Krankengeld für Krankenversicherte Gewährung bei Erkrankung des Kindes

If you are unable to work due to your child's illness, you can receive child sickness benefit from your statutory health insurance fund. Under certain conditions, you can transfer the child sickness benefit days to your partner.

You receive child sickness benefit as compensation for lost wages if you

• are covered by statutory health insurance,
• are entitled to sickness benefit,
• your child has statutory health insurance, is ill and is under 12 years old,
• have no other person in the household who can look after the child,
• have to supervise, look after or care for your child and are therefore unable to work,
• are released from work by your employer and do not receive continued payment of wages (no paid leave of absence).

For parents of children with disabilities who are dependent on help, the age limit of 12 years does not apply.

You can apply for child sickness benefit from your statutory health insurance fund. To do this, you must submit the so-called child sickness certificate (sample 21).

Children's sickness benefit is generally 90 percent of your lost net salary. If you received one-off payments from your employer in the year before the child fell ill (e.g. Christmas bonus), the child sickness benefit is 100 percent of the lost net salary. For self-employed persons whose main occupation is self-employment, children's sickness benefit is paid in the amount of the sickness benefit in the event of your own incapacity to work. Due to the statutory contribution assessment ceiling, the maximum amount of children's sickness benefit is capped.

Children's sick pay is subject to social insurance contributions. This means that your health insurance fund automatically deducts nursing care, pension and unemployment insurance contributions. Health insurance contributions are not due.

You can claim

• 10 working days of child sickness benefit per child per year
• If you are a single parent, your entitlement increases to 20 working days.
• If you have 3 or more children, you can receive up to 25 working days of child sickness benefit per year; single parents can receive up to 50 working days.

Due to the COVID-19 pandemic, the number of working days on which you can receive child sickness benefit has been increased and is 2021:

• 1 child: maximum 30 working days, single parents maximum 60 working days;
• 2 children: maximum 60 working days, single parents maximum 120 working days;
• 3 or more children: maximum 65 working days, single parents maximum 130 working days.

Due to the coronavirus pandemic, you can also apply for child sickness benefit in 2021 if you have to look after your child at home due to

• an official school or daycare center closure due to the pandemic,
• officially ordered or extended company or school vacations,
• suspension of compulsory attendance at school,
• other pandemic-related restrictions on childcare services for your child,
• quarantine of your child (entry ban) or
• an official recommendation that your child should not attend daycare or school.

You must provide your health insurance company with proof of one of the reasons. Your health insurance company can request a certificate from the daycare center or school.

If your employer gives you paid leave from work, this time will count towards your entitlement to child sickness benefit. This means that your entitlement to child sickness benefit is suspended for as long as your employer gives you paid leave. For example, if your employer has continued to pay you your net salary for 5 days, you will still be entitled to child sickness benefit for 5 working days of your maximum entitlement to child sickness benefit of up to 10 working days per year (1 child).

If you have already used up your maximum number of days of child sickness benefit, it may be possible for your partner to transfer the days of child sickness benefit to you. You must also submit an application to your health insurance fund for this. Your employer must also be prepared to give you another period of unpaid leave.

If your child is seriously ill and under 12 years old or disabled and dependent on help, you will receive child sickness benefit for an unlimited period. You must also meet the following requirements:

• You and your child have statutory health insurance,
• You are entitled to sickness benefit,
• Your child must be supervised, looked after or cared for by you due to a fatal illness, which is why you are unable to work,
• your child's illness must have already reached an advanced stage, require palliative medical treatment or you or your partner wish to receive this treatment and the illness must lead to a limited life expectancy of weeks or a few months,
• You are on leave of absence from your employer and do not receive continued payment of salary (no paid leave of absence).

You must submit a certificate of your child's serious, fatal illness to your health insurance fund.

• Medical certificate about your child's illness and need for care ("child illness certificate", sample 21)
• In the case of seriously ill children, additionally if necessary:
• Medical certificate stating that your child is suffering from a serious, fatal illness
• In the case of children with disabilities, additionally if necessary:
• Medical certificate or, if applicable, proof that your child has a disability and is dependent on your help
• In the case of quarantine or closed care facilities due to the corona pandemic, if applicable
• Proof of the closure of a childcare facility, the ordering or extension of company or school vacations, the lifting of compulsory attendance at school, the restriction of childcare services, the ordering of a quarantine (ban on entering) or the official recommendation not to attend the childcare facility.

Please ask your health insurance provider whether proof is required.

• Your child is under 12 years old or has a disability and is dependent on help.
• Your child has been diagnosed with an illness and therefore requires care, supervision or nursing care.
• No other person in your household can look after the child.
• You and your child have statutory health insurance.
• You are employed and are entitled to sickness benefit.
• You are on unpaid leave from your employer.
• Even if you are self-employed and have statutory health insurance, you can receive child sickness benefit from the first day of your child's illness. The prerequisite for this is that you yourself are entitled to sickness benefit,

For seriously ill children:

• Your child is terminally ill and has a life expectancy of a few weeks or months.
• Your child's illness is already at an advanced stage and requires palliative medical treatment or you or your partner would like this treatment.
• Your child is under 12 years old or disabled and dependent on assistance.
• You and your child have statutory health insurance.
• You are employed and are entitled to sickness benefit.
• You are on unpaid leave from your employer.
• Even if you are self-employed and have statutory health insurance, you can receive child sickness benefit from the first day of your child's illness. The prerequisite for this is that you are entitled to sickness benefit yourself, for example via a so-called optional tariff with your health insurance fund.

For the transfer of children's sickness benefit days:

• Both you and your partner are covered by statutory health insurance.
• Both you and your partner are entitled to sick pay.
• Your employer has agreed to the transfer of the children's sick pay days. This means that your employer has agreed to give you additional days off.
  

You do not have to pay anything for the application.

You can submit the application for child sickness benefit and the application for the transfer of child sick days by post and - in the case of many statutory health insurance funds - in person at the office or online.
The procedure is normally as follows:

• You will receive a medical child sickness certificate (sample 21).
• Fill in the application form from your statutory health insurance fund. This can be found on the back of sample 21. If necessary, your health insurance company will request further information in a separate application.
• Submit the child sickness certificate (sample 21) together with any other necessary documents to your health insurance fund.
• Inform your employer about the child sickness certificate.
• The health insurance fund will check your application and transfer your child sickness benefit to you. For employees: Your health insurance fund will only pay your child sickness benefit after your employer has provided the health insurance fund with the necessary details of your lost net pay.
• Special regulation for childcare due to the corona pandemic:
• Complete the application form from your statutory health insurance fund.
• Enclose proof from the school or daycare center.
• Submit the application together with the proof and any other documents required to your health insurance company.
• The health insurance company will check your application and transfer your child sickness benefit to you. For employees: Your health insurance fund will only pay your child sickness benefit after your employer has provided the health insurance fund with the necessary information on your lost net pay
  

Processing normally takes around 4 to 9 working days.

In order to process and decide quickly, your health insurance fund must have the necessary information and any required documents in a complete and meaningful form.
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.

You should go to the doctor with your child as soon as possible - preferably on the first day of illness - to obtain the child sick note (sample 21) and inform your employer of your absence.

If you have private insurance and the other parent has statutory insurance, it depends on where the child is insured: If the child has statutory insurance, the parent with statutory insurance can apply for child sickness benefit.
If your child has an accident at school or daycare, you will receive child injury benefit from the accident insurance. This is usually calculated and paid by your health insurance fund on behalf of the relevant accident insurance provider.
If you are unemployed, the employment agency will continue to pay unemployment benefit for a limited period if you are unable to continue your job search due to the illness and the resulting need to care for your child.

• Objection
• Action before the social court
  

• Sickness benefit for sick children
• Application for child sickness benefit for mothers or fathers with statutory health insurance
• Prerequisite:
  • Parent is insured with entitlement to sickness benefit
  • Sick child has statutory health insurance, is under 12 years old or disabled and requires assistance
  • Medical certificate confirming the child's illness and the need for supervision, care or nursing of the child ("child sick note", so-called sample 21)
  • Parent is gainfully employed and cannot work due to the need to care for the sick child
  • No other person living in the household can look after the child
  • Employees are not entitled to paid leave from their employer
  • Corona special regulation 2021: Entitlement also exists if child must be cared for due to
    • official closure of the daycare center (Kita) or school due to the pandemic,
    • a quarantine of the child (ban on entering),
    • officially ordered or extended school or company vacations,
    • the lifting of compulsory attendance at a school or restriction of access to childcare facilities or
    • official recommendation not to attend the facility.
    • Health insurance company can request proof from the daycare center or school
• Amount:
  • Generally 90 percent of the lost net pay
  • For annual one-off payments from the employer (e.g. Christmas bonus): 100 percent of the lost net salary
  • Self-employed persons in their main occupation: children's sick pay in the amount of the sick pay in the event of their own incapacity to work
  • Health insurance company deducts social security contributions
  • Maximum amounts per day apply based on the statutory contribution assessment ceiling
  • Children's sickness benefit for seriously ill children: in the amount of the sickness benefit for own incapacity to work
• Maximum period of entitlement per calendar year:
  • For each parent: 10 working days per child, maximum 25 working days
  • Single parents: 20 working days per child, maximum 50 working days
  • Corona special regulation 2021:
  • 1 child: maximum 30 working days, single parents maximum 60 working days;
  • 2 children: maximum 60 working days, single parents maximum 120 working days;
  • 3 or more children: maximum 65 working days, single parents 130 working days
  • Child sickness benefit for seriously ill children: unlimited entitlement
• Transfer of child sickness benefit days to other parent possible (clarify with employer and health insurance fund)
  • Prerequisite: both parents have statutory health insurance
  • Employer gives parent unpaid leave
• Application to statutory health insurance fund
• Information from: statutory health insurance funds
• Responsible: statutory health insurance funds
  

- Forms: yes

- Online procedure possible: Many statutory health insurance companies offer an online procedure.

- Written form required: no

- Personal appearance necessary: no