Health Insurance Fund approves changes to sick-leave criteria and adds reliefs for insured
Amendments approved on October 6, 2026 keep primary care authority up to 15 days and add electronic filing and other patient-friendly measures.
On October 6, 2026 the Health Insurance Fund (FZOM) board approved amendments to the rulebook that set the criteria for establishing temporary incapacity for work.
The Fund said the changes do not shorten the right to sick leave or limit its duration when continued absence is medically justified. The decision keeps the primary care physician authorised to certify incapacity for up to 15 days; cases exceeding 15 days are decided by the Fund's medical commission.
“The change from seven to five days does not mean that the sick leave ends on the fifth day. It refers to the period after which, if the medical condition requires extension of the sick leave, the medical criteria provided for the specific diagnosis are applied. The key boundary of 15 days under the authority of the primary care physician remains unchanged,” the Health Insurance Fund (FZOM) said.
Practical reliefs and digital steps
FZOM described a series of concrete measures aimed at cutting unnecessary paperwork and patient movement through the health system. The most important changes announced include:
- for some diagnoses patients will no longer need mandatory laboratory tests; the primary care physician will be able to assess them;
- timeframes specified in the criteria will be extended for certain diagnoses;
- after the 15th day, the proposal for temporary incapacity for work (PSR) will be submitted electronically by the primary care physician instead of via paper procedures;
- expansion of cases in which sick leave can be issued without the insured person’s physical presence, particularly for severely ill, immobile or hospitalized patients and other justified situations;
- for chronic diseases existing diagnostic findings may be used if they remain within the valid period, avoiding unnecessary repeat testing;
- clarified conditions for retroactive establishment of sick leave in justified situations, including after completed hospital treatment;
- relief for pregnant and breastfeeding women concerning radiological diagnostic procedures that use ionising radiation, when the condition is confirmed by a specialist report;
- for certain severe illnesses exceptions are foreseen from the obligation to obtain a consultative opinion for sick leaves longer than 60 days.
The Fund said the new solutions are the result of several months of expert work and analysis of the current criteria, a significant portion of which date back to 2012.
Photo: press material from the event
