Benefits Provided under Sickness Insurance

Benefits Provided under Sickness Insurance

The following benefits are provided to employees from the insurance:

  • Sickness benefit,
  • Maternity benefit,
  • Attendance allowance, 
  • Compensatory benefit in pregnancy and maternity.

Self-employed persons, if they pay sickness insurance premium, are entitled to sickness benefit and maternity benefit.

For concurrent employments, benefits will be calculated from the income from all employments where the employee qualifies, but the benefits will be granted only once (with the exception of the compensation allowance in pregnancy and maternity). 

1. Sickness Benefit

From 1st  January 2014  an employee is entitled to this benefit from the  15th  calendar day of his or her temporary incapacity to work, for the calendar days. (Till 31st  December 2013 it was from the 22nd calendar day.)

During the first two weeks of the temporary incapacity to work, an employer provides the employee with a compensation wage for working days; however, the compensation for wages, salary or remuneration is not paid for the first 3 days of this period. The employee is only entitled to the compensation wage for the period of the employment relationship that establishes the participation in sickness insurance.

The support period lasts no longer than 380 calendar days from the date of the temporary incapacity to work or quarantine order, unless stated otherwise.

The amount of sickness benefit per calendar day is 60% of the reduced daily basis of assessment.

The daily basis of assessment is reduced as follows: for sickness benefit and attendance allowance, 90% up to the amount of the first reduction level; 60% from the amount above the first reduction level up to the second reduction level; 30% from the amount above the second reduction level up to the third reduction level; and the amount above the third reduction level is disregarded. The same reduction rules apply to maternity benefit and the compensation allowance for pregnancy and maternity, with the amount of the first reduction level to include 100%. The reduction level amounts valid from 1 January of the calendar year are announced as a notification by the Ministry of Labour and Social Affairs in the Collection of Acts. The reduction levels from January 2016 are as follows:

·    1st reduction level - CZK 901

·    2nd reduction level - CZK 1 351

·    3rd reduction level - CZK 2 701

Those who receive retirement pension or stage three invalidity receive the sickness benefit from the 15th calendar day of their temporary incapacity to work or from the 15th calendar day of the ordered quarantine, for no longer than 63 calendar days, from no later than the day on which the insured activity ends.

Those insured who have intentionally incurred a temporary incapacity to work are not entitled to sickness benefit. If an insured person has incurred a temporary incapacity to work caused by his or her involvement in a fight or as a direct consequence of being drunk or having misused narcotics or psychotropic substances, or while committing a deliberate crime or deliberately committed offence, this person is entitled to half the sickness benefit per calendar day, irrespective of whether the person has any family or not. If the insured sustained a temporary incapacity to work or was ordered into quarantine while escaping from a place of custody or imprisonment, the person is not entitled to sickness benefit either.

As previously, the protection period is usually 7 calendar days from the date when sickness insurance expires. For women whose insurance expired during pregnancy, the protection period for the right to maternity benefit is 180 calendar days from the date when the insurance expired. Even for these women, if the insurance period was shorter, the protection period is only the same number of days as the number of days of the insurance. The protection period is not provided on the grounds of insured activities of a recipient of retirement pension or full disability pension; on the grounds of other employment, i.e. employment where the employee works instead of working in the other employment on the basis of which the employee is insured and where the employee has taken time-off for the period of working under another employment; and on the grounds of other employment carried out only during the recreational leave from the other employment. In addition, the protection period is not provided on the grounds of small employment; on the grounds of employment negotiated by an insured person who is a pupil or student if the employment is only for school holidays or holidays in general; and if the insurance of a convict expires at the time of his or her escape from the place of imprisonment.

 

2. Maternity Benefit (hereinafter referred to as the “MB”)

A basic condition for entitlement to financial assistance while on maternity leave is participation in insurance (e.g., continuation of insured employment) at the time of commencement of maternity leave (financial assistance during maternity). The time of commencement is understood as the day determined by the expectant mother herself between the eighth and sixth week prior to the expected date of birth, or the date of birth if the birth occurs prior to the time of commencement of maternity leave. If the insured mother does not stipulate such date during this period, the time of commencement of financial assistance during maternity leave is understood to commence at the beginning of the sixth week prior to the expected date of birth. A woman who commences maternity leave after leaving work within the period of protection is also entitled to the benefit. The period of protection for women whose insurance (employment) terminated during pregnancy is 180 calendar days from the date of termination of the insurance. If, however, the insurance period lasted a shorter period of time, the period of protection amounts only to the number of calendar days that the insurance lasted. If the insurance was not terminated during pregnancy, the period of protection amounts to 7 calendar days from the day of termination of the sickness insurance (provided the insurance lasted at least during this period). The period of protection does not ensue from certain insured activities (e.g., from agreements to complete a job, from small-scale employment).

The insured person must have participated in the sickness insurance scheme for at least 270 calendar days over the last two years before the date of starting the maternity leave to have the right to this benefit.

The period of participation in sickness insurance for the right to MB includes the period of studies at a secondary school, vocational college or university considered to be the systematic preparation for a future profession, for the purposes of pension insurance, if the beginning of the sixth week before the anticipated childbirth date falls on the period of 270 calendar days from the date of the successful completion of the studies, or the care of the child was assumed within 270 days after the date of the successful completion of the studies. The period of receiving full invalidity pension if the pension recipient was deprived of this pension is also included and the insured activity as well as the period of insurance interruption occurred or persisted after being deprived of this pension.

The support period for the MB begins with the start of the maternity leave (no later than the beginning of the 6th week before the anticipated date of childbirth), and is 28 weeks for an insured woman who bears a child, even if she is an employee who is not married, is widowed, divorced, or alone for other serious reasons. For an insured woman who bears two or more children at the same time, the support period is 37 weeks and, after 28 weeks of the support period, the MB will only be received if the insured woman continues to take care of at least two of these children. For an insured person who assumed the care of a child (on the basis of a decision of the relevant authority, due to the mother’s death, or long-term serious disease, or on the basis of an agreement under this Act), the support period is 22 weeks. If this insured person takes care of two or more children at the same time, the support period is 31 weeks and, after 22 weeks of the support period, the MB will only be received if the insured person continues to take care of at least two of these children.

An insured person who is the father of a child or husband of a woman who bore the child also has the right to MB, if the person has concluded a written agreement with the mother of the child that he will take care of the child. The agreement must include data laid down by law, and may be concluded with effect no sooner than the beginning of the 7th week after the childbirth.

From the first calendar day, the MB amount is 70% of the daily basis of assessment per calendar day.

 

3.  Attendance Allowance

An employee who cannot work because he or she has to attend an ill member of the employee’s household, or take care of a healthy child below the age of 10 because the school or other child facility has been closed (due to a breakdown, epidemic, other unforeseen event), the child has been ordered into quarantine, or the person who otherwise takes care of the child has fallen ill has the right to attendance allowance.

An employee is not entitled to attendance allowance for attending or taking care of a child if another natural entity is, on the grounds of taking care of the child, entitled to receive MB or entitled to parental benefits; this does not apply if the other person has fallen ill, sustained an injury, is in situations set out by law, born a child or been ordered into quarantine, and consequently cannot take care of the child.

In the same case of attendance (care), the attendance allowance is only paid to one of the eligible or to two eligible persons successively if they replace one another in the same case of attendance (care). Only one replacement can be made.

The support period for the attendance allowance is no longer than 9 calendar days. If an employee who permanently takes care of at least one child below the age of 16 who has not finished compulsory education lives alone the support period is no longer than 16 calendar days.

The support period for the attendance allowance is suspended during hospital care of the person under treatment in a healthcare facility.

The amount of the attendance allowance from the first calendar day is 60% of the daily basis of assessment per calendar day.

Some groups of insured, due to the nature of their activities, are not entitled to the attendance allowance (such as employees under small employment).

 

4. Compensatory Benefit in Pregnancy and Maternity (hereinafter referred to as the “CBPM”)

The CBPM is provided to a female employee who was transferred to a different position because of her pregnancy and maternity and, as a result, receives a lower wage through no fault of her own. The benefit is provided to a pregnant employee or mother until the end of the 9th month following birth, provided she had been doing work that such women are prohibited from doing. This also applies to female employees who cannot carry out their current work because it would, according to a medical opinion, pose a risk to their pregnancy, motherhood or breastfeeding.  The benefit is provided for the number of calendar days that the transfer to a different position lasted. It is paid out to the pregnant employee no longer than up until the start of the sixth week prior to the expected date of birth. During maternity, the equalisation benefit is provided until the end of the 9th month following birth and to women who breastfeed for the period they are breastfeeding.

 

Latest modifications 27. 1. 2016