From Day One: Germany Tightens Sick-Leave Rules, Scraps Phone Certificates and Four-Day Grace Period
02.07.2026 - 13:29:28 | boerse-global.de
Under a rule change that took effect immediately, workers must now present a doctor’s certificate on their very first day of absence, and the widely used telephone sick note has been abolished altogether.
The decision has drawn sharp criticism from the Green Party, which warns that the new requirement risks overwhelming already strained medical practices. Data from the National Association of Statutory Health Insurance Physicians (KBV) underscores the concern: roughly one-third of the 116 million annual sick notes cover absences of no more than three days – cases that now must be assessed by a physician from day one.
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Employer flexibility preserved, but phone diagnosis ends
Previously, a medical certificate was only mandatory from the fourth day of illness. That grace period is gone. The obligation to provide proof now starts legally on the first missed shift. The existing electronic sick-note system (eAU) remains in place as the procedure for transmitting certificates.
The federal government has, however, left room for flexibility. Companies can continue to negotiate individual deviations with their workforce through collective agreements or internal rules. For patients, obtaining a sick note now requires a personal visit to a doctor’s office or a video consultation – telephone assessments are no longer accepted.
High absenteeism triggers political action
Chancellor Friedrich Merz pointed to persistently elevated sickness rates as the driving force behind the tightening. He described the situation as a “significant competitive disadvantage” for Germany as a business location. Health Minister Judith Warken announced a comprehensive review of previous practices.
The statistics give weight to the argument. The DAK health insurer reported an average of 19.5 sick days per insured employee in 2025. The Barmer health fund highlights stark regional variation: the Saarland leads nationally with 25.4 sick days per worker, and psychologically related absences there reached 6.2 days per capita – a notably high level.
Part of a wider reform package
The sick-note change is one element of a 34-point reform catalogue agreed by the coalition. The package also includes tax relief worth around €10 billion annually for low and middle incomes, scheduled to take effect on 1 January 2027. A family of four with a gross annual income of €60,000 would save more than €600 per year.
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To offset the cost, the so-called “wealth tax” has been adjusted: a rate of 45 percent applies from an income of €250,000, rising to 47 percent above €280,000. The coalition also agreed on a fixed manufacturer discount of 15.5 percent for patented pharmaceuticals.
Pharmacies gain as telemedicine expands
Separately, the Pharmacy Supply Development Act (ApoVWG) has come into force. The pharmacy fee per pack rises to €9, with €9.50 planned for early 2027. Pharmacies will also begin offering assisted telemedicine – statutory health insurance members can now receive initial assessments or video consultations on the premises. The measures aim to strengthen primary care, even as the new certificate rules formalise access to sick leave.
