Area: Health
Competent authority: MZ, ZZZS
EZU URL: .nan
Initiative ID: 1008
Initiative accepted and completed: '2020-05-18'
Initiative classified in EZU: .nan
Initiative forwarded in response: '2020-03-17'
Initiative published: '2020-03-17'
Initiative submitted: '2020-03-17'
Response from the competent authority: "Reply from the Health Insurance Institution\
  \ of Slovenia:We would like to clarify the proposals:Direct payment of wage compensation\
  \ charged to the compulsory health insurance to the workerWe would like to start\
  \ by pointing out that there is no legal basis for ZZZS to directly pay wage compensation\
  \ charged to the compulsory health insurance to workers. Article 137 of the ZDR-1[1]\
  \ provides for the employer as the primary payer of the compensation, who then reimburses\
  \ the compensation paid to the employer from the ZZZS. Article 217 of the ZDR-1\
  \ also provides for a fine for non-compliance with this obligation. The legal basis\
  \ for the direct payment of wage compensation by the ZZZS is provided only exceptionally,\
  \ namely in the event that the employer fails to pay wages and wage compensation\
  \ to employees within the statutory or contractually agreed time limit.Even otherwise,\
  \ we do not consider that such a legal arrangement as proposed by the petitioner\
  \ would be appropriate, since wage compensation is a social benefit that compensates\
  \ for wage losses and must therefore be provided as promptly as possible. The payment\
  \ of the allowance by the employer gives the worker access to his entitlement earlier\
  \ (the allowance is paid at the same time as other workers' wages). In most cases,\
  \ however, the employer is in possession of all the relevant data for the calculation\
  \ of the allowance, and the allowance is paid simply on the basis of the sickness\
  \ certificate issued, without the worker having to submit a separate application.\
  \ If the benefit were paid directly by the ZZZS, the right would have to be claimed\
  \ by way of an application and the payment procedure would be prolonged, as the\
  \ ZZZS does not have access to many of the data already held by the employer (data\
  \ on the workers' TRR, data on tax deductions for family members, data on deductions\
  \ from wages (credits, insurance premiums), data on the individual worker's working\
  \ calendar and data on the actual use of sick leave). In addition, the employer\
  \ would also have to participate in the procedure, as it is the only one in possession\
  \ of certain information necessary for the calculation of the allowance (e.g. the\
  \ worker's working calendar, the worker's actual absence from work). All of the\
  \ above would significantly prolong the process of payment of the allowance, and\
  \ the worker would, as mentioned, have to come to his/her entitlement later, which\
  \ would put such a vulnerable category of insured persons at an even greater disadvantage\
  \ compared to other healthy insured persons who work and receive their salary on\
  \ a regular basis, without having to make any special requests. The financial implications\
  \ of the proposed regulation cannot be ignored either, as it would require a significant\
  \ increase in staffing on the part of the ZZZS.Submission of a refund claim before\
  \ payment of wage compensation to workersSubmission of a refund claim before payment\
  \ of wage compensation to workers is not possible (but the preparation of a claim\
  \ is possible), as 137. Article 137 of the ZDR-1, Article 17 of the Regulations[2]\
  \ and Article 229(4) of the Regulations[3] provide that the ZZZS shall not reimburse\
  \ the employer for wage compensation accrued if it has not paid it to the workers\
  \ who were entitled to it. It follows from the foregoing that the Institute may\
  \ not reimburse compensation if it has only been calculated but not paid. By certifying\
  \ on the return that it has paid the allowance to the worker, the employer guarantees\
  \ that it has done so. If the contrary is found, the employer shall also be criminally\
  \ liable. However, the submission of the REK form does not necessarily mean that\
  \ the compensation has actually been paid to the employees, since, in accordance\
  \ with Article 284 of the Income Tax Act-2[4], employers may also file the REK form\
  \ before the payment of the income. The ZZZS uses the information it obtains from\
  \ the FURS regarding the submitted REK forms for control purposes only.The basis\
  \ for the assessment of the wage benefit - information on the basis With regard\
  \ to the verification of the basis for the assessment of the wage benefit, we would\
  \ like to point out that the ZZZS does not have the FURS' information on the payments\
  \ at its disposal before the employer submits a claim for reimbursement, as it has\
  \ no legal basis for access to this information, which is tax secret. Thus, ZZZS\
  \ cannot enable the checking of the basis itself already at the time of the preparation\
  \ of the claim on the SPOT portal. Even otherwise, ZZZS is not entitled to provide\
  \ the employer with the above information. The employer has the right to request\
  \ from the insured person, in relation to a specific calculation, the information\
  \ on the basis which the employer has obtained from the previous employer or from\
  \ the FURS (e.g. income tax decision, other certificates). On the basis of the opinion\
  \ of the Information Commissioner, the ZZZS may only in individual cases where this\
  \ is necessary (if the employer is not able to obtain the information in any case\
  \ and duly proves this with evidence - e.g. However, not separately by individual\
  \ payers, otherwise the provision of the above information by the Institute to employers\
  \ is not allowed under the current legislation.Slow operation of the systemWith\
  \ regard to the allegations that the system is slow, we would like to point out\
  \ that we have not received any such complaints so far, so we would suggest that\
  \ you check the operation of your system or the links to it. Incidentally, we would\
  \ like to point out that the SPOT system also provides the possibility to submit\
  \ reimbursement claims via a web interface, which allows the calculation and the\
  \ reimbursement claim to be prepared from the data of the software you use for the\
  \ calculation of salary and salary compensation. For more information, please visit:\
  \ https://zavezanec.zzzs.si/wps/portal/portali/azap/e-poslovanje/vlaganje-refund-zahtevkov-za-nadomestila-plac.Izra\u010D\
  un reimbursements on the SPOTV system With regard to the proposal to automatically\
  \ create a reimbursement claim by downloading the e-patient payslip, we have to\
  \ inform you that this is unfortunately not possible, as ZZZS does not have all\
  \ the necessary data for the calculation - e.g. information on the working calendar.\
  \ There is also no legal basis that would allow ZZZS or FURS to control or automatically\
  \ fill in the basis data on the SPOT portal - i.e. to transmit it to the employer,\
  \ since ZZZS is only entitled to that data once a claim for reimbursement has been\
  \ submitted, and not before, as explained above. Nor can the information on the\
  \ working calendar be provided by the ZZZS. ZZZS has only the weekly work commitment\
  \ of the insured person (e.g. 40, 20 hours per week), but not the distribution of\
  \ working time by days (e.g. 8 hours per day, 4 hours per day, etc.), as not all\
  \ insured persons work 5 days of 8 hours per day according to the general working\
  \ calendar.Finally, we would like to point out once again that there is no legal\
  \ basis that would allow ZZZS to directly pay the wage allowance to the employees,\
  \ nor would it make sense to do so. However, ZZZS is and will continue to make every\
  \ effort, in the light of the applicable legal framework and the available options,\
  \ to regulate the reimbursement procedure in a way that is as employer-friendly\
  \ as possible.We apologise for the delay in replying; in the wake of the declared\
  \ epidemic, ZZZS's professional services have been assigned a number of new tasks\
  \ in relation to the prevention and management of the emergency situation.We would\
  \ like to apologise for the delay in replying.\r\n[1] Labour Relations Act (Official\
  \ Gazette of the Republic of Slovenia, No. 21/13, 78/13 - corrected, 47/15 - ZZSDT,\
  \ 33/16 - PZ-F, 52/16, 15/17 - Decree of the US, 22/19 - ZPosS and 81/19)[2] Regulation\
  \ on claiming payment of wage compensation from the compulsory health insurance\
  \ at the request of the employer (Official Gazette of the RS, no. 12/20)[3]Rules\
  \ of compulsory health insurance (Official Gazette of the RS, No. 79/94, 73/95,\
  \ 39/96, 70/96, 47/97, 3/98, 3/98, 51/98 - decree of the US, 73/98 - decree of the\
  \ US, 90/98, 6/99 - corrected, 109/99 - Decree of the US, 61/00, 64/00 - Amended,\
  \ 91/00 - Amended, 59/02, 18/03, 30/03, 35/03 - Amended, 78/03, 84/04, 44/05, 86/06,\
  \ 90/06 - Amended, 64/07, 33/08, 7/09, 88/09, 30/11, 49/12, 106/12, 99/13 - ZSVarPre-C,\
  \ 25/14 - Decree of the US, 25/14, 85/14, 10/17 - Z\u010CmIS, 64/18 and 4/20)[4]\
  \ The Tax Procedure Act (Official Gazette of the Republic of Slovenia, no. 13/11\
  \ - Official consolidated text, 32/12, 94/12, 101/13 - ZDavNepr, 111/13, 22/14 -\
  \ Decree of the US, 25/14 - ZFU, 40/14 - ZIN-B, 90/14, 91/15, 63/16, 69/17, 13/18\
  \ - ZJF-H, 36/19 and 66/19)"
Text file: 1008.txt
Title: Proposal on sickness reimbursement
URL: https://www.stopbirokraciji.gov.si/pobuda/?st=1008
