German Partial Sick Leave Law Takes Shape as Health Insurers Face €40 Billion Deficit

Germany introduces partial sick leave tiers (25/50/75%) from 2027 to close €40B gap by 2030, with employer-employee consent and new benefits.

Germany’s statutory health insurance system is heading for a projected shortfall of up to €40 billion by 2030—the gap for 2027 alone is estimated at roughly €15 billion. To close that hole, the federal government has drafted a sprawling reform package whose most striking feature is the introduction of partial incapacity for work, set to take effect in 2027.

The model, inspired by Sweden, would allow insured employees to remain on the job for a reduced portion of their regular hours while officially registered as ill. Instead of a blanket sick note, doctors would assign one of three fixed tiers: 25, 50, or 75 percent of the usual work schedule. Sweden already processes a significant share of its sick leave through such part-time arrangements.

How the financing works

For the first six weeks of partial incapacity, the employer continues to pay the full salary. From week seven onward, funding is split: the company compensates the hours actually worked, while the employee receives a new partial sickness benefit for the hours missed. That benefit equals 70 percent of the lost gross pay—capped at 90 percent of the corresponding net pay. The legal basis will be enshrined in two new paragraphs, §44c and §44d, of the Social Code Book V (SGB V).

Who can take part—and who must agree

Partial incapacity is not automatic. Three conditions apply:
- A physician must determine the exact degree of work capacity.
- The illness must have lasted longer than four weeks.
- Both the employee and the employer must consent.

Voluntariness is central to the draft. However, if the employer does not respond within seven calendar days to a worker’s request, silence counts as approval.

The Federal Joint Committee (G-BA) is tasked with producing detailed medical-assessment guidelines within six months of the law coming into force.

Criticism over rigid tiers and unresolved legal questions

Bremen’s health senator, Claudia Bernhard, has warned that nursing services could face financial trouble if tariff increases are no longer fully refinanced. Experts also fault the strict 25/50/75-percent gradation. Unanswered legal questions remain about the interplay with the existing Continued Remuneration Act (Entgeltfortzahlungsgesetz).

Additional measures beyond sick leave

To shore up the statutory funds, the package includes several other levers:
- Higher prescription-drug co-payments (ranging from €7.50 to €15)
- Reduced subsidies for dental prosthetics
- A sugar tax on beverages from 2028
- A rise in the annual earnings ceiling for mandatory insurance from 2027

The law is scheduled to pass the Bundesrat (upper house of parliament) in early July.

In a parallel move, Health Minister Nina Warken presented a nursing-care reform draft at the beginning of June. Proposed changes include higher contribution-assessment ceilings, increased contributions for childless individuals, and the abolition of contribution-free spousal coverage from 2028. The plan also envisions cuts to pension-insurance contributions for family caregivers—a move that has drawn sharp criticism from social-welfare associations and politicians.