The German upper house, the Bundesrat, has approved the Beitragssatzstabilisierungsgesetz – a savings package designed to cut health-insurance spending by €18.8 billion through 2027. Patients will soon face a co-payment of up to €15 for prescription drugs, homeopathy will no longer be covered by statutory insurance, and the contribution assessment ceiling will rise by €300. The move comes as part of a broader reform agenda championed by the black-red coalition, which aims to bring down record-high sickness rates and make the labour market more flexible. While employer associations welcome the plans, unions and doctors are pushing back.
Under the proposed sick-leave rules, employees would have to present a medical certificate from the first day of illness, replacing the current three-day grace period. The pandemic-era option of a telephone sick note is being scrapped, though video consultations will remain available. The government points to explosive growth in sick-pay expenditure: according to BKK market researchers, spending on Krankengeld hit €21.6 billion in 2025 – an all-time high – driven mainly by mental-health disorders and musculoskeletal complaints.
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From 2028, a partial sick note inspired by the Swedish model is planned. Workers with health limitations would be allowed to work for a few hours each day, keeping them connected to their employer and easing the transition back to full duties.
One of the most divisive elements targets dismissal protection. Starting in 2027, companies would find it easier to terminate high earners – those with a monthly gross salary of roughly €15,000 – by offering a severance package. The measure affects just 0.27 percent of all employees, according to data from the IAB research institute. Dismissals under this clause would become automatically effective under certain conditions, with a proposed severance of 0.5 monthly salaries per year of service. If the worker quickly finds a new job, the severance payment would be tax-advantaged. But experts at IAB and DIW are sceptical: the affected group is often over 55, and the €15,000 threshold could discourage salary growth. Legal professionals warn that the relaxation might set a precedent for lower-income brackets later on.
The reform comes at a time when employment tribunals are buckling under a surge of cases. The legal-protection insurer Arag reports that the number of work-related claims has risen by 63 percent in five years. In 2025 alone, claims contesting dismissals jumped by 33 percent, a trend that continued into 2026. Courts in Baden-Württemberg have also recorded a sharp increase in new proceedings. Industry insiders attribute the rise to economic uncertainty and climbing insolvency numbers.
Critics are vocal. Ricarda Lang, former co-leader of the Greens, warns that requiring a doctor’s note from day one fosters a “culture of mistrust” toward ill employees, which she says could ultimately lengthen recovery times. Doctor’s representatives fear their practices will be overwhelmed by the flood of certificates. The full legislative package is scheduled for detailed debate after the summer break, with the coalition betting on lower absenteeism and relief for businesses – a bet that its opponents call risky and counterproductive.
