Legal basis

 

Detailed regulations governing area of social insurance system in Poland are contained in the Act of 13 October 1998 on the social insurance system (Journal of Laws of 2015, text 121 as amended).

 

Rules concerning eligibility and payment of benefits from sickness insurance are described in the Act of 25 June 1999 on the money benefits from social insurance in case of illness and maternity (Journal of Laws of 2014, text 159 as amended).

 

Who is a subject to sickness insurance?

 

Subjects to a compulsory sickness insurance are:

• employees,  members of farmers’ production cooperatives.

 

Subjects to a voluntary sickness insurance, on their own request, are persons who are subjects to a compulsory old-age and disability pension insurances:

• outworkers,
• persons performing work on the basis of agents’ contract or other services agreement and their associates, including persons taking care of children on the basis of activation agreement (nannies),
• entrepreneurs and their associates,
• persons performing paid work on the basis of the work referral during imprisonment or temporary arrest, clergy.

 

Sickness insurance contribution level

 

Level of a sickness insurance contribution is 2,45% of an assessment basis.

 

Assessment basis for employees and insured non-employees

 

Employees

 

Assessment basis for sickness, maternity and care allowances is an average salary paid in a period of 12 months before the month preceding month in which the incapacity for work occurred.

 

If the incapacity for work occurred before the period of 12 months of sickness insurance is completed, than the salary paid for full months of insurance is taken to calculate the assessment basis.

 

The sickness allowance assessment basis for one day incapacity for work is 1/30 part of salary taken for calculating the assessment basis.

 

Calculation of the assessment basis includes an income, which is the assessment basis for sickness insurance contributions, after deducting contributions for old-age and disability pension insurances, financed from employees’ own funds. The assessment basis is not to be renewed if, benefits of the same or other types were paid continuously or the interval between their reception was shorter than 3 months.

 

The assessment basis due to full-time labour cannot be less than the employees’ minimum salary, after deduction of the amount equal to 13,71% of this salary.

 

Insured non-employees

 

Assessment basis is an income from 12 months period preceding the month in which incapacity for work occurred. To calculate assessment basis for these insured, the income which is basis for sickness insurance contribution is taken. The assessment basis for insured non-employees cannot exceed 250% of average salary.

 

Types of allowances paid from sickness insurance:

• sickness allowance,
• rehabilitation benefit,
• compensatory allowance,
• maternity allowance,
• care allowance.

 

Sickness allowance

 

Insured is entitled to a sickness allowance if he became unable to work during the sickness insurance period.

Employees are entitled to the sickness allowance from the 34^th day of illness (in case of employees after 50 years of age – from 15^th day of illness). For initial 33 days employees receive sick pay, financed by an employer (in case of employees after 50 years of age for initial 14 day of illness).

 

Sickness allowance assessment basis for insured employee is an average monthly salary paid in a period of 12 months preceding the month in which incapacity for work occurred.

 

Sickness allowance is paid for the duration of incapacity for work, but no longer than for 182 days. If the incapacity for work is caused by tuberculosis or occurs during pregnancy, sickness allowance is paid for period no longer than 270 days. The duration of receiving the sick pay is included in the allowance period.

 

Insured becomes eligible to the sickness allowance

1. after 30 days of continuous sickness insurance – if he/she is insured compulsory,
2. after 90 days of continuous sickness insurance – if he/she is insured voluntary.
3.  

Following persons are entitled to the sickness allowance from the first day of sickness insurance:

1. school or university graduates, who were covered by sickness insurance within 90 days from graduation or reception school/university diploma,
2. if the incapacity for work was caused by the accident at work or on the way to/from work,
3. compulsory insured, who has previous, at least 10-year period of compulsory sickness insurance.

 

Monthly sickness allowance is 80% of assessment basis. For the period of hospital treatment sickness allowance is 70%.

 

Allowance is paid in amount of 100% assessment basis if incapacity for work:

• occurred during pregnancy,
• was caused by the accident at work or on the way to/from work,
• occurred as a result of medical examination indispensable for candidates for donors of cells, tissues and organs and as a result of donation of cells, tissues and organs.

 

Rehabilitation benefit

 

Rehabilitation benefit is paid in case when insured exhausted the right to sickness allowance but is still incapable for work, although continuation of treatment or rehabilitation prognosis recovering the ability to work. Rehabilitation benefit is paid for the period necessary for the recovery, but no longer than for 12 months.

 

Decision of granting the rehabilitation benefit is made by Social Insurance Institution (Zakład Ubezpieczeń Społecznych – ZUS) on a basis of medical report made by Agreed Medical Evaluator (AME) or, if there was an appeal, on the basis of ZUS medical board’s report.

 

Persons entitled to old-age pension, disability pension, unemployment allowance, pre-retirement benefit or allowance, teachers’ compensatory benefit and health-saving furlough are not entitled to the rehabilitation benefit.

Rehabilitation benefit is payable at a rate of 90% of assessment basis for the first 3 months and 75% for the subsequent period. If the incapacity for work takes place during pregnancy, the rehabilitation benefit is payable at a rate of 100% of assessment basis.

 

Compensatory allowance

 

Compensatory allowance is paid to persons whose monthly salary decreased due to undergoing a vocational rehabilitation, or to the employee who, due to the changes in health has been shifted, within the same employer, to another position, customised to the need of adaptation or training for a specified job.

 

The need for vocational rehabilitation is certified by regional occupational health centre or the ZUS Agreed Medical Evaluator. The compensatory allowance is granted for a period of vocational rehabilitation, but no longer than 24 months. The right to the compensatory allowance expires on a day of vocational rehabilitation termination and shift to another job, or – if further rehabilitation is futile, due to the employee’s health.

 

The compensatory allowance is a difference between the average monthly salary paid in the period of 12 months and the monthly salary paid for the work performed in conditions of the vocational rehabilitation.

 

Maternity allowance

 

Maternity allowance is granted to a person who during the period of insurance or parental leave:

-        born a child,

-        took a child up to an age of 7 for upbringing and applied to a family court for its adoption (in case of a child with postponed compulsory schooling – up to the age of 10),

-        took for upbringing within foster family a child up to the age of 7 (in case of a child with postponed compulsory schooling – up to the age of 10), excluding professional foster family.

 

Maternity allowance is paid for the period of maternity and additional maternity leave, as well as leave on the conditions of the maternity or additional maternity leave and extra maternity leave.

 

The period of maternity leave or the leave on the conditions of maternity; leave is:

• 20 weeks if one child is born during single delivery,
• 31 weeks if two children are born during single delivery,
• 33 weeks if three children are born during single delivery,
• 35 weeks if four children are born during single delivery,
• 37 weeks if five or more children are born during single delivery.

 

Maternity allowance can be also granted to the insured father or other insured member of the family if:

-        mother dies or leaves the child and

-        abovementioned persons will interrupt performing work or their other payable duties to take care of the child.

 

If mother took at least 14 weeks of the maternity allowance it be can transferred to the insured father of the child.

 

Father can also apply for the maternity allowance if mother needs hospital treatment or her health incapables her for taking care of child, and after 8 weeks she will interrupt receiving the allowance.

 

The period of paying the maternity allowance for additional maternity leave or additional leave on the conditions of maternity leave is:

• 6 weeks if one child is born during single delivery,
• 8 weeks if two or more children are born during single delivery.

 

The maternity allowance for an additional period can occur once or in two parts falling one after another.

 

The period of maternity allowance for the parental leave is 26 weeks. It can be used once or in up to 3 parts following directly one after another, that cannot be shorter than 8 weeks.

 

Father can be granted with maternity allowance for the period of additional maternity leave or parental leave, equally as mother.

 

After 1 January 2016 new regulations will be introduced, which will include the period of additional maternity leave to the period of extra maternity leave. A s a result the extra maternity leave will be 32 weeks if one child is born during single delivery or 34 weeks if two or more children are born during single delivery.

 

Maternity allowance paid for the maternity leave, additional maternity leave as well as leaves on the conditions of maternity and additional maternity leaves is paid at a rate of 100% of assessment basis. Maternity allowance paid for the parental leave period is paid at the rate of 60% of assessment basis.

 

If mother, no later than 14 weeks after childbirth (or adoption of a child), applied for payment of the maternity allowance for the period of maternity leave, full-time additional maternity leave and full-time extra maternity leave – the maternity allowance will be paid at a rate of 80% of assessment basis for all abovementioned periods.

After 1 January 2016 new regulations will be introduced. In statutory specified cases the maternity allowance will be paid at the rate of 100% of the assessment basis for the period of 8, 6 or 3 weeks of extra maternity leave.

 

Maternity allowances are subject to contributions for old-age and disability pension insurances, financed from the State budget.

 

Insured father upbringing a child has also a right to the maternity allowance for the period of paternal leave, up to 2 weeks, but no longer than to the child’s age of 12 months.

 

Care allowance

 

Care allowance is granted when occurs the need of personal taking care of:

• child up to the age of 8 in case of:

-        unforeseen closure of nursery, children’s club, kindergarten or school to which the child attends, and in the event of nanny’s illness with whom parents have signed an activation agreement, or a daily caregiver who takes care of the child;

-        childbirth or illness of a spouse of the insured, who permanently takes care of the child, in case the birth or illness prevents the spouse from taking care of the child,

-        stay of the spouse, who permanently looks after the child, in a healthcare institution,

• sick child up to the age of 14,
• other sick member of family (spouse, parents, parents in law, grandparents, grandchildren, siblings and children above the age of 14 – if they stay within the insured’s in household during the period of taking care).

 

In case the care is taken of a child up to the age of 14 the care allowance is granted for the period of taking care, but no longer than 60 days in a calendar year. If the care is taken of another member of a family or the child above the age of 14 than the care allowance is paid for the period no longer than 14 days in a calendar year.

 

The care allowance is granted exclusively in case there are no other members of the family, who could take care of a child or family’s other member.

 

Monthly care allowance is 80% of an assessment basis.