Pharmacy and sick notes

If you have statutory health insurance, you may need to pay part of the cost of a covered medicine. Children under 18 are exempt from that medicine co-payment. If you cannot work because you are ill, tell your employer; sick-note dates are usually retrieved from your insurer, with some exceptions.

In short

• Until 31 December 2026, statutory patients aged 18 or over generally pay 10 percent of the price of a covered medicine, at least 5 euros and at most 10 euros, and never more than the product costs. From 1 January 2027 the band is 7.50 to 15 euros. Children under 18 do not pay that co-payment.
• If the pharmacy substitutes several smaller packs for an unavailable prescribed pack, the co-payment is charged once. Over-the-counter products the doctor does not prescribe are generally outside this rule.
• Adults’ full inpatient hospital treatment has a separate co-payment for at most 28 days per calendar year: 10 euros a day until 31 December 2026 and 15 euros from 1 January 2027. Certain rehabilitation co-payments count toward that limit. For insured people aged 18 or over, the co-payment for remedies and home nursing is generally 10 percent plus 10 euros per prescription until the end of 2026, and 10 percent plus 15 euros from 2027. The adult home-nursing co-payment is limited to the costs of the first 28 calendar days of use each year. For pregnancy complaints or in connection with childbirth, section 24e exempts covered medicines and remedies from the respective co-payments.
• From 1 January 2027, if an employment relationship ends during incapacity for work, statutory Krankengeld from the day after employment ends is 60 percent of net pay. The 67 percent rate refers to the insured person or their spouse or registered life partner having a qualifying child; the statute also says both spouses or life partners must be subject to unlimited income tax and not live permanently apart. Ask the insurer how the conditions apply, including if you have no spouse or registered life partner.
• Tell the employer at once that you are unfit and how long it is likely to last. If incapacity lasts more than three calendar days, the certificate is due by the following working day; the employer can require it earlier. A household Minijob, a privately insured employee, a doctor outside contracted statutory care, and illness certified abroad still follow the paper rule in section 5.
• The data the insurer gives the employer include the dates, first or follow-up status, and an accident flag. They do not include the diagnosis.
• Section 5 applies to your own inability to work because of illness, not to illness elsewhere in your family. Ask the insurer which certificate it wants for a child or a dependant.

What you need to know

Section 31(3) applies the medicine co-payment to insured people aged 18 or over. Until 31 December 2026, section 61 sets it at 10 percent of the price, at least 5 euros and at most 10 euros, and never more than the product costs. From 1 January 2027 the Act of 24 July 2026 sets it at 10 percent, at least 7.50 euros and at most 15 euros, still never more than the product costs.

Children under 18 do not pay that co-payment; some medicines and insured people can also be exempt. If the pharmacy has to substitute several smaller packs because the prescribed pack is unavailable, the co-payment is charged once, on the pack size that matches the prescribed quantity.

Full inpatient hospital treatment under section 39(4) has a separate co-payment for insured people aged 18 or over: 10 euros a calendar day until 31 December 2026 and 15 euros from 1 January 2027, for at most 28 days per calendar year. Certain rehabilitation co-payments already paid in that year are credited toward it. Ask the insurer which payments count; the 28-day limit is not a general limit for every inpatient service.

For insured people aged 18 or over, the co-payment for remedies and home nursing is generally 10 percent plus 10 euros per prescription until 31 December 2026, and 10 percent plus 15 euros per prescription from 1 January 2027.

For pregnancy complaints or in connection with childbirth, section 24e exempts covered medicines and remedies from the respective co-payments. For home nursing, section 37(5) limits the adult co-payment to the costs incurred for the first 28 calendar days of use per calendar year.

These service-specific limits are separate from the income-based annual burden limit in section 62 below, which the Act does not change. Over-the-counter products that the doctor does not prescribe are generally outside the medicine co-payment, because there is no statutory supply to share. This page does not list the exceptions in the medicines directive.

The employer’s side of a sick note is section 5 of the Continued Remuneration Act and section 109 of Book IV. You tell the employer at once that you are unfit and how long it is likely to last. Statutory members normally have the unfitness established without handing the employer the old paper certificate. The insurer provides the employer with permitted data, including the dates, first or follow-up status, and an accident flag; the diagnosis is not included.

Section 5(1a) applies the electronic route only to employees insured with a statutory fund. It excludes a Minijob in a private household and assessments by doctors who do not take part in contracted statutory care.

Privately insured employees stay on the paper rule in section 5(1). Illness certified abroad does too: a doctor abroad is outside that contracted care, and section 5(2) adds notice of the address abroad and, for a statutory member, notice to the fund.

In each of these cases, if incapacity lasts more than three calendar days, the certificate is due by the following working day; the employer can require it earlier.

Statutory Krankengeld, which can follow the employer’s continued pay, is capped by section 47 at 70 percent of regular contributory pay and at 90 percent of net pay. The pay used in that calculation stops at the contribution ceiling.

From 1 January 2027, section 47 (2a), enacted by the Act of 24 July 2026, applies when an employment relationship ends during incapacity for work. From the day after employment ends, statutory Krankengeld is 60 percent of net pay.

The 67 percent rate refers to the insured person or their spouse or registered life partner having a child who qualifies under section 32 (1) and (3) to (5) of the Income Tax Act. The statute also says both spouses or life partners must be subject to unlimited income tax and not live permanently apart.

Ask the insurer how the conditions apply to your case, including if you have no spouse or registered life partner. Until employment ends, the 70 and 90 percent caps still apply. The sick-leave guide states the general rule.

The emergencies and doctors guide explains emergency and on-call medical help. Pharmacy rotas for nights and Sundays are organised locally; check which pharmacy is on duty in your area.

What to do

1. Take the prescription to a pharmacy. Ask what the section 61 co-payment is for that pack before you pay, and keep the receipt. An annual burden limit can also cap co-payments; ask your insurer how it applies to you.
2. If you cannot work, tell the employer without delay. Book the medical assessment within the time section 5 states, and keep the certificate you are given.
3. Do not send the diagnosis to the employer. If electronic retrieval fails, contact the practice and employer promptly about proof. Check whether a paper exception applies and provide the employer’s certificate where required; do not assume every statutory member is exempt from providing it.
4. For a child or a dependant, ask the insurer which certificate it wants. Section 5 is the employee’s own unfitness, not every family illness.

Keep the receipts and ask the insurer

Section 62 limits co-payments in a calendar year to a burden limit. The limit is 2 percent of annual gross receipts for living expenses. It is 1 percent only in the chronic-illness cases the section defines. Those percentages stay when the co-payment amounts rise on 1 January 2027. That 1 percent line does not cover every chronic illness.

For insured people born after 1 April 1972 who, from 1 January 2008, did not regularly use the health checks in section 25(1) before the illness, the limit stays 2 percent unless they take part in a structured treatment programme for that illness. The Federal Joint Committee’s guideline on this rule sets exceptions, so a missed check does not by itself keep the limit at 2 percent. For specified cancer screenings, documented counselling can count as regular use. For the other checks in section 25, the guideline requires neither an examination nor counselling for this limit. It also exempts specified groups from the counselling duty, including people with a severe mental illness covered by the sociotherapy rules and people with a significant intellectual disability. This page does not calculate either percentage, and it does not decide which line or exception applies. Keep the receipts and ask your insurer.

If the limit is reached during the calendar year, the insurer must issue a certificate that no further co-payments are due for the rest of that year. The certificate must not show income. The insurer also applies the section’s rules for a shared household and for certain benefits. Children under 18 remain exempt from the medicine co-payment stated above. That exemption is separate from this limit.

For the 1 percent limit, you generally must prove to the insurer that the necessary treatment continues, at the latest after each calendar year. The insurer can waive that yearly proof when the necessary findings are already made and nothing suggests the chronic illness has ended.

Common mistakes

• Paying a percentage of a hospital day and calling it the pharmacy rule. For a medicine, section 61 uses 10 percent with a 5 to 10 euro band until 31 December 2026, and 7.50 to 15 euros from 1 January 2027. Adults’ full inpatient hospital treatment is a separate daily amount, limited to 28 days per calendar year: 10 euros until that date and 15 euros from 1 January 2027. Check which rehabilitation payments are credited toward the limit.
• Handing the employer a photo of the diagnosis. Use the employer’s certificate if paper proof is required; electronic retrieval does not include the medical reason.
• Assuming every medicine on the shelf is reimbursed. Section 61 prices the co-payment of a statutory supply. It does not put every box on prescription.