How to apply for a sickness benefit

What is a sickness benefit?

Sickness benefit is a social insurance benefit to which is entitled an insuree who is recognized as temporarily unable to work due to a sickness, occupational disease, accident, accident at work or who is ordered quarantine measure/isolation. The benefit is paid by the Social Insurance Agency after fulfilling the conditions established by law.

Am I entitled to a sickness benefit?

Entitlement to a sickness benefit has:

  • employee,
  • self-employed person with compulsory sickness insurance (SEP),
  • voluntarily sickness insured person (VIP for sickness) and
  • a natural person who became temporarily unable to work after the termination of the sickness insurance during the protection period (see Protection period (SK)).

What conditions do I have to meet?

You are entitled to a sickness benefit if you meet the following conditions on the date of temporary incapacity for work:

  • you have a certified of temporary incapacity for work issued by a doctor,

  • you are covered by sickness insurance on the date the reason for providing the sickness benefit originated or you are covered by a Protection period after the end of the insurance,

  • if you are an employee:
    • you do not have the income for work performed, which is considered the assessment basis paid for the period of temporary incapacity for work (it determines for which period the income is paid and whether it is income for work performed),
    • payment of sickness insurance premium by the employer is not monitored,

  • if you are a SEP:
    you have paid your sickness insurance premium on time and in the correct amount (see Conditions for paying sickness insurance premium (SK)),

  • if you are a person with voluntary sickness insurance (VIP):
    • you have paid your sickness insurance premium on time and in the correct amount (see Conditions for paying sickness insurance premium (SK)),
    • in the last two years before the occurrence of temporary incapacity for work, you were insured for at least 270 days (for these purposes, in addition to the current voluntary sickness insurance, any other terminated sickness insurance is also taken into account),​​​​​​
  • ​you follow the treatment regime.

Please note, if you are claiming sickness benefits from several sickness insurances, you must fulfil the qualifying conditions for each of them.

How do I apply for a sickness benefit?

The decisive factor is how the doctor issues you a certificate of temporary incapacity for work:

  • If the doctor issues you a certificate electronically (ePN), you do not need to submit a separate application for a sickness benefit to the Social Insurance Agency. The issuance of an ePN by a doctor is automatically considered a request for a benefit, which will be assessed and handled by the Social Insurance Agency. After visiting the doctor, you no longer have any other obligations.
  • If the doctor issues you the certificate on a paper form, you request the benefit via part II. of the form.

What do I need from the doctor?

If the doctor does not issue you the certificate electronically in the event of temporary incapacity for work, t the so-called Certificate of Temporary Incapacity for Work wil be filled out. It is a 5-part form from which the doctor will hand over to you:

  • Part I of the certificate – identification of the insured person who is temporarily unable to work – is used to check compliance with the treatment regime. The doctor marks the check-up dates on it. Carry the certificate with you to each check-up and give it to the doctor after the end of the temporary incapacity for work.
  • II. part of the certificate - application for a sickness benefit/accident supplement - with this part you will claim the sickness benefit. Before sending it to the Social Insurance Agency, indicate which benefit you are requesting (sickness benefit and/or accident supplement). Also, do not forget to fill in and sign the "Declaration of the Insuree" on the other side of the form.
  • IIa. part of the certificate - application for income compensation in case of temporary incapacity for work - if you are an employee, with this part you claim income compensation from the employer. If you are SEP or VIP (voluntarily insured person), you do not need this part.

Please note, if the doctor recognizes you as temporarily unable to work from several insurances, they will issue you a separate Certificate of Temporary Incapacity for Work for each insurance.

During the check-up, the doctor proceeds as follows:

  • They will issue you a Certificate on the Duration of Temporary Incapacity for Work, if the temporary incapacity for work will continue for the following calendar month after its occurrence.

If they doe so, sign the card in the "Declaration of the Insuree" section and send it to the Social Insurance Agency branch.

  • they terminate the temporary incapacity for work. If they doe, give them Part I of the certificate (see above) and collect IV. part of the certificate – Notification to the Employer and the branch of the Social Insurance Agency about the Termination of Temporary Incapacity for Work. Sign the report and immediately send it to the branch of the Social Insurance Agency, which pays your sickness benefit.

Please note, if you are an employee whose temporary incapacity for work lasts a maximum of 10 days, you submit the report only to your employer!

How to proceed when submitting a paper application for a sickness benefit?

1

Deliver the Certificate of Temporary Incapacity for Work (Part II) from the doctor to the branch of the Social Insurance Agency

relevant according to:

  • the seat of the last employer, if you are an employee in the Protection period,
  • place of permanent residence, if you are SEP or VIP.
2

If you are an employee, submit the application to your employer

If you are an employee, submit the application to your employer, who will confirm it and deliver it to the Social Insurance Agency branch.

Please note, II. part of the certificate you hand over to the employer only if your temporary incapacity for work lasted more than 10 calendar days. The employer confirms it and sends it to the relevant branch of the Social Insurance Agency within three days after the 10th day of the temporary incapacity for work.

3

If the temporary incapacity for work is confirmed due to an accident, attach the completed form to the application

Accident report (SK).

4

If you are an employee, submit the following temporary incapacity for work documents to the employer for inspection or confirmation

If you are an employee, submit the following documents on temporary incapacity for work to the employer for inspection or confirmation: IV. part of the certificate and the Certificate on the Duration of Temporary Incapacity for Work. You will thus present an obstacle in the work and its duration to your employer.

 

 

GOOD ADVICE:

We recommend submitting the application for a sickness benefit immediately after the doctor has issued the application (see Limitation (SK))

If the doctor has recognized you as unfit for work via ePN

With ePN, the doctor and the institutions exchange all the necessary data electronically, you have no obligations or worries about confirmations.

  • You do not deliver any certificates of your incapacity to work to the employer or the Social Insurance Agency.
  • You are not requesting a wage compensation or sickness benefit.
  • You do not report the account number in the bank to which your sickness benefit will be transferred.
  • You do not announce the end of temporary incapacity for work.

More information: ePN – Electronic Sickness Certificate on Incapacity for Work​ (SK)​​​​​​

You can find more information in the section: SICKNESS INSURANCE – SICKNESS (SK)

If you want to apply for sick leave during quarantine or isolation, you can find information in the section: Sickness benefit during quarantine / isolation