Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Sweden (Ratification: 1970)

Direct Request (CEACR) - adopted 2023, published 112nd ILC session (2024)

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In order to provide a comprehensive view of the issues relating to the application of the ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 102 (social security, minimum standards), 121 (employment injury benefits), 128 (invalidity, old-age and survivors’ benefits), 130 (medical care and sickness benefits) and 168 (employment promotion and protection against unemployment) together.

The Committee notes the observations of the Swedish Confederation for Professional Employees (TCO) communicated with the Government’s report on Convention No. 130.

The Committee takes note of the information provided by the Government regarding the application of Articles 8, 10(1)(3), 14, 15, 24(4), 43, 69 and 71(3) of Convention No. 102; Articles 6, 9(1)(2), 10, 11, 16 and 22 of Convention No. 121; Articles 18, 23, 29 and 32 of Convention No. 128; Articles 7, 9, 13, 19, 28 and 30 of Convention No. 130; and Articles 18 and 26 of Convention No. 168.

Article 9(3), in conjunction with Articles 14(2) and 22 of Convention No. 121. Duration of employment injury benefits. The Committee takes note of the Government’s indication in its report that the work injury annuity is provided up to the age of 65 at the latest, or one month before reaching the age of 68 if a person continues to work. The Committee recalls that Article 9(3) of the Convention requires the benefits to be granted throughout the contingency. The Committee further recalls that Article 22 of the Convention does not provide for the possibility to suspend the benefits upon reaching a certain age. The Committee requests the Government to provide information on: (i) the benefits provided to injured persons after they have reached the age of 65 and stopped working; (ii) whether these benefits are paid at the level required by Article 14(2) of the Convention; and (iii) whether there are any qualifying conditions for the entitlement to such benefits.

Article 19(2) of Convention No. 121. Calculation of employment injury benefits. The Committee takes note that the amount of the work injury annuity is determined based on the sickness benefit qualifying income (SGI). The Committee further notes that the SGI is considered as an income from employment which is expected to last for at least six consecutive months, according to section 3(2) of Chapter 25 of the Social Security Code of 2010. The Committee requests the Government to provide information on how the SGI is determined for persons with employment shorter than six months in case of permanent loss of earning capacity or corresponding loss of faculty due to employment injury.

Article 15(3), in conjunction withArticles 17(a), 18(1)(a) and 26 of Convention No. 128. Reduction of pensionable age. The Committee notes the Government’s indication that there are no specific provisions concerning the retirement age of persons who have been engaged in arduous and hazardous occupations under the public pension system. The Committee further notes that the retirement age for the old-age income pension is flexible and starts at the age of 63 in 2023 (section 3 of Chapter 56 of the Social Insurance Code of 2010). The Government also indicates that from 2026, the retirement age will be linked to the increase in life expectancy. The Committee requests the Government to indicate the replacement rate of the old-age income pension drawn at the earliest retirement age, by a skilled manual male employee who has completed 30 years of contribution or employment, in accordance with Titles I and III of the report form for Article 26 of the Convention.

Article 23(a), in conjunction with Articles 24(1)(a) and 26 of Convention No. 128. Replacement rate of survivors’ benefits. The Committee notes the Government’s indication that the adjustment pension provided to a surviving spouse is 55 per cent of the deceased’s pension base. In addition, the reduced guarantee pension is provided to persons who have resided in Sweden for at least three years. The Government further indicates that the child pension is equal to 35 per cent of the deceased’s pension base for one child and increases by 25 per cent for each additional child. The child pension may be supplemented by the surviving children’s allowance of 40 per cent of the price base amount in case the child pension is low. The Committee requests the Government to calculate the replacement rate of survivors’ benefits provided to a standard beneficiary (a surviving spouse with two children) in case the deceased spouse completed 15 years of contribution or employment, in accordance with Titles I and IV of the report form for Article 26 of the Convention.

Article 25, in conjunction with Articles 1(h) and 21 of Convention No. 128. Duration of survivors’ benefits. The Committee notes the Government’s indication that the adjustment pension is provided to a surviving spouse aged under 65 for a period of 12 months, or as long as the surviving spouse lives with a dependent child aged under 12. The Committee recalls that the right to a survivors’ benefit is provided to surviving spouses who are caring for a dependent child of the deceased (Article 21(2)(3)(b) of the Convention). According to Article 1(h) of the Convention, the term “child” covers a child under school-leaving age or under 15 years of age, whichever is higher or a child who is an apprentice or student or has a chronic illness or infirmity disabling him/her for any gainful activity, under prescribed conditions. The Committee requests the Government to provide information on the measures taken to extend the duration of the adjustment pension provided to a surviving spouse who is caring for a dependent child older than 12 years of age.

Article 15 of Convention No. 102 and Article 19 of Convention No. 130. Coverage of the self-employed. The Committee notes the Government’s indication that the conditions for entitlement to sickness benefits are the same for self-employed persons and employees. The Committee further notes the TCO’s observations indicating that the entitlement to sickness benefits and their amount depend on the verification of the SGI by the National insurance board. In this respect, the TCO points out that such verification is particularly problematic for self-employed persons, whose SGI is often much lower than their actual income. The Committee requests the Government to provide information on the measures taken or envisaged to ensure that self-employed persons are entitled to benefits based on the SGI determined from their actual income.

Article 11(1) of Convention No. 168. Persons protected by unemployment benefits. The Committee notes that in its 2022 conclusions on the application of the European Code of Social Security by Sweden, it noted as regards the income-loss insurance coverage that 78 per cent of the work force held membership in the unemployment insurance funds. The Committee requests the Government to provide information on the measures taken or envisaged with a view to increasing the income-loss insurance coverage up to at least 85 per cent of all employees. It further requests the Government to provide statistical data on the number of persons covered by the income-loss insurance.

Article 15 (1)(b) of Convention No. 168.Replacement rate of unemployment benefits. The Government indicates that a daily basic amount of unemployment benefit is SEK510 (approximately €43) in 2023. The Committee requests the Government to indicate whether the basic amount of the unemployment benefit is fixed at not less than 50 per cent of the statutory minimum wage, if it exists, or of the wage of an ordinary labourer, or at a level which provides the minimum essential for basic living expenses, whichever is the highest.

Direct Request (CEACR) - adopted 2017, published 107th ILC session (2018)

The Committee has examined the reports on the abovementioned Conventions received in 2016, as well as the 50th annual report on the application of the European Code of Social Security received in 2017 and the Consolidated report (CR) on the application of the Code and certain ILO social security Conventions ratified by Sweden (Conventions Nos 12, 102, 121, 128, 130, 168) for the period 2006–16. The Committee has also taken note of the observations submitted in August 2016 by the Swedish Trade Union Confederation (LO), the Swedish Confederation for Professional Employees (TCO), and the Swedish Confederation of Professional Associations (SACO) concerning the application of Conventions Nos 102 and 130.

Part II of the CR (Medical care). Articles 8 and 69 of Convention No. 102 and Article 7(a) of Convention No. 130. Contingencies covered. The Committee requests the Government to confirm that medical care includes preventive care, is provided for “any morbid condition, whatever its cause”, and is not limited to emergency care only in certain cases such as, for example, in cases of attempted suicide, intoxication by alcohol or drugs, participation in a fight, etc.

Article 10(1) of Convention No. 102 and Article 13 of Convention No. 130. Types of medical care. The Committee requests the Government to indicate what types of medical care are covered by the public health insurance, in particular with respect to domiciliary visiting, dental care, medical rehabilitation, supply, maintenance and renewal of prosthetic and orthopaedic appliances, and specify how the list of “the essential pharmaceutical supplies” is established in Sweden.

Article 10(3) of Convention No. 102; Article 9 of Convention No. 130. Objectives of medical care. The Committee requests the Government to state how the objectives of medical care are defined.

Part III of the CR (Sickness benefit). Article 14 of Convention No. 102; Article 7(b) of Convention No. 130. Contingency covered. The Committee requests the Government to indicate the definition of “sickness” and “capacity to work” established in the national legislation.

Article 15 of Convention No. 102; Article 19 of Convention No. 130. Coverage of the self-employed. The Committee notes that persons protected under Convention No. 102 are defined by reference to its Article 15(b), which covers classes of the economically active population, including self-employed. The Committee requests the Government to provide information on the conditions of entitlement and level of benefit of self-employed persons under the national legislation.

Article 71(3) of Convention No. 102; Article 30 of Convention No. 130. Due provision of benefits. The CR states that for the first 14 days of illness the responsibility to pay sick pay is on the employer, from the 15th day of the sickness cash benefit is paid by the Swedish Social Insurance Agency. The Committee requests the Government to indicate how the payment of sickness benefit to the beneficiary is ensured in case of the employer’s failure to pay.

Part IV of the CR (Unemployment benefit). Article 24(4) of Convention No. 102; Article 18 of Convention No. 168. Waiting period. The Committee requests the Government to indicate the measures taken or envisaged to reduce the waiting period for unemployment benefit to the first six calendar days.

Article 26 of Convention No. 168. Special provisions for new applicants for employment. The Committee requests the Government to specify what categories of new applicants for employment among those listed in Article 26(1) of Convention No. 168 are protected by the national legislation. The Committee requests the Government to indicate the nature and conditions of social benefits provided to these categories.

Part V of the CR (Old-age pension). Article 15(3) of Convention No. 128. Reduction of pensionable age. The Committee requests the Government to indicate the pensionable age established for the persons engaged in occupations deemed to be arduous or unhealthy.

Article 18 of Convention No. 128. Minimum qualifying period. The Committee requests the Government to indicate the length of the qualifying period required for obtaining the full and the reduced old-age pension benefits and confirm that, in calculating the replacement rate of the old-age benefit for the standard beneficiary (man with wife of pensionable age), the income related pension of the husband is calculated on the basis of 30 years of insurance and the guaranteed pension for the wife – on the basis of 20 years of residence.

Part VI of the CR (Employment injury benefits). Insufficient information. In its direct request of 2011 on Convention No. 121, the Committee requested the Government to include in its next report due in 2016 detailed information requested in the report form on the status of application in law and practice of the provisions of the following Articles of the Convention: 8 (list of occupational diseases); 9 (conditions of entitlement to benefits); 11 (offsetting of the cost of medical care); 14 (prescribed degrees of incapacity); 15 (lump sum compensation); 16 (helper’s allowance), 17 (review of incapacity); 22 (grounds for the suspension of benefits); and 26 (prevention, rehabilitation and placement services). The Committee observes that the report of 2016 provided clear answers on the status of application of Articles 8, 14, 15 and 16, stating that there is no list of occupational diseases, no degrees of incapacity in work injury insurance, no lump sum compensation, and no helper’s allowance in the insurance scheme. The Committee points out that such answers suggest that these Articles might not be applied in the national law and practice. The Committee also observes from the CR that the information supplied by Sweden since 2006 with respect to employment injury benefits is insufficient to conclude on the application of a number of other provisions of the Convention mentioned below. This concerns in particular medical care and sickness benefit, which are provided in case of employment injury not by the work injury insurance but by other insurance schemes having different conditions of entitlement, on which the required information is also lacking in the reports on Convention No. 130. The Committee notes in this respect that the LO, the TCO and the SACO point out in their observations concerning Convention No. 118 that an EU citizen who plans to work in Sweden for less than one year has difficulty gaining access to health care in Sweden, and that a governmental investigation is currently analysing the Swedish legislation’s coherence with international standards. In view of the insufficient information available, the Committee requests the Government to indicate in detail the manner in which effect is given to all Articles of Convention No. 121.

Reform of the work injury insurance. The TCO points out in its observation that work injury insurance has become increasingly under debate and the inquiry has been launched for a more equal and legally secure occupational injury insurance (dir. 2016: 9), but the Government’s report does not contain any account of the application of the existing legislation in practice. In this respect, the SACO and the TCO highlight a dramatic decrease in the number of approved life annuities by the Swedish Social Insurance Authority from 7,375 in 2008 to 2,009 cases in 2015, which cannot be explained by a better working environment and a healthier population. The TCO also points out that the requirement to prove that the reduction in the working capacity is expected to last at least one year for being entitled to insurance compensation, effectively means that many victims of employment injuries stand without compensation. In this respect the Government’s report of 2016 states that annuity can be granted if the incapacity for work is deemed to be lasting a year or more and is reduced by one fifteenth. The Committee requests the Government to reply in detail to the observations made by the trade unions. The Committee requests the Government to describe the objectives and the findings of the abovementioned inquiry for a more equal and legally secure occupational injury insurance and add a general appreciation of the manner in which Convention No. 121 is applied in Sweden, including for instance extracts from official reports as well as information concerning the practical difficulties encountered in the application of the Convention, in accordance with Part V of the report form.

Article 6 of Convention No. 121. Contingency covered. The Committee requests the Government to explain how the work injury insurance compensates the loss of income in cases where the working capacity is reduced by less than one quarter.

Article 9(1)(2) of Convention No. 121. Qualifying period. The Committee requests the Government to confirm that there is no qualifying period for entitlement to each benefit provided in case of employment injury. In this connection, the Committee notes from the observations made by the TCO that according to existing legislation only incomes that are predicted to last at least six months may be included in the calculation of sickness benefits. According to the TCO, this effectively means that employees with employment shorter than six months are not eligible for sickness benefits. The Committee asks the Government to explain how employees with employment shorter than six months are protected against incapacity for work resulting from employment injury.

Article 9(3) of Convention No. 121. Duration of benefit. The Committee requests the Government to confirm that employment injury benefit is paid throughout the contingency and to indicate whether there is a waiting period in respect of incapacity for work.

Article 10 of Convention No. 121. Medical care and allied benefits. The Committee requests the Government to confirm that medical care includes in particular types of care specified in points (c)(e)(f)(g) of Article 10.

Articles 11 and 16 of Convention No. 121. Cost-sharing and avoidance of hardship. According to the CR, the same rules of cost-sharing are applied regardless if there has been a work injury or not. The Committee requests the Government to demonstrate that the rules of cost sharing applied under the general health insurance scheme would not cause hardship for the standard beneficiary (a family of four persons) in case of a long term hospitalization and medical rehabilitation after a severe employment injury requiring the constant help of another person over the period of one year.

Part VII of the CR (Family benefit). Article 43 of Convention No. 102. Length of the qualifying period. According to the CR, all children residing in Sweden are covered by the child allowance. The Committee requests the Government to confirm that a child ordinarily residing in Sweden for six months will be automatically entitled to the child allowance.

Part IX of the CR (Invalidity benefits). In its reports, the Government refers to two benefits paid in the event of incapacity for work: the activity compensation paid for a maximum of three years during the period of incapacity from 19 to 29 years of age, and the income-related sickness compensation paid until the achievement of pension age during the period of incapacity from 30 to 64 years. The Committee requests the Government to confirm that Part IX is applied to these two benefits, which together constitute Invalidity benefit in terms of Part IX, and demonstrate how they complement each other to ensure protection throughout the contingency in case full invalidity has been acquired at the age of 25 years.

Part X of the CR (Survivors’ benefit) Article 23 of Convention No. 128. Calculation of benefit. The Committee notes that the calculation of the survivors’ benefit is done on the basis of the adjustment pension and the child pension. The Committee requests the Government to explain the rules of calculation of these two benefits and provide calculations in case the breadwinner had completed only 15 years of insurance.

Part XI of the CR (Standards to be complied with by periodical payments). Article 29 of Convention No. 128. Adjustment of the old-age, invalidity and survivors’ benefits to the cost of living. The Committee requests the Government to provide statistics requested in the report form under this Article for the period 2011–17 and explain the Government’s policy in this regard.

Part XIII of the CR (Common provisions). Article 69 of Convention No. 102; Article 22 of Convention No. 121; Article 32 of Convention No. 128; Article 28 of Convention No. 130. Suspension of benefit. The Committee requests the Government to indicate how these provisions are applied in national law and practice with regard to medical care, sickness benefit, old-age benefit, employment injury benefit, family benefit, maternity benefit, invalidity benefit, and survivors’ benefit. Recalling that sickness, invalidity and unemployment benefit schemes are subjected to the common labour market activation rules with a view to increasing the employment rate, the Committee requests the Government to explain the regime of sanctions applied in cases of refusal to participate in prescribed activation measures.

Direct Request (CEACR) - adopted 1993, published 80th ILC session (1993)

The Committee notes the communications, dated 12 October 1992 and 25 February 1993, received from the Swedish Confederation of Professional Employees relating to the application by Sweden, among others, of Convention No. 130. It also notes that these communications were duly transmitted by the Office to the Government for comments. The Committee therefore hopes that the Government will provide any comments and relevant information on the matters raised by the Swedish Confederation of Professional Employees for examination at its next session.

[The Government is asked to report in detail for the period ending 30 June 1993.]