Sickness benefit in Germany: when it starts, stops and runs out

Last checked against the official sources: 29 August 2026

Sickness benefit replaces your wage once the six weeks of employer-paid continuation end. Most people who lose it do not lose it by running out of time — they lose it through a one-day gap between two certificates. The statute ties the survival of the entitlement to the date of the next medical determination, and expressly excludes Saturdays from working days. That single detail decides whole cases.

The start: the day of determination, not the day of illness

§ 46 fixes the starting point precisely. For inpatient treatment at the fund’s expense, the entitlement arises from the start of that treatment. Otherwise it arises from the day incapacity for work is medically determined.

The difference is heavy in practice: fall ill on Monday and see the doctor on Wednesday, and the entitlement begins Wednesday. The two earlier days are not counted. Postponing the appointment — however reasonably — costs days that cannot be recovered.

The gap that ends the entitlement — and Saturdays

This is the provision that defeats most claims, and it sits in the second sentence of § 46.

The entitlement survives until the day further incapacity for the same illness is medically determined — if that determination is made at the latest on the next working day after the end of the last certified period. Then comes the decisive clause: “Saturdays do not count as working days for this purpose.”

Translated into real life: if your certificate ends on a Friday, Saturday is not a working day and neither is Sunday — so Monday is the next working day, and seeing the doctor then preserves the chain. But if it ends on a Tuesday and you renew only on Thursday, the chain is broken.

The practical rule: renew before the certificate expires, not after. The statute gives you exactly one day of margin, and it is counted in working days, not calendar days.

78 weeks — and how they are actually counted

§ 48 says the insured receive sickness benefit without a time limit, then imposes the real constraint: for the same illness, at most seventy-eight weeks within any three years, counted from the day the incapacity began.

Three points are routinely misread:

• The three years are a rolling window starting on the first day of incapacity, not on 1 January.
• A further illness does not extend the period. If a second illness arises during the incapacity, the duration stays as it was — that is the express second sentence.
• Suspended periods count as if paid. Paragraph 3 provides that times when the entitlement is suspended, or the benefit is withheld, are treated as periods of receipt when the duration is calculated.

The first six weeks are normally paid by the employer rather than the fund, but they fall inside the seventy-eight because the count starts from the day incapacity began.

After the period ends: when a new claim arises

Paragraph 2 opens a way back, on narrow terms. Anyone who has drawn sickness benefit for seventy-eight weeks for the same illness in the last three-year period acquires a new entitlement for that same illness once a new three-year period begins — on three cumulative conditions:

1. Insured with an entitlement to sickness benefit when the new incapacity arises.
2. Not incapacitated by that illness for at least six months in the meantime.
3. Gainfully employed or available to the employment service during those six months.

The second and third conditions operate together over the same period: six months free of that illness and simultaneously working or available for work.

Who has no claim — and who can opt in

§ 44(2) excludes whole groups. The ones that matter in practice:

• Family-insured persons under § 10 — spouses and children covered free of charge. Full medical cover, but no sickness benefit.
• Students, participants in certain programmes, basic-security recipients and the other numbered groups.
• The main-occupation self-employed — unless they declare to their fund that the membership is to include the entitlement (the election).
• And employees who have no entitlement to at least six weeks of continued pay — under the Continued Remuneration Act, a collective agreement, a works agreement or a contractual promise — unless they likewise make an election.

That last group covers a great many short and flexible contracts. The election is the statutory way out: a declaration to the fund that membership includes sickness benefit — a decision made before the illness, never after.

Frequently asked questions

When does sickness benefit start?

From the day incapacity for work is medically determined, not from the day the illness began. For inpatient treatment, from the start of that treatment.

My certificate ends on Friday — when must I renew?

The determination must be made at the latest on the next working day, and Saturdays do not count, so that is Monday. Safer still is to renew before the certificate expires.

How long does it last?

At most 78 weeks within any three years for the same illness, counted from the day incapacity began. A further illness arising during the incapacity does not extend it.

Do family-insured people get sickness benefit?

No. Those insured under § 10 are expressly excluded; treatment is fully covered but there is no sickness benefit.

I am self-employed — do I have a claim?

Not by default, only if you file an election with your fund stating that your membership includes sickness benefit. That decision is made before the illness.