Mandatory Health Insurance Rules
Step 1 - Reassessing Social Security
In the Roadmap "Which Social Security Rules Apply" you have determined the social security regime that applies to the assignment. The next critical step is to ascertain the employee's healthcare coverage within that regime.
In this step, the Navigator will help you to reassess the Country of Insurance and the Country of Residence of the employee and their family members.
Navigating the complexities of healthcare administration and expense payment in global mobility situations can be a challenging maze. To effectively manage this, it's crucial to adopt a structured approach and first reassess:
1. The Country of Insurance
This is the country where the employee is subject to mandatory social security including health insurance coverage.
Should an employee or any family members be found without social security coverage, providing alternative solutions like private insurance, voluntary contributions or monetary compensation is essential to prevent an insurance gap.
2. The Country of Residence:
This is the country where the employee and any dependent family members habitually live, their home country, where their centre of interest is.
3. The Country of Temporary Stay
A temporary stay is a period during which the employee is staying in a place other than the one where they usually live and they do not move their "centre of interest" there.
Elaboration
When an employee's country of residence, country of insurance, and current location are all the same, the healthcare process is straightforward. They register with the relevant health authority, pay contributions, and all medical expenses are handled according to that system's coverage, rates, and conditions (e.g., excesses or personal contributions) by an institution located in that country.
However, international employment often involves complex combinations of countries where individuals are mandatorily insured, reside, work, and may temporarily stay (e.g., for holidays, home leave, or business trips).
Caution
Defining Family Membership: The Role of Country of Residence
The definition of a family member is determined by the legislation of the country of residence. For instance, some countries, such as Turkey, may even apply an extended family definition and consider the parents of the employee as family members. Health insurers in the country of insurance are required to accept this definition, even if their own national interpretation of 'family' is more limited.
Tips & Best Practices
The Definition of Residence
This is the country where you habitually live, your home country. In other words, where your centre of interest is. A list of criteria is provided by article 11 of the Implementing Regulation 987/2009