December 3, 2022

Benefits to insured persons

1. Benefits in kind

The benefits in kind are provided by the National Organisation for the Provision of Health Services (EOPYY) based on the Unified Regulation of Health Benefits (EKPY) (eopyy.gov.gr/ekpy/view).

Entitlement conditions:

Persons directly insured at e-EFKA are entitled to benefits in kind if they meet the conditions to be granted an insurance capacity in kind and specifically:

  • Salaried employees are required to have completed fifty (50) days of insurance either in the year prior to their illness or in the previous 15 months, excluding in the latter case the last calendar quarter.
  • Non-salaried employees are required to have completed two (2) months of insurance during the previous calendar year.
2. Cash benefits

Cash benefits are as follows:

a) sickness allowance
b) maternity allowance
c) invalidity or incapacity benefits
d) death benefit
e) other benefits.

Salaried employees insured at e-EFKA are entitled to cash benefits from the ex IKA-ETAM if: they have completed one hundred and twenty (120) working days in the calendar year prior to the announcement of the sickness or the probable/actual date of birth or in the previous 15 months, excluding in this case the working days completed in the last calendar quarter of the 15 months pursuant to the provisions of Article 148(2) of Law 3655/2008 (Government Gazette, Series I, No 58).

The persons directly insured at e-EFKA, who work in the private sector and are insured at the ex IKA-ETAM, are entitled to the sickness benefit pursuant to Article 35 of Law 1856/1951, which is granted on the following conditions:

  • they are considered, due to physical or mental illness, unable to continue working in the opinion of their doctor and subject to the approval of the primary or secondary health committee of the primary national healthcare network (PEDY) when the opinion is from a private doctor and when they are sick for more than 15 days;
  • they are fired from their job, which can be evidenced by their employer’s certificate;
  • they are absent for more than 3 days from the announcement (waiting time).
  • During the period (1-3 days) from the declaration of incapacity for work until the beginning of the subsidy from the Social Security Institute (IKA), the employer is obliged to pay only half of the wages or the corresponding salary, and the difference shall not be covered by IKA (Article 5 of Law 178/1967). For this period the employer is obliged to pay contributions.
  • If the sickness lasts more than 3 days, the employee is entitled to receive a sickness benefit from IKA-ETAM from the fourth (4th) day and for as long as the sickness subsidy lasts. If the employee has been working for more than 10 days, the employer is obliged to pay the difference between the salary and the sickness benefit for up to 13 days when the duration of the employment is up to one (1) year, or for 26 days or 1 month when the duration of the employment is more than (1) year. The employer is obliged to pay the corresponding insurance contributions (Articles 657 and 658 of the Civil Code).

Sickness benefits are divided into benefits in kind and cash benefits. They are paid under specific conditions and for a specific period of time. Sickness benefits may vary depending on the category of employees per e-EFKA Insurance Sector.

A necessary condition for sickness benefits is the existence of insurance capacity, i.e. the right of access to hospital and medical care (health providers, pharmacies, doctors contracted with EOPYY, etc.). To check and find information on whether someone has insurance capacity, e-EFKA has a special website (Click here), in which all the relevant information is available (i.e. conditions, procedures, etc.).

Also, as part of the Digital Transformation of e-EFKA, an e-service for the granting of sickness benefits has been put into pilot operation since 22 January 2021 for the salaried employees insured at the IKA-ETAM.

Specifically, through the Electronic Prescribing system of IDIKA SA, the insured persons’ doctors certify the incapacity of the insured person to work due to illness. The insured person may submit the relevant application using their TAXISNET codes within a period of eight (8) months from the date of the announcement of the sickness, at the link: efka.gov.gr/epidoma or through the Single Digital Public Administration Portal (gov.gr). For detailed instructions and the online application, you may visit the relevant website of e-EFKA (click here).

In relation to pregnancy, in order to receive maternity leave the employee is required to present a doctor’s certificate confirming the expected day of childbirth to her employer.

Pursuant to Article 9 of Law 2224/1994 (Government Gazette, Series 1, No 112) and Article 11 of Law 2874/2000 (Government Gazette, Series 1, No 286), employees in the private sector are granted maternity leave for a total of 119 days (17 weeks), of which 56 days (8 weeks) must be granted before the expected day of childbirth and the remaining 63 days (9 weeks) as maternity leave after childbirth. If childbirth takes place at a time earlier than originally expected, the rest of the leave must be granted after the birth to ensure a total leave time of 119 days (17 weeks). The time of this leave is remunerated in accordance with the relevant applicable provisions.

Maternity benefit is paid to working mothers who are directly insured. The relevant website of e-EFKA provides detailed instructions on the conditions and how this benefit is granted (click here).

Maternity benefit is granted if 200 days of insurance have been completed in the previous 2 years before the expected or actual day of childbirth and (b) they are absent from work in accordance with the provisions of Article 39 of Law 1846/1951 and the provisions of Article 11 of Law 2874/2000 (Government Gazette, Series I, No 286).

The amount granted by IKA-ETAM is equal to the presumed wage of the insurance category in which the insured is classified, based on the average salary for the last 30 working days in the calendar year immediately preceding the declaration of incapacity and may not be less than the presumed salary of the 1st insurance category (i.e. from a minimum of EUR 11.06 to a maximum of EUR 47.47) pursuant to Articles 38 and 37 of Compulsory Law 1846/1951.

The above benefit paid by IKA-ETAM is supplemented by OAED by up to the amount of the regular earnings of each beneficiary from the moment that the relevant obligation of the employer ceases pursuant to Article 4 of Law 549/1977, Presidential Decree No 776/1977 and Article 1 of Presidential Decree No 221/1997.

Pursuant to the legislation on IKA-ETAM, this time of subsidy (supplementation of maternity benefit) of the above employees by OAED is considered as insurance time in IKA-ETAM for benefits in kind.

Note: For hotel employees and workers in the food sector who are included in the ‘Special Account for Hotel Employees of IKA-ETAM’, the amount of maternity benefits as well as the sickness allowance are subject to a 10% increase for each protected member, without the limitation applicable to the amount of the sickness benefit (which may not be more than 70% of the average earnings on which the benefit was calculated) as to the maximum benefit (Article 37 of the statute of the Insurance Fund of Hotel Employees). The subsidy conditions are the same as those of IKA-ETAM.

e-EFKA grants its retirees the extra-institutional benefit, or absolute disability benefit if they meet the conditions of Article 12 of Law 1140/1981 (Government Gazette, Series I, No 68), or sickness and incapacity benefit of Article 54 of PD 169/2007 (Government Gazette, Series I, No 210).

– Private sector

Extra-institutional benefit (Article 42 of Law 1140/1981, Government Gazette, Series I, No 68, as in force).

This is granted to retirees and insured persons in the private sector under specific insurance time conditions who suffer from specific diseases, such as quadriplegia-paraplegia, with a medical disability rate of 67% or more. Moreover, under Law 4554/2018 (Government Gazette, Series I, No 130) this benefit is granted, as of 18 July 2018, to those who suffer from diseases that, in the opinion of the competent health committee, result in the same form of disability as the explicitly mentioned diseases.

Total invalidity benefit

It is granted to private sector employees who retire due to disability if they are in an ongoing situation that requires constant supervision, care and support from another person (absolute disability) regardless of their condition. It is also granted to private sector old-age pensioners if they are blind or if they have retired due to old age under the special pension provisions applicable to disabled insured persons provided that the amount of pension granted is calculated on the basis of their actual insurance time and not the privileged period of insurance of 10 500 days or 35 years. Those who receive total disability benefit are not entitled to the extra-institutional benefit cumulatively (Article 42 of Law 1140/1981, Government Gazette, Series I, No 68 as in force).

Applications for extra-institutional or total disability benefit must be submitted electronically, upon identification, on the website of the Electronic National Social Security Agency (gov.gr) [Article 17(1) of Law 4670/2020, Government Gazette, Series I, No 43).

– Public sector

The sickness and disability benefits under Article 54 of Presidential Decree 169/2007 for civil and military employees of the public sector for physical or mental disability not due to the Service.

Death benefit is granted as a lump sum by e-EFKA to the person in charge of the funeral for a deceased person who was directly insured or retired or to their indirect family members, in accordance with the statutory provisions of the affiliated Institutions, until the issuance of the Uniform Regulation of Cash Benefits of e-EFKA. Death benefit is paid only in cases where deductions were made to the deceased person’s earnings for sickness contributions and the conditions are met on a case-by-case basis by a member of the e-EFKA Institution.

Detailed information can be found on the relevant e-EFKA website (click here), which contains detailed instructions on the required procedures.

Moreover, e-EFKA has developed a special online service (click here) for the electronic submission of death benefit applications. The receipt for the expenses with your details (TIN) must have already been issued by the company that arranged the funeral service. In addition, the company must have registered the document electronically, using the e-EFKA application ‘Funeral Cost Documents’.

Campsites

Article 10 of Law 1276/1982 (Government Gazette, Series I, No 100), as in force, and Article of Law 2556/1997 (Government Gazette, Series I, No 2070) provide for the possibility of hosting children of persons insured, retired and employees of e-EFKA in private children’s campsites during the summer period each year, for a daily fee which is determined by Joint Ministerial Decision (JMD) of the Ministers for Finance and Labour, Social Security and Social Affairs.

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