Sickness Benefit - Everything You Need to Know

Persons covered by sickness insurance are entitled to benefits in the event of incapacity for work. However, not every person who applies for insurance acquires the right to receive benefits from ZUS from the day of registration. What is the waiting period? Can I qualify for sickness benefit after the end of sickness insurance? How much can you receive from ZUS for the period of incapacity for work? We explain everything in the article!

The period of acquiring the right to sickness benefit

The insured person acquires the right to sickness benefit after the waiting period, which amounts to:

• 30 days with compulsory health insurance;
• 90 days for voluntary health insurance.

The right to unemployment benefit is due to persons:

• school graduates who were covered by sickness insurance within 90 days of graduating from school or obtaining a university diploma,
• insured persons whose inability to work was caused by an occupational disease, an accident at work or on the way to or from work,
• obligatorily insured persons who have at least 10 years of compulsory sickness insurance,
• deputies and senators who joined sickness insurance within 90 days of completion.

The insured employee acquires the right to sickness benefit when the inability to work lasts more than 33 days or more than 14 days, in the case of a person over 50 years of age. The exception is the turn of the calendar year, if the inability to work continues uninterrupted and on December 31, the employee is entitled to sick pay, then from January 1, he continues to retain the right to sick pay for a period of 33 days or 14 days. The right to sickness benefit arises from the first day of incapacity for work if it is an accident at work or an occupational disease.

Persons engaged in outwork and alternative service have the right to the remuneration provided for in Art. 92 KP on the same terms as employees.

On the other hand, other insured persons are entitled to sickness benefits from the first day of incapacity for work, as they are not entitled to remuneration.

The right to unemployment benefit after termination of sickness insurance

Sickness allowance is also payable for incapacity for work arising after the termination of the sickness or accident insurance title, if the incapacity lasted continuously for at least 30 days and arose no later than within:

• 14 days from the end of the sickness insurance title;
• 3 months from the end of sickness insurance in the case of an infectious disease with a hatching period longer than 14 days, or another disease whose symptoms become visible after a period longer than 14 days from the onset of the disease.

Sickness benefit - the period of payment of the benefit

Sickness benefit is granted for no longer than 182 days, and in the case of tuberculosis or when the incapacity for work occurs during pregnancy, no longer than 270 days.

This benefit is granted to an insured person who becomes incapable of work during the period of sickness insurance.

As a rule, ZUS pays out benefits within 30 days from the moment the insured person reports incapacity for work.

The period during which the allowance is not granted

Sickness benefit is not payable for the period of sick leave during which the employee retains the right to remuneration, although it is included in the benefit period. The allowance is also not payable for periods of incapacity for work during:

• unpaid leave, parental leave;
• temporary arrest or imprisonment, with the exception of paid work on the basis of an assignment to work during imprisonment or pre-trial detention;
• for the first five days, if the incapacity for work was caused by alcohol abuse;
• in the event of improper use of a sick leave from work,
• if it was caused as a result of an intentional crime or a misdemeanor committed by the insured, etc.

After termination of employment, sickness benefits will also not be granted to people who:

• have an established entitlement to an old-age pension due to incapacity for work, regardless of the reason for granting the pension, so it may also be a pension due to an accident at work or an occupational disease;
• are continuing gainful employment or are engaged in gainful employment that constitutes an entitlement to sickness insurance or a right to sickness benefits;
• have an established entitlement to unemployment benefit, pre-retirement allowance or pre-retirement benefit;
• they were subject to compulsory social insurance for farmers;
• if the insurance ceases after the end of the full period of receiving sickness benefit.

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The amount of sickness benefit

Monthly sickness benefit is 80% of the calculation basis. For the period of stay in the hospital, the person is entitled to 70% of the calculation basis. In the case of an employee who has reached 50 years of age, starting from the calendar year after the year in which he has reached the age of 50, the monthly sickness benefit for the period of stay in hospital from the 15th to the 33rd day of incapacity for work in a calendar year is 80% of the allowance calculation basis. . The right to sickness benefit in the amount of 80% of the calculation basis in connection with hospital stay is also granted to insured persons who are not employees, to whom Art. 92 of the Labor Code, i.e. people doing homework and people on alternative service.

However, 100% of the calculation basis is due if the incapacity for work has arisen:

• during pregnancy;
• as a result of an accident at work, on the road or from work, or an occupational disease;
• arose as a result of undergoing the necessary medical examinations provided for candidates for donors of cells, tissues, organs and as a result of undergoing the procedure of cell, tissue and organ donation.

Example 1.

Ms Małgorzata became unable to work due to illness on March 5 and was unable to work until May 28. In the period from March 12 to April 10, she was in the hospital. Employees are entitled to the remuneration referred to in Art. 92 of the Labor Code, for the period from March 5 to April 6 (33 days) in the amount of at least 80% of the calculation basis. For the period from April 7 to April 10, the employee is entitled to an allowance in the amount of 70% of the calculation base, and for the further period - 80% of the calculation base.

The subject of the allowance is not considered easy to interpret. Therefore, it is worth knowing all the basic information on this subject before an entrepreneur or his employees become incapable of work, which is the basis for the payment of benefits from ZUS.