Sick Leave in Germany: Krankschreibung, Entgeltfortzahlung and Krankengeld Explained

In Germany, a sick note is called a Krankschreibung, and it sits inside two separate legal mechanisms rather than one continuous benefit. For the first six weeks of an illness, the employer keeps paying full salary under the Entgeltfortzahlungsgesetz (EFZG). After that, the employee's statutory health insurer takes over instead, with a reduced payment called Krankengeld.

This page works through both stages: the waiting period before employer pay continuation applies, the notification and certificate rules including the eAU process and telephone based certification, what Krankengeld pays once it starts, and the separate question of whether an illness can lead to a dismissal.

Information last verified on 19 July 2026. This page provides general legal information and does not constitute legal advice in an individual case.

Two legal regimes, not one continuous benefit

German law does not treat sick leave as a single ongoing wage replacement. Two separate regimes apply one after another, and mixing them up is the most common source of confusion in casual descriptions of krankschreibung.

For the first phase, the employer keeps paying full wages under the EFZG. For the second phase, once that period ends, the employee's statutory health insurer pays Krankengeld instead, at a reduced rate. The switch between the two happens automatically once the six week mark under § 3 EFZG is reached, though an employee should already be in contact with their health insurer well before that point.

The four week qualifying period before pay continues

Before continued pay applies at all, the employment relationship has to have run without interruption for at least four weeks. This comes from § 3 Abs. 3 EFZG, and it is easy to miss because most coverage of German sick pay jumps straight to the six week figure.

In practice, this means someone who falls ill in the first week or two of a new job is not automatically covered by employer pay continuation for that illness. Statutory health insurance and other protections may still apply, but the EFZG claim itself only starts to run once four full weeks of unbroken employment have passed.

Worked example. An employee who starts a new job on 1 July 2026 and falls ill in the second week of employment has not yet completed the four week qualifying period and has no EFZG claim for that illness. The same employee falling ill on 30 July 2026, after four unbroken weeks of employment, is covered under § 3 EFZG from the first day of that later illness.

Six weeks of full pay under § 3 EFZG

Once the qualifying period is met, § 3 Abs. 1 EFZG entitles an employee who is unable to work through no fault of their own to continued pay from the employer for up to six weeks of that illness. Full pay means the normal wage, not a reduced rate, so the amount paid is the same as if the person had been at work.

Worked example. An employee earning 3,000 euro gross a month who is signed off for four weeks with the flu continues to receive the full 3,000 euro for that month, paid on the normal payroll schedule, not a reduced amount and not a separate benefit application.

The six week limit runs per illness rather than per calendar year, though renewed incapacity from the same underlying condition within certain windows does not automatically restart a fresh six weeks. A genuinely new and unrelated illness starting after the first has resolved generally does start its own six week period.

Notifying the employer and the medical certificate

Being unable to work does not by itself excuse an employee from communicating that fact. § 5 EFZG requires the employee to inform the employer of the incapacity and its expected duration without delay, generally understood as before the working day is due to start.

A medical certificate is generally required once the incapacity lasts longer than three calendar days, to be handed in by the next working day after that. § 5 EFZG also lets the employer demand a certificate earlier than that, including from the very first day of any absence, so an employment contract or a specific employer instruction can require a doctor's note from day one rather than day four.

If the illness continues past the date given on the first certificate, a new certificate covering the extension is required in the same way. Employees insured under the statutory scheme also have their own timing rules for obtaining the certificate from the practice, since it is the practice, not the employee, that now sends the record onward electronically.

The eAU: how the paperwork changed, and what did not

Since 1 January 2023, most employees no longer hand a paper slip to their employer. Instead, the doctor's practice transmits the elektronische Arbeitsunfähigkeitsbescheinigung, the eAU, to the employee's statutory health insurer, recording the employee's name, the date incapacity was determined, whether it is an initial or follow up certificate, whether an accident is suspected, and a diagnosis code the employer never sees.

The employer then retrieves the relevant data from the health insurer through its own payroll system or the SV-Meldeportal, rather than receiving the diagnosis or the paper certificate itself. Employers cannot request this data in bulk or in advance of a reported absence; each retrieval is tied to an individual case.

What has not changed is the duty already set out in § 5 EFZG. An employee still has to tell the employer immediately that they cannot work and roughly how long that is expected to last. The eAU replaced the paperwork trail between the doctor and the employer; it did not replace the employee's own notification.

Telephone based certification (telefonische Krankschreibung)

A related but separate question is whether a certificate can be issued without an in person or video appointment at all. Since a resolution of the Gemeinsamer Bundesausschuss (G-BA) of 7 December 2023, telefonische Krankschreibung is a permanent part of the Arbeitsunfähigkeits-Richtlinie, not a leftover pandemic measure.

The conditions are narrow. A certificate issued this way can cover no more than five calendar days, it is only available to a patient the practice already knows, symptoms cannot be severe enough to require an in person examination, and it is meant for situations where a video consultation genuinely would not do the job.

An earlier, temporary version of telephone based certification existed during the coronavirus pandemic. The December 2023 resolution is what made a version of it a lasting fixture of German primary care rather than an emergency exception, and any source dating this change to 2025 has the wrong date.

After six weeks: Krankengeld from the health insurer

Once the six weeks of employer pay continuation for a given illness are used up, the source of wage replacement changes. § 44 SGB V gives an insured person a right to Krankengeld from their statutory health insurer once illness makes them unable to work and the continued pay period has ended or does not apply.

Under § 47 SGB V, Krankengeld is calculated at 70 percent of regular gross pay, but it cannot exceed 90 percent of net pay. Whichever of those two figures is lower is the one that actually applies, and in practice it is usually the net cap that governs the final amount rather than the 70 percent gross figure most people quote first.

Worked example. Take an employee with a regular gross monthly wage of around 3,000 euro and an approximate net monthly wage of 2,000 euro. Divided by 30, that is roughly 100 euro gross and 66.67 euro net a day. Seventy percent of the gross daily figure is about 70 euro; ninety percent of the net daily figure is about 60 euro. Because 60 euro is the lower figure, Krankengeld in this example runs at roughly 60 euro a day, around 1,800 euro for a full 30 day month, noticeably less than the salary or a simple 70 percent of gross would suggest.

Krankengeld also carries its own deductions before it reaches the account, since pension, long term care and unemployment insurance contributions are still taken from it even though it is not taxed as ordinary wage income at the time of payment. It is later factored into the annual tax return through the Progressionsvorbehalt, which can raise the tax rate applied to other income earned in that same year.

Under § 48 SGB V, Krankengeld for the same illness runs for a maximum of 78 weeks within any rolling three year period. A new 78 week entitlement for that same illness generally opens up again only once the person has gone at least six months without incapacity connected to it and has been working or available for job placement during that gap. An unrelated new illness starting later has its own separate 78 week allowance.

Can an employee be dismissed while sick, or for being sick too often

Being on sick leave does not by itself protect an employee from dismissal, and it also does not by itself justify one. A genuine illness related dismissal (personenbedingte Kündigung wegen Krankheit) is possible under § 1 KSchG, but only in businesses where the Kündigungsschutzgesetz applies and only under a demanding three stage test the labour courts apply consistently.

First, there has to be a negative prognosis: a real, forward looking expectation of continuing or repeated incapacity, not just a description of illness already in the past. Second, that expected future incapacity has to seriously disrupt the employer's operations, for example through ongoing cover costs or repeated planning disruption, rather than a minor inconvenience. Third, weighing both sides' interests has to show that the disruption is genuinely unreasonable for the employer to keep absorbing.

The Bundesarbeitsgericht applied this same three stage structure in its decision of 13 May 2015, case 2 AZR 565/14, involving a long term illness and disability benefits, and confirmed there that an employer normally has to have already attempted a betriebliches Eingliederungsmanagement process before a health related dismissal can be treated as proportionate. See dismissal by the employer for how the wider Kündigungsschutzgesetz rules and the three week challenge deadline work.

The BEM meeting after six weeks of incapacity in a year

Separately from any dismissal question, § 167 Abs. 2 SGB IX places its own duty on the employer once an employee has been unable to work, continuously or repeatedly, for more than six weeks within any twelve month period. The employer then has to offer a betriebliches Eingliederungsmanagement (BEM) process.

A BEM meeting is not a disciplinary step, and participation is voluntary for the employee. Its purpose is to work out, together with the employee's representation body and, where relevant, the representative for severely disabled staff, what adjustments or support might help the employee return to and remain at work, drawing in an occupational physician or rehabilitation and integration bodies where useful.

An employer that skips this step before dismissing a frequently or seriously ill employee has a materially harder case to defend in front of a labour court, since the BEM process is treated as part of testing whether dismissal was really the last remaining option.

Falling sick during an approved holiday

§ 9 BUrlG addresses a specific overlap: what happens if illness strikes during an already approved holiday. Days of incapacity proven by a medical certificate are not counted against the annual leave entitlement for that year.

This means an employee who falls ill for three days during a two week holiday does not lose those three days from their leave balance; they are, in effect, restored, provided a doctor's certificate documents the incapacity for those specific days. The employee is still expected to notify the employer promptly, the same as with any other illness, even while away. See vacation entitlement in Germany for how the wider holiday rules work.

Can an employee leave the house while signed off sick

A persistent myth holds that a Krankschreibung comes with a fixed legal duty to stay indoors. That is not accurate. The real test employers and courts apply is whether the employee's conduct is consistent with recovering from the specific condition they were certified for, not whether they left the house at all.

A short walk, a pharmacy visit, or getting fresh air can be entirely compatible with recovering from a cold or a back strain, while an activity that plainly delays healing, such as intensive sport during a diagnosis that specifically requires rest, is a different matter. The more careful approach for anyone unsure is to consider what a treating doctor would say about a specific activity for that specific diagnosis, rather than relying on a general rule in either direction.

Employers have occasionally challenged a certificate's credibility based on an employee's visible activity during sick leave. The outcome in those disputes usually turns on whether the activity was inconsistent with the certified condition, not on a blanket rule against leaving home.

Minijobbers and sick pay

Sick leave law does not carve out an exception for Minijobbers. Someone working a Minijob has the same claim to continued pay from the employer under the EFZG, on the same four week qualifying period and six week maximum, calculated pro rata to actual pay.

Krankengeld is a different story. Because a Minijob does not, on its own, carry compulsory statutory health insurance for the worker, most Minijobbers have no independent claim to Krankengeld once the employer's six weeks of continued pay run out, unless they are separately insured, for example through a main job, family coverage, or voluntary insurance. See Minijob in Germany for how Minijob social insurance treatment works more broadly. For the wider picture of how German employment law is structured, see German law explained.