Daily sickness allowance in Germany: align deferral and daily amount

Match the start to the actual loss of earnings

Two decisions belong together when advising on German private daily sickness allowance: when should benefits start, and what daily amount fits the income basis? Begin with the period during which the client would meet ongoing expenses without the planned benefit. A high daily amount does little for an early gap if its agreed start is much later. Conversely, an early start does not establish whether the amount matches the desired income replacement.

First ask how income would develop during an absence from work. For an employee, actual continued payments may influence the start. For a self-employed person, establish which personal income continues without their own work. Occupation alone does not answer this. Your comparison needs the actual circumstances so the client can assess a shorter or longer period financed personally. A familiar policy label does not replace that clarification.

Distinguish the deferral period from other time concepts

The PKV service portal defines the deferral period as the time between incapacity for work arising and the first day of daily sickness benefit. Distinguish this from a waiting period after insurance begins, for which model conditions MB/KT 2009 have separate rules. Explain the terms separately if they appear in the offer. Clients should know whether you mean access to cover after inception or the time before benefits within a later insured event.

The first contractual benefit day and actual receipt of money also differ. Assessment requires the specified evidence; the model conditions refer to statutory rules for when payment becomes due. Do not treat the chosen deferral as a promised transfer date. Personal planning needs to identify the phase consciously financed by the client and any further question about the actual payment process. An unresolved question about receipt stays visible.

Identify continued payments and personal income reliably

For employees, establish the continued payments actually agreed or evidenced. Put their relevant period beside the intended benefit start. Do not assume identical durations from a general example. If employer information or specialist assessment is missing, obtain that specific basis. Clients can then assess whether the proposed start follows their actual protection or leaves a period to finance themselves.

For self-employed clients, distinguish cash receipts from newly earned income. An invoice already issued may be paid later without new work during illness. Personal planning needs to know which funds remain available and for how long. The policy’s definition of insurable income is a separate question. Put the two views together so delayed receipt is not accidentally treated as a permanently continuing income source.

Separate personal living costs from business commitments. Clients may include both in liquidity planning; this does not create a blanket entitlement to daily sickness allowance for all business expenses. Check the actual policy’s income definition and keep additional business protection questions separate. This is practical: a full payment plan shows needs, while the contract assessment shows the basis the offered allowance can insure. The figures need not have the same meaning.

Use the right basis for the daily amount

Section 4(2) MB/KT 2009 limits the allowance, together with the other daily sickness payments specified there, to net occupational income converted to a calendar-day amount. The model also specifies a reference period and permits a different policy period. Do not treat an arbitrary monthly figure as an already confirmed insurable amount. Ask about the actual income definition, evidence and relevant period in the offer.

The period matters especially for fluctuating income. One good month does not answer an averaging exercise; one weak month should not become the permanent basis without assessment either. Clarify with the insurer which documents the proposed calculation requires. You need not invent a tax definition of income. Clients should understand why personal cash planning and the contractual maximum are assessed separately and then compared.

Consider existing protection by its actual content. Another policy’s name does not establish whether it pays for the same absence or how it counts towards a limit. The model conditions also contain rules about further daily allowance insurance. Clarify relevant coordination before an additional agreement. This places a new daily amount on a clear overall basis instead of mentally filling the same income gap several times with uncoordinated promises.

Weigh earlier benefits against longer self-funding

Compare only actual deferral options with their associated daily amounts and premiums. Keep the desired replacement income as comparable as possible. Otherwise, a lower premium may include both a later start and a lower payment. Clients should see which difference they are assessing. If only a particular combination is offered, describe it as such instead of inventing a separate price for one element.

A longer period of self-funding can be a conscious choice for someone with suitable available funds. Check that those funds are genuinely allocated to work absence. A reserve earmarked for another known payment is not fully available for both purposes. Also ask how the person would approach successive absences. This concerns their desired resilience, rather than a universal reserve amount prescribed as suitable for everyone.

For an earlier start, check which specific additional period it covers. The benefit lies in that time shift, not simply a smaller number in the policy name. Show the real premium difference and the actual change in benefit. Explain any other conditions changing with it. The client can decide whether the earlier access offered fits their personal planning better.

Understand the evidence process during selection

MB/KT 2009 link incapacity for work to medical findings and contain evidence and notification rules. Read the actual wording, including deadlines and requirements. A self-described limitation and the required contractual finding are not automatically identical. You do not make medical findings as an intermediary. You explain which responsible professional provides the necessary evidence and how the notification process relates to the policy.

When clarifying the offer, also ask how repeated periods of incapacity are treated. Are certain periods combined under the actual conditions, or does the deferral restart? The answer must come from the actual policy. Recollection of another contract is insufficient. This point may change the choice between options even if they initially show the same daily amount or a similarly labelled start.

Include the possible end of benefits

Daily sickness allowance and occupational disability insurance serve different contractual purposes. Section 15 MB/KT contains termination rules for occupational disability and limited continuation under its stated conditions. Do not transfer that definition to a separate disability policy. Long-term income protection requires more than selecting a deferral. The respective benefit routes and any transition must be assessed against the actual conditions.

A partial return to work may also affect payment. Section 1(3) of the model conditions provides for benefits during gradual reintegration where the policy or its terms allow it. Check this specifically if important to the client. Assuming unchanged payments regardless of the extent of work would go too far. Medical assessment and the actual benefit decision remain with the responsible professionals and insurer.

Compare two assumed bridging periods

The following example is entirely fictional. It uses freely chosen planning assumptions and describes neither a real client nor a pair of offered policies.

A self-employed person wants to consider an assumed uncovered need of €80 per day. Over a first bridging period of 14 days, that totals €1,120. Over 28 days it would be €2,240. This calculates only an assumed daily funding need. The days are not confirmed deferral options; the need is neither an insurer-approved income amount nor a contractual benefit entitlement.

Ask which assumed period could be supported by the funds actually reserved for it. Then put a real offer, with its income definition, deferral and daily amount, alongside it. If its basis differs from the personal assumption, explain that exact difference. The person distinguishes the self-funding considered from the benefit actually offered. A premium decision uses the real option rather than the fictional calculation alone.

In personal planning, identify the days and payment deadlines being considered. A need spread over calendar days differs from an amount per usual working day. State the chosen basis explicitly. If larger payments fall at the start of the bridging period, an evenly spread average is insufficient to establish availability. Check with the client that the intended funds will be available at those particular times too.

Maintain coordination when circumstances change

If income, occupation or actual continued payments change, revisit that specific basis. The model conditions require notification of certain changes, including non-temporary income reductions and occupational changes. A previously suitable deferral may take on a different role. Clarify the new circumstances and contractual response. Do not infer an automatic allowance increase from a pay rise or the end of all cover from a job change.

For a requested increase, check actual adjustment rights and requirements. The service portal describes policy-dependent opportunities, for instance linked to events and deadlines. General advertising does not establish applicability to an existing contract. Distinguish what is insured, requested and confirmed. Clients can see whether new income planning is already reflected or needs another decision.

Record start and amount together

Finally, ask the client to explain the connection: which phase do they finance, which income basis was assessed and which daily amount belongs to which confirmed start? A missing answer becomes a specific enquiry. Keep the documents and replies with the rationale. Later, it remains clear why the chosen deferral suited the original circumstances and which change would matter in a reassessment.

Reach new clients for specialist advice

Register your brokerage for private health insurance enquiries. The welcome email takes you to webRichtung Customer. Choose industry, area, delivery option and monthly limit and see the price before ordering. You clarify daily allowance needs and insurability personally; an enquiry is no completed income or benefit assessment.

Sources

PKV service portal: private daily sickness allowance, in German and model conditions MB/KT 2009, June 2024, in German, particularly sections 1–4, 6, 9 and 15. Read in full on 18 October 2026. Model conditions do not describe every policy; individual wording determines requirements and scope.