Do I need occupational disability insurance as an employee with private health insurance?

An employee who is unable to work receives up to six weeks of continued pay. During this phase the employer contribution to private health and long-term care insurance also continues.

From the 43rd day of illness the calculation changes. The agreed private Krankentagegeld (i) replaces part of the lost net income. At the same time, the employer contribution to private health insurance usually ends together with continued pay. The employee then has to finance the previous employee share and the previous employer contribution alone.

A Krankentagegeld (i) of, for example, €180 per day amounts to €5,400 per month over 30 days. Whether this daily rate can be insured and matches your needs depends on your actual income and the insurer's conditions. The daily rate should therefore be calculated from your real financial need.

For Krankentagegeld (i) it is not enough to look only at your previous net income. When continued pay ends, privately insured people face an extra cost, because the employer contribution to health and long-term care insurance stops.

If a privately insured employee simply gets the same daily rate as statutory Krankengeld (i)KrankengeldStatutory sick pay from the statutory health insurance fund. It starts when the employer stops paying wages, usually from the seventh week of illness., a considerable monthly gap can open up despite the identical rate. Reasons include the private health and long-term care premium that continues and the different treatment in social insurance.

We therefore calculate Krankentagegeld (i) backwards from the income you want to have available. The calculation includes living costs, the full private health and long-term care premium and the question of how you continue your retirement savings during a long incapacity for work.

The model conditions for private daily sickness allowance insurance define incapacity for work as a temporary state. According to medical findings, the insured person must be temporarily and completely unable to do their job.

For occupational disability the model conditions use a different definition. Occupational disability exists if, according to medical findings, the insured person is more than 50 percent unable to work in their previous job for an unforeseeable period. Under § 15 (1) (b) of the model conditions for daily sickness allowance insurance, the insurance relationship generally ends when this occupational disability starts.

If a claim is already running at that time, the model conditions provide limited further benefits. Payment then ends no later than three months after the start of occupational disability. For your specific contract, the insurance conditions actually agreed always apply.

There is no fixed month after which a private health insurer must automatically ask about possible occupational disability. During a longer incapacity for work, however, the insurer can request medical records and check whether a temporary incapacity for work still exists.

Questions that can become relevant: diagnoses, the course so far, functional limitations, medication and the assessment of whether you can be fit for work again in the foreseeable future. A flat statement such as "after six months the insurer checks for occupational disability" would therefore not be reliable.

This leads to a decisive point for the insured person. Do not wait to claim private disability benefits until your Krankentagegeld (i) is already in question. The claim under the disability insurance and the review by the daily sickness allowance insurer can run at the same time.

The Beitragsbemessungsgrenze for health and long-term care insurance in 2026 is €5,812.50 per month. This results in a maximum statutory Krankengeld (i) of €135.63 per calendar day before the remaining social insurance contributions. Statutory Krankengeld itself is tax-free under § 3 no. 1 EStG, but it is subject to the progression clause.

For an insured person without children, in 2026 employee shares of pension, unemployment and long-term care insurance, among others, are paid out of Krankengeld (i). The exact payment depends on your personal situation. For a fair comparison, calculate with the actual amount paid out and not only with the maximum gross Krankengeld.

Occupational disability in private disability insurance and reduced earning capacity in the statutory pension insurance are two different assessments. For the reduced earning capacity pension, what matters is how many hours a person can still work on the general labor market under the legal requirements.

Under § 43 SGB VI, a full reduced earning capacity pension is generally possible if you can work less than three hours a day. With three to under six hours, partial reduced earning capacity can apply. Private disability insurance, by contrast, looks at occupational disability as agreed in the contract and at the job you last did.

Private disability insurance can therefore pay even though there is no entitlement to a reduced earning capacity pension. If you want to protect your income, do not plan the statutory reduced earning capacity pension as an equal replacement for private disability insurance.

When statutory Krankengeld (i) ends, the choice is not automatically only between a reduced earning capacity pension and basic income support. Under the requirements of § 145 SGB III, the so-called continuity rule can apply.

The Bundesagentur für Arbeit describes that in such cases unemployment benefit can usually continue to be paid while the Deutsche Rentenversicherung carries out its assessment. Requirements and process depend on your actual capacity to work and on your entitlement to unemployment benefit.

If a privately insured employee becomes occupationally disabled, the private premium does not disappear. If the employment or the employer contribution ends, the disability pension must also cover the full health and long-term care insurance premium.

If Krankentagegeld (i) ends because of occupational disability, an Anwartschaft for the daily allowance cover can make sense, depending on insurer and plan. Premium and availability must be checked against the insurer's actual conditions.

If a privately insured person receives a statutory reduced earning capacity pension, they can apply for a subsidy towards private health insurance under § 106 SGB VI. For 2026 the calculated subsidy is 8.75 percent of the statutory gross pension. It is capped at half of the actual expenses for private health insurance.

The subsidy therefore does not replace a former employer contribution of the same amount. With a low reduced earning capacity pension, the subsidy in euros can be correspondingly small. The pensioner continues to pay the premium for the private Pflegepflichtversicherung (i)PflegepflichtversicherungCompulsory long-term care insurance. Everyone with health insurance in Germany must have it, privately insured people through their private insurer. alone.

This is exactly why the private premium belongs in disability planning. A disability pension of, for example, €3,000 is not fully available for rent and living costs for a privately insured person if the full health and long-term care insurance premium also has to be paid from it.

PKV-Welt standard: For privately insured employees, the right disability pension is not based only on today's net income. The possible loss of the employer contribution to private health insurance belongs in the calculation.

For people in statutory health insurance, the later contribution burden depends on the insurance status. A pensioner who meets the requirements of the Krankenversicherung der Rentner (i)KVdR · Krankenversicherung der RentnerStatutory health insurance for pensioners. Whether you qualify depends on how long you were in statutory insurance during your working life. is treated differently from a voluntary member.

For people voluntarily insured in statutory health insurance, further income is used to calculate contributions under § 240 SGB V. Whether and to what extent a private disability pension is subject to contributions, and whether a spouse's income counts, depends on the actual insurance status and the contribution rules. This question should therefore not be answered with a flat percentage.

Comparing private and statutory health insurance in case of occupational disability can therefore not be decided by today's health insurance contribution alone. Insurance status, a possible reduced earning capacity pension, the level of the disability pension and other income change the calculation.

For a privately insured employee, we see Krankentagegeld (i) and occupational disability insurance as two components that follow each other. Krankentagegeld covers a longer but temporary incapacity for work. Disability insurance takes over long-term income protection when the contractual requirements are met.

For the level of Krankentagegeld (i), we therefore include the full private health and long-term care premium after continued pay ends. For the level of the disability pension, we include the same effect again, because the private premium has to be financed during occupational disability too.

If you set up these two calculations separately, you can miss a gap. For employees with private health insurance, aligning Krankentagegeld (i), disability pension and health insurance premium is therefore a fixed part of our advice.