It answers 10 basic questions Ministry of Labor and Social Securityon the occasion of the submission to the Parliament of the amendment for the exceptional granting of insurance capacity.

Here are the questions and answers:

1. For which groups the exceptional insurance capacity continues to be provided for the period 2024-2025?

These are categories that face objective difficulty in responding and meeting the necessary conditions.

Specifically, the exceptional insurance capacity is granted to the following persons and their family members:

– To those affected by natural disasters. That is, to e-EFKA insured persons who maintain a business establishment or carry out an activity or work in areas affected by natural disasters or other natural disasters and fall under the scope of the ministerial decisions issued in the year 2023 or issued this year, as well as the unemployed of above regions that are registered in the Digital Register of the Public Employment Service. In this case, the insurance capacity is granted from the day of occurrence of the natural disaster, regardless of debts to e-EFKA.

– To employers and insured persons who have a business establishment or activity in areas of the Attica Region affected by the fires of July 23 and 24, 2018 and to those registered in the e-EFKA registers directly insured affected by the fires of July 23 and 24, 2018 and respectively fall under the scope of the Legislative Content Act of July 26, 2018, ratified by article 3 of Law 4576/2018.

– To the workers at the Skaramanga Shipyards, the Perama Shipyard Repair Zone and the Elefsina Shipyards.

2. Does the non-extension of exceptional insurability for certain groups leave them out of health care?

Absolutely not. No one is left without access to health because they do not have insurance capacity, as today all legal residents in the country with an active AMKA have free access to the public health system and are entitled to nursing and medical care. This includes not only hospitals, but also primary health care structures.

3. Why can’t the exceptional insurance capacity be extended for everyone?

Everyone should understand that there is no a la carte insurance coverage. Insurance contributions are mandatory for everyone and their payment is essential for the sustainability of our insurance system.

Our insurance system is based on insurance solidarity and reciprocity. Only certain people cannot pay contributions and all receive the same benefits from EOPYY. On the other hand, it ensures that everyone has unrestricted free access to public health services, financed by taxation.

The insurance package is unified, to ensure both the right to insurance and retirement, as well as the right to health and the additional (beyond the State) benefits of the EOPYY to the insured. A system in which the insured chooses which contributions to pay each time loses its mandatory character with disastrous consequences both for the pension benefits of the insured and for the sustainability of our insurance system.

4. Why was the insurance capacity exceptionally extended from 2020 until today to specific groups?

During the economic crisis, exceptional insurance capacity was given to special population groups with social criteria. In 2020 and from there, due to the health crisis, the exceptional granting of insurance capacity was initially extended for all insured persons.

The last extension, due to Covid, until 29/2/2024, was given with art. 90 of Law 5018/2023 in 13 categories. Of these, there is reason for an extension in specific categories, since for the others the reasons for maintaining exceptions have now disappeared.

The most numerous category of deviation from the rule is that of the self-employed, who for the first time in 2022 were given the possibility to obtain an annual insurance capacity by paying only health contributions, which correspond to about three months’ contributions. Out of 800,000 potential beneficiaries, about 400,000 paid the three months’ contributions corresponding to the amount of health contributions, of which about 100,000 were farmers and 300,000 were unemployed.

Already, our country is growing significantly faster than the Eurozone average, unemployment is now in the single digits. Two minimum wage increases have been given and a third is expected. Two pension increases were given for the first time in 12 years. The three years in the private sector “thawed”.

In this economic and social environment, the government and the Ministry of Labor and Social Security have decided to extend the exceptional granting of insurance capacity to those categories that have objective difficulty in responding.

5. What is insurance capacity?

In essence, the insurance capacity provides the directly and indirectly insured (family members), in addition to the free access to public hospitals provided by AMKA, additional access at the expense of EOPYY to private health structures, coverage of health care benefits in kind from EOPYY, such as, for example, private prescriptions for medical or other therapeutic procedures, diagnostic tests, hospitalizations, medicines, etc.

6. What applies from 1 March 2024?

Upon expiry of the exceptional grant of insurance capacity, the general rule will apply, namely:

– for employees, it is required to have worked at least 50 days in the previous year and

– for the self-employed, it is required to complete at least two months of insurance during the previous year, to pay the required contributions by the end of the previous year and, if there is a debt, it must have been settled and the settlement respected.

7. What should those who received an exceptional extension, until 02/29/2024, have to do in order not to lose their insurance capacity?

The debtors will have to settle all their obligations to the EFKA in terms of contributions for 2023 either by repaying them in full or by settling the debts in up to 24 installments.

As long as one pays off the amount owed in full, he will get annual insurance capacity, while if he settles it, he will get monthly.

It is emphasized once again that all citizens, regardless of their insurance capacity, as long as they have AMKA, have access to public health structures.

8. What applies to employees whose employers have not paid the insurance contributions?

For those employees who have submitted an APD for the required time of 50 days, their insurance capacity is automatically renewed regardless of whether the employer has paid the insurance contributions.

In case of non-submission of APD, then the employee can submit a complaint to the competent auditing bodies of EFKA, in order to count the insurance time.

9. I meet the conditions for insurance capacity, but this does not appear in EFKA. What should I do;

EFKA’s electronic systems are updated at regular intervals and citizens can confirm whether they have insurance capacity through the https://apps.e-efka.gov.gr/eAccess/login.xhtml platform.

However, if the system still does not show that they have insurance capacity, despite meeting the conditions, they should send an email to the email: [email protected].

Of course, the easiest and most direct way is to visit the local EFKA Offices. Citizens’ service for the granting of insurance capacity in this case is done without an appointment. Citizens will be served by all Local Authorities, regardless of where they belong, to update their information in the Registry.

10. What provision is there for children and vulnerable social groups?

From July 2022, the prescription of medicines, therapeutic procedures and diagnostic tests will be done by all doctors certified in the Electronic Prescription System (ESP), i.e. also private individuals, for the following categories of uninsured citizens:

a. minors up to 18 years old,

b. patients with intellectual or mental disability, autism, Down syndrome, bipolar disorder, depression with psychotic symptoms, cerebral palsy or severe and multiple disabilities, amputees receiving the extra-institutional benefit with a disability rate of 67% or more, as well as those with a disability certified by KEPA 80% or more, for any condition,

c. patients with diseases whose medicines are administered with zero participation of the insured, as well as uninsured patients suffering from the immune deficiency syndrome (AIDS).

In addition, for all uninsured citizens, the prescription of all vaccinations is provided.