Direct Request (CEACR) - adopted 2002, published 91st ILC session (2003)

The Committee notes that the Government’s report does not contain information on most of the points raised in its previous direct request. It therefore requests the Government to provide full particulars on the following points.

1. Part II (Medical care), Article 7 of the Convention. Act No. 26790 to modernize social security in the area of health, and Supreme Decree No. 009-97-SA, provide that benefits for prevention and health promotion are a priority and their purpose is to maintain the health of the population. Furthermore, compulsory preventive care is provided under promotional prevention programmes run by the Peruvian Social Security Institute (IPSS) and private companies, through their own services and those provided by Health-care providers (EPS) (section 9 of the Act and sections 11 and 19 of the Supreme Decree). The Committee requests the Government to provide detailed information on the implementation of these provisions in practice.

Article 10, paragraph 1. The Committee notes the information provided by the Government to the effect that, while the Act establishes as a minimum requirement that EPS provide regular insured persons with the Health-care contained in the capa simple (simple coverage), they are offering and concluding contracts to provide the additional care contained in the capa compleja (complex coverage). It requests the Government to provide examples of the above contracts.

Article 10, paragraph 2. Section 42(1) of the Supreme Decree provides that the participation of insured persons in the cost of medical care may not exceed 2 per cent of their monthly income in the case of outpatient treatment or 10 per cent in the case of hospitalization, unless the worker explicitly consents to a higher charge when the vote is taken at the enterprise on the choice of Health-care provider and Health-care plan. Furthermore, under section 42(3) of the Supreme Decree, the worker’s contribution to the cost of treatment, whether outpatient or inpatient, may not exceed 10 per cent. The Committee requests the Government to indicate whether the maximum amount specified in section 42(3) can also be exceeded with the insured person’s consent.

Article 12. The Committee would be grateful if the Government would indicate in its next report the period during which medical care must be provided, with an indication of the relevant provisions.

Part XIII (Common provisions) (in conjunction with Parts II, III and VIII), Article 69. The Committee would be grateful if the Government would provide copies of any legal or regulatory texts providing for the possibility of suspending medical or cash sickness and maternity benefits. Please provide in particular a copy of the text governing the conditions and procedures which must be adopted by the IPSS under section 15 of Supreme Decree No. 009-97-SA.

Article 70. Please provide a copy of the regulations adopted by the Health Care Providers Superintendence under section 91 of Supreme Decree No. 009-97-SA, which provides for the settlement of disputes through arbitration, the provisions of which also apply both to persons entitled to Health-care through an EPS and through the employer’s own services. The Committee also requests the Government to indicate whether decisions made by arbitration bodies can be appealed in the ordinary courts. Finally, the Committee would be grateful if the Government would indicate whether disputes between the beneficiaries of Health-care and the IPSS are also subject to arbitration, as this is not set out explicitly in section 91.

Part XIV (Miscellaneous provisions) (in conjunction with Parts II, III and VIII). (a) Article 76. With reference to its observation, the Committee notes the information provided on the geographical scope of the health scheme and on the population covered. It requests the Government to provide, in accordance with Article 76, paragraph 1(b)(i), in the manner required by the report form, the following statistics on the number of persons protected with regard to medical care, as well as sickness and maternity benefit: (a) number of employees protected: (i) under the general scheme; (ii) under the special scheme; (b) total number of employees; and (c) number of employees protected as a percentage of the total number of employees.

(b) Please provide statistical data, as requested in Article 76, paragraph 1(b)(ii), in conjunction with Article 65, concerning the amount of cash benefits for sickness and maternity, in the manner required by the report form under Article 65. Please also indicate whether a ceiling has been set, either for sickness or maternity benefit, or for the wage taken into account for the calculation of these benefits.

Finally, the Committee requests the Government to indicate whether section 52(2) of Supreme Decree No. 009-97-SA, according to which workers may once a year decide individually to transfer from the IPSS to a Health-care provider (EPS) and vice-versa, also applies in the case of new workers referred to in section 53 of the same Supreme Decree.

2. The Committee recalls that the Government had requested information from the Superintendence of Banks and Insurance on the pensions system with a view to preparing the report on the application of the Convention and that it will transmit this information when it receives it. As this information has not reached the Office, the Committee hopes that the Government’s next report will contain detailed information in reply to the points raised in its 1997 direct request relating to the private social security system, which read as follows:

1. Part IX (Invalidity benefit), Article 56 and Article 57, paragraph 1, of the Convention (in relation with Article 65). (a) In accordance with section 100 of Presidential Decree No. 206-92-EF issuing regulations respecting the private pensions system of 6 December 1992 and sections 65 and 66 of Decision No. 141-93-EF/SAFP of 27 August 1993, pensions for total permanent invalidity are equivalent to 70 per cent of monthly remuneration, which may not exceed a maximum level adjusted according to the consumer price index. Furthermore, in accordance with section 112 of the above Presidential Decree No. 206, in the event of permanent total invalidity, insured workers may either: (a) avail themselves of the early pension system referred to in section 40 of Legislative Decree No. 25897 of 27 November 1992; or (b) select the pension system established in section 42 of the above Legislative Decree. Lastly, under the terms of section 117 of Presidential Decree No. 206-92-EF/SAFP, up to 20 per cent of the costs of the medical examinations and procedures required to qualify for invalidity benefit are at the expense of the worker.

The Committee requests the Government to indicate in its next report, on the basis of detailed statistics, whether the amount of invalidity benefit, whatever the type of pension chosen and the cost of the examination and procedures set out in section 117, attains the percentage established by the Convention (40 per cent) for a standard beneficiary (with a wife and two children) whose wage is equal to the wage of a skilled manual male employee.

(b) Please also specify the level of the benefit provided to an invalid who, after becoming an invalid, reaches the age of entitlement to a pension established under section 39 of Legislative Decree No. 25897 of 27 November 1992 (see section 115 of Presidential Decree No. 206-92-EF above).

2. Part XI (Standards to be complied with by periodical payments), Article 65, paragraph 10. In its previous comments, the Committee noted that, under sections 37, 46(e) and 51(a) of Decision No. 141-93-EF/SAFP of 27 August 1993, family and personal lifetime annuities, as well as temporary annuities with deferred retirement benefits are adjusted on a monthly basis as a function of the consumer price index in the city of Lima, which is prepared by the National Statistical Institute, or according to any indicator which may replace it. The Committee requests the Government to provide in its next report all the statistical information requested in the report form under Article 65, Title VI.

3. Part XIII (Common provisions) Article 70. Please indicate the rules governing the right of appeal of insured persons in case of the refusal of the benefit or complaint as to its quantity.