Sickness insurance

 

Sickness insurance is insurance in the case of loss or decrease in income due to temporary incapacity to work, pregnancy, maternity.

The following benefits are paid from the system of sickness insurance:

  1. sickness benefit
  2. maternity benefit
  3. benefit for nursing a sick relative
  4. equalisation benefit

 

Sickness insurance is mandatory for the following groups:

  • employee with regular monthly income
  • self-employed person meeting conditions regarding the income out of business (see more here >>, in Slovak only)

 

For the purpose of sickness insurance, an employee shall be an individual in a legal relationship with a right to a regular monthly income and also a person performing activities on the basis of agreements on work performance besides work contract with a regular monthly income, except for a person:

  • performing activities on the basis of a Contract for part-time work of students and
  • performing activities on the basis of an agreement on the performance of work or contract for services, if the person is granted the old-age, disability, retirement pension and has reached the old-age, disability, retirement age.

 

Voluntary sickness insured person can be a person after the age of 16 years, having permanent residence on the territory of the SR, temporary residence permit or permanent residence permit (EU/EEA/Swiss citizens fulfil this condition if they have residence in EU/EEA/Switzerland), if the person:

  • is not granted the old-age pension, early retirement or disability pension because of a decline of earning capacity by more than 70%,
  • is not granted disability pension when reaching the retirement age and
  • at the same time is voluntarily pension insured.

 

Sick pay – income during sick leave

During the sick leave an employee/insured person does not receive any salary, but he/she, after being certified as temporarily unfit to work due to illness or injury, or due to quarantine by an authorised doctor, is entitled to a sick pay. It is at the rate of 25 % of the employee's basis of assessment for the first 3 days, then at the rate of 55 % of the employee's basis of assessment. During the period of first 10 days of the sick leave the benefits are paid by his/her employer; from the 11th day the sick pay is paid by the Social Insurance Agency (at the rate of 55 % of the employee's basis of assessment).

(The daily assessment base for the determination of sickness benefits is the quotient of the sum of the assessment bases, based on which the insured person paid sickness insurance in the relevant period, and the number of days in the relevant period.)

Conditions of entitlement:

  • valid sickness insurance;
  • after termination of sickness insurance – being in the period of entitlement to sickness benefits or within the duration of the protective period. The duration of the protective period is 7 days. If the period of sickness insurance was shorter than 7 days, the duration of the protective period is equal to the duration of sickness insurance. The duration of the protective period for a female insured person, whose sickness insurance terminated at the time of her pregnancy, is 8 months;
  • persons with voluntary sickness insurance are entitled to sickness benefits if, during the last 2 years preceding temporary incapacity to work, they were covered by sickness insurance for not less than 270 days;
  • entitlement to sickness benefits ceases on the day following the last day of temporary incapacity to work, not later than with the lapse of the 52nd week from the beginning of temporary incapacity to work (support period);
  • employees are entitled to sickness benefits if they do not receive income that may be considered as an assessment base.

Filing the claim:

  • using a form of the Social Insurance Agency – Certificate of Temporary Work Incapacity issued by the medical practitioner of a health establishment, submitted by means of the employer.

Obligations of the recipients of benefits:

  • to present proof of the facts that are relevant for granting or terminating the entitlement to sickness benefits, their payments, or their amount;
  • to comply with the treatment regime prescribed by the attending physician at the time of the temporary incapacity to work;
  • to stay at the address reported in the certificate at the time of temporary incapacity to work;
  • to state the birth identification number in the application (or the social security identification number);
  • to notify the Social Insurance Agency of the termination of temporary incapacity to work within 3 days of its termination, if temporary incapacity for work lasted more than 10 days (by means of the employer).

Commercial insurance companies offer the possibility of additional health insurance during sickness leave as the income of an employee is being reduced.

 

Maternity leave, family care

In connection with the childbirth and care for a new born child, women are entitled to maternity leave lasting 34 weeks. If a woman is a single parent, she is entitled to the maternity leave of 37 weeks. If a woman gives birth to two or more children at the same time, she is entitled to the maternity leave of 43 weeks. The date of commencing the maternity leave is set by the attended physician, usually 6 weeks before the expected date of childbirth (at earliest 8 weeks prior to the childbirth). This period is calculated to the total duration of 34 weeks. In connection with the care for a new born child, men are also entitled to the paternity leave of the same scope from the date of birth of the child of whom they take care.

For the purposes of extended care of children, employers are obliged to grant women and men who so request, parental leave until the day the child turns three years old of the child (it can be requested at any time up to the age of 3, even if the mother/father has been working after the maternity/paternity leave).

In case of children with long term poor health requiring special care, employers are obliged to grant women and men, who so request, parental leave until the day the child turns six years old.  Such leave is granted for the duration requested by the parent, but generally for at least one month.

Maternity leave granted in connection with the birth must not be shorter than 14 weeks and may not be terminated or interrupted before the lapse of 6 weeks from the date of the birth.

An employer must excuse the employee´s absence from work on the grounds of temporary incapacity to work due to illness or injury, periods of maternity and parental leave, quarantine, attending to a sick family member or caring for a child younger than 10 years of age who for important reasons, cannot be left in the care of a childcare establishment or school that the child normally attends, or in case of medical examination or quarantine of the person who otherwise takes care of the child.

 

Maternity benefit

Women having sickness insurance for at least 270 days in the last 2 years before expected childbirth are entitled to maternity benefit from the beginning of the 6th week preceding the expected date of delivery (childbirth) as determined by an attending practitioner, but not before the beginning of the 8th week preceding the expected delivery date, or from the date of birth if it comes earlier than the aforesaid dates.

Generally, the benefit is provided during 34 weeks from the commencement of entitlement. In case that a woman is a single mother, her entitlement to maternity benefits terminates at the end of the 37th week from the commencement of entitlement to the maternity benefit. If a woman gives birth to 2 or more children at the same time, and takes care of at least 2 of these children, her entitlement to maternity benefits terminates at the end of the 43rd week from the commencement of entitlement to the maternity benefit.

The period of entitlement to maternity benefit for an insured person who has given birth to a child may not be shorter than 14 weeks from the commencement of entitlement to maternity benefits and may not be terminated earlier than 6 weeks from the date of birth.

If another insured person is taking care of a child, such a person shall be entitled to maternity benefit as from the date of assuming the care of the child for a period of 28 weeks from the commencement of entitlement to maternity benefit (or, if is a single person, until the end of the 31st week from the

commencement of the entitlement to maternity benefits, or if assuming care of 2 or more children, until the end of the 31st week from the commencement of the entitlement to maternity benefits)

The maternity benefit is at the rate of 65 % of the daily assessment base, or of the probable daily assessment base, and it is provided from the 1st day of entitlement only to 1 insured person.

Conditions of entitlement:

  • pregnancy or the care for a new-born child;
  • valid sickness insurance;
  • being covered by sickness insurance for not less than 270 days during the last 2 years preceding childbirth (delivery);
  • after termination of sickness insurance – being in the period of entitlement to sickness benefits or within the duration of the protective period. The duration of the protective period for a female insured person, whose sickness insurance terminated at the time of her pregnancy, is 8 months.

Filing the claim:

  • using the form of the Social Insurance Agency – Maternity Benefit Application, certified by a medical practitioner of a health establishment, submitted by means of the employer or the applicant if relevant.

Obligations of a recipient of benefits:

  • to present, the proof of the facts relevant for the awarding or withdrawing of the entitlement to maternity benefit, entitlement to its payments, and its amount;
  • to state his/her birth identification number in the application, to notify the Social Insurance Agency of the birth identification number of the child.

 

Nursing benefit

Sickness insurance entitles an insured person for a nursing benefit – an income to be paid during the nursing of a sick child, sick husband/wife, sick parent or sick husband's/wife's parent or taking care of a child under 10 years of age that is placed under quarantine. In addition, the nursing benefit can be paid also when the preschool or school establishment, that the child normally attends, are dissolved or placed under quarantine, or in case of sickness or quarantine of the person who otherwise takes care of the child or in the case of hospitalisation of that person due to expected delivery.

Benefits for nursing a sick relative are at the rate of 55 % of the daily assessment base, or of the probable daily assessment base, they are provided from the 1st day of the care to the end of the care, at maximum for 10 days. It is provided for the same case only once and only to 1 insured person.

Filing the claim:

  • using the form of the Social Insurance Agency – Application for benefit for nursing a sick relative, certified/issued by a medical practitioner of a health establishment, submitted by means of the employer.

 

Equalisation benefit

The female employee is entitled to this kind of benefit, if redeployed for another job, as the work performed before is prohibited to pregnant women or, according to the medical report threatens her pregnancy, and the work she was transferred to provides for a lower income without her fault,

compared to the income she had earned before her redeployment. The amount of the equalisation benefit is 55 % of the difference between the monthly assessment basis and the assessment basis from which the female employee pays premium for the sickness insurance in separate calendar months after being transferred to another job. The equalisation benefit is provided for a calendar month, even if the female employee was transferred to another job or secondment was finished during the calendar month.

The basic role of the social insurance system in Slovakia is the protection of the economically active population in the event of life contingencies. Mandatorily insured are employed and self-employed persons regarding the income out of business. Social insurance is financed by contributions; it is administered by the Social Insurance Agency (SIA).