The electronic certificate of incapacity for work (eAU) - what employers, practices and patients need to consider

What are electronic incapacity for work and electronic sick notes?

The eAU has many names. To avoid confusion, we will first clarify common synonyms. In correct officialese, the term "eAU", "electronic certificate of incapacity for work" or "electronic certificate of incapacity for work" is used. In everyday life, you often just hear "electronic incapacity for work". Among employees, however, the terms "electronic sick note", "electronic sick report" and "electronic sickness certificate" are commonly used, as the eAU replaces the conventional yellow sick bill. In principle, all these variants mean the same thing.

Introduction of the eAU in Germany

The electronic certificate of incapacity for work (eAU) has been mandatory since January 1, 2023. It replaces the previous paper certificate.

The eAU was introduced in Germany in stages. In the first stage, the employee procedure, the certificate of incapacity for work was transmitted electronically from the doctor's surgery to the health insurance fund. However, patients continued to receive a paper sick note for the employer.

Since the second stage, the employer procedure, was rolled out, the paper printout for the employer is no longer required. The certificate of incapacity for work (AU) is now transmitted electronically from the health insurance fund to the employer.

Legal situation - for whom is the eAU mandatory?

The basis for the electronic certificate of incapacity for work is the Appointment Service and Care Act (TSVG), which makes a standardized electronic procedure for transmitting information on incapacity for work mandatory for statutory health insurance physicians and hospitals in Germany.

In addition, the TSVG stipulates that the obligation to provide information to the health insurance funds lies with the doctors and facilities that determine the incapacity for work. The German Social Code (SGB) also plays a role. According to Section 109, the health insurance funds must provide the employer with a report for retrieval upon receipt of the incapacity for work data.

The basic obligation of the employee to inform the employer of their incapacity to work remains in place in accordance with Section 5 of the Continued Remuneration Act (EntgFG). As a rule, this obligation exists even before the visit to the doctor.

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What are the exceptions to the eAU?

Not all types of certificate of incapacity for work are affected by the obligation to issue them electronically. Exceptions are

• AU for private patients
• AU from abroad
• Illness of a child
• Employment ban
• Rehabilitation and reintegration
• Mini job in a private household

How does the eAU work?

Health insurance companies, doctors, patients and employers are all involved in issuing and processing electronic certificates of incapacity for work. The linchpin here is the telematics infrastructure (TI) - the state platform for healthcare applications in Germany. As the way it works is different for the various players, we will take a closer look at the parties involved below.

The electronic certificate of incapacity for work in medical practices

Just like the conventional AU, the eAU is also issued by the attending physician. The patient receives a printed version for themselves. The doctor's surgery then transmits the incapacity for work data to the health insurance fund via the telematics infrastructure by midnight at the latest. The same applies to hospitals.

If there is a technical fault, the doctor's surgery can send a paper certificate by post to the health insurance fund. If the fault is already known when the patient visits the doctor, they can also receive a paper certificate for their employer.

Technical requirements

To issue the eAU, doctors need the following technical requirements:

• Electronic health professional card (eHBA) as authorization
• eHealth connector for creating qualified electronic signatures
• Connection to a service for communication in the medical sector (KIM service)
• KBV-certified software for practice management

What tasks does the health insurance fund take on?

After receiving the incapacity for work data, the health insurance fund makes the electronic certificate of incapacity for work available for retrieval by the employer . The employer receives a corresponding notification. If the eAU cannot be retrieved on the day following the sick note (e.g. due to a technical fault), the employer will receive an error message.

What do employers need to consider with the eAU?

If the employee is covered by statutory health insurance, the employer itself or an authorized representative such as a tax consultant can obtain the eAU from the health insurance fund. The information from the certificate of incapacity for work can then be recorded accordingly in payroll accounting.

Note: There is no kind of "subscription" for employees' eAUs. Each initial or follow-up certificate must be requested separately by the employer.

How does the eAU work for employees?

If the employee has statutory health insurance, he or she has no responsibilities with regard to the transmission of his or her sick note. This is an automated process between the doctor, health insurance company and employer. However, they must inform their employer independently that they are absent due to illness.

Privately insured employees still have to send the printed sickness certificate or an electronic equivalent to their health insurance fund and employer themselves.

What information should be included in a certificate of incapacity for work?

There are basically two versions of the certificate of incapacity for work - one for doctors, health insurance companies and patients - and a second for employers. The latter contains less information for reasons of health data protection and medical confidentiality. The health insurance company needs this information to check the entitlement to continued payment of remuneration and sick pay.

General information on the eAU:

• Cost unit identification
• Name, address, date of birth and insurance number of the patient
• Name and doctor number of the doctor
• Accident insurance doctor (yes or no)
• Date of issue of the AU
• Start and expected end of the AU
• Initial or follow-up certificate
• Work as a cause (yes or no)

Information that the employer does not receive:

• ICD-10-coded diseases or symptoms
• Status of the insured person
• Establishment number of the issuing body
• Accident as cause (yes or no)
• Healthcare problems (yes or no)
• Rehabilitation services (yes or no)
• Gradual reintegration (yes or no)
• Sickness benefit case (yes or no)
• Final certificate (yes or no)
• Other special features

Conclusion: The eAU and the modern healthcare system

Alongside electronic patient files and e-prescriptions, the electronic certificate of incapacity for work is an important part of the digitalization of the healthcare system. It replaces the previous paper certificate and offers numerous advantages for all parties involved - including automated signature processes, more efficient communication between different parties and, in the long term, even a reduction in costs thanks to leaner processes.

For these benefits to really come to fruition, the technology must work in the background. The German government's telematics infrastructure is primarily responsible for this. But the software used in doctors' surgeries must also work efficiently and reliably.

Increase the individual benefits of eAU for your medical practice by cleverly combining it with other digital processes such as digital anamnesis. This will increase employee satisfaction and give you more time for your patients. Nelly can help you with this.

Create a digital workflow in your practice now. We will advise you on your individual case free of charge and without obligation!

Contact Nelly now!

‍Thepersonal designations used in this article always refer equally to all persons. For the sake of better readability, we do not use the same name twice or in the opposite gender.

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