What you live on when illness outlasts six weeks

When you fall ill in Germany and cannot work for more than six weeks, your employer's legal obligation to pay your full salary ends. At that point, your statutory health insurer (Krankenkasse) takes over with a benefit called Krankengeld—sickness benefit. Understanding how Krankengeld works, what it covers, and how long you can receive it is crucial for managing your finances during a prolonged illness. This guide explains the rules, amounts, and important eligibility requirements.

The Two-Phase Sick Pay System in Germany

Germany's sick pay system operates in two distinct phases. During the first six weeks of illness for any given condition, your employer must continue paying your full regular gross salary. This is called Entgeltfortzahlung (continued pay)—a legal requirement under the Entgeltfortzahlungsgesetz, the Continued Remuneration Act. Your employer pays directly, and your health insurance does not contribute at all during this period. If you recover, return to work, and then fall ill with the same condition within three years but with fewer than six months of full work in between, the employer still pays, but the payment counts toward your overall 78-week entitlement. If you develop a completely different illness, a fresh six-week period begins independently from your employer.

After those six weeks end, if you are still unable to work, your Krankenkasse takes over. This is when Krankengeld begins. Unlike the employer's full-pay obligation, Krankengeld is a reduced income-replacement benefit. The health insurance fund—not your employer—pays directly to you for up to 72 additional weeks (totaling 78 weeks across both phases) for the same illness within any three-year period.

How Much Krankengeld You Receive

The Calculation Formula

Krankengeld is calculated using a formula with two alternative limits, and the lower amount wins. Your payment is the lower of: 70% of your gross regular salary, or 90% of your net salary. In practice, the 90% of net figure usually becomes the binding limit for most employees, which offers slightly more protection than the 70% gross calculation.

The Krankenkasse calculates your base salary using your income from the preceding three months, averaged across working days. If you received bonuses, holiday pay, or one-time payments (Einmalzahlungen) in the 12 months before your illness began, these can increase your average and thus your Krankengeld amount. However, an absolute cap exists: Krankengeld is never more than 70% of the annual Beitragsbemessungsgrenze, the contribution assessment ceiling. In 2026, this ceiling is €5,812.50 per month, meaning the maximum daily Krankengeld is approximately €135.63, or roughly €4,069 per month gross.

What Happens to Your Krankengeld After Deductions

Important: even though Krankengeld is calculated on a gross basis, it is not the gross amount you receive. Social insurance contributions are deducted from your Krankengeld. Specifically, you pay employee contributions for pension insurance, unemployment insurance, and long-term care insurance (Pflegeversicherung). However, unlike regular salary, no health insurance contribution is deducted—the health insurer pays the benefit without reducing it further for its own costs. These deductions typically reduce your net Krankengeld by roughly 10–12% from the gross figure.

Maximum Duration: 78 Weeks Within Three Years

You can receive Krankengeld for a maximum of 78 weeks within any rolling three-year period, all for the same illness. Note that the first six weeks paid by your employer count toward this 78-week total—you do not get an additional 78 weeks on top of the employer period. This means the total income-protected sick leave for one condition is effectively up to 78 weeks (or approximately 18 months), combining both phases: six weeks from your employer at full pay and up to 72 weeks from the health insurer at Krankengeld rates.

The three-year clock resets and a new count begins if you are back at work for at least six months, or if 12 months have passed since the first day of illness for that condition. If you fall ill with a completely different diagnosis, those weeks count separately toward a new 78-week limit, allowing you dual protection for multiple unrelated conditions within a three-year span.

Eligibility Requirements

To qualify for Krankengeld, you must meet several conditions. You must be employed and actively contributing to Germany's statutory health insurance system (gesetzliche Krankenversicherung or GKV). You must hold a valid work permit or residence permit that authorizes employment in Germany. You must be unable to work due to illness—confirmed by a medical certificate from a doctor—and you must have been employed with your current employer for at least four calendar weeks. You must remain employed throughout your sickness period; your employment contract cannot be terminated while you are receiving Krankengeld. Additionally, your Krankenkasse may request that you attend medical examinations to verify your continued incapacity for work.

If you are in your first four weeks of employment with a new employer, you do not receive the employer's full six-week continued pay. Instead, your health insurer pays Krankengeld from day one at the standard reduced rate (70% gross / 90% net) if you fall ill during that probationary period. After four weeks, the standard rules apply.

What You Must Do: Documentation and Timing

On the first day you are unable to work, you must notify your employer of your illness, usually by phone or email before your shift begins. You do not need to disclose your diagnosis or specific medical details to your employer. However, you should let them know how long you expect to be absent if you can estimate it.

A doctor's certificate (AU-Bescheinigung or Krankschreibung) is required. Most employers expect one by the third or fourth day of absence, though your employment contract may require one from day one (especially during probation). Your doctor typically issues this certificate on your first medical visit. Since January 2023, the certificate is issued electronically (eAU) and transmitted directly by your doctor to both your Krankenkasse and your employer; you should not need to carry a paper form. However, check with your doctor or insurer about submission procedures, as some practices still provide paper copies if requested. If you become ill on a weekend or after hours, you can obtain a retroactive certificate within three days of the illness start if medically documented.

Special Case: Self-Employed and Freelancers in the GKV

If you are self-employed (Selbstständige) or a freelancer and you are insured in the statutory health insurance system (GKV)—either because you chose it or because you remained in it after transitioning from employment—Krankengeld rules differ significantly from salaried employees. Unlike employees, you do not receive employer-paid sick pay because there is no employer. Instead, self-employed members face a gap: if you choose to pay the standard GKV contribution rate, you do not automatically receive Krankengeld. Payment begins only from the 43rd day of illness (week seven and beyond) at the standard 70% of income rate, capped at the Beitragsbemessungsgrenze. This six-week income loss can be devastating for a self-employed person.

To bridge this gap and cover earlier illness, self-employed members can opt for a Wahltarif (optional higher tariff), an enhancement that raises your GKV contribution by approximately 0.6 percentage points. With this tariff, you can receive Krankengeld starting as early as day 15, day 22, or day 43 of illness, depending on which specific option you select. The tariff ends at day 78 of illness. Beginning from day 43 onward, you receive the regular 70% of income benefit. However, Wahltarife come with significant conditions: once you enroll, you are locked into your chosen Krankenkasse and tariff for a minimum of three years, and you cannot switch to another insurer or private insurance during that period. A three-month waiting period typically applies after enrollment, meaning illnesses occurring during that window are not covered. You should carefully compare available Wahltarife across different Krankenkassen and assess your own income stability before committing.

An alternative for self-employed individuals is to take out private Krankentagegeld (daily sickness allowance) insurance in addition to GKV membership, which offers more flexibility than Wahltarife, with no long-term lock-in and no waiting periods once the policy is active. Comparing all three options—accepting the six-week gap, enrolling in a Wahltarif, or purchasing supplemental private insurance—is essential to your financial security.

If You Have Private Health Insurance

If you hold private health insurance (private Krankenversicherung or PKV), Krankengeld is not automatically included. Whether you receive any sickness benefit beyond the employer's six weeks depends entirely on your individual policy. Some private insurers include a Krankentagegeld (daily sickness allowance) component, while others require you to purchase it separately or do not offer it at all. You must review your policy documents carefully or contact your insurer to confirm whether you have coverage and what the terms are. If you lack Krantentagegeld coverage and fall ill after six weeks, you face a complete loss of income unless your employer voluntarily supplements you. Many expats with private insurance discover this gap only when they become ill, so clarifying your coverage status before sickness occurs is critical.

What Happens After 78 Weeks

Once you have exhausted 78 weeks of Krankengeld within a three-year period for the same illness and you are still unable to work, Krankengeld payments stop. At this point, you must apply for disability benefits. Contact the Agentur für Arbeit (Federal Employment Agency) or your local Sozialamt (social welfare office) to explore options. Depending on your situation, you may qualify for unemployment benefits for those with reduced earning capacity (Arbeitslosengeld bei Arbeitsunfähigkeit) or, if your incapacity is permanent or long-term, a disability pension (Erwerbsminderungsrente). Eligibility for a disability pension typically requires that you have made sufficient contributions to the German public pension system (usually at least 60 months of contributions). Each option involves different income levels and qualifying procedures, so seek professional advice or contact your local employment agency early to understand your options.

Key Reminders for Expats

Krankengeld requires active membership in the GKV at the time you fall ill. If you have lapsed your health insurance contributions or are not enrolled in any statutory insurance, you will not be eligible when illness strikes. Ensure your Krankenversicherung is always current and your employer is correctly reporting your income to your insurer.

Different illnesses are counted separately. If you fall ill with flu in January and recover, then develop a broken arm in March, each condition begins its own six-week employer period and its own 78-week Krankengeld window. You do not combine or deplete a shared annual allowance.

Krankengeld is taxable income and counts toward your annual tax filing, although typically your insurer handles withholding. However, when you file your Steuererklärung (tax return) with the Finanzamt (tax authority), ensure Krankengeld received is correctly reported.