Chapter III: Sickness cash benefits
When are you entitled to sickness cash benefits?
Sickness cash benefit is paid from mandatory health insurance to compensate for temporary loss of working capacity of economically active insured persons. Hence, it is paid to employees, self-employed persons, owners of private businesses, top athletes and chess players, and farmers.
What is covered?
Sickness cash benefit is usually paid by the employer for the first 30 days of absence. There is no requirement of prior insurance and the amount of benefit depends on the cause of absence.
From the 31st day of absence, the sickness cash benefit is paid by the Health Insurance Institute of Slovenia. In certain cases it is paid already from the first day of absence. This is the case for instance when tissue, organ or blood are donated, incapacity to work is due to caring for an immediate family member, isolation or attendance/assistance ordered by the physician.
Sickness cash benefit is usually paid for up to one year. Longer entitlements are exceptionally allowed, if medical treatment could not be completed within that time. It might also be paid for up to 30 days after termination of an employment contract. Duration is limited in case of nursing an immediate family member, for instance a child or a spouse. It is limited to seven working days and 15 working days for children under seven years of age or disabled children. Certain extensions are possible, for instance in the most severe cases up until the child matures.
Sickness cash benefit is calculated on the basis of average monthly salary, or the average contribution assessment basis (for instance for self-employed persons), in the calendar year preceding the year of absence.
The amount of sickness cash benefit varies between 80 and 100% of the calculation basis. For instance, it amounts to 80% for non-work related injury and nursing of an immediate family member, 90% for non-work related disease, and 100% in case of donation of tissue or organ, blood donation, or isolation ordered by a doctor.
How are sickness cash benefits accessed?
Sickness cash benefit is paid for the first 30 days on the grounds of an assessment of work incapacity or need for nursing a family member made by the chosen personal physician.
After that, or in other cases when sickness cash benefit is paid from the mandatory health insurance from the first day of absence, the decision from a designated physician is required. Appeal to the Health Commission of the Health Insurance Institute of Slovenia is possible in this case.
Technically, sickness cash benefit is also paid by the employer from the 31st day of absence onwards. The employer is reimbursed by the Health Insurance Institute of Slovenia when he or she sends in the valid and fully detailed certificate relating to the loss of working capacity and the financial statement.
Your right to sickness cash benefits when moving within Europe
As a general rule, sickness benefits in cash (i.e. benefits normally intended to replace an income which is suspended due to sickness) are always paid according to the legislation of the country where you are insured, regardless of where you are residing or staying.∗ When moving to another country of the European Union, Iceland, Liechtenstein, Norway or Switzerland, whenever certain conditions have to be fulfilled in order to become entitled to sickness benefits, the competent institution (i.e. institution in the country in which you are insured) must take account of periods of insurance, residence or employment that you have completed under the legislation of any of the above-mentioned countries. This thus guarantees that people will not lose their sickness insurance coverage when changing employment and moving to another state.
Further information about the coordination of social security rights when moving or travelling can be found at http://ec.europa.eu/social-security-coordination.