14.07.2022

INSURANCE DURING SICK LEAVE

During a continuous sick leave of an employee, the declared insurance income, according to documents submitted by the employer, is the minimum insurance income, and the remuneration of the employee according to an open-ended employment contract is higher. Is this legal?

Public relations related to state social insurance (SSI) and supplementary mandatory pension insurance (SMPI) are regulated by the Social Insurance Code (SIC), and those related to health insurance - by the Health Insurance Act (HIA).

Insurance income is a basic concept in insurance law. Insurance income is monthly income and is the basis on which insurance contributions are calculated and made.

In the specified case, on the basis of Article 9, Paragraph 2, Item 2 of the SIC, the time of paid and unpaid leave for temporary incapacity for work, leave for pregnancy and childbirth and for the adoption of a child up to the age of 5, as well as paid and unpaid child-rearing leave is considered as insurance service without making insurance contributions.

The insurance income for the purposes of compulsory health insurance is determined in the Health Insurance Act depending on the insured persons. The health contribution is calculated on the insurance income defined in the law.

The regulatory framework that determines the income on which health contributions are due for persons temporarily unable to work due to illness is Art. 40, para. 1, item 5 of the Health Insurance Act. The health contributions for persons temporarily unable to work due to illness, pregnancy and childbirth, on leave to raise a small child in accordance with Art. 164, para. 1 and 3 of the Labor Code (LC) and leave for the adoption of a child up to the age of 5 in accordance with Art. 164b, para. 1 and 5 of the LC are due on the minimum insurance income for self-insured persons. Contributions are for the account of the employer and are equal to the part of the contribution owed by him, being paid by the 25th of the month following the month to which they relate.

It is clear from the cited provision that the income on which health contributions are owed for these persons is tied to the minimum monthly insurance income for self-insured persons and is not proportional to the amount of compensation received from the state social insurance.

In view of the above and in accordance with Art. 9, paragraph 2, item 2 of the SIC for the periods of temporary incapacity for work, no insurance income is determined on which insurance is due in the sense of the SIC, but with the provision of Art. 40, para. 1, item 5 of the Health Insurance Act is regulated insurance income only for the purposes of health insurance in the amount of the minimum insurance income for self-insured persons, determined by the Law on the State Public Insurance Budget for the relevant year.

On the same income, the employer (insurer) is obliged to pay health contributions in an amount equal to the part of the health contribution owed by him (4.8 percent). In the considered hypothesis, for those referred to by the provision of Art. 40, para. 1, item 5 of the HIA periods, namely the periods of temporary incapacity due to illness, pregnancy and childbirth, on leave to raise a small child in accordance with Art. 164, para. 1 and 3 of the LC and leave for the adoption of a child up to the age of 5 in accordance with Art. 164b, para. 1 and 5 of the LC, no insurance contributions are due from and at the expense of the insured person.

According to Art. 5, para. 4 of SIC and Art. 39, para. 1 of the Health Insurance Act insurers and employers should periodically submit data to the NRA in accordance with Ordinance No. Н-13 of December 17, 2019 on the content, terms, manner and order of submission and storage of data by employers, insurers for the insured under them persons, as well as by self-insured persons in accordance with the provisions of the ordinance and insurance legislation. It is in this connection in the Declaration model No. 1 "Data on the insured person" (Appendix No. 1 to Art. 2, Para. 1 of the Ordinance) that the insurance income, on which health insurance contributions are due for the periods of temporary incapacity to work, is filled in a separate field of the declaration - item 17 "Income on which health insurance contributions are due for the persons under Art. 40, para. 1, item 5 of the Health Insurance Act".