Daily sickness allowance

from Wikipedia, the free encyclopedia

The daily sickness -Versicherung in Germany is a voluntary supplementary insurance for employees, freelancers and self-employed . In the event of illness, such insurance can compensate for or reduce possible loss of income. It is a sum insurance in which the insurance benefit is not based on a specific damage to be calculated (as in the case of damage insurance ), but is previously agreed abstractly at a certain amount.

Insurance needs

As in the other areas of private health insurance, the insured event in private daily sickness allowance insurance requires medically necessary treatment due to illness or accident, in the course of which the insured person becomes unable to work (Section 192 (1) and ( 5) of the Insurance Contract Act (VVG)). There must be complete incapacity for work and a (dental) medical diagnosis. An activity in the context of professional reintegration according to Section 74 of the Social Security Code V can also lead to the loss of insurance benefits from the private daily sickness allowance insurance. The medical assessment must document that the insured person is not able to carry out their specific job in any way (only the “yellow slip” is not sufficient). If the insured person can carry out individual professional activities that do not make sense in isolation, the insurer's obligation to provide benefits does not apply. Since people with statutory health insurance usually receive sick pay , those with private health insurance tend to fall back on the daily sickness allowance . Above all, self-employed persons who have neither agreed on sick pay nor receive statutory sick pay, secure their workforce. The same applies to employees who do not receive sick pay and who do not want to forego income security after six weeks of continued wage payments. For employees with statutory health insurance, a private supplement usually only closes small gaps in care. If a self-employed person only insures the lost profit and not the lost sales with his daily sickness allowance insurance, he still has a considerable economic risk, especially with a high expense ratio, which can endanger his existence.

Change in the law in the area of ​​daily sickness allowance insurance for pregnant women on April 1, 2017

The amendment to the law relates to Section 192 sentence 5 of the VVG and was rectified by the Bundestag on February 16, 2017 (printed matter 18/11205).

The insurance companies that offer daily sickness allowance insurance are obliged from April 1, 2017 to compensate the loss of earnings that occurs during the protection periods according to § 3 Paragraph 2 and § 6 Paragraph 1 of the Maternity Protection Act and on the day of childbirth with the agreed daily sickness allowance, insofar as the insured person Person is not entitled to any other reasonable compensation for the loss of earnings caused during this time.

This passage presupposes the existence of a private daily sickness allowance insurance.

The private health insurance association must now adapt the model conditions and expand the individual tariff conditions. Regardless of the change in conditions, as of April 1, 2017, all women with private daily sickness benefit insurance have a corresponding benefit obligation. It also exists if the conditions have not been adapted to the legal situation by then.

Prohibition of enrichment

The daily sickness allowance may, in accordance with the commonly used general insurance conditions (see Section 4 (2) of the 2009 model conditions for daily sickness allowance insurance of the Association of Private Health Insurance), together with other daily sickness and sickness allowances (e.g. injury allowance , transition allowance ) converted to the calendar day , do not exceed the net income resulting from the professional activity . The calculation of the net income is based on the average earnings of the last 12 months before the application or before the incapacity for work . This prohibition of enrichment does not find a corresponding basis in the law, since § 200 VVG applies to damage insurance, but not to sum insurance. The applicability of this clause is controversial. The Federal Court of Justice has not yet issued a decision on this. In addition, the fact that injury benefits can be offset, leading to a reduction in insurance benefits, is largely considered to be unlawful. According to Section 4 (3) of the 2009 model terms and conditions, the insured person is also obliged to notify the insurer immediately of any not just temporary reduction in net income resulting from professional activity so that the insurer can exercise his right to adjust. It is predominantly assumed that the insurer only has a right to adjust for the future and that insurance benefits above the net income do not automatically entitle the insurer to reduce the insurance benefits to the net income.

Regulation of waiting periods

The actual daily sickness allowance, the amount of benefits granted by the insurer per day depending on the contract , is not paid to the insured person from the occurrence of the insured event , but only after a waiting period has expired , during which there is no entitlement to benefits. In the case of employees , the waiting period is usually 42 days and thus excludes drawing benefits while the statutory wage is still being paid. In contrast to this, self-employed persons can agree to the daily sickness allowance with many providers from the fourth day of sickness.

Differentiation from sick pay

The sickness benefit , the corresponding benefit of the statutory health insurance , is not an additional insurance for those with compulsory insurance, but a statutory standard benefit and is therefore paid for with the normal contributions. However, since August 1, 2009, people with voluntary health insurance have to take out an optional tariff in order to be entitled to sickness benefit. Otherwise such members only have to pay a reduced contribution rate.

Ratings for daily sickness allowance insurance

The magazine Finanztest published a test of daily sickness benefits insurance for the first time in the July 2013 issue. Since the amount of sickness benefit from statutory health insurance is limited to a maximum of 2756.25 euros per month (as of July 2013), appropriate supplementary insurance is only worthwhile for employees with a gross monthly income of over 4000 euros, is the conclusion of the financial test. The price range of the 30 checked tariffs was between eight and 20 euros per month. Two offers failed in the test with poor, eight were rated good.

See also

Web links

Individual evidence

  1. ^ BGH judgment of April 4, 2013 - IV ZR 239/11, VersR 2013, 615.
  2. ↑ Calculate the maximum daily sickness allowance. ( Memento of the original of July 23, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. on optimal-vergleich.de. @1@ 2Template: Webachiv / IABot / www.optimal-vergleich.de
  3. ↑ Printed matter 18/11205 (PDF) German Bundestag. Retrieved June 24, 2019.
  4. ↑  Compare daily sickness allowance supplementary insurance at ACIO.de
  5. ↑ Sick pay for the self-employed. on akademie.de.
  6. ^ Stiftung Warentest: Test of daily sickness benefits insurance. In: Finanztest. 07/2013, pp. 70–80 and test.de of July 9, 2013.