When your employer’s six weeks of continued pay run out, your statutory health insurance fund takes over with Krankengeld — roughly 70% of your gross pay, capped at 90% of your net, for up to 78 weeks per illness (§ 44 SGB V). For anyone facing a longer illness in Germany, Krankengeld is the financial backbone — and the traps are procedural: a one-day gap in sick notes, a missed deadline in a fund letter, or an unprepared „Aussteuerung” at week 78 can each cost months of income.
When Krankengeld starts
Krankengeld is a benefit of the statutory health insurance system for members insured with sick-pay entitlement — the normal employee. The entitlement legally arises on the day your incapacity is medically determined (§ 46 SGB V), but while the employer still owes Entgeltfortzahlung, the claim „rests” (§ 49 SGB V). In the standard case it therefore begins in week seven, seamlessly after the employer’s six weeks end. It applies earlier where no employer payment is due — during the four-week waiting period in a new job, for instance, or when the six-week pot for a recurring illness is exhausted.
Crucially, Krankengeld does not depend on the employment continuing: if you are dismissed while ill, the fund keeps paying as long as the incapacity persists and is certified. A dismissal during illness is itself frequently attackable — see termination while on sick leave.
How much you receive
The statutory formula (§ 47 SGB V) works per calendar day and takes the lower of two values:
- 70% of your regular gross pay (calculated from the last billing period, divided by 30), and
- 90% of your regular net pay.
For most employees the 90%-of-net cap bites. From this gross Krankengeld, your share of pension, unemployment and long-term care contributions is deducted — typically a little over 12% — while health insurance itself is contribution-free during receipt. The practical rule of thumb: expect roughly 75–80% of your previous net pay. Krankengeld is tax-free but subject to Progressionsvorbehalt — it raises the tax rate on your other income for that year, which can produce a back payment at tax time. High earners hit a ceiling: pay above the contribution assessment limit is ignored, capping Krankengeld at a statutory maximum of approximately €135 per calendar day (2026 figure).
How long: 78 weeks — including the employer’s six
Krankengeld for the same illness is limited to 78 weeks within a three-year block period (Blockfrist), counted from the first day of incapacity for that illness. Two points routinely surprise clients:
- The employer’s six weeks count toward the 78. You therefore receive at most 72 weeks of actual Krankengeld payments per illness within the block.
- Additional illnesses during an ongoing incapacity do not extend the clock. If a second condition joins while you are already unfit, the 78 weeks keep running on the combined case.
A genuinely new, unrelated illness after a period of fitness starts its own 78-week entitlement. And once a three-year block expires, the same illness can found a fresh entitlement in the next block — but only if, in the meantime, you were at least six months free of incapacity for that condition and were working or available for work (§ 48 SGB V).
Keeping the entitlement alive
Most Krankengeld losses we see are self-inflicted through formalities, not medicine:
- Seamless certification. Your follow-up certificate must be issued at the latest on the next working day after the previous one expires (§ 46 SGB V). A gap can end the entitlement — and with it, in the worst case, your insured status. Book the follow-up appointment before the current note runs out.
- Duties to cooperate (§§ 60 ff. SGB I). Attend Medizinischer Dienst examinations, answer the fund’s questionnaires, and respond to letters. Non-cooperation lets the fund suspend payments.
- The § 51 SGB V letter. The fund may set you a 10-week deadline to apply for medical rehabilitation. Ignore it and Krankengeld stops. Comply carelessly and the rehab application can later convert, by legal fiction, into an application for a reduced-earning-capacity pension (Erwerbsminderungsrente) — a potentially drastic and largely irreversible status change. This letter should never be answered without advice.
Week 78: Aussteuerung and the bridge into ALG
When the 78 weeks are exhausted, you are „ausgesteuert”: Krankengeld ends even if you are still unfit for work. The safety net is the Nahtlosigkeitsregelung (§ 145 SGB III): the Agentur für Arbeit pays unemployment benefit (ALG I) despite your continuing incapacity, as long as your reduced earning capacity has not been formally established by the pension insurance. This bridge only works if you prepare it:
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Track the 78-week clock
Your fund will tell you the projected Aussteuerung date on request. Note it early — everything else keys off this date.
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Register with the Agentur für Arbeit about 3 months ahead
Contact the Agentur für Arbeit roughly three months before Aussteuerung and apply for ALG under § 145 SGB III. Late registration risks benefit gaps.
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Clarify the pension question deliberately
The Agentur will typically ask you to have your earning capacity assessed. Whether and when an Erwerbsminderungsrente application makes sense is a strategic decision — take advice first.
If your employment ended during the illness, remember that vacation not taken because of sickness must still be paid out — see vacation payout on termination. And if anyone suggests you sign a termination agreement while on Krankengeld, be careful: beyond the usual severance questions, a voluntary exit can trigger a benefits Sperrzeit and complicate the Nahtlosigkeit bridge.
Privately insured: Krankentagegeld is a different animal
Private health insurance has no statutory Krankengeld. Instead, you have — only if you bought it — a contractual daily sickness allowance (Krankentagegeld): a fixed euro amount per day, starting on the day agreed in your policy (ideally day 43, matching the end of employer pay). No 70%/90% formula, no 78-week logic — the policy terms govern. The classic trap: Krankentagegeld ends when the insurer deems you not merely sick but occupationally disabled (berufsunfähig), which can abruptly cut income if no disability cover is in place. Review your policy terms early.
Worked example
Project manager in Cologne, gross €4,800 per month, net €3,000, statutorily insured. Burnout diagnosis; unfit for work from 1 February.
- Weeks 1–6: employer continues the full €4,800 gross per month.
- From week 7: Krankengeld. 70% of gross: €4,800 ÷ 30 = €160/day → €112.00. 90% of net: €3,000 ÷ 30 = €100/day → €90.00. The lower value applies: €90.00 per calendar day. After deducting his contribution share (about 12%), roughly €79 net per day, i.e. about €2,380 per month — approximately 79% of his previous net.
- Month 14: the fund sends a § 51 SGB V letter. With advice, he applies for psychosomatic rehab in a way that preserves his position; the rehab improves matters but he remains unfit.
- Month 16: three months before the projected Aussteuerung (78 weeks from 1 February of the previous year), he registers with the Agentur für Arbeit. At Aussteuerung, ALG I under § 145 SGB III follows seamlessly at roughly €1,900 per month.
Total received during 72 weeks of Krankengeld: about €39,700 — money that would have been at risk at several points had a sick note lapsed or the § 51 deadline passed.
Frequently asked questions
Does Krankengeld continue if my employment ends while I am sick?
Yes. As long as the incapacity persists, is seamlessly certified and the 78 weeks are not exhausted, the fund keeps paying after the employment ends. Membership continues by operation of law during receipt. The end of the job does not end the benefit.
Do I accrue pension entitlements while on Krankengeld?
Yes. The fund pays pension, unemployment and care contributions from the benefit (that is what the ~12% deduction funds), so the period counts toward your pension record — at a reduced assessment basis.
Can I travel while receiving Krankengeld?
Within Germany, generally yes, if it does not impede recovery. Abroad requires the fund’s prior consent — leaving without it can suspend the benefit (§ 16 SGB V). Ask in writing first.
What happens if there is a gap between two sick notes?
A gap can be fatal: the entitlement may end, and re-establishing it is often impossible once the insured status has changed. If a gap has occurred, take advice immediately — depending on the facts (weekends, fund errors, doctor unavailability), some gaps are curable.
Is Krankengeld really tax-free?
It is paid without tax deduction, but it is subject to Progressionsvorbehalt: it increases the tax rate applied to your other income in that year. Couples filing jointly in particular should expect a possible back payment and may want to adjust prepayments.