Congé de Maladie
Congé de maladie payé
A worker is entitled to cash sickness benefits in case of incapacity for work due to non-occupational sickness or accident. Law does not require a qualifying period for cash sickness benefits.
In case of illness or non-work related accident, employee has to inform his/her employer personally or through an intermediary on the first day of absence about the reasons for being absent from work and submit within the third day of absence a medical certificate from a physician certifying his/her disablement and the estimated duration of his/her sick leave.
An employer has to support the salary payment for all employees in case of sickness or injury. During the period of sick leave, employer has to pay employees an amount corresponding to their full gross monthly wage until the end of month that includes the 77th day of the incapacity for work (meaning that on average, workers are paid salary by the employer for 13 weeks). After this period, employee receives sickness allowance from the Health Insurance Fund. Workers have the right to sick pay for a period of 52 weeks within a period of 104 weeks paid from the Health Insurance Fund. Worker must submit a medical certificate by 10th week indicating his/her continued incapacity for work. The benefit is continued subject to the favourable opinion of Medical Control Service.
Employer can recover some of the sick pay paid from the Employer's Mutual Insurance, a social security institution set up for the purpose. The Employer's Mutual Insurance reimburses up to 80% of the sickness allowance paid by the employer within a 77-day period. After this period, the benefits are paid by the Health Insurance Fund directly.
sources: §121(6) & 233(6) of Labour Code 2006, last amended in 2016
The health care providers (doctors and hospitals) provide services according to a schedule of fees already established under collective agreements. The insured person is free to choose the service provider (doctor and hospital). No qualifying period is required for access to health care except that the person must be insured. The medical benefits include general and specialist care, hospitalization, laboratory services, maternity care, dental care, appliances, medicine, transportation, therapeutic cure, palliative care, and general & occupational rehabilitation services.
The medical benefits are provided for an unlimited period of time as long as the person is insured. Even after the end of insurance, a person is entitled to medical benefits during the current month and further three months provided that the worker was insured for an uninterrupted period of six months. The right to medical care is extended for six months for illnesses already being treated.
An insured person has to pay all cost of the treatment received and then apply to the sickness fund for a refund from which the amount the concerned personhasto pay his/her self is deducted. Cost sharing is allowed although insurance covers most of the cost of medical benefits. The insured person has to co-share 20% of the doctor's visit to home, 12% for consultation, 10% for other outpatient services, €20.93 a day for hospitalization, 5% for dental care fees exceeding €60 a year, and either 20% or 60% of the cost of medicine.
Sécurité de l'emploi en cas de maladie
In case of illness or non-work related accident, employee has to inform his/her employer personally or through an intermediary on the first day of absence about the reasons for being absent from work and submit within the third day of absence a medical certificate from physician certifying his/her disablement and the estimated duration of his/her sick leave.
After following this procedure, a worker cannot be dismissed or called to a preliminary meeting even if dismissal is justified and due to a serious fault committed by a worker before absence. The protection from dismissal applies for a specific period (26 weeks from the first day of absence) unless the employee's sickness or injury is due to voluntary participation in a crime or offence. If an employee is terminated during this period, such dismissal is unfair and affected employee may claim damages. However, the law now states that if the Medical Control Service deems an employee fit for work, protection against dismissal will come to an end (after expiration of the period for filing a claim against the Medical Control Service’s decision).
sources: §121(6) of Labour Code 2006, last amended in 2016