Demande directe (CEACR) - adoptée 2000, publiée 89ème session CIT (2001)

I.  With reference to its previous comments, the Committee wishes to draw the Government’s attention to the following points.

1.  Part II (Medical care), Article 16, paragraphs 2 and 3, of the Convention.  In its previous comments the Committee observed, under section 19 of Part V of the Social Code, if membership in the statutory insurance scheme ceases, entitlement to benefits shall continue for not more than one month after the termination of membership, provided that no gainful activity is exercised. Similar provision is made in section 19(3) for family members, when the family insurance ceases on the death of the insured person. The Committee recalled 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". Article 16, paragraph 3, further provides that, in such cases, the duration of medical care shall be extended for prescribed diseases recognized as entailing prolonged care. The Committee therefore asked the Government to provide detailed information on the measures taken or envisaged to give full effect to these provisions of the Convention, in respect of formerly insured members who, not having subscribed to voluntary insurance, had no medical protection.

According to the Government’s report, in case the membership of the statutory health insurance ceases, the coverage remains valid as long as the persons concerned are in receipt of maternity benefit or sickness benefit for a sickness which started before the cessation of the membership of the insurance (section 192, paragraph 1(2) of the 5th Book of the Social Code). Besides, the persons concerned have also the possibility to take out voluntary health insurance or be entitled to medical care, which in theory is equivalent to that provided by the statutory insurance scheme, if they draw assistance for their subsistence in accordance with the Federal Assistance Act (sections 37 and 38 of the Federal Public Assistance Act). The Committee notes this information. It further notes that persons in receipt of unemployment benefit continue to be covered by the statutory health insurance (section 186, paragraph 2(a), of the 5th Book of the Social Code). The Committee would like the Government to confirm in its next report that in case the employment contract ceases during the sickness, the person concerned shall, in all other cases covered by paragraphs 2 and 3 of Article 16 of the Convention, continue to be entitled to medical care throughout this contingency, provided this care may be limited to a prescribed period which shall not be less than 26 weeks. Please also indicate how family members are protected in these cases.

2.  Part III (Sickness benefits), Article 27.  In its previous comments the Committee pointed out that section 58 of Part V of the Social Code, under which a funeral grant shall be paid only if the deceased person was insured at 1 January 1989, was not in conformity with paragraph 1 of Article 27 of the Convention. Having pointed out to the Government that it might avail itself of the derogation provided for under paragraph 2 of Article 27 of the Convention, the Committee requested information relating to this provision.

In this connection, the Committee notes from the information supplied by the Government in its report that the conditions required by paragraph 2 of Article 27 for derogation from the provisions of paragraph 1 appear to be met as regards subparagraphs (a) and (b), since Germany has accepted Part IV of the Invalidity, Old‑Age and Survivors’ Benefits Convention, 1967 (No. 128) and the rate of the sickness benefit should reach that prescribed in subparagraph (b) if net amounts are counted. However, the Government states that it is unable to provide statistics on the number of persons covered by voluntary insurance which provides a funeral grant, as required by subparagraph (c) of paragraph 2. The Committee nonetheless notes that, according to the Government’s estimates, the number of people who may be entitled to a funeral grant under the legislation on statutory sickness insurance is still high (61 million, i.e. approximately 85 per cent of insured persons). But this number will necessarily decline since the funeral grant applies only to persons insured at 1 January 1989. In these circumstances, the Committee hopes that the Government will not fail to continue indicating in all its future reports the number of persons covered by insurance - compulsory or voluntary - which provides for a funeral grant.

II.  The Committee also asks the Government to provide information on the following points in its next report.

1.  Scope.  Please provide the statistical information requested under Articles 10 and 19 of the report form. If the Government intends also to take into account the protection resulting from a non‑compulsory insurance for the protected persons, it is asked also to provide the information requested in the report form under Article 6.

2.  Shared medical costs.  The Committee notes the information supplied by the Government under Article 17 of the Convention, and in particular the entry into force of the First Statutory Health Insurance Reform Act (1.NOG). The Government is asked to provide detailed information on the practical implementation of the reform and its implications for Article 17 of the Convention bearing in mind that, according to the new provisions, any increase in contributions other than those connected with adjustments in the health funds’ risk management, will automatically lead to an increase in the beneficiaries’ share in medical costs.