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

Replies received to the issues raised in a direct request which do not give rise to further comments (CEACR) - adopted 2019, published 109th ILC session (2021)

The Committee notes the information provided by the Government, which answers the points raised in its previous direct request and has no further matters to raise in this regard.

Direct Request (CEACR) - adopted 2012, published 102nd ILC session (2013)

Establishment of an integrated health system. With reference to its previous comments, the Committee notes with interest the adoption of Act No. 18.211 of 13 December 2007 respecting the integrated health system, the objective of which is to ensure complete health services for all residents (section 1). The basic principles of the integrated health system include universal coverage and the accessibility and long-term nature of health services. The Act provides that the public and private institutions which make up the integrated national health system are bound to provide users with complete health programmes approved by the Ministry of Health with their own resources or through public or private service providers (section 45). The Ministry of Health is made responsible for the implementation of this system by organizing the interaction between public and private complete health care providers (section 2). The Committee would be grateful if the Government would provide detailed information in its next report on the manner in which the new legislation gives effect to each of the provisions of the Convention (in accordance with the report form) and if it would indicate the extent to which the objective of universal coverage sought by the integrated health system is progressively achieved in practice.

Article 10(b) of the Convention. Protection of the members of the insured person’s family. The Government refers in its report to the adoption of Act No. 18.211 of 13 December 2007 on national health insurance, which sets out the schedule for the progressive inclusion in the health system of the spouses of employed workers. Around 250,000 additional individuals should be covered by the health system following a transitional period between December 2010 and December 2013. The Committee notes this information with interest and requests the Government to ensure that progress is achieved in the coverage of the family members of insured persons so as to give full effect to Articles 13, 15, 16(1) and 17 of the Convention.

Article 22. Amount of sickness benefit. As the Government’s report does not contain calculations demonstrating that the maximum amount of sickness benefit is not too low, the Committee once again requests the Government to indicate the wage of a skilled manual male employee and the amount of the national minimum wage for the next reference period.

Direct Request (CEACR) - adopted 2008, published 98th ILC session (2009)

With reference to its previous comments, the Committee notes the statistical information supplied by the Government on the number of employees protected by the current health insurance system, in relation to the total number of employees (Part II (Medical care, Article 10(a) in conjunction with Article 19 of the Convention (Persons protected)). It also notes that the scope of assistance to public servants has continued to increase, through the medical services provided by the public bodies themselves, or through the payment of mutual insurance contributions by the state institution, coverage which in some cases extends to the official’s dependants, as in the case of the legislative authority. Officials’ salaries continue to be paid in full during sick leave. However, the health system is in the process of being reformed, further to the adoption of Act No. 17930 of 19 December 2005 on the national budget, with a view to establishing an integrated national health system, the goal of which will be to cater fully for all residents of the country by providing equitable and universal coverage. It will be financed by a national health insurance, to be established through legislation, and to this end a draft bill was submitted to Parliament on 19 July 2006 for the decentralization of the association of health services, regarded by the authorities as a fundamental component of implementation of the integrated health system. The Committee notes the above information. It requests the Government to supply information on the progress made on the announced reform of the health system, particularly: (a) whether the integrated national health system has been made operational and, if so, the measures taken to this end;
(b) whether the abovementioned draft bill has been adopted and, if so, to send a copy thereof.

Article 10(b) of the Convention. Protection of the members of the insured person’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 insurance scheme, but are protected by the State Health Services Administration (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. It has also requested information which showed, on the basis of the relevant regulatory or administrative provisions, that the medical care referred to by section 270 of Act No. 15903 of 1987 indeed meets the requirements of the abovementioned Articles of the Convention. Finally, the Committee requested the Government to indicate whether the right to medical care depends on whether or not the beneficiary’s resources exceed a certain limit. In view of the fact that the Government’s report does not contain any reference to the points raised, the Committee hopes that the Government will supply information on them and also on the impact of the planned reform of the health system on the provisions of the Convention.

Article 12. Protection of pensioners and members of their families. The Committee notes that section 25 of Legislative Decree No. 14407 of 22 July 1975 was amended by Act No. 17786 of 23 June 2004. The new text allows its harmonization with section 18 of Legislative Decree No. 14407, which established that, in the event of an industrial accident or occupational disease, the Social Security Bank would take care of the difference between the contribution from the State Security Bank and the benefit laid down in section 13(2) of that Act. Although common sickness benefit may not be combined with unemployment benefit, salaries, pre-retirement advance payments or industrial accident compensation, medical care benefits are maintained in full. The financial benefits provided for in section 25 may not be accumulated. The Committee requests the Government once again to provide additional information on the application in practice of the mechanism provided for in section 186 of Act No. 16713 of 3 September 1995, pursuant to which the payment of mutual contributions, which is covered by the Social Security Bank, was extended to passive affiliates who receive a pension, provided that their income does not exceed 1,300 pesos (as from 1 January 1998). It also requests the Government to indicate by means of specific examples the amount of the mutual contribution to be paid by the standard beneficiary who has become a recipient of the social security pension in order to continue to be entitled to medical care for himself and also for his spouse and two children, and to state the nature and scope of medical care provided for those persons.

Article 16, paragraphs 2 and 3. In its previous comments, the Committee asked the Government to indicate the legal provisions which ensured the maintenance of entitlement of medical care for beneficiaries who cease to belong to the category of protected persons, including the extension of the period during which such medical care will be granted for diseases recognized as entailing prolonged care. In view of the fact that the Government’s report does not contain information in this regard, the Committee requests the Government once again to indicate the legislative provisions which guarantee, in the cases covered by Article 16, paragraphs 2 and 3, of the Convention, that medical care will 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.

Part III (Sickness benefit) and Article 22 (Amount of sickness benefit). With reference to its previous comments, the Committee notes the statistics provided by the Government in its report relating to the minimum wage (1,397 pesos). 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 this requirement of the Convention in all cases. The Committee therefore requests the Government to supply updated information as requested in the report form under Article 22 of the Convention, indicating, in particular, the wage of a skilled manual male employee, and also data on the amount of the national minimum wage for the same reference period.

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

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.

Direct Request (CEACR) - adopted 1996, published 85th ILC session (1997)

1. Part II of the Convention (Medical care). Article 10 (Protection of the members of the insured's family). In its previous comments, the Committee noted that spouses and children of insured persons do not enjoy compulsory coverage as dependants under the existing sickness insurance scheme but are protected by the State Health Services Administration (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. As the Government's latest report contains no such information, the Committee cannot but once again express the hope that this information will be contained in the Government's next report, together with any regulations adopted under the above section 270.

2. Article 12 (Protection of pensioners and members of their families). In its previous comments, the Committee had 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 medical care of a curative and a preventive nature under the existing sickness insurance scheme, but have access to medical care under the ASSE. It had asked the Government to provide information on the nature and scope of such medical care. In reply, the Government indicates that a special commission has been set up to study the possibility of instituting and financing a medical benefit of a preventive and curative nature for persons receiving social security pensions. The Committee notes this information with interest. It recalls in this respect that, according to the Government's previous reports, it has been examining since 1989 the question of establishing a sickness insurance scheme covering these categories of persons. The Committee therefore hopes that, as a result of these studies, the Government will indicate the measures taken in this respect in its next report. In the meantime, the Committee reiterates its request for information on the nature and scope of the medical care provided in practice to the above-mentioned persons by the ASSE.

3. Article 16, paragraphs 2 and 3. In its previous comments, the Committee had asked the Government to indicate the legal provisions ensuring the maintenance of the entitlement to medical care for beneficiaries who cease to belong to the categories of persons protected, including the extension of the period during which such medical care will be granted for diseases recognized as entailing prolonged care. In reply, the Government again refers only to sections 14 and 15 of Act No. 14407 of 22.07.75, and to section 9 of Decree 7/1976. The Committee has to point out in this respect, as in fact it has been doing since 1979, that the above provisions of Act No. 14407 refer exclusively to cash sickness allowances and do not concern the entitlement to medical care. As to section 9 of Decree No. 7/1976, its first paragraph reserves the right to invalidity and involuntary unemployment for those who have exhausted the right to cash sickness benefits; its second paragraph provides for continued coverage for unemployed, pre-retired and retired persons if they chose to pay the relevant contributions. Therefore, the Committee once again hopes that the Government will take the necessary measures in the near future in order to ensure that: (a) in accordance with Article 16(2) of the Convention, any beneficiary who ceases to belong to a category of persons protected shall enjoy further entitlement, which is mandatory under law, to medical care for a case of sickness which started while he belonged to the said category, for not less than 26 weeks; and (b) in accordance with Article 16(3) that such duration be extended for prescribed diseases recognized as entailing prolonged care.

4. Part III (Sickness benefit). Article 22 (Amount of sickness benefit). In reply to the Committee's previous comments, the Government indicates the minimum (U$10.73), median (U$13.43) and maximum (U$15.61) hourly wage of a turner in the steel industry, as of June 1993, representing the wage of a skilled manual male employee; the monthly family allowance which in May 1994 constituted U$34.48; and the maximum sickness benefit which in May 1994 attained the sum of U$1,293.00, which is equivalent to three times the national minimum wage. The Committee notes with interest the statistical information. It observes that the maximum sickness benefit paid to a standard beneficiary appears to attain 70 per cent of the median monthly wage of a turner in the iron and steel industry, account being taken of the family allowance paid for two children. This would meet the benefit level prescribed by the Convention, assuming that the said turner works 40 hours a week, i.e. 173 hours a month, since the statistics given in the report refer to different time bases for the wage of a turner (hourly basis) and for the maximum sickness benefit (monthly basis). The Committee therefore requests the Government to communicate with its next report all the statistics required by the report form adopted by the Governing Body under Article 22 of the Convention for the same time basis and for the same reference period, in order to be able to fully appreciate the application of the Convention on this point. The Government is also requested to supply the sources of the national statistics relating to the wage of a turner.

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

The Committee notes the information supplied by the Government in its report concerning the scope of individual coverage of medical care and sickness benefits. The Committee wishes to draw the Government's attention to the following points:

1. Part II of the Convention (medical care). (a) Article 10 (protection of the members of the beneficiary's family). In its previous comments, the Committee asked the Government to take the necessary measures to ensure that the spouses and children of insured persons enjoy compulsory protection under the existing sickness insurance scheme, in accordance with this provision of the Convention. In its report, the Government indicates that spouses and children of insured persons are not specifically covered in their capacity as dependents, but that if they are not covered by any of the existing private medical schemes, they are protected by the State Health Services Administration (ASSE) which is responsible for organizing first-level medical care for its beneficiaries. The Committee again asks the Government to provide information, in accordance with Articles 13, 15, 16(1) and 17 of the Convention, on the working of the above Administration in practice and on the nature and scope of the medical care referred to in section 270 of Act No. 15903 of 1987, and to state whether the regulations envisaged in section 270 have been adopted and, if so, to provide a copy of them. It also asks the Government to indicate to what extent benefits are granted irrespective of the level of the beneficiaries' resources.

2. Article 12 (protection of beneficiaries and members of their families). In its previous comments, the Committee asked the Government to take the necessary measures to guarantee, in accordance with this provision of the Convention, that persons who are in receipt of a social security benefit for invalidity, old age, death of the breadwinner or unemployment and, where appropriate, the wives and children of such persons, shall continue to be protected in respect of medical care of a curative and a preventive nature. In its report, the Government states that effect is given to this provision of the Convention in the case of persons receiving social security benefit for temporary invalidity or unemployment. However, persons receiving benefits for total and permanent invalidity, old age and death of the breadwinner, and, where appropriate, their wives and children, have access to medical care under the ASSE. In these circumstances, the Committee asks the Government to provide information on the nature and scope of such medical care (see under Article 10 of the Convention).

3. Article 16, paragraph 2 (maintenance of the entitlement to medical care). With regard to beneficiaries who cease to belong to the category of persons protected, the Committee notes that they continue to be entitled to medical care for as long as they receive sickness benefit, which can be extended for up to ten years. The Committee asks the Government to indicate which provisions establish this entitlement and whether provision is made for the maintenance of the entitlement to medical care in respect of persons not receiving sickness benefit.

4. Article 16, paragraph 3 (sicknesses requiring prolonged treatment). The Committee again asks the Government to indicate whether any provision is made for the duration of medical care to be extended for diseases recognized as entailing prolonged care and, if so, to state under which laws or regulations.

5. Article 22 (amount of sickness benefits). With regard to its previous comments, the Committee notes the statistical information on the wage of the skilled manual male employee. However, it observes that the Government has not provided the information required by the report form, and the Committee is therefore unable to assess to what extent effect is given to this provision of the Convention. It requests the Government to provide the following information in respect of the same period: (a) the wage of a skilled manual male employee, determined in conformity with paragraphs 6 or 7 of this provision of the Convention; (b) the maximum amount of sickness benefits (three times the amount of the national minimum wage); and (c) the amount of family allowances payable to two children, during employment and during the contingency.

Direct Request (CEACR) - adopted 1989, published 76th ILC session (1989)

The Committee notes the information supplied by the Government in reply to its previous comments and wishes to point out the following:

1. Part II of the Convention (Medical care). (a) Article 10 (Protected persons). The Committee notes, from the statistics supplied in the report, that the percentages prescribed by the Convention for the scope of sickness insurance are nor yet attained in Uruguay. Indeed, this instrument provides that the beneficiaries of such insurance are to be all employees, including apprentices, and the wives and children of such employees; or prescribed classes of the economically active population, constituting not less than 75 per cent of the whole economically active population, and the wives and children of persons of the said classes; or prescribed classes of residents constituting not less than 75 per cent of all residents. The Committee has, however, examined the legislative texts attached to the report and notes that some progress has been achieved, particularly with regard to the possibility of affiliation to the Collective Medical Assistance Institute (IAMC), the extension of sickness insurance to enterprises employing one worker only and the introduction of procedures that will make it possible for the sickness insurance to progressively extend coverage to civil servants. The Committee also notes the creation of the "Health Services Administration" by virtue of Act No. 15.903 of 1987 and requests the Government to supply detailed information in its next report on the working of that Administration in practice and the nature and scope of the medical care provided. The Committee also hopes that the Government will make every effort to extend the coverage of sickness insurance to other categories of employees or persons in the active population, so as, in this respect, to give effect to the Convention, which has been ratified for several years already. (Please also supply in all future reports the statistical data requested, under the above Article, by the report form on this Convention.)

(b) Articles 12 and 16. For a number of years, the Committee has been requesting the Government to take the necessary measures to give full effect to the above Articles of the Convention, which provide respectively that persons who are in receipt of benefits for invalidity, old age, death of the bread-winner or unemployment and, where appropriate, the wives and children of such persons, shall continue to be protected in respect of medical care and medical prevention, and that beneficiaries who cease to belong to the categories of persons protected, shall continue to be entitled to medical care, in case of sickness which started while they belonged to the said categories, for a period of not less than 26 weeks (and for as long as they receive sickness benefit); the above provisions also provide that the duration of medical benefit shall be extended for prescribed diseases recognised as entailing prolonged care. In its last report, the Government makes no mention of progress being achieved in the implementation of the above provisions of the Convention; it indicates, however, that the question of establishing a sickness insurance scheme meeting the requirements of the Convention is under examination. The Committee therefore trusts that the Government will not fail to supply information in its next report on the outcome of this examination and on the measures taken in this respect.

2. Part III (Sickness benefit). (a) Article 19 (Protected persons). See comments under Article 10 above.

(b) Article 22. (Amount of sickness benefit). For a number of years, the Committee has been requesting the Government to supply the statistics requested in the report form on this Convention, under Article 22, so that it can assess whether the amount of the sickness benefit payable to a standard beneficiary (a man with a wife and two children) corresponds to the rate prescribed by the Convention (60 per cent) where the previous earnings of the beneficiary are equal to or lower than the wage of a skilled manual male employee (in view of the fact that national legislation establishes a maximum amount to be taken into account for the calculation of these benefits). The Committee notes that, with the exception of the texts of Decree No. 76/988, communicated with the report, which contains indications on the amounts of wages applicable to the various categories of workers, the Government has not supplied any of the statistics requested. The Committee can only, therefore, renew its request and hope that the next report will contain the data in question.