Sickness benefit in general

What is the sickness benefit?

The sickness benefit is an income compensation benefit that is paid by the statutory health insurer. It compensates for loss of earnings in the event of incapacity for work or during a hospital stay. Payment begins after the 42-calendar-day continued payment of remuneration has expired.

The sickness benefit is calculated based on the regular salary. This is transmitted via the EEL procedure and based on the last payroll period before the incapacity to work.

Who is eligible for the sickness benefit?

According to Section 44 (1) SGB V, all statutory insured employees are entitled to the sickness benefit if they:

are unable due to sickness.
are treated, at the expense of the health insurer, in a hospital, a preventive care or rehabilitation center.

The entitlement to the benefit starts on the first day of a medically determined incapacity to work. However, this entitlement is suspended for the first 42 calendar days, as employers are obliged to pay continued remuneration during this time. The health insurance company therefore only pays sickness benefit from the 7th day onwards. Week. An exception to this are employees who fall under the waiting time regulation for the first four weeks of their employment.

Please note:
In the event of incapacity to work due to organ, tissue, blood, or stem cell donation, you are also entitled to sickness benefit. In this case, the EEL procedure won't apply. The application for the benefit needs to be submitted on paper.

Duration and amount of sickness benefit

The amount of sickness benefit is 70% of the regular gross salary subject to social security contributions, but no more than 90% of the last net salary. Regular one-off payments such as Christmas bonuses and vacation allowances are also taken into account. The sickness benefit itself is capped at a maximum amount of €135.63 per day (value in 2026).

The calculation is made by the health insurance fund on the basis of the data transmitted by the employer using the EEL procedure.

The payment period is limited to a maximum of 78 weeks within any three-year period if the illness is the same. If another illness occurs while benefits are being received, the duration will not be extended.

The period of continued remuneration is also included in the benefit period.

Date of EEL contribution statement for sickness benefit

An EEL contribution statement must be submitted immediately by the employer as soon as it becomes apparent that the employee will exceed the sick leave period of 42 calendar days and thus lose their entitlement to continued payment of remuneration.

Please note:
In Personio Payroll, an EEL form is created as soon as an absence is set to Sick without continued pay (unpaid absence) in the Reporting and Absence Times tab.

Create EEL notification 01 for sickness benefits

Review prerequisites

Ensure that the entries for the following attributes are correct.

Type of health insurance = Public
Consider in German payroll = Yes

If necessary, also check the history and make any necessary adjustments.

Record absences

To record the absence, follow these steps:

Go to the Absence tab in the employee's profile.
Enter the start and end dates of the absence. The period must exceed 42 calendar days or be connected with other sick leave periods (prior illness request).
Answer these questions:
- Did you still work on the first day of your absence?
- Does your sick leave relate to an organ, tissue, or stem cell donation?
You can add further information about the sick leave in a comment if you wish.
Save your entry.

Please note:
Ensure that absence types are set up correctly. An EEL contribution statement can only be created for absences with the category "illness."

Review absence periods

In order to create an EEL notification, you now have to confirm the unpaid sick leave absence. Proceed as follows:

Go to Payroll > Compliance.
Click on Review absence periods.
Confirm that the employee is sick without continued payment of remuneration (unpaid absence).
Save your entry.

The employee's salary is automatically reduced based on the partial wage payment method stored, and an EEL form is created in the compliance tab.

Complete and send EEL notification

In the last step, you need to fill in, review and send the EEL notification. This involves the following steps:

Go to Payroll > Compliance.
For the relevant employee, click on Request EEL certificate. Tip: You can access these using the filter function with the category " Income statement ."
Check the automatically created template for the EEL notification. We explain what to look out for in the dedicated section below.
Submit the EEL notification.

You can also reject an EEL contribution statement, for example, if you have switched to Personio Payroll and an EEL contribution statement has already been created by the previous provider.

If you accidentally reject an EEL notification, you can create a new one by deleting and recreating the relevant absence in the employee profile.

How to check the EEL form

To ensure that all data in the EEL notification is correctly transmitted to the health insurer, we recommend checking each EEL form. Below, we explain what you should bear in mind in each section.

Employee and company data

Check the employee's and the company's data.

Incorrect information cannot be adjusted directly in the template. To correct the employee data, adjust the relevant attributes in the employee profile. You can edit the company master data in the settings.

Feedback on compensation for reduced income

Under Feedback, you can activate two checkboxes:

Amount of income replacement benefit: Activate this check box if you would like to receive feedback on the income replacement benefit from the social security agency. This will allow you to determine whether a continued remuneration that you pay is subject to contributions, e.g. for a company car during the employee's incapacity to work.
End date of wage replacement benefits: Activate this checkbox if you want the social security agency to notify you when your income replacement benefits end. This request helps to avoid overpayments.

Absence

Under Absence, check the periods of the sick leave absence. This information is taken automatically from the previously created absence in the employee profile.

Additional remuneration

After the continued remuneration has ended, further remuneration payments can be made, e.g. benefits in kind or subsidies to the sickness benefit. These must be stated as additional remuneration if, together with the sickness benefit, they exceed the reference net salary by more than €50.00. Payments are taken over from the Salary tab of the employee profile.

Termination of employment

If the employment has already been terminated, check the following in the Termination section:

Date of the last working day
Termination reason
Date the termination was received

In the case of a fixed-term employment, the date field for employment termination remains empty.

Kurzarbeitergeld*

These fields are automatically filled in based on the data in the employee and company profile.

Nursing care insurance and working hours policy

Check this section for the status of the long-term care insurance bonus for people without children. The relevant month is the month in which the compensation benefit begins. The number of children under 25 is automatically taken from the employee profile.

If the employee was initially employed on a work schedule pursuant to Section 7 (1a) SGB IV (e.g. value credit), this field is marked as Yes.

Last payroll periods settled before the start of incapacity for work

Please note:
If existing, the billing periods are transferred directly from Personio Payroll. If you change systems, you will need to fill these fields manually for the first few months after the change.

The last month before the start of incapacity for work is always the basis for calculating sickness benefit.

With the same remuneration: It is sufficient to fill in the fields under Last payroll period (period 1).
In case of variances in remuneration: In the event of variances in the last three months prior to incapacity for work (e.g., due to regular overtime or fluctuating piecework wages), all three payroll periods must be certified.

The fields under Last settled payroll period (period 1) must always be filled out.

Tip:
Read our best practices on the theme.

The following table explains the individual fields and what information must be entered there:

Field	Description
Compensation type	The compensation type is taken over automatically from the employee's profile. A distinction is made between: 1 = Hourly salary 2 = Fixed monthly salary 3 = Other (according to pieces, piece wages, etc.)
Current pay for the last 12 months prior to the start of the incapacity to work / action, converted without contributions	Includes, among other things, the non-contributory contributions to the company pension scheme over the last 12 months. This information may be taken from the employee's payslip or payroll account.
Agreed gross remuneration	Only to be entered if the salary for the previous month differs from the agreed monthly salary. The unreduced gross remuneration is entered.
Agreed net remuneration	The net salary calculated from the agreed gross salary is entered here.
Start and end date	The basis is the remuneration from the last settled, expired, and at least 4-week payroll period. Enter the relevant dates in the Start and End fields (e.g. 01/01/2025 to 31/01/2025).
Gross salary	The current remuneration that is subject to contributions during the last payroll period according to Section 14 SGB IV. This is done without taking into account deferred compensation and the transition area (midijob).
Net remuneration	Calculated from the gross salary.
Absences without pay (in days)	Unpaid absences such as unpaid vacation. Already maintained in the Absence tab of the employee profile and transferred automatically
Health insurance (KV), Pension insurance (RV) , and Unemployment insurance (AV)	If there were any one-off payments in the 12-month period prior to the incapacity to work, the social insurance contributions calculated as a result are transferred here. You'll find the data in the payroll account.

Working hours

The working hours section in the EEL form is only displayed and filled in if the relevant employee has compensation type 1 = Hourly salary.