Demande directe (CEACR) - adoptée 2006, publiée 96ème session CIT (2007)

Convention (n° 130) concernant les soins médicaux et les indemnités de maladie, 1969 - Allemagne (Ratification: 1974)

I. With reference to its previous comments, the Committee wishes to draw the Government’s attention to the following points.

1. Part II (Medical care), Article 16, paragraphs 2 and 3, of the Convention. With reference to its previous comments, the Committee notes that, according to the Government’s report, persons whose membership in the statutory health insurance fund ceases during a period of illness because their employment has been terminated remain insured as long as they are entitled to sickness benefit (section 192, paragraph 1(2), of the 5th Book of the Social Code). Entitlement to sickness benefit is limited to 78 weeks. Moreover, the persons whose employment has been terminated and who are receiving unemployment benefit or unemployment benefit II are covered by the statutory health insurance system, in accordance with the Fourth Act on modern labour market services of 24 December 2003. In such cases, family insurance which was in effect before the termination of employment continues for as long as the person receives unemployment benefit. Furthermore, the family members of persons receiving unemployment benefit II, who are included in the category of persons requiring insurance under section 7(3), Book II, of the Social Code, are subject to compulsory insurance if they are not covered by family insurance. In addition, the children of persons covered by family insurance are also covered by family insurance without paying contributions (section 10(1)(1) of the Act to simplify administrative procedures in social law of 21 March 2005). The Committee notes this information. With regard to persons who, following termination of employment, are entitled to neither unemployment benefit or unemployment benefit II, the Committee notes that they may join the statutory health insurance system on a voluntary basis within three months of the end of coverage, provided that they have previously been insured under the statutory scheme for a minimum period of 12 months before their coverage ended, or for a total period of 24 months in the previous five years.

The Committee understands that in practice most of the persons in the situation referred to above are covered by compulsory insurance, as sickness benefit continues to be paid for 78 weeks to a person and his/her family members even where termination of employment occurs before the expiration of the period of entitlement to sickness benefit. In addition, persons who do not receive sickness benefit, but are entitled to unemployment benefit II, and their family members, are covered by the statutory health insurance. However, it would appear from the information provided in the report that those persons whose employment is terminated and who receive neither sickness nor unemployment benefit and who are in need of medical care have to take out voluntary insurance. The Committee would be grateful if the Government would confirm whether this interpretation is correct. The Committee would also be grateful if the Government would confirm whether a person who takes out a private insurance and his/her family members are covered without a qualifying period. Please also indicate the manner in which German legislation ensures that insured persons who have worked for fewer than 12 months, those who are dismissed or leave their employment voluntarily, and who are not entitled to unemployment benefit, as well as their family members, are entitled to medical benefit for a minimum period of 26 weeks, as required by Article 16, paragraph 2, of the Convention.

2. Part III (Sickness benefit), Article 27. In its previous comments, the Committee noted that section 58 of Part V of the German Social Code provides that a funeral grant shall be paid only if the deceased person was insured on 1 January 1989 and requested the Government to provide statistical information on the number of persons covered by voluntary and compulsory insurance which provides for a funeral grant, as required under Article 27, paragraph IV, of the Convention.

According to the Government’s report, the Committee notes that the entry into force of the Act to modernize statutory health insurance of 1 January 2004 abolished the death grant. In this respect, the Committee would like to point out once again to the Government that it may wish to avail itself of the derogation provided for under Article 27, paragraph 2, of the Convention. The Committee also notes that the Government has once again not been able to provide statistical information on the number of people covered by compulsory and voluntary insurance which provides a funeral grant as required by Article 27, paragraph 2(c), and hopes the Government will be able to do so in its next report.

According to the Government’s report, sickness benefit corresponds to 70 per cent of the amount of the insured person’s regular wages and income on which social contributions are assessed. The actual percentage of net income varies from one individual to another, and the maximum benefit may correspond to 90 per cent of the insured person’s normal net income. In this connection, the Committee recalls that the conditions required by paragraph 2 of Article 27 for derogation from the provisions of paragraph 1 appear to be met as regards subparagraphs (a) and (b), since Germany has accepted Part IV of the Invalidity, Old-Age and Survivors' Benefits Convention, 1967 (No. 128), and the rate of the sickness benefit should reach that prescribed in subparagraph (b) if net amounts are counted. In these circumstances, the Committee reminds the Government that, in order to avail itself of the derogation envisaged in Article 27, paragraph 2, of the Convention, the majority of the persons protected must be covered by voluntary insurance which is supervised by the public authorities and provides a funeral grant.

II. In its previous comments, the Committee asked the Government to provide information on the following points.

1. Scope. In its previous comments, the Committee requested the Government to provide the statistical information requested under Articles 10 and 19 of the report form and, in case the Government also intended to take into account the protection resulting from a non-compulsory insurance for protected persons, to provide the information requested in the report form under Article 6.

The Committee notes that 92.2 per cent of all employees are covered by the statutory health insurance system in relation to medical care. The Government does not provide any statistical information regarding sickness benefit. However, as persons affiliated with the statutory health insurance system are covered by sickness benefit, it is assumed that the rate of coverage is the same. The Committee requests the Government to continue providing statistical information as requested under Articles 10 and 19 of the report form.

2. Cost sharing in medical costs. Taking into account the entry into force of the First Statutory Health Insurance Reform Act, the Committee asked the Government to provide detailed information on the practical implementation of the reform and its implications for Article 17 of the Convention, particularly in respect of the cost sharing by beneficiaries in medical costs.

According to the Government’s report, the entry into force of the Act to modernize statutory health insurance on 1 January 2004 modified the existing legislation on contributions (cost sharing) and exemptions. Under the new legislation, insured persons of 18 years of age and older are required to pay a “medical practice fee” of 10 euros for “out-patient” treatment which must be paid for the first visit to a doctor without referral in each quarter. In the case of “in-patient” hospital treatment, insured persons of 18 years and above are required to pay a charge of 10 euros per calendar day for a maximum of 28 days per year. In addition, insured persons are required to contribute 10 per cent of certain costs, such as medication and medical care (up to a minimum amount of 5 euros and a maximum of 10 euros, but never more than the cost of the medication). When medication and nursing care are provided at home, the patient’s contribution is 10 per cent and 10 euros per prescription. No contribution is required for children under the age of 18, apart from travel costs. The new legislation establishes limitations on cost sharing. Each insured person is required to bear up to a maximum of 2 per cent of his or her gross annual income of accommodation charges. The limitation for persons who suffer from chronic illness is 1 per cent of their annual gross income in accommodation charges. The Committee notes this information and allegations made by the German Confederation of Trade Unions (GCTU) in this respect. The Committee further notes the Government’s reply to the GCTU allegations, in which it indicates that the new cost-sharing rules are so designed as to avoid hardship for persons with small means, in particular as the cost sharing for recipients of social security and of unemployment benefit II is based on a fictional income of 345 euros in 2006.

The Committee also notes the GCTU’s allegations regarding the failure by the Government to meet its obligations under Article 2, paragraph 3(a), (b) and (c), of the Convention. In this respect, the Committee wishes to point out that Germany has not availed itself of the derogation set out in paragraph 1 of this Article and that paragraph 3(a), (b) and (c) of this Article do not therefore apply to Germany.