Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Uruguay (Ratification: 1973)

1. Part II (Medical care), Article 10(a) of the Convention (Persons protected). The Committee notes the Government's statement that all employees of the private sector are protected and that, in supplying statistics on the scope of Part II, the Government refers to Article 10(a) of the Convention which stipulates that the protection must cover all employees, including apprentices, and the wives and children of such employees. From the statistical information supplied by the Government, the Committee notes that the number of employees in the private sector, including apprentices, who were covered under the general scheme of the Social Insurance Bank, in 1997 only represented 40 per cent of the total number of employees for 1996, a figure which did, however, include all "active workers", and not simply employees. In addition, public sector employees, for whom medical protection is guaranteed by the State bodies employing them, are also included in the categories protected by special schemes. The Committee therefore hopes that in its next report the Government will be able to include more detailed statistical data on the categories of persons protected by the different existing schemes, both in the private sector and in the public sector, so as to demonstrate that medical care effectively covers all employees in the country, in conformity with Article 10(a) of the Convention.

Article 10(b) (Protection of the members of the insured's family). In its previous comments, the Committee noted that spouses and children of insured persons did not enjoy compulsory coverage as dependants under the existing sickness insurance scheme, but are protected by the Administration of the State Health Services (ASSE) which is responsible for organizing first level medical care for its beneficiaries, in accordance with section 270 of Act No. 15903 of 1987. In order to ascertain whether the requirements of Articles 13, 15, 16(1) and 17 of the Convention are being fulfilled, the Committee had asked the Government to provide detailed information on the nature and scope of the medical care provided in practice by the ASSE, indicating in particular to what extent benefits are granted irrespective of the level of the beneficiaries' resources.

The Government limits its reply to the indication that medical care provided by ASSE is total in nature, covering all types of sickness without exception, and that its coverage and quality are satisfactory. No prior qualifying period is required to obtain the right to medical care. It specifies, however, that the care is only free for those persons recognized by the Ministry of Public Health as being "incapacitated" (no pudientes).

While noting these general statements, the Committee hopes, once again, that in its next report the Government will be able to include detailed information showing, on the basis of the relevant regulations or administrative provisions, that the medical care referred to under section 270 of Act No. 15903 of 1987 effectively fulfils the requirements of Articles 13, 15, 16, paragraph 1, and 17, of the Convention. It also requests the Government to supply a copy of all regulations adopted under section 270 mentioned above. Finally, the Committee notes that the medical care supplied by the ASSE is free, subject to the level of the beneficiary's income. It wishes to know whether the right to medical care itself is subject to the condition that the beneficiary's income is not in excess of a certain limit.

2. Article 12 (Protection of pensioners and members of their families). In its previous comments, the Committee noted that persons receiving social security benefits for total and permanent invalidity, old age and death of the breadwinner and, where appropriate, their wives and children, are not protected in respect of the need for curative and preventive medical care under the existing sickness insurance scheme, but that the possibility of establishing and financing such care for persons receiving a pension from the social security was under study. As regards provision of free sickness insurance to cover these persons, the Government points out in its report that section 186 of Act No. 16713 of 3 September 1995 extends this entitlement to passive affiliates receiving a pension, through payment of the mutual contribution by the Social Security Bank, on condition, however, that their total income does not exceed $Ur 1,300 (as of 1 January 1998). Beneficiaries of pensions not covered by this provision may nevertheless, under section 13(B) of Legislative Decree No. 14407 of 22 July 1975, maintain their ASSE medical care cover, by paying the mutual contribution themselves at a level equal to that paid by the Social Security Bank for the collective membership of its active beneficiaries. Finally, section 13(C) of the abovementioned Legislative Decree enables insured persons to extend ASSE medical care to members of their family through the payment of the collective contribution.

The Committee notes this information. It would be grateful if the Government would supply additional information in its next report on the practical application of the mechanism provided under section 186 of Act No. 16713. Please also indicate, giving clear examples, the amount of the mutual contribution payable by a standard beneficiary who becomes the recipient of a social security pension in order to maintain medical care coverage for himself and for his wife and two children, and to supply details on the nature and scope of the medical care provided to these persons.

3. Article 16, paragraphs 2 and 3. In its previous comments, the Committee asked the Government to indicate the legal provisions ensuring the maintenance of entitlement to medical care for beneficiaries who cease to belong to the category of person protected, including the extension of the period during which such medical care will be granted for diseases recognized as entailing long care. In reply, the Government states that medical care is guaranteed throughout the entire period of the incident so long as the beneficiary continues to belong to the category of protected persons. Under section 23 of Act No. 14407, a worker on sick leave may not be dismissed and must subsequently be reinstated in his employment. The right to medical care is maintained while the worker is receiving a sickness indemnity for a period of up to two years. In the event of his ceasing to belong to a category of protected persons, the worker shall receive medical care provided by the ASSE. The Committee requests the Government to indicate the legal provisions which guarantee, in the cases foreseen by Article 16, paragraphs 2 and 3, of the Convention, that medical care shall automatically be provided by the ASSE to the beneficiaries concerned (the insured person himself and his wife and children) who have ceased to belong to one of the categories of protected persons.

4. Part III (Sickness benefit), Article 22 (Amount of sickness benefit). The Committee notes the statistics provided by the Government in its report, on the amount of the minimum ($Ur2,743), median ($Ur3,037) and maximum ($Ur3,274) monthly wage of a turner in the iron and steel industry, for June 1995, which represents the wage of a skilled manual male worker; the amount of family allowance in 1995 ($Ur63.34), based on the monthly average between a family allowance corresponding to 8 per cent of the national minimum wage and 16 per cent of the same wage for low-income families; and the maximum sickness indemnity, subject to a ceiling of three times the national minimum wage, which averaged $Ur575 in 1995. The Committee notes from these statistics that in 1995 the maximum sickness benefit, subject to this ceiling, increased by family allowance, represented 64.5 per cent of the minimum monthly wage of a standard beneficiary, 58.5 per cent of the median wage and 54.6 per cent of the maximum wage. In this connection, it recalls that, under Article 22 of the Convention, the amount of sickness benefit increased by the amount of family allowances for the standard beneficiary must attain at least 60 per cent of the total of his previous earnings and of the amount of any family allowances payable to persons with the same family responsibilities and also the same level of income. The Committee draws the Government's attention to the fact that, given the level of the national minimum wage during the reference period, the ceiling established for the maximum amount of sickness benefit would appear too low to satisfy all the cases in this requirement of the Convention. In order to be able to assess the application of the Convention on this point more fully, and to keep track of developments, the Committee hopes that the Government's next report will contain the updated statistics called for in the report form under Article 22 of the Convention, as well as the information on the amount of the national minimum wage for the same reference period.