Solicitud directa (CEACR) - Adopción: 2004, Publicación: 93ª reunión CIT (2005)

The Committee refers the Government to its observation and takes note of the information in the Government’s report, particularly that pertaining to Article 7 of the Convention (practical implementation of the medical care system). It wishes to draw the Government’s attention to the following points.

Article 10, paragraph 1, of the Convention. In response to the Government’s request for samples of the contracts concluded with the Health Care Providers (EPS) to cover affiliates’ medical care, the Government states that it appended copies of such contracts to its report. Since the report contained no such enclosures, the Committee requests the Government to send them with its next report.

Article 10, paragraph 2. With regard to beneficiaries’ share in the cost of medical care, the Government indicates that it seems to be unnecessary to provide for an exemption from the 10 per cent maximum share in the cost of outpatient and inpatient treatment established in section 42(3) of Supreme Decree No. 009-97-SA, because the worker’s express consent is required in order for the maximum to be exceeded. The Government’s report refers in this connection to Resolution No. 073-2000-SEPS/CD of the Supervisory Authority. Since the abovementioned resolution was not provided, the Government is asked to send a copy of it with its next report. Please also indicate the measures taken to ensure that beneficiaries’ share in the cost of medical care does not cause them hardship, in accordance with this provision of the Convention.

Article 12. The Government states that it will send the information on the period during which medical care must be provided and on the relevant provisions as soon as these become available. The Committee notes this statement and trusts that the Government will take the necessary steps to collect and send this information as soon as possible.

Part XIII (Common provisions) (in conjunction with Parts II, III and VIII), Article 69. With reference to its previous comments, the Committee notes the information on instances of the suspension of cash benefits allowed by section 12 of Act No. 26790. It requests the Government to provide the texts of any other legal or regulatory provisions allowing for the suspension of benefits in cash and in kind. Since Resolution No. 248-GG-ESSALUD-2001 and Agreement No. 59-22-ESSALUD-99 of the Management Board, referred to in the report, have not been sent, the Committee requests the Government to include them with its next report. It again requests the Government to provide copies of the texts governing the conditions and procedures which must be adopted by the IPSS under section 15 of Supreme Decree No. 009-97-SA.

Article 70. The Committee takes note of the provisions of the Arbitration Act, No. 26572 of 3 January 1996, allowing arbitration awards to be challenged in the courts of law. With regard to dispute settlement, it notes that health-care beneficiaries may apply, through ESSALUD, either to the Insurance Ombudsman, an independent body responsible for enforcing the rights of beneficiaries, or to the ordinary courts or for arbitration. Noting that the Government refers in its report to a publication by the Conciliation and Arbitration Centre of the EPS Supervisory Authority containing various instruments governing this matter, the Committee would be grateful if the Government would provide a copy of this document with its next report.

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 information sent by the Government on the number of employees protected by the health insurance under the general scheme and under special schemes. As to the other information requested - the total number of employees and the number of employees protected as a percentage of the total number of employees - the Committee hopes that the Government will provide these data shortly in order to give an accurate picture of the manner in which the Convention is applied in the country.

The Committee notes in this connection that in 2002, insured persons with health insurance coverage (ESSALUD) amounted to 18.3 per cent of the economically active population nationwide. The Committee observes that since 1994, in absolute terms there has been no change in the number of ensured persons, and that this, combined with the increase in the economically active population since that date, has caused a significant decline in persons insured under ESSALUD expressed as a percentage of the economically active population. In these circumstances, the Committee hopes that the Government will shortly provide all the information requested so that the Committee is in a position to assess application of the Convention in the country.

Since the Government’s report provides no information in reply to several other matters raised previously, the Committee requests the Government to answer these points in its next report. It again requests the Government to provide the statistical information 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.

Lastly, the Committee hopes that the Government will indicate whether section 52(2) of Supreme Decree No. 009-97-SA, under which workers may once a year decide individually to switch from ESSALUD to an EPS, and vice versa, also applies to the new workers referred to in section 53 of the same text.

Part IX (Invalidity benefit), Articles 56 and 57, paragraph 1 (in conjunction with Article 65). (a) The Committee notes that the Government’s report does not reply to its previous comments. It accordingly asks the Government once again 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 wages are 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 abovementioned Supreme Decree No. 206-92-EF).

Part XI (Standards to be complied with by periodical payments), Article 65, paragraph 10. Since the Government refers to statistical information not enclosed in the report, the Committee hopes that the Government will provide all the statistical information requested by the report form under Article 65, Title IX, with its next report.

Part XIII (Common provisions), Article 70. The Committee notes with interest the provisions of sections 208 and 209 of Act No. 27444 on the general administrative procedure for complaints and appeals. It notes that according to section 1 of the abovementioned Act, the Act applies to bodies of the public administration and to private legal entities engaged in public service activities. The Committee understands that Act No. 27444 applies to bodies coming under private health and pension systems, and requests the Government to confirm whether this is the case.