ČESKÁ SPRÁVA SOCIÁLNÍHO ZABEZPEČENÍ

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.

e-Sick Leave (eNeschopenka)

As of 1st January 2020, the Czech Republic transitions from a paper-based system to an electronic system for processing Decisions on temporary incapacity to work, the e-Sick Leave (Act No 589/1992, on Social security and State employment policy premiums, and Act No 187/2006, on sickness insurance, as amended).

Note:

In the first 14 calendar days of temporary incapacity to work in accordance with the Labour Code, the employer pays the employee wage or salary compensation; from the 15th calendar day the sickness benefit (sickness insurance benefit) is paid by the competent District Social Security Administration (DSSA; in Czech OSSZ). In the case of self-employed persons, the DSSA pays sickness benefits from the 15th calendar day of the temporary incapacity to work.

More information (in Czech) at https://www.cssz.cz/web/cz/eneschopenka.

Exemption:

In the event of a system or internet failure, the attending physician shall issue a document on temporary incapacity to work through a paper form and send it to the appropriate DSSA, which will transfer the document to the CSSA electronic system.

 

Basic rules:

  • Communication between the physician and the CSSA/DSSA and between the employer and the CSSA/DSSA takes place electronically
  • The attending physician shall hand over to the sick insured person a printed Certificate of an insured person temporarily incapable to work, i.e. in paper form
  • e-Sick Leave newly consists of 3 parts:
    • Parts I. and III. are sent by the physician electronically upon the start or termination of temporary incapacity to work to the competent District Social Security Administration (DSSA)
    • Part II. is handed over to the insured person by the physician in paper form – Certificate of an  insured person temporarily incapable to work
       
  • The data in e-Sick Leave are the same as in the past: especially personal data on the insured person, including the Czech birth number (PIN); diagnosis – this information is not provided to the employer and can only be found on parts I. and III.; date of start and termination of temporary incapacity to work; medical check-ups; permission to go out; place of stay during incapacity to work; health service provider identification data; also the expected length of incapacity to work in the document for foreign  insured persons
  • The employee is obliged to inform his employer immediately (More…Information for employees / Self-employed persons)
  • The employer can obtain information about the temporary incapacity to work of its employees in several ways, one of which is the possibility to ask the CSSA to send a notification of the start of temporary incapacity to work (More…Information for employers)
  • The employer has certain obligations towards the CSSA after 14 days of temporary incapacity to work (More…Obligations of the employer)

Employees / Self-employed persons insured abroad and staying in the Czech Republic shall receive from the Czech physician:

  • Certificate of an insured person temporarily incapable to work;
    and
  • Confirmation of the duration of the temporary incapacity to work (for purpose of claiming a benefit abroad, the physician shall indicate the date of start of incapacity to work and the probable duration of the incapacity to work).

(More…Employees / Self-employed persons insured abroad and staying/living in the Czech Republic)

 

Information for employers:

The attending physician no longer issues a paper-based Certificate on temporary incapacity to work for the employer; the information is available electronically.

The employer is informed about the start of incapacity to work in two ways:

  1. The employee must immediately inform his or her employer about the obstacle at work (by phone, e-mail, SMS)
  2. Notification sent to the employer – only upon the employer’s request through the CSSA ePortal and after the employer has previously logged in to the CSSA ePortal. In this case, employers will receive automatic notifications whenever a physician decides on the start, duration and termination of temporary incapacity to work (More…Notification of temporary incapacity to work – CSSA ePortal)


Notification of temporary incapacity to work – CSSA ePortal (https://eportal.cssz.cz/)

(So far only in Czech, ePortal will be expanded to include the English version in 2020)

The employer must be logged in the CSSA ePortal (More …Login and access to the CSSA ePortal) and must activate notification services via the Request for sending / cancelling of sending information on temporary incapacity to work of employees.

The employer will first receive an unverified notification of the start/duration/termination of temporary incapacity to work. Once the event is processed in the CSSA systems, the information will be available on the CSSA ePortal and the employer will also receive a verified notification. Processing time varies depending on the accuracy of the reported data.

Notifications can be sent to the employer in two ways:

  1. to an e-mail address – the report contains only a general notification that new information about temporary incapacity to work of employees is available on the CSSA ePortal.
  2. to data box – the report contains all specific data on the employee’s temporary incapacity to work.

Information on temporary incapacity to work of employees

ePortal’s services offer the employer not only the detailed information on the temporary incapacity to work of each employée and a summary of all incapacitated employees, but also possibility to export this information to a PDF file signed with an electronic seal and the necessary interactive forms.

Login and access to CSSA ePortal:

Access to the services will be enabled based on the user’s identification through:

  1. the data box system https://www.datoveschranky.info/
  2. one of the resources within the National Identity Authority (NIA)

An employer may authorise its employee or other natural or legal person to use the CSSA ePortal. In the case of an authorisation of a legal person, it is necessary to notify to the DSSA/CSSA the natural person who will act on the legal person´s behalf.

An employer using payroll software can also take advantage of the new DZDPN service, which allow the employer to download information about temporary incapacity to work (TIW) directly into their software, which must be set up for the service and must include the necessary components.

More information in the Guide for employers and accounting companies.

 

Obligations of the employer

(More…. https://www.cssz.cz/web/eneschopenka/zakladni-informace-pro-zamestnavatele)

The employer is obliged to send to the District Social Security Administration (DSSA, in Czech OSSZ) in electronic form to the designated electronic address without delay after the first 14 days of temporary incapacity to work the following:

  • data for the calculation of sickness benefits and information on the method of payment of wage, salary or remuneration (in accordance with Section 97(2) of Act No 187/2006, on sickness insurance, as amended). The employer shall send these data via a form called Attachment to the application for benefit.

Information about the termination of temporary incapacity to work and data necessary for the payment of the last benefit shall be provided by the employer via a form called Employer / Voluntary Sickness insured person report form on termination of incapacity to work.

If they have any questions, employers / accountants can contact the competent DSSA.

 

Information for employees / self-employed persons

Employees / self-employed persons insured in the Czech sickness insurance system:

From 1st January 2020, the attending physician gives the sick insured person only a printed Certificate of an insured person temporarily incapable to work.

The certificate is used for records of further examinations at the physician’s office and remains with the insured person after the termination of incapacity to work. A sick insured person also proves his or her identity in the case of inspection of the regime prescribed by the physician.

The other documents relating to incapacity to work are sent electronically directly to the District Social Security Administration (DSSA, in Czech OSSZ), including the confirmation of the duration of the temporary incapacity to work.

  • The employee is obliged to inform the employer without delay (by e-mail, SMS, phone) that he or she has fallen ill and to observe the regime prescribed by the physician.

    The employee does not have to hand over any other documents to the employer during his or her illness. The sickness benefit (after 14 days of incapacity to work) is paid out in the same way the employer pays the employee his or her the usual wage or salary. All communication takes place between the physician, the DSSA and the employer.
     
  • The self-employed person is paid sickness benefits in the same way this person pays sickness insurance premiums.

    Newly, self-employed persons must fill in the form Report of employer/voluntarily sickness insurance insured person at the end of incapacity to work immediately after termination of temporary incapacity to work by a physician. (The form can also be picked up, filled in and submitted in person at a DSSA branch.). Without this report, the last sickness benefit cannot be paid. A self-employed person does not have to submit other documents during his or her illness.

 

Employees/Self-employed persons insured abroad and staying / living in the Czech Republic

A person who is insured with a foreign sickness insurance system and becomes ill in the Czech Republic receives the following two paper documents from the Czech attending physician on his/her first visit (start of temporary incapacity to work):

  • Certificate of an insured person temporarily incapable to work (Part II. of the Decision on temporary incapacity to work)

    and
     
  • Confirmation of the duration of the temporary incapacity to work, in which the physician indicates the date of start of the incapacity to work and the likely duration of the incapacity to work, as a rule, the next check-up with the physician. Confirmation of the duration of the temporary incapacity can be printed in two copies by the physician so that the patient has one for the employer and one for the foreign competent institution (e.g. the German health fund).

The insured person shall prove his or her temporary incapacity to work to employers/institutions abroad by the above two forms.

Thereafter, the physician shall at least once a month issue a Confirmation of the duration of the temporary incapacity to work.

The physician will electronically hand over the information about the start of temporary incapacity to work to the District Social Security Administration (DSSA) (Part I. of the Decision on temporary incapacity to work).

At the end of the incapacity to work in the Czech Republic, the physician shall issue electronically the Part III. of the Decision on temporary incapacity to work, which he or she shall send to the competent DSSA. The physician shall also record the data on the termination of the incapacity to work in the Certificate of an insured person temporarily incapable to work, which will remain with the insured person for the purposes of administration of his or her incapacity to work abroad.

 

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.