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Sickness insurance benefits for employees

21 August 2023

Life conditions and daily variables require the need for insurance systems that ensure a better climate for the health of individuals and their families, as it includes coverage for exposure to accidents or diseases that hinder people from performing their work, and the sickness insurance system for workers, employees and pensioners is the best reliable system at present.

What is sickness insurance?

This type of insurance provides insured persons, who are hindered by illness from performing their work, the opportunity to be entitled to health insurance benefits, until they are cured and return to complete work, including:

  • Insured persons who are unable to work for long periods as a result of an accident.

  • Cases of total disability and inability to return to work.

How to calculate the value of sickness insurance?

Sickness insurance for workers, employees and pensioners is estimated in accordance with the Social Insurance Law No. 148 of 2019, as it is calculated at a value representing 75% of the daily wage of the insured, provided that contributions are paid for a period of 90 days, provided that the percentage then rises to 95% of the said wage.

What are the conditions for benefiting from sickness insurance benefits?

There are some conditions that must be met to obtain this type of insurance, the most important of which is that the insured must be a participant in this system for a period of not less than three consecutive months, or six separate months, provided that the last two consecutive months in this case.

Cases in which the use of sickness insurance ceases to exist

Some cases of the insured conflict with the insurance controls, so the benefit of the entitlement to payment of compensation does not stop in the following cases:

  • In case of special leave, secondments.

  • In the case of scientific scholarships, study vacations, where the insured spends them outside the country.

  • In the event that the insured works for another party, the terms of insurance shall cease.

The value of women's compensation in cases of pregnancy and childbirth

The Social Insurance Law stipulates that working women are entitled to receive a compensatory value estimated at 75% of the daily wage in cases of pregnancy and childbirth, provided that contributions are paid, and that the period of their contribution to insurance is not less than 10 previous months, including the period of maternity leave agreed upon within the following laws:

  • Children's laws.

  • Labor laws.

  • Public business sector.

  • Regulations of civil servants in the State.

The most important benefits of sickness insurance for employees, employees and pensioners

This type of insurance provides several advantages to insured persons according to the text of the law, the most important of which are:

  • Article 75 stipulates the care of the insured in case of illness or injury, and the right to follow treatment procedures and receive medical care in accordance with the law.

  • In the event of pregnancy and childbirth, the insured woman receives 75% of the daily wage for the duration of the leave agreed upon in accordance with the Labor Law.

  • The insured is entitled to pay 75% of his daily wage by the competent authorities, as compensation for injury or illness that hinders him from performing his work.

  • The eligibility to pay compensation for the duration of the illness until the completion of recovery or proof of complete disability or death, provided that it does not exceed 180 days during the year.

  • The benefit of disbursing exceptional compensation throughout the period of illness, in cases of chronic diseases, provided that the compensation is suspended in the event that it is discovered that the insured violated the treatment instructions.

  • The competent authority shall bear the expenses of the patient's transportation, whether by regular means of transportation, or private means of transportation, in the event that the treating doctor decides that the patient's condition requires it.

In what cases does sickness insurance not apply?

There are some controls and warnings imposed on the disbursement of sickness insurance, in accordance with the agreed laws to prevent wasting money and infringing on the rights of others, as the eligibility to pay compensation for illness or injury does not apply in the following cases:

It is proved that the insured deliberately caused damage to himself.

The occurrence of an injury inside the work resulting from violating the laws and instructions of prevention and safety clearly indicated in the place.

The injury is caused by unlawful or intentional conduct on the part of the insured person.

In the event of an accident or injury, and it is proven that the insured has been subjected to the influence of alcohol or drug abuse.

What are the funding sources for the sickness insurance project?

This project is financed through the monthly contributions of the insured, which include:

  • Employer's share.

  • Share of the insured.

How to calculate the share of the insured?

The share of the insured is calculated according to the following percentages:

  • 1% of workers' wages.

  • 4% of the monthly subscription value of the insured.

  • 1% of pensioners benefiting from medical care.

  • 2% of pensioners if they are beneficiaries and eligible for medical care.

How to distribute sickness insurance shares?

After accumulating the sickness insurance fund, it is distributed according to the following percentages:

  • 0.25% for wage compensation covers for the insured

  • 4% to provide treatment and medical care to pensioners.

There have been some amendments to sickness insurance in recent years, including the Social Insurance Law, as it was keen to develop the benefits of sickness insurance for workers, employees and pensioners to ensure them the best ways to coexist in cases of injury or diseases that prevent them from practicing work.