Introducing occupational health management (BGM) in SMEs: obligations, steps, evidence

According to an evaluation by the AOK Scientific Institute, the average duration of illness per person employed reached 21.4 working days in 2024, the highest level since the survey began in 1990. For medium-sized companies this means: loss of productivity, incorrect workload on the remaining workforce and costs of an average of 4,265 euros per employee per year according to calculations by the Federal Institute for Occupational Safety and Health (BAuA) from March 2025. The operational side Health management (BGM) is the structured answer. Numerous components are not optional, but mandatory: Section 5 of the Occupational Safety and Health Act, Section 2 of the DGUV Regulation 2, Section 167 of SGB IX and the obligation to appoint a company doctor in accordance with Section 2 of the ASiG.

This article is aimed at management, human resources management and safety specialists in SMEs with 20 to 500 employees who are systematically setting up the BGM for the first time or consolidating an existing patchwork want. You will find out which obligations are mandatory, which building blocks make up an effective WHM, how company doctors and safety specialists are involved, which subsidies the health insurance companies provide and how CIVAC delivers the documentation as a compliance platform and officer-as-a-service in two working days. Both models are covered: Workspace licence and external order. The information can also be scaled to larger medium-sized companies and is industry-neutral, with adjustments for production, logistics and care facilities.

The BGM is not defined as a term in the law, but its individual components are legally clearly defined. Section 3 of the Occupational Safety and Health Act (ArbSchG) obliges every employer to take the necessary occupational safety measures, taking into account the circumstances that influence the safety and health of employees at work. Section 5 ArbSchG requires the risk assessment, Section 6 ArbSchG requires documentation, Section 12 ArbSchG requires instruction. DGUV regulation 2, valid since January 1, 2011 and in the version last updated in 2023, regulates the appointment of company doctors and occupational safety specialists based on working hours per employee.

§ 167 Paragraph 2 SGB IX obliges employers to implement company integration management (BEM) if an employee has been unable to work continuously or repeatedly for more than six weeks within a year. In its ruling of September 7, 2022 (5 AZR 211/21), the Federal Labour Court made it clear that failure to provide a proper BEM makes subsequent termination due to illness significantly more difficult. A complete overview of the interlocking roles can be found on our overview page for thecompany doctor. The voluntary pillar of company health promotion (BGF) is financially supported by Section 20b SGB V, supplemented by the tax exemption according to Section 3 No. 34 EStG of 600 euros per employee per year. Anyone who ignores the mandatory modules risks fines according to Section 25 ArbSchG of up to 30,000 euros per incident. State supervisory authorities, such as LASI with guideline LV 52, check the mandatory modules during on-site inspections or after complaints. A fully documented BGM with clear responsibilities significantly reduces the risk of fines and increases the ability to defend yourself in labour court proceedings in the event of dismissals due to illness.

A tried-and-tested WHM rests on four pillars. First: Occupational safety with risk assessment, instruction and documentation in accordance with the ArbSchG. Secondly: occupational health care with mandatory examinations according to ArbMedVV and general occupational health advice from the company doctor. Third: Company integration management in accordance with Section 167 SGB IX with an offer of discussions, an action plan and a reintegration process. Fourth: Company health promotion (BGF) with offers for exercise, nutrition, stress management and addiction prevention. The pillars are closely interlinked because a risk assessment must record psychological stress (Section 5 Paragraph 3 Number 6 ArbSchG) and concrete WHP measures are derived from this.

Operationally, this means the definition of a WHM coordinator, the formation of a WHM steering group with management, human resources management, company doctor, safety specialist and works council, as well as a documented annual plan with goals, measures, key figures and budget. CIVAC structures these steps in the workspace with 490 ready-to-use audit templates, including mental stress risk assessment, BEM invitation letter, catalogue of WHP measures, employee survey and annual report to management. Licence the workspace for your internal representatives, or have our representatives order it. The reporting line ensures a direct connection to management with a time stamp and read confirmation so that the employer can provide evidence in accordance with Section 6 of the ArbSchG. The appointment certificate, signed, filed, verifiable. Experience has shown that SMEs fail not because of their willingness, but because of the distribution of responsibilities between management, human resources and external company doctors. A clearly tailored WHM coordinator with an assigned reporting line solves this bottleneck. The CIVAC platform supports this role assignment with a responsibility register that is assigned to the respective duties of the DGUV V2 and withstands audit checks. A clearly defined annual plan also reduces friction with the works council because participation rights according to Section 87 Paragraph 1 Number 7 BetrVG can be planned instead of clashing depending on the event.

According to § 2 and § 5 ASiG, the appointment of a company doctor and an occupational safety specialist (SiFa) is mandatory for the first employee. DGUV regulation 2 differentiates between basic care with fixed working hours and company-specific care based on a catalogue of tasks. The deployment times are staggered according to care group in Appendix 2 of DGUV V2, around 0.2 hours per employee per year in Group III (low risk) to 1.2 hours in Group I (high risk). The care can be provided by an employed company doctor, by a resident doctor with occupational health qualifications or by an external inter-company service.

For SMEs with 20 to 250 employees, the entrepreneurial model according to Section 2 Paragraph 4 ASiG and Annex 3 DGUV V2 is an economically attractive variant in which the management itself organises basic care, only receives advice from the company doctor and the SiFa on an ad hoc basis and completes compulsory training. CIVAC operates both models as an officer-as-a-service: appointment of the external company doctor with an appointment certificate, operational plan and annual report or support of the entrepreneurial model with a training module, consultation log and documentation template. You can find out more about the role and the operating times on the SiFa role page. The auditor calls, the evidence is ready. The appointment is made in writing and the appointment certificate is filed both in the appointed person's personnel file and in the central compliance file folder. If the external service changes, CIVAC takes care of the orderly handover with a handover protocol so that preventive examinations and deployment times continue without any gaps. The interaction between the company doctor and SiFa is also channeled through the workspace: joint inspections are coordinated in a calendar, the inspection protocols are immediately available to both roles.

The mental stress risk assessment has been expressly part of the ArbSchG since October 25, 2013 (Section 5 Paragraph 3 Number 6). Unlike the physical risk assessment, it is often neglected in practice, although state regulatory authorities, such as LASI, have been carrying out increased testing since guideline LV 52 of 2022. The assessment covers the five dimensions of stress: work content, work organisation, social relationships, work environment and new forms of work. Methodologically acceptable are employee surveys, moderated workshops, observation interviews and combined methods. The assessment is repeated at least every three years and updated as necessary in the event of significant changes.

The documentation must contain the stress factors, the assessment, the derived measures, those responsible, the deadlines and the effectiveness control. Section 6 ArbSchG prescribes written or electronic recording. CIVAC provides the psychological stress risk assessment as a German template with a questionnaire, evaluation matrix, catalogue of measures and effectiveness control. The workspace manages template versions, documents each update with a timestamp, and issues reminders 60 days before the next mandatory assessment. Others run compliance like a filing cabinet. We run it like software. The evaluation is automatically anonymized so that protection obligations according to Art. 9 GDPR are adhered to. Supervisory authorities assess the quality of the assessment based on the depth of the stress analysis and the traceability of the measures derived. A pure survey without deriving measures is regularly criticized in practice and leads to additional demands with a deadline. Methodologically, the combination of online questionnaires and in-depth workshops in small teams has proven successful because acceptance increases when employees can contribute their perceptions in moderated discussions. The CIVAC platform provides questionnaires and workshop guidelines centrally.

The BEM is obliged to offer every employee a structured interview within one year after a period of illness of more than six weeks. The aim of the conversation is to find ways together to restore the ability to work and avoid becoming unable to work again. Participation is voluntary, the offer is mandatory. The Federal Labour Court has made it clear in several decisions, most recently on September 7, 2022 (5 AZR 211/21), that a subsequent termination due to illness without proper BEM is only effective in narrow exceptional cases. The non-offerment of the BEM makes the ability to act in human resources management considerably more difficult.

Operationally, the BEM requires a documented letter of invitation with reference to the voluntariness, confidentiality and participation rights of the works council or the representative of the severely disabled, a meeting protocol, an action plan and an effectiveness check. The file must be kept separately from the personnel file; access rights must be limited to the BEM representative and his representative. CIVAC delivers the BEM package with invitation letter, discussion guide, protocol, action plan and effectiveness control. File management takes place in the workspace with EU data residency, separate authorisation scheme and four-eye principle when approving measures. The deadline begins as soon as the six weeks of illness are known; the system monitors the deadline based on the sick leave data from the HR department. In the workspace, the BEM cases are statistically evaluated after anonymization so that management can track the effectiveness of the measures without personal reference. A quarterly overview supports the reporting to the supervisory board and shareholders' meeting. Escalation thresholds for management are preset in the workspace, for example if the BEM rate deviates significantly in relation to the sick leave rate or if reintegration plans are not implemented within the intended period. The close integration with the inclusion officer and the representative for the severely disabled is ensured by dedicated roles in the workspace so that § 178 SGB IX is adhered to.

§ 20b SGB V obliges statutory health insurance companies to provide benefits for occupational health promotion in companies. In the Prevention Guide, the National Association of Statutory Health Insurance Funds sets a funding amount of up to 600 euros per employee per year in accordance with Section 20 SGB V, depending on the type of measure and choice of health insurance fund. Exercise offerings, nutritional advice, stress management, addiction prevention and company health circles are eligible for funding. The prerequisite is a structured needs analysis, a documented action plan and an effectiveness control; the risk assessment for psychological stress covers all three components if it is carried out in a methodically clean manner.

In terms of tax, the employer can allocate up to 600 euros per employee per year for certified measures free of income tax and social security contributions in accordance with Section 3 Number 34 EStG. Funding and tax exemption can be cumulated, provided the respective requirements are met. CIVAC supports the application with a funding overview for each health insurance company, the sample template for the needs analysis and the connection to certified providers from the prevention directory of the Central Prevention Testing Centre. The CIVAC SLA for the complete WHM starter package consisting of risk assessment, BEM template, funding application and annual report is two working days instead of the industry standard two to six weeks. Audit-proof, documented, § 20b SGB V-proof. For SMEs, the platform offers a ready-made funding map that summarizes and automatically updates the respective conditions of the ten largest statutory health insurance companies. Application forms can be downloaded pre-filled directly from the workspace. Double eligibility, for example from health insurance and professional association, is possible for certain measures and is automatically checked in the workspace so that no funds are lost. The deadline for the application is usually before the start of the measure. When selecting certified providers, we recommend looking at the prevention directory of the Central Prevention Testing Centre, which is updated annually.

A WHM strategy has three time horizons. In the short term, in the first 90 days, it is about appointing the representatives (company doctor, SiFa, BEM representative, fire protection officer, hygiene officer), forming the steering committee and carrying out the risk assessments. In the medium term, in the first year, it involves the employee survey, the action plan, the funding application from the health insurance company and the first implementation measures. In the long term, from the second year onwards, it is about monitoring effectiveness, adapting the action plan and incorporating the WHM key figures into the management's reporting.

Key figures are the prerequisite for any serious effectiveness measurement. The standard is sick leave (absence rate in percent), days off work per employee, fluctuation rate, participation rate in WHP measures, survey results and BEM quota. CIVAC provides a WHM dashboard in the workspace that pulls these key figures from the existing HR data, evaluates them anonymously and presents them in the annual report to the management. Licence the workspace for your internal representatives, or have our representatives order it. The steering committee meets preferably quarterly; the workspace system provides the agenda, templates and minutes of resolutions. The strategy is closely linked to ESG reporting because social indicators are incorporated into the CSRD sustainability statement. Strategic anchoring in management is critical to success. Without a clear mandate, WHM remains a personnel project that is the first to be dismantled in crisis situations. The CIVAC reporting line makes the WHM contribution to the company's risk position visible and protects the program from budget cuts. The quarterly meeting of the steering committee is supported in the workspace with an agenda, template, minutes and tracking of measures, so that no decisions are lost and the effectiveness remains measurable over several quarters. External support from CIVAC reduces internal effort and measurably accelerates effectiveness.

Four stumbling blocks occur regularly. First: the BGM is understood as an HR well-being program and overlooks the legally binding components ArbSchG, ASiG and SGB IX. Consequence: risk of fines and no health insurance funding. Secondly: the psychological stress risk assessment is formally checked off without actually examining the five stress dimensions. The state supervisory authorities recognise this immediately in practice. Third: the BEM is offered verbally in individual cases, but not documented. Consequence: dismissals due to illness later fail in court. Fourth: applications for funding from the health insurance company are not submitted because the needs analysis is missing. The result: a four-digit funding amount per employee is left behind.

If you want to avoid these stumbling blocks, you need a platform that makes the mandatory modules visible, monitors deadlines and bundles the documentation in one place. CIVAC integrates the roles of company doctor, occupational safety specialist, fire protection officer, hygiene officer and BEM officer in a workspace with separate authorisation schemes for each role. Others run compliance like a filing cabinet. We run it like software. The supervision by the federal states, such as the StMAS in Bavaria or the LAGetSi in Berlin, can understand every mandatory component without the management having to search through several filing cabinets. More about the role architecture on the Compliance Representative overview page. The central file also survives personnel changes. An additional hurdle is the lack of connection to the representatives of the severely disabled or the inclusion officer. § 178 SGB IX and § 167 SGB IX prescribe their participation in the BEM process; non-participation leads to ineffectiveness. CIVAC integrates the inclusion officer as a separate role in the WHM setup. A lack of coordination with the data protection officer is also a recurring stumbling block because health data is one of the data that is particularly worthy of protection according to Art. 9 GDPR and requires its own processing basis.

If you want to systematically introduce WHM in SMEs, you go through three steps. First: a 30-minute screening with the CIVAC Compliance Matrix clarifies the status quo, identifies gaps in the mandatory modules ArbSchG, ASiG and SGB IX, checks eligibility for funding according to Section 20b SGB V and creates a prioritised list of measures. Second: choice of model. Licence the workspace for your internal representatives, or have our representatives appointed, including company doctor, occupational safety specialist, BEM representative and hygiene representative. Third: conclusion of contract, delivery of appointment certificates, templates for risk assessment, BEM and funding application within two working days, plus inclusion in the central compliance file with EU data residency and ISO/IEC 27001:2022 ISMS including 93 controls.

CIVAC is a compliance platform and officer-as-a-service based in Frankfurt, 25 officer roles live and 490 Ready-to-use audit templates. The BGM is managed in the workspace together with the compliance officer, the data protection officer and the HinSchG reporting office, without data mixing and with a separate authorisation scheme for each role. Turn reading into an assignment. Write to info@civac.de or use the contact form on civac.de to arrange the BGM screening. The screening is non-binding, lasts 30 minutes and ends with a written recommendation on orders, model, schedule and funding potential. Upon request, we will provide references from comparable SMEs under NDA. Initial consultation appointments are available within five working days. If necessary, the orders for company doctors, SiFa and BEM representatives can be introduced staggered in order to conserve internal acceptance and staff capacity. CIVAC accompanies the gradual introduction with defined milestones and measurable success monitoring after 90 and 180 days. Experience shows that the investment pays off in the first year through reduced sick leave and avoided labour law risks.