In the Official Gazette (Part I) no.218 of 16 March 2023 was published the Emergency Ordinance no.10 amending and supplementing the Emergency Ordinance no.158/2005 on social health insurance leave and allowances.
According to the document, the reasons for the appearance of this Emergency Ordinance are:
- the financial pressures on the budget of the Single National Health Insurance Fund, caused by the increase in expenditure and in the number of recipients of social health insurance benefits, but not accompanied by a proportionate increase in the revenue from the amounts representing contributions for holidays and social health insurance benefits;
- the fact that the basis for calculating social health insurance benefits is based on the value of the gross minimum wage in the country, which in 2023 has increased by approximately 110% compared to the value established for 2017, which has led to an increase in the amount of social health insurance benefits received by insured persons and, implicitly, to an increase in the expenditure of the budget of the Single National Health Insurance Fund;
- the fact that insured persons in employment pay both the social health insurance contribution and the contribution for leave and health insurance benefits on their income, without having the option to take out voluntary insurance on a higher income, which results in an inequality between the amount of maternity benefits enjoyed by the majority of insured persons in employment and the amount of benefits enjoyed by persons not in employment, who can take out voluntary insurance on a freely chosen income.
One of the main amendments of the EMERGENCY ORDINANCE no.158/2005 to the fact that the right to social health insurance holidays and allowances for persons insured on the basis of an insurance contract for social health insurance holidays and allowances is conditional on the payment of a contribution for insurance for holidays and allowances at the rate of 1%, applied to the monthly income entered in the insurance contract.
The change is that this contribution no longer applies to the chosen monthly income stated in the insurance contract.
The above-mentioned contribution rate is due and payable by insured persons on the basis of an insurance contract for holidays and health insurance benefits, for an income representing the monthly income or, as the case may be, the average monthly income entered in the tax return submitted for the payment of the health insurance contribution, which may not be less than the value of a basic gross minimum wage per country guaranteed in payment, established according to the law, and may not exceed the value of 3 times of it.
We emphasize that the calculation methodology for determining the average monthly income entered in the tax return submitted for the payment of the social health insurance contribution shall be established by the implementing rules of this Emergency Ordinance.
In the case of persons insured on the basis of an insurance contract for sick leave and health social insurance benefits, the basis for calculating sick leave and health social insurance benefits shall be determined as the average of the insured income, entered in the insurance contract, of the last 6 months of the 12 months from which the insurance period is constituted, up to the limit of 3 gross minimum basic salaries per country guaranteed in payment.
The old provisions excluded from this rule persons who opted to take out an insurance contract in order to benefit from sick leave and maternity benefits, for which the basis for calculating benefits is determined as the average of the insured income recorded in the insurance contract for the last 6 months of the 12 months of the insurance period, up to a maximum of 12 gross minimum monthly salaries.
According to paragraph (1) of Article II of the EMERGENCY ORDINANCE 10/2023, insurance contracts for health insurance leave and allowances concluded with health insurance houses by insured persons on the basis of insurance contracts for health insurance leave and allowances, according to the provisions in force at the date of this Emergency Ordinance, and whose insured monthly income is higher than the income entered in the tax declaration submitted for the payment of the social health insurance contribution or, as the case may be, higher than the value of 3 minimum gross basic salaries per country, for insurance contracts for maternity leave and allowances, shall be amended by additional acts until the 1st of the month following the month in which 60 days have elapsed since the date of publication in the Official Gazette of this Emergency Ordinance (i.e. 1 June).
The changes entered in the additional documents shall be made within the previous term, upon notification to the health insurance funds, under penalty of termination of the insurance contracts for holidays and health insurance benefits concluded with them.
The regulation specifies that the monthly income entered in the above-mentioned contracts, as well as the monthly contribution calculated and paid on this income, for the period up to 1 June, shall not change. Moreover, the entitlement to social health insurance benefits in respect of sick leave certificates issued up to 1 June shall be granted until the situation which led to the need to issue those certificates ceases to exist.
By derogation from the provisions of Article 10 paragraph (3) of the Emergency Ordinance no. 158/2005, approved with amendments and additions by Law no.399 /2006, with subsequent amendments and additions, as amended by this Emergency Ordinance, in the case of ongoing insurance contracts, which are amended in accordance with paragraph (1), article II of Emergency Ordinance 10/2023, the basis for calculating the maternity allowance shall be determined as the average of the insured income, entered in the insurance contract, of the last 6 months of the 12 months from which the insurance period is constituted.
Legal basis:
– Emergency Ordinance 10/2023 for the amendment and completion of Government Emergency Ordinance No. 158/2005 on social health insurance leave and allowances;
– Emergency Ordinance 158/2005 on social health insurance leave and allowances.