Text file: 10859.txt
author: "Du\u0161an S."
downvotes: 5
end consideration date: 2020-03-10
id: '10859'
number comments: 31
number views: 1499
proposal type: Competent authority response
response: "Response from the Ministry of Health\nFirst of all, we would like to clarify\
  \ the legal framework of the obligation to pay compulsory health insurance contributions\
  \ (one of the social security contributions) in order to help the petitioner understand\
  \ the reasonableness and necessity of the aforementioned payment of compulsory health\
  \ insurance contributions. The Law on Health Care and Health Insurance (Official\
  \ Gazette of the Republic of Slovenia, no. 72/06 - Official consolidated text, 114/06\
  \ - ZUTPG, 91/07, 76/08, 62/10 - ZUPJS, 87/11, 40/12 - ZUJF, 21/13 - ZUTD-A, 91/13,\
  \ 99/13 - ZUPJS-C, 99/13 - ZSVarPre-C, 111/13 - ZMEPIZ-1, 95/14 - ZUJF-C, 47/15\
  \ - ZZSDT, 61/17 - ZUP\u0160, 64/17 - ZZDej-K, and 36/19; hereinafter referred to\
  \ as \"ZZVZZ\"), in Article 13, paragraph 1, of the Act No. Article 13 provides\
  \ that compulsory health insurance comprises insurance against sickness and injury\
  \ outside work and insurance against occupational injury and occupational disease.\
  \ Persons engaged in any occupation or profession must also be insured against occupational\
  \ injuries and diseases under this heading, since the pursuit of an occupation or\
  \ profession increases the risks of these injuries and diseases. Under this insurance,\
  \ insured persons are entitled to health services, wage compensation for temporary\
  \ incapacity for work and reimbursement of travel expenses. The scope of the rights\
  \ under the compulsory health insurance depends on the basis of the insurance -\
  \ i.e. whether the insurance is based on the pursuit of a primary occupation or\
  \ activity as a sole or main occupation (insured for all rights) or whether the\
  \ activity is pursued as a secondary occupation or on the basis of a work contract,\
  \ student work, etc. (Articles 17 and 18 of the Health Insurance Act - insured only\
  \ for medical services and reimbursement of travel expenses).\nWe would also like\
  \ to further clarify that insured persons under the insurance for occupational injury\
  \ and occupational disease are entitled to a different (more favourable) percentage\
  \ of coverage of the benefits under the compulsory health insurance, e.g..:\n wage\
  \ compensation for temporary incapacity for work is covered to the full extent,\
  \ i.e. 100% of the base, and not only between 70% and 90% of the base; if the insured\
  \ person's employment relationship is terminated during the temporary incapacity\
  \ for work, and the reason for the temporary incapacity for work is an occupational\
  \ injury or occupational disease, the insured person is entitled to the benefit\
  \ until the reason for the temporary incapacity for work ceases to exist, and not\
  \ only for 30 calendar days after the termination of the employment relationship;\
  \ treatment and rehabilitation of occupational injuries and diseases is fully covered\
  \ by the compulsory sickness insurance, whereas in other cases only the percentage\
  \ provided for in Article 23(1) of Regulation (EC) No 2308/71 is covered. The difference\
  \ is covered by the insured person himself or by supplementary health insurance.\n\
  As regards the petitioner's claim that he has already paid the compulsory health\
  \ insurance contributions for his profession and therefore does not have to pay\
  \ any additional contributions for his 'afternoon s.p.', we reply that this is not\
  \ the case. It is true that the petitioner is covered by the compulsory sickness\
  \ insurance for injury and illness outside work and for occupational injury and\
  \ illness, but only in the context of the performance of that particular work, that\
  \ is to say, the work which he performs under his employment contract, by virtue\
  \ of his employment contract. The petitioner's work as an \"afternoon s.p.\" However,\
  \ he is again exposed to an additional risk of occupational injury and occupational\
  \ disease, which means that he must also be covered by compulsory sickness insurance\
  \ and pay a contribution for occupational injury and occupational disease as a result\
  \ of carrying on that activity. Accordingly, even in the event of an injury sustained\
  \ in the course of his 'afternoon s.p.s.' activities, he is entitled to full coverage\
  \ under the compulsory sickness insurance for the treatment and rehabilitation of\
  \ the injury and to reimbursement of travel expenses incurred in the treatment or\
  \ rehabilitation of the injury.\n Response from the Ministry of Labour, Family,\
  \ Social Affairs and Equal Opportunities\nThe current Law on Pension and Disability\
  \ Insurance (Official Gazette of the RS, No 96/12, 39/13, 99/13 - ZSVarPre-C, 101/13\
  \ - ZIPRS1415, 44/14 - ORZPIZ206, 85/14 - ZUJF-B, 95/14 - ZUJF-C, 90/15 - ZIUPTD,\
  \ 102/15, 23/17, 40/17, 65/17, 28/19 and 75/19; hereinafter referred to as \"ZPIZ-2\"\
  ), in the first indent of the first paragraph of Article 20(1)(a) of the Law on\
  \ Social Security and Social Insurance, provides for the following Article 20, first\
  \ paragraph, of the ZPIZ-2 provides that a person who is self-employed in a gainful\
  \ occupation or other permitted occupation, but is not insured under that occupation,\
  \ shall be insured for disability and death resulting from an occupational injury\
  \ or occupational disease. In accordance with Article 143 of the ZPIZ-2, contributions\
  \ for such persons are payable in flat-rate amounts determined by the Pension and\
  \ Disability Insurance Institute of Slovenia, and the persons liable for the payment\
  \ of contributions are the insured persons themselves, in accordance with Article\
  \ 154(2) of the ZPIZ-2.\nThe above therefore applies to persons who are covered\
  \ by compulsory insurance under another title, but who are insured for their afternoon\
  \ activity by paying a lump sum on the basis of Article 20 of ZPIZ-2 (special cases\
  \ of insurance). Injuries or illnesses arising from the pursuit of the activity\
  \ in question are thus considered to be occupational injuries/illnesses, and the\
  \ insured persons have more or higher rights on the occasion of the occurrence of\
  \ an insured event than if they had not had such insurance. Thus, an increased risk\
  \ of disability and death is paid because a person is engaged in an activity for\
  \ which he is not covered by compulsory pension and invalidity insurance on another\
  \ basis. The fact that the individual carries out an additional activity increases\
  \ the chances of occupational injuries and diseases for which the individual is\
  \ not and cannot be covered by compulsory affiliation to the compulsory pension\
  \ and invalidity insurance scheme, since this affiliation only covers the risk of\
  \ occupational injuries and diseases occurring in the course of the work on the\
  \ basis of which the individual is insured. This means that an individual who has\
  \ an employment relationship is insured against the risk of disability and death\
  \ due to an occupational injury or disease only when such injury or disease is caused\
  \ by the performance of work within the framework of an employment contract, or\
  \ by a regular journey to or from work if transport is organised by the employer,\
  \ or on a business trip. If such an individual were injured or became ill in the\
  \ course of his or her self-employed activity, such injury or illness would not\
  \ be recognised as an occupational injury or illness, and any rights that might\
  \ accrue to such a person under pension and invalidity insurance would be at the\
  \ expense of the solidarity of other insured persons.\nAs regards the rights themselves,\
  \ we would also like to clarify that the rights based on disability and death depend\
  \ on whether the injury or illness giving rise to the disability is the result of\
  \ an occupational injury, an occupational disease, or an illness or injury outside\
  \ work. For example, an insured person who suffers an occupational injury/illness\
  \ may be entitled to an invalidity pension irrespective of the pensionable service\
  \ completed up to the time of the disability, but if the disability is the result\
  \ of an injury/illness outside work, an invalidity pension may be granted provided\
  \ that, at the time of the disability, the insured person has completed a pensionable\
  \ service covering at least one-third of the period from the attainment of the age\
  \ of 20 years up to the time of the onset of the disability, counted as full years\
  \ of work. In certain cases, such inclusion in special insurance cases may mean\
  \ that an individual is entitled to a benefit to which he would not otherwise be\
  \ entitled. On the other hand, we would like to clarify that the assessment of rights\
  \ itself depends on the cause of the injury/illness, since the invalidity pension\
  \ is assessed at the percentage prescribed for a man for 40 years of pensionable\
  \ service in accordance with Article 37 of the Social Insurance Act, irrespective\
  \ of the fact that such an individual may have only 1, 2 or 10 years of pensionable\
  \ service. The invalidity pension for an individual whose invalidity is the result\
  \ of an injury/illness outside work shall be calculated on the basis of the pensionable\
  \ age at a percentage determined by reference to the completed pensionable age,\
  \ but in 2020 at least 37 % (men) or 39 % (women). The same shall apply in the event\
  \ of death resulting from an injury/illness arising from the pursuit of the activity\
  \ in question. Again, the widow, descendants or other family members may be entitled\
  \ to a widow's/family pension precisely because such an individual was covered by\
  \ the special insurance scheme in question, and a higher benefit may also be awarded.\n\
  We would like to clarify that, although such an individual is not entitled to pensionable\
  \ service under the special cases insurance scheme and the benefits do not count\
  \ towards the pensionable pension base, this does not mean that individuals cannot\
  \ be entitled to any benefits on this basis. The primary purpose of insurance is\
  \ precisely to provide rights in the event of an insured event.\nOn the basis of\
  \ the above, we consider that the legislation governing compulsory insurance against\
  \ invalidity and death for insured persons who are self-employed but who are not\
  \ insured under Article 15 of the Social Insurance Act (ZPIZ-2) is appropriate and\
  \ adequate, as it is based on the security of these persons in the pursuit of their\
  \ activities, thus ensuring them, in the event of the occurrence of an insured event,\
  \ a higher standard of social protection by means of a relatively low flat-rate\
  \ pension and invalidity insurance contribution than would have been the case if\
  \ there had been no obligation to be insured under Article 20 of the Social Insurance\
  \ Act (ZPIZ-2) had been in place."
response date: 2020-04-07
response due date: null
sent date: 2020-02-10
title: Paying contributions for a supplementary activity ("afternoon s.p.")
upvotes: 52
url: https://predlagam.vladi.si/predlog/10859
