Demande directe (CEACR) - adoptée 1992, publiée 79ème session CIT (1992)

1. Part II (Medical care). (a) Article 16, paragraph 2 of the Convention. The Committee observes that, under section 19(2) of Book V of the Social Code, if membership in the statutory insurance scheme ceases, entitlement to benefits shall continue for no longer than one month after the termination of membership, provided that no gainful activity is exercised. A similar provision is contained in section 19(3) for family members, when the family insurance ends by death of the insured person. The Committee also notes the Government's statement that a formerly insured person, whether insured directly or as a family member, has the opportunity to retain his protection in case of sickness by voluntary insurance. The Committee points out that under Article 16, paragraph 2 of the Convention, "where a beneficiary ceases to belong to the categories of persons protected, further entitlement to medical care for a case of sickness which started while he belonged to the said categories may be limited to a prescribed period which shall not be less than 26 weeks, provided that the medical care shall not cease while the beneficiary continues to receive a sickness benefit". The Committee therefore requests the Government to supply detailed information on the measures taken or contemplated to give full effect to this provision of the Convention, as far as formerly insured members are concerned who did not have recourse to voluntary insurance under section 19 of Book V of the Social Code and are not covered by another social security protection which also provides for health care; it recalls that this was the case under section 183(1) of the former Federal Insurance Code.

(b) Article 16, paragraph 3. The Committee requests the Government to state whether and under which provisions effect is given to Article 16, paragraph 3 of the Convention, which prescribes that notwithstanding the provisions of paragraphs 2 of said Article the duration of medical care shall be extended for prescribed diseases recognised as entailing prolonged care.

2. Part III (Sickness benefits), Article 27. The Committee notes that, under section 58 of Part V of the Social Code, upon the death of an insured person, a funeral grant shall be paid only if the deceased person was insured at 1 January 1989, which is not in conformity with paragraph 1 of Article 27 of the Convention. In so far as the Government wishes to avail itself of the derogation provided for under paragraph 2 of this Article, it is requested to provide detailed information, including statistics, showing that the conditions provided for under Article 27, paragraphs 2(b) and (c), are fulfilled.