Welfare state

Krka, pharmaceutical company in Novo mesto produces generic medicinal products. Photo: Primož Lavre

The right to health-care services comprises services at the primary health care level, including dentistry, health-care services in certain types of social care institutions, specialist out-patient services, hospital and tertiary level services. It also includes the right to health resort treatment, rehabilitation treatment, and transport by ambulance and other vehicles, medicine, and technical aids. Under the compulsory health insurance scheme, insured persons are also entitled to different financial benefits (compensation for salary during temporary absence from work, reimbursement of travel cost etc.).

The state ensures the functioning of social care institutes, creates the conditions for private social work activities, stimulates and supports the development of self-help, charity work, programmes enabling a more independent life for the disabled, and voluntary work. Rights to social care services and contributions are determined according to the principles of equal availability and free choice for all those entitled.

The state makes efforts to prevent social exclusion, particularly by influencing the social position of the population in the areas of taxation, employment and work, and through grants, housing policy, family policy, health care, education and in other policy areas.

Health Care

The system of health insurance is divided into compulsory health insurance, voluntary health insurance for additional coverage, and insurance for services that are not a constituent part of compulsory insurance.

Compulsory health insurance

The compulsory health insurance covers all population with permanent residence in Slovenia which is covered under the unique compulsory insurance scheme either as mandatory member or as their (family) dependants. Virtually the entire (100%) population is insured.

Compulsory health insurance is provided by the Health Insurance Institute of Slovenia (Zavod za zdravstveno zavarovanje Slovenije). All employed and self-employed persons and all retired persons who receive a pension from a Slovenian insurance provider are insured under the health insurance scheme. The status of insured person can also be obtained by the family members of the insured person if they do not have the possibility of entering the scheme on another basis and if they have permanent residence in the Republic of Slovenia (unless it is defined otherwise by international agreement).

A child is health insured as a family member up to the age 15 years, or up to the age of 18 years if (s)he is not insured in other way, and after this age if he is attending school, i.e., to the end of regular education.

Compulsory health insurance does not always cover all health care services and not in full prices. The following are some of the services granted to be covered in full price by compulsory insurance:

  • all health programs for children and youth: diagnosis, treatment and rehabilitation of diseases and injuries suffered by children, schoolchildren, minors with developmental impairments and students, as long as they attend school;
  • counselling in family planning, contraception, pregnancy and childbirth care to female patients;
  • services pertaining to programmes of preventive care, diagnosis and treatment of infectious diseases, including HIV infection;
  • treatment and rehabilitation of occupational diseases or injuries, malignant diseases, muscular or muscular nerve diseases, mental diseases, epilepsy, haemophilia, paraplegia, quadriplegia and cerebral palsy, as well as advanced diabetes, sclerosis multiplex, and psoriasis;
  • medical services related to the donation and transplantation of tissues and organs, emergency medical treatment, including emergency transportation, nursing care visits, and treatment and care in the home and in social institutions;
  • long term nursing care as home visits, and provision of treatment and home nursing in social care institutions, etc.

In the cases of all other services, the compulsory health insurance covers just certain percentages of their full prices. The difference to the full price shall either be covered by the insured person himself, or can be covered by the voluntary health insurance policy.

Voluntary health insurance

You can also take out voluntary health insurance provided by insurance companies in order to acquire additional entitlements. It is advisable to insure yourself for the difference in the full value of health services that are not covered in full by the compulsory health insurance scheme. The majority of the population is included in a voluntary health insurance scheme.

The Health Insurance Card

The health insurance card is electronic personal document, issued, free of charge, to every person upon the first regulation of the compulsory health insurance status. The card needs to be presented at a doctor visit.

The European Health Insurance Card

Introduced in June 2004, the card substantially facilitates access to medical assistance for EU citizens travelling to another Member State. Furthermore, it guarantees a quick and simplified reimbursement of expenses incurred locally or shortly after return to the place of residence. Since 1 January 2006, the European Health Insurance Card is issued and recognised by all concerned countries and replaces the previously used paper forms.

The European Health Insurance Card is issued to:

  • EU nationals,
  • nationals of the European Economic Area (EEA),
  • Swiss nationals,
  • family members of the above, whatever their nationality,
  • nationals of other countries, who are covered by a social security system in one of the Member States of the EU, the EEA or Switzerland.

Your EHIC should be requested from the national health insurance institutions before leaving for Slovenia.

The telephone number for the emergency medical assistance and ambulance service is 112.

The level of health care in Slovenia, provided through the public health service network, which also includes private service providers on the basis of concessions, is entirely comparable with the level of health care in the advanced countries of Europe.

Primary health care services in Slovenia are organised locally, such that they are equally accessible to all people without discrimination.

Social security

The Slovenian state ensures the functioning of social care institutes and works towards preventing social exclusion.

The state works towards preventing social exclusion, particularly by influencing the social position of the population in the areas of taxation, employment and work, and through grants, housing policy, family policy, health care, education and other policy areas.

Social security in Slovenia is based on contributions paid by all employed and self-employed persons into the social security scheme.

Unemployment insurance

Employees in an employment relationship are compulsorily insured against unemployment. Independent sole traders, self-employed persons and, in some cases, persons that own companies may also voluntarily insure themselves against unemployment, as may Slovenian citizens who are in an employment relationship with an employer in a foreign country, and the spouses of these citizens.

Employment service of Slovenia  can provide with all additional information.

Allowance for period of sickness

If you fall ill, your employer will pay you an allowance for your absence from work from its own funds for the first 30 days. You must present your employer with a sick note obtained from your general practitioner.

After the first 30 days the Health Insurance Institute  pays the allowance, after obtaining the opinion of the general practitioner or the competent health committee at the Health Insurance Institute. The base for calculating the level of the allowance is the average monthly pay or the average base for the payment of contributions in the calendar year preceding the year in which the temporary inability to work arose.

The Health Insurance Institute pays an allowance for absence from work from the first day of absence from work on the grounds of transplantation of live tissue or organs for the benefit of another person, the effects of donating blood, care for a close family member, isolation and the requirement to accompany a patient as ordered by a doctor, and injuries sustained in certain circumstances.

Family and maternity benefits

The family benefits you can claim at a social services centre are: parental allowance, assistance on the birth of a child, child benefit, large family allowance, childcare allowance and partial payment for loss of earnings.

Maternity leave lasts a total of 105 days. A pregnant woman commences maternity leave 28 days before her due date. During this period she receives a maternity allowance. The level of the allowance is determined using the average pay received by her over the preceding 12 months.

A father has the right to paternity leave of 90 days. The first 15 days must be used by the time the child has reached the end of its sixth month; the remainder may be used in the form of full leave until the child has reached three years of age. The level of paternity allowance for the 15 days which a father takes when the child is born amounts to 100 % of the father’s average pay. The father receives no allowance for the remaining 75 days, although his social security contributions, amounting to the minimum wage, are paid for the duration of paternity leave.

One of the parents has a right to leave in order to look after or care for a child for a period of 260 days immediately upon expiry of maternity leave. The level of childcare allowance is determined on the basis of the average pay which the beneficiary received in the preceding 12 months. However, the allowance may not exceed two-and-a-half times the gross average pay.

Child allowance provides the parents or child with an additional benefit for maintenance, upbringing and education; the level of this allowance is determined with reference to income per family member. It is an additional benefit for the maintenance, upbringing and education of a child in cases where the income per family member does not exceed 99 % of the average wage in Slovenia in the preceding calendar year. The level of the child allowance is set according to the classification of the family within a particular earnings category, taking into account the average monthly income per family member in the preceding calendar year.

Entitlement to a child allowance may be claimed at any time at the social security department with territorial jurisdiction in relation to the child’s place of habitual residence. Entitlement to a child allowance is granted for a period of one year.

Other family allowances include parental allowance, the childbirth grant, the large-family grant, childcare allowance and partial payment for loss of earnings.

Pensions

Pension and disability insurance is compulsory in Slovenia and is uniform for all insured persons. Everyone who pays a monthly contribution to pension and disability insurance from their pay is regarded as a compulsorily insured person. If you wish to provide yourself with additional social security in retirement, you may take out additional insurance with an authorised pensions provider, mutual pension fund or insurance company. You may also be insured individually or collectively through your employer.

Old-age pension

Old-age insurance is governed in Slovenia by Pension and Disability Insurance Act.  An insured person is a person included, on a compulsory or voluntary basis, in the pension and disability insurance scheme.

The minimum requirements for entitlement to an old-age pension are:

    * age 58 (and 4 months for women; plus 8 months for men) and the completion of a pension period of 40 years (men) and 38 years (women);

    * a pension period of 20 years (men and women) and age 63 (men) or 61 (women);

    * a pension period of 15 years (men and women) and age 65 (men) or 63 (women).

Please check the web page of the Ministry of labor, family, social affairs and equal opportunities  for latest legislation.

javporn.in