Service Finder
Applying for sickness benefit for self-employed persons in statutory health insurance
Service Description
If you are self-employed and insured with a statutory health insurance fund, you are not entitled to sickness benefit. This means that if you are unable to work for a longer period of time for health reasons, you will not receive any money from your health insurance fund.
If you would like to have such additional cover and be entitled to sickness benefit, you must inform your health insurance fund of this in writing. This written notification is also called a "declaration of choice".
If you submit a declaration of choice to your health insurance fund, you will pay a slightly higher contribution to statutory health insurance, which also includes the entitlement to sickness benefit. You are entitled to statutory sickness benefit from the 43rd day of incapacity for work.
The amount of sickness benefit is generally 70 percent of your income from work over the past 12 months. This refers to the income on which your health insurance fund has based the assessment of your insurance contribution.
If you have opted for an optional declaration and wish to receive sickness benefit from your health insurance fund in a specific case, you must note the following:
- Entitlement to sickness benefit only arises from the 7th week of incapacity for work in each case.
- If you are ill, you must submit a sick note to your health insurance fund within 1 week in order to receive sickness benefit.
During the period in which you receive sickness benefit, you may still have to pay contributions to your long-term care insurance, health insurance and social insurance:
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If you receive sickness benefit, you do not have to pay health insurance contributions for the earnings replacement benefit. However, if you are compulsorily insured for pension, unemployment or long-term care insurance, you must continue to pay these contributions during your sick leave.
Process flow
You can submit the application for statutory sickness benefit (declaration of choice) in writing or - in the case of many statutory health insurance funds - in person at the office or online.
- Submit the application informally. This means that you must inform your health insurance fund in your own words that you want to increase your contribution rate in order to receive sickness or maternity benefit.
- Some statutory health insurance funds offer you forms for declaring your choice.
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Your health insurance fund will confirm receipt of your letter or form and your future entitlement to sickness or maternity benefit.
Requirements
- The declaration of election is only valid for a future case of illness.
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If you are unable to work at the time of submitting the application or if you become unable to work between the day you submit the application and the day it takes effect, the application will take effect from the day on which you are able to work again.
Which documents are required?
- Income tax assessment
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In special cases, further documents may be required. Please contact your health insurance company for more information.
What are the fees?
You do not have to pay anything for the processing of your election declaration.
What deadlines do I have to pay attention to?
- The declaration of choice can be submitted to your health insurance fund at any time. Entitlement to sickness benefit begins at the start of membership of your health insurance fund when you submit the declaration of election with your membership application.
- The declaration of choice is valid for 3 years.
- If you do not cancel the relevant tariff before the 3 years have expired, it will be extended by 12 months.
- You cannot cancel your declaration of choice even if you change health insurer.
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It is not possible to switch to private health insurance during the 3-year period.
Processing duration
Processing normally takes 3 to 7 working days.
Your health insurance company must have the necessary information and any required documents in a complete and meaningful form in order to process and decide quickly.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
Legal basis
Applications / forms
- Contradiction.
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Action before the social court
Appeal
- Forms: yes
- Online procedure possible: Many statutory health insurance companies offer an online procedure.
- Written form required: yes
- Personal appearance necessary: no
What else should I know?
If you have health insurance through the Künstlersozialkasse (KSK), you are automatically entitled to sick pay.
The various health insurance funds offer different optional tariffs with which you can already receive sickness benefit before the 43rd week. For more information, please contact your statutory health insurance fund.
Author
The text was automatically translated based on the German content.
- Sickness benefit for self-employed persons (declaration of choice) Approval
Remark: Display of performance in the source portal
Technically approved by
Federal Ministry of Health
Professionally released on
30.11.2021
Source: Zuständigkeitsfinder Thüringen (Linie6PLus)