Area: Zdravstvo
Competent authority: ZZZS
EZU URL: .nan
Initiative ID: 465
Initiative accepted and completed: '2015-04-16'
Initiative classified in EZU: .nan
Initiative forwarded in response: '2015-03-12'
Initiative published: '2015-03-12'
Initiative submitted: '2015-03-09'
Response from the competent authority: "Response of the Health Insurance Institute\
  \ of Slovenia:With regard to the above-mentioned question, the Institute notes the\
  \ following: the insured person was covered by compulsory health insurance as a\
  \ sole proprietor until the closure of her business, under Article 15(5)(1) of the\
  \ Health Care and Health Insurance Act (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, 63/13-ZUlPTDSV, 91/13, 99/13-ZUPJS-C, 99/13-ZSVarPre-C,\
  \ 111/13-ZMEPIZ-l and 95/14-ZUJF-C; hereinafter referred to as ZZVZZ). The insured\
  \ person is now included in the compulsory health insurance \"as a citizen\" as\
  \ defined in Article 15, paragraph 1, point 21 of the ZZVZZ. According to the quoted\
  \ provision of the ZZVZZ, the insured persons are citizens of the Republic of Slovenia\
  \ and foreigners who have a permanent residence permit and who are entitled to pay\
  \ a contribution to the compulsory insurance under the law regulating the claiming\
  \ of rights from public funds. Article 15, paragraph 1, point 1, point 20 of the\
  \ ZZVZZ and their family members shall have their rights to health services and\
  \ cash benefits (wage compensation for the period of temporary absence from work\
  \ and travel expenses) under the compulsory health insurance suspended during the\
  \ period in which they are not in compliance with their contribution payment obligations.\
  \ However, in the present case, the insured person is currently compulsorily insured\
  \ under Article 21(21) of the above-mentioned ZZVZZ (as a citizen) and is therefore\
  \ covered by the municipality's contribution scheme, which means that she is no\
  \ longer covered by compulsory health insurance under one of the bases of insurance\
  \ referred to in Article 78(1) of the Act. With regard to the insured person's statement\
  \ that she is currently insured \"as a citizen\", we would like to clarify that\
  \ insurance under the second basis does not relieve her from the payment of contributions\
  \ which she did not pay at the time of her insurance as a self-employed person.\
  \ However, as regards the payment of health care services, it is necessary to check\
  \ whether the insured person has both a right to the payment of the compulsory health\
  \ insurance contributions and a right to reimbursement of the difference up to the\
  \ full value of the health care services. If the latter is not granted, the insured\
  \ person must either take out supplementary health insurance or be a self-payer\
  \ for the difference up to the full value of the health services (not all health\
  \ services are fully covered by the compulsory health insurance).The exercise of\
  \ rights from public funds is regulated by the Act on the Exercise of Rights from\
  \ Public Funds (Official Gazette of the RS, No. 62/10, 40/11, 40/12-ZUJF, 57/12-ZPCP-2D,\
  \ 14/13, 56/13-Z\u0160tip-l, 99/13 and 14/15-ZUUJFO; hereinafter referred to as\
  \ ZPJUS), which defines two rights in relation to health insurance: 1) the right\
  \ to payment of a contribution for compulsory health insurance for citizens of the\
  \ Republic of Slovenia with permanent residence in the Republic of Slovenia who\
  \ are not insured under another title under the law regulating health insurance\
  \ (ZZVZZ), and 2) the right to coverage of the difference up to the full value of\
  \ health services under the law regulating health insurance (ZZVZZ). In accordance\
  \ with Articles 29 and 30 of the Social Welfare Act, both of these rights are decided\
  \ by the social work centre by means of a decision.As the insured person does not\
  \ provide any additional information in her letter regarding the possible claiming\
  \ of rights from public funds, the Institute proposes that she contact either the\
  \ competent social work centre or the nearest regional unit of the Institute for\
  \ any further clarification regarding the reasons why she should now be paying for\
  \ medical services as a self-payer. Any possible relief or simplification of the\
  \ above is not within the competence of the Institute, which is only a provider\
  \ of compulsory health insurance, but is subject to legislative change in the context\
  \ of the health reform being prepared by the Ministry of Health."
Text file: 465.txt
Title: Health insured as a citizen
URL: https://www.stopbirokraciji.gov.si/pobuda/?st=465
