The new insurance capacity regime for professionals

By Dimitris Katsaganis

The insurance capacity for the self-employed – that is, their access to public medicine and pharmaceutical care – will run at three “speeds” from the current month until March 2023.

The first “speed” belongs to those who had in the previous year (February 2021-February 2022) completed at least 50 days of insurance and have no debts to the funds (EFKA, EOPYY).

The second “speed” belongs to those professionals who have debts to the funds (EFKA, EOPYY), but have regulated them, comply with their regulations and thus have insurance capacity, ie access to the NSS and the prescription of drugs.

In the third “gear” will belong – after the legislative regulation of the Ministry of Labor, which was announced by e-EFKA with its announcement yesterday – those self-employed, who have unregulated debts but pay in 2022 retroactively the debts that concern exclusively the health contributions, ie in favor of EOPYY (ie not the main insurance contributions) for the year 2021.

More analytically, in relation to the second “speed” with its announcement, e-EFKA states that from March 1 and for one year (until February 28, 2023) the insurance capacity in the vast majority of directly and indirectly insured, was renewed. that is, who in the previous year had taken out at least 50 days of insurance as well as in certain special categories of insured:

– Persons who received, for a period of at least two (2) months or fifty (50) days within the year 2021, special purpose compensation from the Ministry of Labor and Social Affairs after submitting a unilateral responsible statement and relevant ministerial decisions (artists, creators and professionals of culture, guides and tour guides, foresters, resin collectors, etc.)

To the unemployed over the age of 29 and up to 55, who have made use of the provisions of par. 4 of article 5 of law 2768/1999 (A` 273)

– To the insured of the former OGA who have debts from overdue insurance contributions, if a decision has been issued by the competent committees of financial weakness and for the period of time defined by this decision

– To the unemployed insured of the OAEE age over 30 and up to 67 years old, who have ceased their profession and have used the provisions of par. 8 of article 2 of law 3845/2010 (A` 65),

– To those affected by natural disasters and natural disasters, which fall within the scope of the relevant ministerial decisions

– In special groups of insured persons, who have made use of the special provisions of Law 4254/2014 (A` 85)

-The persons who are subject to the insurance of eEFKA as employees-members of the Boards of Directors SA

– To the employees of the company “Rolling Stock Company of Greece SA”, the Skaramaga Shipyards, the Perama Shipbuilding and Repair Zone and the Elefsina Shipyards

-Horse riders, apprentice riders and racehorse trainers,

It is reminded that the insured have the opportunity by visiting the website of e-EFKA to be informed and to confirm that they have insurance capacity through the online service “Insurance Capacity”.

Similarly, through the electronic service “Granting of Insurance Capacity of an indirect member” the directly insured can proceed to the inventory and the granting of insurance capacity of his indirect members.

Regarding the new, third in a row “speed”, as provided by the same announcement of e-EFKA, with a legislative provision that is promoted for voting in Parliament, the possibility is given to self-employed, self-employed, self-employed and farmers who have unsettled debts to EFKA and therefore not entitled to insurance capacity, to be able to exceptionally receive it for one year, regardless of their debts, if they have paid within 2021 or pay within 2022 retroactively for the year 2021, the amount corresponding to the annual contribution for benefits in kind and in cash.

This amount is calculated at 12 times the monthly insurance category for benefits in kind and in cash, which they had chosen for the year 2021. This possibility is provided exceptionally and only once as from March 1, 2023 the regime that It has always been valid and which provides for the provision of insurance capacity to those who are not self-employed or to those who have settled debts. The method of payment of this amount for those who have not already covered it with their contributions will be determined with a new announcement of the Agency.

It should be clarified that insurance capacity concerns the right of access to healthcare. However, even if a citizen does not have insurance capacity from EFKA, there is relevant health coverage based on the rules of the Ministry of Health.

It is emphasized that for those self-employed (self-employed, self-employed, farmers) who have normally paid their debts to KEAO but to date their payments have not appeared in the system and therefore their insurance capacity has not been digitally rendered, they can visit local branches by making an appointment electronically and gain immediate insurance capacity.