Sickness Insurance Benefits

The following benefits are granted from the sickness insurance scheme for self-employed persons:

  • Sickness Benefits
  • Maternity Benefits in Cash
  • Paternity Benefit  (Fathers Post-Natal Care) (effective as of 1 February 2018)
  • Long-Term Attendance Allowance (effective as of 1 June 2018)

The self-employed person is entitled to sickness benefits if he/she has been assessed as temporarily unable to work or has been quarantined, provided the temporary work inability or quarantine lasts for more than 14 calendar days.

 

Conditions for entitlement to sickness benefits

The general conditions applicable to employed persons also apply to self-employed persons. In addition, the following conditions for entitlement to sickness benefits apply:

  • a self-employed person does not personally carry out an independent gainful activity during the time of inability to work (quarantine),
  • the period of participation of the self-employed person in sickness insurance has lasted for at least three months immediately preceding the day of the origination of the inability to work (quarantine);

The entitlement to benefits arises if the conditions for entitlement to benefits are satisfied during the period of insurance or if the temporary inability to work starts within the protection period of 7 calendar days from the day of terminating the insurance. If the duration of the insurance was shorter, then the protection period is equal to the number of calendar days for which the insurance lasted. The period of protection does not ensue from insurance of the work of self-employed persons who enjoy an old-age pension or disability pension for a third-degree disability.

 

Conditions for entitlement to maternity benefits in cash

The general conditions applicable to employed persons also apply to self-employed persons and in addition, the following applies:

  • the self-employed person must not personally carry out an independent gainful activity when receiving maternity benefits in cash,
  • the period of participation of the self-employed person in the sickness insurance scheme must be at least 180 days during one year before the day when the payment of maternity benefits in cash started,
  • at the same time the insurance period must have lasted for at least 270 calendar days during the last two years before the day when the payment of maternity benefits in cash started.

 

Conditions for entitlement to paternity benefit (from 01 February 2018)

Paternity benefit (the father’s care for a newborn child) is a new sickness insurance benefit for the father of a newborn child or for the person who cares as a foster parent for a newborn child based on a decision of a competent authority, providing that the child is younger than seven years of age as of the date the foster care begins. The benefit can be paid for 1 week as a maximum. Paternity leave can begin on the date as determined by the insured person within six weeks of the date of birth of the child or of the date the foster care begins.

General conditions applicable to employees apply also to self-employed persons; in addition to those conditions, paternity leave is preconditioned by:

  • The self-employed person’s participation in sickness insurance for at least three months immediately preceding the day of paternity leave.
  • That the self-employed person does not carry out his/her gainful employment for the term of paternity leave.

 

Conditions for entitlement to long-term attendance allowance (from 01 June 2018)

Long-term attendance allowance is a new sickness insurance benefit for the care-giver providing that he/she cared for a person needing long-term care. The benefits can be paid only to insured persons subject to further conditions for 90 calendar days as a maximum.

General conditions applicable to employees apply also to self-employed persons; in addition to those conditions, long-term attendance allowance is preconditioned by:

  • The self-employed person’s participation in sickness insurance for at least three months immediately preceding the day of long-term attendance.
  • For the time the self-employed person receives long-term attendance allowance, he/she must not carry out his/her gainful self-employment or any other gainful employment.

 

Calculation of sickness benefits for self-employed persons

Sickness and maternity benefits are determined on the basis of the daily assessment base which is calculated as the assessment base for the decisive period divided by the number of calendar days of the decisive period.

If any excluded days are included in the decisive period the number of calendar days of the decisive period is reduced by them. Calendar days in those calendar months in which the self-employed person does not pay sickness insurance premiums or in which the self-employed person does not participate in sickness insurance are excluded. The assessment base is the total of the monthly bases.

The decisive period is usually the 12 calendar months before the calendar month in which the social event occurred. The calculation of sickness benefits for self-employed persons is carried out by the same method as the calculation for employees’ benefits.