Krankentagegeld

What is Krankentagegeld?

Krankentagegeld (KT) is a private daily allowance paid by a PKV insurer when you are certified as unable to work. Unlike statutory Krankengeld, which is automatic for GKV members, KT is contractual, you choose the daily rate, the waiting period, and whether you want the product at all.

Who needs it:

• PKV employees, the statutory Krankengeld does not apply to them. Without a KT, income stops after the six-week employer wage continuation.

• Freelancers and self-employed, no employer wage continuation, no statutory sick pay unless they opted into the GKV's Wahltarif (optional sick-pay tariff). Without KT, income stops from day 1 of a serious illness.

• High-earning GKV employees, statutory Krankengeld is capped. A top-up KT closes the gap between the cap and their actual net.

How the product works

You choose two numbers at signup:

The daily rate (Tagessatz)

• Freely chosen, but you must be able to document your net income at signup to justify it

• German insurance law prohibits over-insurance (§ 192 Abs. 5 VVG): you cannot insure a daily rate higher than your net daily earnings

• Typical market range: €100-200 per day

• Can be adjusted up or down during the contract as your income changes (documentation required)

The waiting period (Karenzzeit)

• The number of days you cover yourself before KT payments start. German policies usually quote the first day of payment (e.g. "ab Tag 43"); below we use plain days-of-waiting.

• Typical options: 0, 14, 21, or 42 days (i.e. benefit starts on day 1, 15, 22, or 43)

• Longer waiting period → lower premium

• 42 days is standard for PKV employees, benefit starts on day 43, the day after the six-week employer wage continuation ends

• Freelancers typically choose 14 or 21 days depending on their cash buffer

Duration and limits

Once the waiting period ends, KT pays for as long as:

• A physician continues to certify incapacity, AND

• Permanent Berufsunfähigkeit (BU) has not been determined

Unlike statutory Krankengeld, there is no 78-week cutoff. KT continues indefinitely under an active illness.

The contract's Beitragsbefreiung (premium waiver during the benefit period) is common, while KT is being paid, your premium is typically suspended or heavily reduced (tariff-dependent).

The BU trap: the most important detail

Here is the single most under-explained feature of KT policies. Under § 15 MB/KT, Krankentagegeld ends at the onset of Berufsunfähigkeit (BU), defined as being more than 50 % unable to work in the specific occupation, on a non-foreseeable basis.

The insurer's internal BU assessment may happen months after the actual medical event. Once the determination is made:

• KT pays a run-off period of up to 3 months (Nachleistungsfrist) and then stops

• If the DRV has not (yet) approved Erwerbsminderungsrente, or only approves a reduced amount, an income gap opens

• Average EMR in Germany 2024: ~€1,001 per month: usually well below previous income

KT is not a disability insurance. Long-term income protection against permanent inability to work requires a separate Berufsunfähigkeitsversicherung (BU), ideally running parallel to the KT.

Maternity (§ 192 Abs. 5 VVG)

During Mutterschutz (6 weeks before, 8-12 weeks after birth), PKV members receive KT in addition to Mutterschaftsgeld, not instead of it. This changed with the 2017 VVG amendment and is one of the most underused entitlements. Tariff-dependent in detail, but standard in modern contracts.

DRV membership during KT

During KT receipt, you can voluntarily continue paying into the Deutsche Rentenversicherung for up to 18 months. Two reasons to do it:

• Preserves your Erwerbsminderungsrente entitlement (needs 36 months of contributions in the last 60 months)

• Preserves your right to medical rehabilitation

Contribution base: 18.6 % of 80 % of your pre-illness gross income.