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

With reference to its observation, the Committee notes the information provided by the Government. In particular, it notes the information provided by the Government in reply to its previous comments (Part XIII (Common provisions), Article 70). It wishes to draw the Government’s attention to the following points.

Article 10, paragraph 1, of the Convention. In reply to its previous comments, the Committee notes the copies of the contracts concluded with Health-Care Providers (EPS) to ensure the provision of medical care to insured persons, which were attached to the Government’s report. The Committee proposes to examine them at its next session.

Article 10, paragraph 2. With regard to the sharing by beneficiaries in the cost of medical care, the Government indicated in its previous report that it appeared to be unnecessary to provide for an exemption from the 10 per cent maximum share in the cost of outpatient and inpatient treatment envisaged in section 42(3) of Supreme Decree No. 009-97-SA, as the worker’s express consent is required for this maximum level to be exceeded. In its previous comments, the Committee requested the Government to indicate the measures adopted to ensure that the sharing by beneficiaries in the cost of medical care does not cause them hardship, in accordance with this provision of the Convention. In this respect, the Committee notes the resolution of the Superintendent No. 073-2000-SEPS/CD, provided by the Government with its report. The Committee proposes to examine the resolution at its next session.

Article 12. In reply to the Committee’s previous comments concerning the period during which medical care must be provided and the relevant provisions, the Government indicates that care is provided for as long as the medical condition of the insured person so requires, and provided that the latter has not failed to pay three monthly contributions, whether or not they are consecutive. In the event of invalidity, care is provided until the ONP takes over and provides a pension; care is provided by the Social Health Insurance Scheme (ESSALUD). The Committee notes this information. It once again requests the Government to indicate the legislative provisions applicable in this respect.

Part XIII (Common provisions) (in conjunction with Parts II, III and VIII), Article 69. In its previous comments, the Committee noted the information provided on certain instances of the suspension of cash benefits under the provisions of section 12 of Act No. 26790. It once again requests the Government to provide the texts of any other legal or regulatory provisions allowing the suspension of benefits in cash and in kind. Moreover, as the texts of resolution No. 248-GG-ESSALUD-2001 and Agreement No. 59-22-ESSALUD-99 of the Executive Board have not been provided, the Committee requests the Government to supply copies of them with its next report. Furthermore, it once again requests the Government to provide copies of the texts governing the conditions and procedures which must be adopted by the ESSALUD under section 15 of Supreme Decree No. 009-97-SA.

Article 70. With reference to its previous comments, the Committee notes the text of the resolution of the Superintendent No. 012-98-SEPS approving the Arbitration and Dispute Resolution Regulations of the Conciliation, Arbitration and Dispute Resolution Centre. The Committee proposes to examine the above text at its next session.

Part XIV (Miscellaneous provisions) (in conjunction with Parts II, III and VIII), Article 76. With reference to its previous comments, the Committee notes the statistical data provided by the Government on the numbers of persons protected by ESSALUD in relation to the economically active population (PEA) from 1990 to 2004. It once again requests the Government to provide information on the total number of employees and the number of employees protected as a percentage of the total number of employees.

The Committee once again requests the Government to provide the statistical data required under Article 76, paragraph 1(b)(ii), in conjunction with Article 65, regarding the amount of sickness and maternity cash benefits in the manner required by the report form under Article 65. Please also state whether a ceiling has been set for either sickness or maternity benefit, or for the wage taken into account for the calculation of these benefits.

Finally, the Committee notes that new workers, as indicated in section 53 of Supreme Decree No. 009-97-SA, may choose between ESSALUD and an EPS plan when they commence work and during the first year. In the view of the Government, this provision makes no type of discrimination in exercising this option, except for the requirement to be a worker.

Part IX (Invalidity benefit), Articles 56 and 57, paragraph 1 (in conjunction with Article 65). The Committee hopes that the Government will provide in its next report, as it indicated it would, precise statistical data showing 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 wages are equal to the wage of a skilled manual male employee.

Part XI (Standards to be complied with by periodical payments), Article 65, paragraph 10. The Committee hopes that the Government will provide with its next report all the statistical data requested by the report form under Article 65, Title VI.

Part XIII (Common provisions), Article 70. The Committee notes the information provided by the Government in reply to its previous comments.