, Portuguese, Italian, French workers in Germany — full Krankengeld entitlement.

Scenario 2: Worker in Germany, fell ill while abroad.

• If illness occurs while temporarily abroad (vacation, business trip): doctor must issue local AU certificate, translated.
• Worker must inform Krankenkasse within 7 days.
• Krankengeld may continue for up to 6 weeks abroad with approval.
• For longer absences, Krankenkasse may withdraw Krankengeld.

Scenario 3: Worker returning to home country during illness.

• Long-term return to Turkey, Poland, Russia, Ukraine for treatment: requires Krankenkasse approval.
• Standard rule: Krankengeld can continue 6 weeks abroad in EU/EEA; only 6 weeks abroad in non-EU countries with bilateral agreements.
• For longer treatment abroad, Krankenkasse evaluates case-by-case (typically reimburses only equivalent care available in Germany).

Scenario 4: Worker from third country (Turkey, Bosnia, Serbia, Morocco, Tunisia, etc.):

• If working in Germany with valid permit, full Krankengeld entitlement.
• Bilateral agreements (Turkey 1964, Bosnia, Serbia, Morocco, Tunisia) allow continuation of Krankengeld during medically necessary return to home country.

Common cross-border challenges:

• Foreign medical certificates: must be translated into German (some Krankenkassen accept English-language certificates from EU doctors directly).
• Time zones and communication: keep Krankenkasse informed of any change of address or contact info while abroad.
• Currency: Krankengeld is always paid in euros to a EUR bank account, regardless of where the worker is.

When Krankengeld is exhausted (78 weeks) but the worker is still unable to work, the next step is typically Erwerbsminderungsrente (EM-Rente, reduced earning capacity pension) under SGB VI.

Types of EM-Rente:

• Volle Erwerbsminderungsrente: worker can work less than 3 hours/day in any occupation.
• Teilweise Erwerbsminderungsrente: worker can work 3-6 hours/day.

Eligibility:

• 5 years of GRV (statutory pension) contributions, including at least 3 years in the last 5 years before EM-Rente application.
• Younger workers (<26 years) have shorter contribution requirements.
• Medical evidence of long-term inability to work.

Amount:

• Calculated similar to Altersrente (regular pension): based on accumulated pension points (Entgeltpunkte) and a multiplier.
• Average full EM-Rente in 2026: €1.300-1.700/month gross.
• For workers with shorter contribution histories, often lower.

Application timeline:

• Apply to Deutsche Rentenversicherung (DRV) about 3 months before Krankengeld ends.
• Decision process: 6-12 months, often longer if medical examinations required.
• Bridge funding: while waiting for EM-Rente, worker may receive Bürgergeld + reduced Krankengeld.

Migrant-specific issues:

• Workers with less than 5 years of German GRV contributions may not qualify for EM-Rente — they should explore bilateral pension agreements (Turkey, Morocco, Poland have agreements; many other countries don't).
• Workers can combine German + foreign pension periods under bilateral agreements.
• For Polish, Italian, Spanish workers — EU coordination allows combining EU member state periods.
• For Turkish, Bosnian, Serbian workers — 1964/1966 bilateral agreements allow some combination.

2026 key figures:

• Calculation ceiling (Beitragsbemessungsgrenze GKV): €5.512,50/month → max Krankengeld gross ~€4.013/month → max net ~€3.060/month.
• Lohnfortzahlung: 6 weeks at 100% from employer, no change from previous years.
• Mini-job threshold: €538/month (no Krankengeld for mini-jobbers).
• Kinderkrankengeld: 15 days per parent per child (max 35/parent, 70/family); single parents 30 days per child (max 70 total).

ELE (Entgeltersatzleistung) — wage replacement benefits umbrella:

Krankengeld is one of several ELE benefits, alongside:

• Arbeitslosengeld (unemployment benefit, paid by BA, 60-67% of net).
• Verletztengeld (injury benefit, paid by Berufsgenossenschaft, 80% of regular salary).
• Übergangsgeld (transition benefit during rehabilitation, paid by Rentenversicherung).
• Mutterschaftsgeld (maternity benefit, paid by Krankenkasse + employer Zuschuss).

Lohnfortzahlung details for 2026:

• Employer pays full salary for first 6 weeks of any sickness.
• Applies to all employees employed for 4+ weeks (Wartezeit).
• Apprentices: from day 1 (no Wartezeit).
• Mini-jobbers: Lohnfortzahlung yes, but no Krankengeld after.
• For workers fired during sickness: Lohnfortzahlung continues only while contract is valid; Krankengeld kicks in after contract ends (with proper insurance continuation).

Employer reimbursement (U1):

• Small employers (under 30 employees) can join the U1 reimbursement pool — they get partial reimbursement of Lohnfortzahlung costs.
• U2 pool reimburses Mutterschaftsgeld Zuschuss.

2026 trends:

• Increase in psychological illnesses (depression, anxiety, burnout) — now ~30% of long-term Krankengeld cases.
• Long-COVID continues to be a significant Krankengeld category (5-10% of cases).
• Krankenkasse digitalisation (eAU) reducing administrative burden.
• Higher Krankengeld payouts due to wage inflation and contribution ceiling increases.

Two illness categories have grown significantly in Krankengeld cases over the last 5 years: psychological illnesses and Long-COVID.

Psychological illnesses:

• Now account for ~30% of long-term Krankengeld cases (up from 18% in 2015).
• Most common: depression, anxiety disorders, burnout (Erschöpfungssyndrom), PTSD.
• Average Krankengeld duration for psychological illness: 35 days (vs 14 days for physical illness).
• About 15% of cases extend beyond 78 weeks, requiring EM-Rente application.

Process for psychological illness:

1. Doctor (GP or psychiatrist) issues AU with diagnosis (often ICD-10 F32-F33 for depression, F41 for anxiety).
2. Krankenkasse may request second opinion if illness persists beyond 6 months.
3. Treatment includes psychotherapy (covered by Krankenkasse), sometimes inpatient rehab.
4. Gradual return-to-work through Wiedereingliederung is highly recommended.

Long-COVID:

• WHO defines Long-COVID as symptoms persisting 3+ months after COVID-19 infection.
• Affects ~10-15% of COVID-19 survivors.
• Common Long-COVID symptoms: fatigue, brain fog, breathlessness, chest pain, joint pain, anosmia.
• Recognized as Berufskrankheit (occupational disease) for healthcare workers in 2021.
• For Long-COVID, Krankengeld can be received for the full 78 weeks if doctor confirms ongoing impairment.

Migrant workers and mental health:

• Migration-related stressors (cultural adjustment, language barrier, family separation, war trauma) increase risk of depression and anxiety.
• Many Krankenkassen now offer psychotherapy in multiple languages (Turkish, Polish, Arabic, Russian, English) — ask your Krankenkasse for the list.
• Refugee-specific trauma centers (BzFO Berlin, REFUGIO Munich, XENION Berlin) provide specialized care.
• Long-term Krankengeld for psychological illness in migrant workers often leads to recommendation for cultural mediator (Migrationsberater) involvement in BEM.

Practical advice:

1. Don't hide psychological symptoms from your doctor — they directly affect Krankengeld eligibility.
2. Request a thorough Long-COVID assessment if you had COVID-19 and have persistent symptoms.
3. Krankenkasse may request you participate in rehabilitation (Reha) — accept this, as Reha is fully covered and helps recovery.
4. If the illness persists, plan for EM-Rente application 3-6 months before the 78-week cap.
5. For psychological illness, gradual return-to-work via Wiedereingliederung is often more sustainable than abrupt return.