Insurance capacity: Answer to 10 basic questions from the Ministry of Labour – 2024-03-01 16:36:16

On the occasion of the deposition at Parliament of the Amendment for its exceptional granting insurance capacitythe Ministry of Labor and Social Security, answers 10 key questions.

1. For which groups the exceptional insurance capacity continues to be provided for the period 2024-2025?

These are categories that face objective difficulty in responding and meeting the necessary conditions. Specifically, the exceptional insurance capacity is granted to the following persons and their family members:

– To those affected by natural disasters. That is, to the insured persons of the e-E.F.K.A. who maintain a business establishment or carry out an activity or work in areas affected by natural disasters or other natural disasters and fall within the scope of the ministerial decisions issued in the year 2023 or issued in the current year, as well as the unemployed of the above areas who are registered in the Digital Register of the Public Employment Service. In this case, the insurance capacity is granted from the day of occurrence of the natural disaster, regardless of debts to e-E.F.K.A.

– To employers and insured persons who have a professional establishment or activity in areas of the Attica Region that were affected by the fires of July 23 and 24, 2018, and to those registered in the e-EFKA registers. directly insured persons who were affected by the fires of July 23 and 24, 2018 and are respectively subject to the scope of the Legislative Content Act of July 26, 2018 ratified by article 3 of Law 4576/2018.

– To the workers at the Skaramanga Shipyards, the Perama Shipyard Repair Zone and the Elefsina Shipyards.

2. Does the non-extension of exceptional insurability for certain groups leave them out of health care?

Absolutely NO. No one is left without access to health because they do not have insurance capacity as today, all legal residents in the country with an active AMKA have free access to the Public health system and are entitled to nursing and medical care. This includes not only hospitals but also primary health care structures.

3. Why can’t the exceptional insurance capacity be extended for everyone?

Everyone should understand that there is no a la carte insurance coverage. Insurance contributions are mandatory for everyone and their payment is essential for the sustainability of our insurance system.

Our insurance system is based on insurance solidarity and reciprocity. Only certain people cannot pay contributions and all receive the same benefits from EOPYY. On the other hand, it ensures that everyone has unrestricted free access to public health services, financed by taxation.

The insurance package is unified, to ensure both the right to insurance and retirement, as well as the right to health and the additional (beyond the State) benefits of the EOPYY to the insured. A system in which the insured chooses which contributions to pay each time loses its mandatory character with disastrous consequences both for the pension benefits of the insured and for the sustainability of our insurance system.

4. Why was the insurance capacity exceptionally extended from 2020 until now to specific groups?

During the economic crisis, exceptional insurance capacity was given to special population groups with social criteria. In 2020 and from there, due to the health crisis, the exceptional granting of insurance capacity was initially extended for all insured persons.

The last extension due to Covid until 29/2/2024 was given with art. 90 of Law 5018/2023, in 13 categories. Of these, there is a reason for an extension in specific categories, since for the others the reasons for maintaining exceptions have now disappeared.

The most numerous category of deviation from the rule is that of the self-employed, who for the first time in 2022 were given the possibility to obtain an annual insurance capacity by paying only health contributions, which correspond to about three months’ contributions. Out of 800,000 potential beneficiaries, about 400,000 paid the three months’ contributions corresponding to the amount of health contributions, of which about 100,000 were farmers and 300,000 were unemployed.

Already, our country is growing significantly faster than the Eurozone average, unemployment is now in the single digits. Two increases in the minimum wage have been given and a third is expected. Two pension increases were given for the first time in 12 years. The three years in the private sector have thawed.

In this economic and social environment, the Government and the Ministry of Labor and Social Security have decided to extend the exceptional granting of Insurance Capacity to those categories that have objective difficulty in responding.

5. What is insurance capacity?

In essence, the insurance capacity provides the directly and indirectly insured (family members), in addition to the free access to public hospitals provided by AMKA, additional access at the expense of EOPYY to private health structures, coverage of health care benefits in kind from EOPYY, such as indicatively, private prescription for medical or other therapeutic procedures, diagnostic tests, hospitalizations, medicines, etc.

6. What applies from March 1st

Upon expiry of the exceptional grant of insurance capacity, the general rule will apply, namely:

– for employees: it is required to have worked at least 50 days in the previous year,

– for the self-employed: it is necessary to complete at least 2 months of insurance in the previous year, to pay the required contributions

by the end of the previous year and, if there is a debt, it must have been settled and settled.

7. What should those who received an exceptional extension until 29.02.24 not lose their insurance capacity?

The debtors will have to settle all their obligations to the EFKA, regarding the contributions for 2023, either by repaying them in full, or by settling the debts in up to 24 installments.

As long as someone pays the amount owed in full, they will get an annual insurance capacity, while if they settle it, they will get a monthly one. It is emphasized once again that all citizens, regardless of their insurance capacity, as long as they have AMKA, have access to public health structures.

8. What applies to employees whose employers have not paid the insurance contributions?

For those employees who have submitted an APD for the required time of 50 days, their insurance capacity is automatically renewed regardless of whether the employer has paid the insurance contributions.

In case of non-submission of APD, then the employee can submit a complaint to the competent auditing bodies of the EFKA in order to count the insurance time.

9. I meet the requirements for Insurance Capacity but this does not appear in EFKA. What should I do;

EFKA’s electronic systems are updated at regular intervals and citizens can confirm whether they have Insurable Capacity through the platform. However, if the system still does not show that they have Insurable Capacity, despite meeting the conditions, they should send an email to email: [email protected].

Of course, the easiest and most direct way is to visit the local EFKA Offices. The service of citizens for the granting of Insurance

Capacity in this case is made without an appointment. Citizens will be served by all Local Authorities, regardless of where they belong, to update their information in the Registry.

10. What provision is there for children and vulnerable social groups?

From July 2022, the prescription of medicines, therapeutic procedures and diagnostic tests will be done by all doctors certified in the Electronic Prescription System (ESP), i.e. also private individuals, for the following categories of uninsured citizens:

a. minors up to 18 years old.

b. patients with intellectual or mental disability, autism, down syndrome, bipolar disorder, depression with psychotic symptoms, cerebral palsy or severe and multiple disabilities, amputees receiving the extra-institutional benefit with a disability rate of 67% or more, as well as those with a disability certified by KEPA 80% or more, for any condition.

c. patients with diseases whose medicines are administered with zero participation of the insured as well as uninsured patients suffering from the immune deficiency syndrome (AIDS)

In addition, for all uninsured citizens, the prescription of all vaccinations is foreseen.