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Sickness benefit

Sickness benefit

Definition / Purpose of the benefit

The sickness benefit shall be provided to the insuree who has been recognized as temporarily incapacitated for work as a result of his or her sickness or accident or is obliged to respect a quarantine measure (hereinafter “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 period of protection.

Claiming

The physician of the medical facility shall issue the document Certificate of Temporary Incapacity for Work. The certificate is a five-part form of the Social Insurance Agency, which is not freely available.

The following documents shall be provided by the physician to the insuree:

  • I. part of the certificate – identity card of a temporarily incapacitated insuree – this part shall be used by the insuree to prove his or her identity to an officer of the Social Insurance Agency who controls the compliance with the treatment regime. Date of control shall be indicated by the physician in this part. This part shall be handed over to the physician by the insuree after the termination of his or her temporary incapacity for work.
  • II. part of the certificate – claim for sickness benefit / accident surcharge – in this part the insuree claims the benefit. Before submitting this part to his or her employer or sending it to the Social Insurance Agency, the insuree should indicate the following data:
    • which benefit is claimed (sickness benefit and/or accident surcharge)
    • statement data (whether benefit from overlapping insurances is claimed and the way of payment of the benefit) and a signature should be added.
  • IIa. part of the certificate – claim for income compensation for temporary incapacity for work – this part should be used by the insuree when claiming income compensation from his or her employer.
  • IV. part of the certificate – report to the employer and branch of the Social Insurance Agency about the termination of the temporary incapacity for work – upon signing the declaration, the insuree shall be obliged to immediately send it to the branch that pays the sickness insurance (with the exception of the employee whose temporary incapacity lasts for a maximum of 10 days – in such a case this part shall be submitted to his or her employer).
  • Other parts of the certificate (Part I after termination of the temporary incapacity for work and Part III at its beginning) should be sent by the physician of the medical facility to the Social Insurance Agency, to the register of temporarily incapacitated insured insurees.
  • If the treating physician recognizes the insuree as temporarily incapacitated from multiple sickness insurances, the certificate shall be issued separately for each of them.

Where and when should I claim?

  • The insuree should submit his or her claim at the territorially competent branch of the Social Insurance Agency as soon as possible after the issue of the application.
  • The employee should submit the II. part of the certificate to the branch only if the temporary incapacity for work lasted more than 10 calendar days. He or she should do so through his or her employer, who should fill in and sign the employer’s confirmation.
  • A compulsorily insured person, self-employed person (SZCO), person with voluntary sickness insurance and natural person within the protective period should submit the II. part of the certificate to the branch of the Social Insurance Agency, which performs / performed the last his or her sickness insurance.