Sickness benefit

Definition / Purpose of the benefit

Sickness benefit is provided to the insured person if he or she has been declared temporarily incapable for working activity or quarantined (hereinafter referred to as “temporary incapacity for work”).

Who is eligible

The following persons are eligible to the sickness benefit:

• employees;
• self-employed persons (SZCO) with compulsory sickness insurance;
• persons with voluntary sickness insurance;
• natural persons who has become temporarily incapacitated after termination of sickness insurance within the protective period.

Claiming the benefit

Upon detecting incapacity for work, the doctor of the medical facility will issue a Certificate of Temporary Incapacity for Work. The certificate is a five-part form of the Social Insurance Agency, which is not freely available.

The doctor will hand over the following documents to the insuree:

• Part I of the certificate - card of the insuree who is temporarily incapable for work – the insuree shall use this part to the employee of the Social Insurance Agency performing the control of the observance of the treatment regime. The doctor also marks the date of the check-up on this part. Upon termination of the temporary incapacity for work, the insuree will hand it over to the doctor.
• Part II of the certificate - application for sickness benefit/additional accidental benefit – with this part the insuree shall claim his or her benefit, while before handing it over to the employer or sending it to the Social Insurance Agency he/she is obliged to indicate the following data:
• which benefit is claimed (sickness benefit and/or additional accidental benefit)
• data in the declaration (whether he/she claims the benefit from the concurrence of insurances, and the method of transfer of the benefit). Then, the insuree adds his/her signature to the application.
• Part IIa. of the certificate - application for income compensation in case of temporary incapacity for work - with this part the employee claims the right to income compensation from the employer.
• Part IV. of the certificate - notification to the employer and the branch of the Social Insurance Agency about the termination of temporary incapacity for work - after signing the declaration, the insuree is obliged to immediately send it to the branch that pays the sickness benefit (except for the employee whose temporary incapacity for work lasted no more than 10 days – it such a case it will be handed over to the employer).
• Other parts of the certificate (Part I after the end of temporary incapacity for work and Part III at its beginning) shall be sent by the doctor of the medical facility to the Social Insurance Agency to the register of temporarily incapacitated insurees.
• If the attending physician finds the insuree temporarily incapable of work from several sickness insurances, he/she will issue a certificate separately for each of them.

Where and when should you make a claim?

• The insuree shall assert the claim at the locally relevant branch of the Social Insurance Agency, preferably immediately after the application is issued.
• Employee shall submit part II. of the certificate to the branch only if the temporary incapacity for work lasted more than 10 calendar days. He/she will do so through his/her employer, who will include and sign the employer's confirmation.
• Self-employed persons (SZCO) with compulsory sickness insurance, persons with voluntary sickness insurance and/or natural persons within the protective period shall submit Part II. of the certificate to the branch of the Social Insurance Agency that performs/last performed their sickness insurance.

Eligibility criteria

Employee

• becomes temporarily incapacitated for work;
• the temporary incapacity for work must occur during the period of sickness insurance or during the protective period;
• does not have any income for work performed, which is considered to be the assessment basis, paid for the period of temporary incapacity for work (the period for which the benefit is paid is decisive rather than in which period and whether it is income for work performed);
• it is not monitored whether the employer has paid sickness contribution.

Self-employed person (SZCO) with compulsory sickness insurance:

• becomes temporarily incapacitated for work;
• the temporary incapacity for work must occur during the period of sickness insurance or during the protective period;
• The person has paid sickness insurance contributions in the correct amount from the first origin of the sickness insurance until the end of the calendar month preceding the calendar month in which the temporary incapacity for work occurred. This applies at most for the last five years preceding the calendar month in which the temporary incapacity for work arose, usually till the end of the calendar month in which the temporary incapacity for work arose (except if the temporary incapacity for work occurred in the calendar month in which the insurance arose for the first time or within the protective period). When assessing the condition of payment of health insurance premiums, the amount of outstanding health insurance premiums shall be tolerated if less than EUR 5. By paying the claim on the insurance premium, the condition of payment of the insurance premium is considered fulfilled for the purposes of the entitlement to the benefit.
• it is not monitored whether the self-employed person (SZCO) earns income during his or her temporary incapacity for work (this does not mean that he or she can perform work for money in person – see adherence to the treatment regimen in How should you Behave during your Incapacity for Work).

Person with voluntary sickness insurance:

• becomes temporarily incapacitated for work;
• the temporary incapacity for work must occur during the period of sickness insurance or during the protective period;
• the person has 270 days of sickness insurance in the last two years before the beginning of his or her temporary incapacity for work (in addition to the current voluntary sickness insurance, any completed sickness insurance shall be taken into account);
• the person has paid sickness insurance contribution in the correct amount from the first occurrence of the sickness insurance until the end of the calendar month preceding the calendar month in which the temporary incapacity for work occurred. This applies at most for the last five years preceding the calendar month in which the temporary incapacity for work occurred, usually by the end of the calendar month in which the temporary incapacity for work occurred (except if the temporary incapacity for work occurred in the calendar month in which the insurance occurred for the first time or within the protective period). When assessing the condition of payment of the health insurance contributions, the total amount of contributions due shall be tolerated if less than 5 EUR. By paying the contributions claim, the condition of payment of the contributions shall be considered fulfilled for the purposes of the entitlement to the benefit.

Protective period

Duration:

• seven days after the end of the sickness insurance;
• if the sickness insurance lasted less than seven days: as many days as the sickness insurance lasted;
• eight months in the case of an insured woman whose sickness insurance expired during her pregnancy.

If not expiring earlier, the duration of the protective period shall expire on the day on which

• the sickness insurance occurred;
• any right to old-age pension, early old-age pension or disability pension occurred.

Amount of the benefit in 2021

The sickness benefit shall be determined from the daily assessment basis (DVZ) or probable daily assessment basis (PDVZ).

• DVZ = the ratio of the sum of assessment bases from which the insuree paid the sickness insurance contribution in the reference period and the number of days of the reference period. DVZ shall be rounded up to four decimal places
• Limitation of the daily assessment basis (DVZ) – The DVZ may not be higher than the DVZ determined from twice the general assessment base that was valid in the calendar year preceding the calendar year in which the reason for provision of the sickness benefit occurred (from 1 January to 31 December 2021 = 71,8028 EUR).
• PDVZ = one-thirtieth of the assessment basis (VZ), from which the sickness insurance contributions would be paid for the calendar month in which the reason for the provision of the sickness benefit occurred (assumed VZ). PDVZ shall be rounded up to four decimal places.
• If the probable daily assessment basis (PDVZ) is higher than the amount corresponding to one-thirtieth of the minimum assessment basis (VZ) (i.e., the VZ referred to in § 138 paragraph 5 of Act No. 461/2003 Coll.), which is valid on the day on which the reason for the provision of the sickness benefit arose (from 1 January 2021 to 31 December 2021 it is 546 EUR), the PDVZ is the amount corresponding to one thirtieth of the minimum assessment basis (VZ) (from 1 January 2021 to 31 December 2021 it is 18,2000 EUR).
• Exception – Probable daily assessment basis (PDVZ) of an employee and/or a self-employed person (SZCO) with mandatory sickness insurance who did not have any assessment basis (VZ) in the reference period as a result of his or her temporary incapacity for work, receiving of maternity benefits, interruption of the mandatory sickness insurance of an employee as a result of her parental leave, interruption of the mandatory sickness insurance of a self-employed person (SZCO) who is entitled to parental allowance, shall be one-thirtieth of the assumed assessment basis (VZ), from which the sickness insurance contributions would be paid for the calendar month in which the reason for the provision of the sickness benefit occurred.
• Limitation of the probable daily assessment basis (PDVZ) – the same as for the daily assessment basis (DVZ).

Cases in which the sickness benefit shall be determined from the probable daily assessment basis (PDVZ) (rather than from the daily assessment basis – DVZ):

• if the employee, the mandatorily insured self-employed person (SZCO) and/or the voluntarily insured person did not have any assessment basis (VZ) in the reference period;
• if the employee who in the current sickness insurance did not reach 90 days of paying the sickness insurance contributions before the reason for the sickness benefit occurred, and in the reference period which is the calendar year preceding the calendar year in which the reason for the sickness benefit occurred he or she did not reach 90 days of paying the sickness insurance contributions with other employers;
• if a reason occurred for a self-employed person (SZCO) with mandatory sickness insurance, for provision of sickness benefit on the day of the occurrence of this sickness insurance (the occurrence of sickness insurance due to the end of its interruption shall not be taken into account);
• if a voluntarily insured person with sickness insurance has been continuously voluntarily insured with sickness insurance for less than 26 weeks

Reference period:

• if the sickness insurance of an employee, a self-employed person (SZCO) or a voluntarily insured person has lasted continuously from at least 1 January of the calendar year preceding the calendar year in which the temporary incapacity for work occurred, until the day on which the temporary incapacity occurred, the reference period for the purposes of establishment of the DVZ is the calendar year preceding the calendar year in which the temporary incapacity for work occurred;
• if the sickness insurance of an employee occurred in the calendar year preceding the calendar year in which the temporary incapacity for work occurred or in the calendar year in which the temporary incapacity for work occurred, and the period of the sickness insurance for which sickness insurance contributions were paid was at least 90 days before the day on which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar month preceding the calendar month in which the temporary incapacity for work occurred;
• if the period of sickness insurance of an employee for which sickness insurance contributions are paid, before the occurrence of the temporary incapacity for work was less than 90 days from the occurrence of this insurance, the reference period for the establishment of the daily assessment basis (DVZ) is the calendar year preceding the calendar year in which the temporary incapacity for work occurred, if the period of the sickness insurance of the employee for which sickness insurance contributions are paid lasted at least 90 days in the previous calendar year, in addition to the period of sickness insurance obtained with the employer where the reason for the provision of the maternity benefits occurred (i.e., the assessment basis (VZ) with the same employer shall not be taken into account);
• if the sickness insurance of a self-employed person (SZCO) arose
• in the calendar year preceding the calendar year in which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar year that is previous to the calendar year in which the temporary incapacity for work occurred;
• in the calendar year in which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar month that is previous to the calendar month in which the temporary incapacity for work occurred;
• in the calendar month in which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar day that is previous to the calendar day in which the temporary incapacity for work occurred;
• if the sickness insurance of a voluntarily insured person lasted for at least 26 weeks and it occurred
• in the calendar year preceding the calendar year in which in the calendar year preceding the calendar year in which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar year that is previous to the calendar year in which the temporary incapacity for work occurred;
• in the calendar year in which the temporary incapacity for work occurred, the reference period for the establishment of the daily assessment basis (DVZ) is the period from the inception of the sickness insurance to the end of the calendar month that is previous to the calendar month in which the temporary incapacity for work occurred;

• if the entitlement to the sickness benefit occurred for an employee, a self-employed person (SZCO) or a voluntarily insured person in the protective period, the reference period for the establishment of the daily assessment basis (DVZ) shall be established as of the day of termination of the sickness insurance;
• when determining the reference period for the purposes of establishment of the daily assessment basis (DVZ) and for the purposes of occurrence on a sickness insurance of an employee, the occurrence and termination of the interruption of mandatory sickness insurance shall not be deemed occurrence and termination of the mandatory sickness insurance for the purposes of establishment of the 90 days of the sickness insurance for which sickness insurance contributions are paid (i.e., no new reference period shall be established after the termination of the interruption of the mandatory sickness insurance and the 90 days of payment of the contributions to the sickness insurance shall be monitored from the beginning of the employee's sickness insurance);
• sickness insurance of an employee of the same type with one employer, which expired and subsequently arose on the following calendar day shall be deemed continuous (§ 20 para. 1 not being affected) for the purposes of establishment of the reference period for the sickness insurance;
• periods for which the insuree is not obliged to pay contributions to the sickness insurance as well as periods of periods of interruption of the mandatory sickness insurance shall be excluded from the reference period for the purposes of establishment of the daily assessment basis (DVZ).

Sickness benefit percentage:

• from the 1st to the 3rd day of temporary incapacity for work 25% of DVZ or PDVZ;
• from the 4th day of temporary incapacity for work 55% of DVZ or PDVZ.

Limitation of the amount of the sickness benefit

• The sickness benefit shall be halved if the insuree became temporarily unable to work due to a condition he or she has caused himself or herself through the consumption of alcohol or as a result of the abuse of other addictive substances.

The amounts of the sickness benefit shall be rounded up to ten euro cents.

Payment of the benefit

Method of payment:

• preferably to the account of the sickness benefits beneficiary in a bank or a branch of a foreign bank;
• at the request of the beneficiary, the sickness benefits shall be paid in cash, i.e., by means of a money order for payment or district circuit (Slovenská pošta, a. s. (Slovak Post Office), see Forms),
• at the written request of the sickness benefits beneficiary, the sickness benefits shall be transferred a account of her husband or his wife in a bank or a branch of a foreign bank, if at the time of receiving of the nursing benefits the beneficiary has the right to dispose of funds in this account and if the spouse agrees to this method of transfer.

Deadlines for payment of the benefits

• Benefits are paid until the end of the month following the calendar month for which the sickness benefit is paid (if the documents are delivered on time).

Pre-condition of the benefit payment

• Documents proving entitlement to the sickness benefit (especially a certificate of duration of temporary incapacity for work or a report of termination of temporary incapacity for work) must be submitted to the branch of the Social Insurance Agency, as a rule, by the 5th day of the calendar month following the month for which the benefit is paid.

Benefit Payment Period / When it is not Paid

Provision

• for calendar days

Sickness benefit provision period

• Entitlement to the sickness benefit occurs as follows:
• employee:
• from the 11th day of his or her temporary incapacity for work;
• in the case of cessation of sickness insurance before the expiry of the 10th day of temporary incapacity for work: from the day following the day of the cessation of the sickness insurance;
• within the protective period: from the first day of the temporary incapacity for work;
• mandatorily insured self-employed person (SZCO) with sickness insurance: from the 1st day of the temporary incapacity for work;
• voluntarily insured person: from the 1st day of the temporary incapacity for work.
• The entitlement to the sickness benefit expires:
• on termination of the temporary incapacity for work, at the latest
• after 52 weeks from the occurrence of the temporary incapacity for work, i.e., at expiration of the support period. (The support period includes also previous periods of temporary incapacity for work if they fall within the period of 52 weeks before its occurrence. If the sickness insurance lasted at least 26 weeks from the end of the last temporary incapacity for work and the insuree did not incur any temporary incapacity for work during this period, the previous periods of the temporary incapacity for work shall not be included in the support period.)
• on the date of validity of any court decision according to which the insuree was lawfully convicted of an intentional criminal offense, as a result of which he or she became temporarily unable to work;
• the date of death of the insuree.

The benefit is not paid

• from the date of violation of the treatment regimen designated by a physician until the end of temporary incapacity for work, for a maximum of 30 days;
• during payment of maternity benefit.

Return of the benefit/Lapse

The beneficiary shall be obliged to return the sickness benefit or part thereof from the date from which it did not belong to him or her or did not belong to him or her in the provided amount; if

• the beneficiary has not fulfilled an obligation imposed by law (e.g., she has not proved the decisive facts);
• received the benefit or part of it, even though he/she knew or should have assumed in the given circumstances that it had been paid wrongly or in an amount higher than he/she was entitled to (e.g., the branch paid him a sickness benefit from a higher daily assessment basis (DVZ) than stated in the sickness benefits decision); or
• the beneficiary knowingly caused the maternity benefit or part of it had been paid incorrectly or in an amount higher than it was due (e.g., he/she did not report that he was legally convicted of an intentional criminal offense in context of which the temporary incapacity for work arose, or he or she did not notify the branch that he was also insured against sickness under the law of one of the EU Member States, etc.).

If a natural or legal person has incorrectly confirmed the facts that are decisive for the entitlement to the benefit or to the payment of the benefit or to the amount of the benefit, and as a result the benefit has been provided incorrectly or in an amount higher than due, such person shall be obliged to reimburse the amounts unduly paid (e.g., the employer incorrectly confirmed higher assessment bases (VZ) in the reference period or did not send registration letters proving the beginning and termination of the interruption of the compulsory health insurance in the reference period).

The entitlement to the payment of the sickness benefit or part thereof shall lapse three years from the date on which the sickness benefit part thereof belonged.

The lapse period shall not run at the time of the sickness benefit proceedings and in the period in which a guardian has not been appointed for the party who must have a guardian.

Control

During the temporary incapacity for work, the professional level of assessment of fitness for work by the attending physician, the diagnostic and treatment processes in relation to the duration of the temporary incapacity for work shall be controlled by a social insurance assessor of the relevant branch of the Social Insurance Agency as part of the performance of the control of assessment of capacity for work.

Adherence to the treatment regime of a temporarily incapacitated insured person, as designated by the attending physician, shall be organized by a social insurance medical assessor and performed by a designated employee of the Social Insurance Agency.

Foreign countries and EU

• If a person with a sickness insurance under the legislation of the Slovak Republic suffered temporary incapacity for work in the territory of another EU Member State, Switzerland, the Kingdom of Norway, the Republic of Iceland and/or the Principality of Liechtenstein (hereinafter the “EU Member State”), i.e., the temporary employee‘s incapacity has been established decided by a physician other than a physician in the territory of the Slovak Republic, he or she shall claim his or her entitlement to the sickness benefit directly in the relevant branch of the Social Insurance Agency as follows:
• by means of a certificate issued by a physician issued in the EU Member State in which the temporary incapacity for work has been recognized - it must also be a certificate in the country of issue for the purpose of claiming sickness benefit (translation of such certificate is not required); or
• if the attending physician in the EU member state in which the temporary incapacity for work occurred does not issue such a certificate of temporary incapacity for work, the claimant should ask the competent institution of the EU Member State in whose territory the temporary incapacity for work occurred to promptly issue for the purpose of claiming the sickness benefit – usually on SED S 055.
• If the temporary incapacity for work occurred in the territory of a state with which the Slovak Republic has a social security contract, and the subject of this contract covers also sickness benefits (e.g., Ukraine), the Social Insurance Agency as the competent institution for the payment of sickness benefits in the Slovak Republic is in principle obliged to accept certificates and forms issued in the Contracting State.
• If the temporary incapacity for work occurred in the territory of a state with which the Slovak Republic does not have a social security contract, but this state acceded to the Convention on the Abolition of the Requirement of Higher Verification of Foreign Authentic Instruments, the form issued by the attending physician in such a state must be certified by an apostille – certificate of credibility of a public document by a competent authority (for more information see the website of the Ministry of Foreign Affairs of the Slovak Republic, section Travelling and Consular Info). In the case of a form that had been issued by physician in the territory of a State which has not acceded to the Convention, a certificate of authenticity of a public document is required from the various authorities.

Rights and obligations

Rights of the insuree

• to claim the entitlement to the sickness benefit and to its payment;
• to apply for a certificate of the sickness benefit, entitlement to the sickness benefit, and its amount ( it is appropriate to specify the purpose of the certificate), confirmation of periods of insurance (through the competent institution of another EU Member State) if he or she is claiming sickness benefit in another EU Member State, in which the entitlement to such benefit is conditional on the completion of a certain period of sickness insurance.

Obligations of the insuree/beneficiary:

• state the birth number (social security identification number) in the submitted documents;
• to prove the facts to the relevant branch which are decisive for the occurrence, duration and cessation of the entitlement to the benefit, the entitlement to its payment and its amount (after a written request from the Social Insurance Agency to prove these facts within eight days from the date of delivery of the request, unless different deadline has been specified by the Social Insurance Agency).

the occurrence of the entitlement to the sickness benefit should be proven in particular as follows:

• by application for the sickness benefit (if the temporary incapacity for work occurred as a result of an accident, there is obligation to submit the form Accident Report for the Purposes of Sickness Benefit (Hlásenie úrazu na účely nemocenského) for confirmation, filled in by the insuree);

the duration of the entitlement to the sickness benefit should be proved in particular as follows:

• by submitting a document on the duration of the temporary incapacity for work issued by a physician at the end of the calendar month - it must be delivered to the branch of the Social Insurance Agency on time, preferably by the 5th day of the following calendar month, otherwise the sickness benefit will be paid one month late;

the cessation of the entitlement to the sickness benefit and its amount, and/or to the change of the amount of the sickness benefit should be proved in particular as follows:

• by submitting Part IV. of the certificate;
• by another document that affects the entitlement to sickness benefit and its amount (e.g., a document proving the performance of gainful activity abroad, a valid court decision convicting the insured person of an intentional criminal offense as a result of which he became temporarily unable to work, a document proving temporary incapacity for work in connection with the consumption of alcohol or the abuse of other addictive substances);
  
• to notify the relevant branch within eight days of the change in the facts that are decisive for the duration of the entitlement to the benefit, the entitlement to its payment and its amount;
• to notify the relevant branch of the termination of the temporary incapacity for work within three days from the date of the termination of the temporary incapacity for work, if the temporary incapacity for work lasted more than ten days (by telephone, fax, e-mail, in writing, by sending part IV of confirmation, in person);
• to notify the relevant branch of any change of address at which he or she is present;
• to participate in the review of the assessment of his or her fitness for work during the period of his or her temporary incapacity for work;
• to adhere to the treatment regimen specified by the attending physician during the period of the temporary incapacity for work;
• to stay during temporary incapacity for work at the address indicated on the certificate;
• the child is not registered in the register in the territory of the Slovak Republic.