Healthcare and Social Security Benefits Guide

Posted on Sep 1, 2024 in Medicine & Health

Healthcare

Healthcare involves providing medical and pharmaceutical services to maintain or improve the health of individuals, enabling them to work and recover physically. This may include prosthetics and orthotics in certain cases.

Who is entitled to health and pharmaceutical benefits?

  • Employees, their spouses, children, and parents (if living with the employee at their expense and not engaged in paid work).
  • Pensioners.
  • Unemployed individuals.

Pharmaceutical Benefits

Pharmaceutical benefits encompass medications, medical devices, and actions taken to ensure patients receive appropriate treatment based on their clinical needs. This includes providing medications in the correct dosage, for the appropriate duration, and at the lowest possible cost to the individual and society.

Generally, beneficiaries contribute 40% of the retail price for medications. However, a reduced contribution of 10% applies to medications for severe or chronic illnesses and those for AIDS patients, with a maximum contribution cap of EUR 2.64.

Free Medications

  • Pensioners and groups undergoing treatment for toxic syndrome.
  • Individuals with disabilities.
  • Treatments for work-related accidents and occupational diseases.
  • Products dispensed for use in settings like schools or healthcare facilities.

Temporary Disability

Workers temporarily unable to work due to illness or accidents, whether work-related or not, are entitled to healthcare and social security benefits. This also includes observation periods for occupational diseases that necessitate work cessation.

Causes of Temporary Disability

  • Common or occupational illness.
  • Work-related or non-work-related accidents.
  • Observation periods for occupational diseases requiring medical leave.

Requirements for Temporary Disability Benefits

  • Registration with Social Security or a similar service.
  • A minimum contribution period:
    • Common illness: 180 days in the preceding five years.
    • Work-related accidents and occupational diseases: no prior contribution required.

Amount of Subsidy

The subsidy amount depends on the base and reason for disability:

  • Common illness or non-work-related accident: 60% of the base from day four to twenty, and 75% from day twenty-one onwards.
  • Occupational illness or work-related accident: 75% of the base from the day after the incident.
  • Workers reaching the maximum duration of temporary disability continue receiving benefits until a permanent disability rating is established.

Regular Basis for Calculation

  • Non-work-related illness or accident: The employee’s contribution base for common contingencies in the month preceding the event, divided by the corresponding number of days.
  • Work-related accident or occupational disease: The employee’s contribution base for professional contingencies in the month preceding the event, divided by the corresponding number of days (considering overtime based on the average contributions over the previous twelve months).
  • Employees in training: 75% of the minimum contribution base.
  • Part-time workers: The sum of contribution bases for the three months preceding the event, divided by the number of days worked.

Recognition of Rights and Payment of Subsidy

  • The National Institute of Social Security (INSS) or the Mutual of Accidents and Occupational Diseases (chosen by the employer) handles the recognition of rights.
  • Companies authorized for voluntary cooperation in managing the General Scheme may also be involved.
  • The company pays the benefit with the same frequency as wages, either directly or through mandatory or voluntary collaboration schemes.

For non-work-related illnesses or accidents:

  • The employer covers the subsidy from day four to fifteen.
  • The INSS or Mutual of Accidents and Occupational Diseases covers the subsidy from day sixteen onwards, although the employer may continue handling the payment.

Duration of Subsidy

  • For occupational illnesses or accidents, the subsidy lasts for twelve months, extendable by six months if medical recovery is anticipated.
  • After this period, the INSS assesses the disability within three months to determine a permanent disability rating. This assessment may be extended up to 24 months if recovery is possible.

Maternity Leave

Workers, regardless of gender, are entitled to legally mandated periods of leave for maternity or adoption.

When both parents are eligible and take leave simultaneously or consecutively, they are both considered beneficiaries, provided they meet the requirements independently.

Requirements for Maternity Leave

  • Registration with Social Security or an equivalent scheme.
  • Minimum contribution period:
    • Under 21 years old: no minimum contribution required.
    • Between 21 and 26 years old: 90 days of contributions within the preceding seven years, or 180 days of working life prior to leave.
    • Over 26 years old: 180 days of contributions within the preceding seven years, or 360 days of working life prior to leave.

Amount of Benefit

:
100 100 of the corresponding regulatory base.