Solicitud directa (CEACR) - Adopción: 2002, Publicación: 91ª reunión CIT (2003)

The Committee notes the Government’s report. It notes, however, that it contains no information on the implementation of Part II concerning medical care. The Committee has nonetheless examined all the legislation to implement the Convention, particularly Act No. 54 of 1956 on employees’ sickness benefit, as amended, and Act No. 48 of 1997 on public health insurance.

So that it may assess fully how effect is given to the Convention, the Committee would be grateful if the Government would provide detailed information on the following points.

Part II (Medical care), Article 10, and Part III (Sickness benefit), Article 19 of the Convention (Scope). Please provide the information and statistics required by the report form under these Articles of the Convention. With regard in particular to Article 19, the Committee would be grateful if, in establishing statistics on the persons protected, the Government would separate those who must be covered by Act No. 48 of 1997 from those who are covered thereby on a voluntary basis.

Part II (Medical care), Article 17 (in conjunction with Article 13) (sharing in the cost of medical care). Please describe in detail the manner in which pharmaceuticals are supplied to insured persons on the basis of the type of medicine (full reimbursement, partial reimbursement, non-reimbursement). Please also indicate the rules on participation by insured persons in the cost of prosthetic and orthopaedic appliances (including their maintenance and replacement) and dental care.

Part III (Sickness benefit), Article 21 (in conjunction with Article 22) (rate of benefit). The Committee notes from the information in the Government’s report that sickness benefits amounted to 74 per cent of the previous wage in 1999 and 75 per cent in 2000, due account being taken of family allowances paid during employment and after the contingency, whereas the rate prescribed by the Convention is 60 per cent. The Committee observes in this connection that both the wage of the skilled manual male employee and the benefits and family allowances were calculated on a monthly basis. However, since according to sections 17 and 18 of the Act of 1956 on employees’ sickness insurance - read in conjunction with section 5 of Act No. 589 of 1992 on social security and unemployment contributions - the amount of the sickness benefit is calculated according to the maximum gross pay of the worker in question established on a daily basis, the Committee would be grateful to receive in the Government’s next report statistics on the rates of benefits specifying how the monthly rate of the sickness benefit was calculated.

The Committee further notes that the skilled manual male employee chosen by the Government is the one defined in paragraph 6(d) of Article 22 of the Convention. It would point out to the Government that the gross average wage referred to by the Government is not necessarily the same as the average earnings of all persons protected referred to in paragraph 6(d).

Article 26 (Duration of sickness benefit). The Committee requests the Government to provide detailed information on the practical effect given to section 15(5) of the Act of 1956 on employees’ sickness insurance, showing that the duration of sickness benefit is still consistent with the provisions of Article 26, paragraph 1, of the Convention, which requires the grant of the benefit to be not less than 52 weeks in each case of incapacity even in the event of an onset of a new incapacity within the time limit prescribed by section 15(4).

Article 27 (Funeral costs). The Committee notes the government statement in its report to the effect that an allowance for funeral costs is paid to the person who has borne the expense of the funeral of a deceased person who was in receipt of or entitled to sickness benefit. The Committee requests the Government to indicate the provisions of the law that apply in this case, specifying the amount of the allowance.

Part IV (Common provisions), Article 28, paragraph 1(h) (suspension of benefit in the event of receipt of more than one benefit). Since the Government has indicated that it avails itself of this provision of the Convention, which allows sickness benefit to be suspended as long as the person concerned is in receipt of another social security cash benefit, the Committee requests the Government to indicate the provisions of the law that apply in this case.

Article 29 (Right of appeal). The Committee requests the Government to provide detailed information on the practical effect given to this provision as regards both medical care and sickness benefit specifying the legislative, regulatory or administrative provisions that apply.

Article 31 (Participation in the administration). Please indicate how effect is given to this provision of the Convention which provides for participation by representatives of the persons protected and representatives of the employers in the management of the system with regard to sickness benefit (for the various sickness insurance funds) and medical care.