A sweeping reform package passed by the German government in July 2026 will introduce a novel concept to the country’s healthcare system: the partial sick note. Starting January 1, 2028, workers whose health issues are expected to last longer than four weeks can be certified as 25, 50, or 75 percent unfit for work.
The arrangement is voluntary on both sides. Employers and employees must agree to it. During the first six weeks of partial incapacity, companies continue paying full wages. After that, a partial sickness benefit kicks in, covering 70 percent of the gross earnings lost, capped at 90 percent of the net loss.
Industry observers view the measure as a more flexible alternative to the existing stepwise reintegration model, though they caution that human resources departments will face extra administrative burdens.
Day-One Doctor’s Note Rule Stirs Opposition
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Reactions from the corporate sector are divided. At chemical giant BASF, the norm has been to submit a certificate on the fourth day. The company is now reviewing how to adapt to the new legal framework. The local works council opposes the stricter approach. Germany’s trade union federation warns that doctor’s surgeries could become massively overloaded.
Higher Costs for Companies and Higher Earners
Financial pressures will mount from 2027. The contribution assessment ceiling for statutory health insurance rises by a one-time increase of €300 per month. Insured patients will also pay more for medications, with co-payments ranging from €7.50 to €15.00.
Additional savings measures in the package include:
- Dental prosthetics: fixed subsidies drop from 60 to 50 percent
- Homeopathy: reimbursement as a statutory benefit ends
- Family insurance: from 2028, a 2.5 percent contribution surcharge applies to certain working spouses
- Sugar tax: set to launch in 2028 to relieve the system over the long term
Primary Care Shortage Worsens
The reform arrives amid growing gaps in medical coverage. A July 2026 study on primary care projects that roughly 12,000 family doctor posts could remain unfilled nationwide by 2040. Already, about 4,400 general practitioners are missing. Rural areas in North Rhine-Westphalia and Lower Saxony are especially affected, where the density of care could drop by nearly 50 percent.
Sick leave rates remain elevated. The DAK health insurance fund reports a 5.3 percent sickness rate for the first half of 2026, a slight decline from the prior year. Employers face a particularly worrying trend: mental illnesses rose by 9 percent. With an average of 184 days absent per 100 insured people, psychological conditions now rank among the top causes of lost work time.
New Rules for Top Earners
The reform also changes labor law for high-income workers. From January 1, 2027, employees earning more than €177,450 in gross annual salary gain a special right to terminate their contract in exchange for severance pay. Additionally, fixed-term contracts without a specific reason are temporarily expanded until the end of 2030, allowing durations of up to 48 months and up to six renewals. The government says the goal is to inject more flexibility into the labor market during a period of economic transformation.
