Health Insurance Fund adopts new sick‑leave rules

On 6 October 2026 the Management Board of the Health Insurance Fund unanimously approved amendments to the rulebook that set the criteria for establishing temporary incapacity for work.

The changes do not reduce the right to sick leave nor limit its duration when medical need exists. Family doctors remain authorised to determine temporary incapacity for up to 15 days; any extension beyond 15 days is decided by the Fund's medical commission. The change from seven to five days refers only to the trigger point for applying diagnostic criteria, not to an automatic end of sick leave on the fifth day.

Fewer in‑person procedures, more electronic handling

The amendments introduce several concrete easements aimed at cutting unnecessary administrative procedures and the need for insured persons to visit health‑care counters. Key provisions include:

• For some diagnoses, laboratory tests will no longer be required and the family doctor will be able to make the assessment directly.
• For specific diagnoses the timeframes set in the criteria have been extended.
• After the 15th day, the proposal for temporary incapacity for work will be submitted electronically by the family doctor instead of via the current manual procedure.
• Cases in which sick leave can be granted without the insured person’s physical presence are expanded — notably for severely ill, immobile and hard‑to‑move persons, for those on hospital treatment, and in other justified situations.
• For chronic diseases existing diagnostic findings may be used if they remain within their validity period, avoiding unnecessary repetition of tests.
• Conditions for retroactive recognition of sick leave are clarified in justified cases, including after hospital treatment.
• Pregnant and breastfeeding women will receive eased rules for radiodiagnostic procedures involving ionising radiation when the condition is properly confirmed by a specialist report.
• For certain serious illnesses exceptions are foreseen from the obligation to seek a consiliary opinion for sick leaves longer than 60 days.

According to the Fund, the package of measures is the result of months of expert work and a review of criteria many of which date to 2012. The changes are presented as an effort to bring the rules in line with modern medical and diagnostic possibilities while reducing burdens on patients and doctors. The Fund also says that open questions raised by board members were reviewed between the interruption and continuation of the 33rd session so the decision could be taken on a fully considered basis.

The amendments take effect after publication in the official manner required by the Fund. Officials emphasise that the 15‑day threshold for family‑doctor authority remains unchanged and that insured persons will retain the right to sick leave whenever their health condition requires it.

Photo: press material from the event