Information - Services - Formalities by subjects - Insurances - Insurances for self-employed and dependents - Sickness benefit in the statutory health insurance; application for self-employed persons - Dienstleistungsportal Bayern

Description

If you are self-employed and insured in a statutory health insurance fund, you are not entitled to sick pay. This means that if you cannot work for a longer period of time due to health reasons, you will not receive any money from your health insurance fund.

If you wish to have such additional coverage and be entitled to sick pay, you must notify your health insurance company in writing. This written notification is also called an "election declaration."

If you submit an election declaration to your health insurance company, you will pay a slightly higher contribution to the statutory health insurance, which also includes the entitlement to sick pay. The entitlement to statutory sickness benefit starts on the 43rd day of incapacity for work.

The amount of sick pay is usually 70 percent of your earned income for the past 12 months. This means the income on which your health insurance fund based the determination of your insurance contribution.

If you have opted for an optional declaration and want to receive sick pay from your health insurance fund in a specific case, you must bear the following in mind:

• The 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 company within 1 week in order to receive sick pay.

During the time you are receiving sick pay, they may have to continue to pay contributions to your long-term care insurance, health insurance, and your social security:

• If you are receiving sick pay, you do not have to pay health insurance contributions for the earnings replacement benefit. However, if you are compulsorily insured under pension, unemployment or long-term care insurance, you must continue to pay these contributions while you are on sick leave.
  

Prerequisites

• The declaration of election only applies to a case of illness occurring in the future.
• If you are incapacitated for work at the time of submitting the application or if the incapacity for work occurs between the date of submission and the effective date of the application, the application shall take effect from the date on which you are again capable of work.
  

Procedure

You can submit the application for statutory sick pay (declaration of election) in writing and - for many statutory health insurance funds - in person at the office or online.

• Make the application informally. This means you must tell your health insurance company in your own words that you want to increase your contribution rate in order to receive sickness or maternity benefits.
• Some public health insurers offer you forms for declaring your choice.
• Your health insurance fund will confirm receipt of your letter or the form and your future entitlement to sickness or maternity benefits.
  

Special notes

If you have health insurance through the Künstlersozialkasse (KSK), you are automatically entitled to sick pay.
The various health insurance companies offer different optional tariffs that allow you to receive sick pay before the 43rd week. For more information, please contact your statutory health insurance fund.

Deadlines

• The declaration of election can be submitted to your health insurance fund at any time. Entitlement to sickness benefits begins at the start of membership in your health insurance fund when you submit the declaration of election with your membership application.
• The declaration of election is valid for 3 years.
• If you do not cancel the corresponding plan before the end of the 3 years, it will be renewed for 12 months.
• You cannot cancel your declaration of election even if you change health insurers.
• It is not possible to switch to private health insurance during the 3 years.
  

Processing time

Processing usually takes 3 to 7 working days.

For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
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 indicated is an average value for all health insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your health insurer by mail.

Required documents

• Required Documents
  • Einkommenssteuerbescheid
  • In Spezialfällen können weitere Unterlagen erforderlich sein. Bitte informieren Sie sich dazu bei Ihrer Krankenkasse.
     

Forms

• Form, Bavaria-wide: Zum Antrag einer Wahlerklärung über den Kassen-Navigator des GKV-Spitzenverbands

  Please note

  This form has to be signed and sent to the responsible authority. You can sign the form manually and send it by email/fax or sign the form electronically with your qualified electronic signature an send it by (secure) email. If the responsible authority has set up a De-Mail account, you can also send the form by De-Mail using an sender-confirmed message.

Fees

• You do not have to pay anything for the processing of your election declaration.

Legal bases

• § 44 Absatz 2 Satz 1 Nummer 2 Fünftes Buch Sozialgesetzbuch (SGB V)
• § 46 Satz 4 Fünftes Buch Sozialgesetzbuch (SGB V)

Remedy

• Opposition.
• Action before the Social Court
  

Links to more information

• Informationen zu Krankengeld auf der Internetseite des Bundesministeriums für Gesundheit