As of this Thursday, February 16, the modification of the regulations on Common Illness Allowance and on the Subsidy for Maternity and Lactationwhich has as its main novelty the change of the entity responsible for these payments followed by the reduction of out-of-pocket expenses of those affiliated with the contributory regime and the simplification of the procedure.
During an ordinary session held on December 15, 2022, the National Social Security Council (CNSS) approved the Resolution No. 560-04 with which it converts the Superintendence of Occupational Health and Risks (Sisalril) in the entity responsible for the entire referral process subsidiesfrom the request to the payment, this function was until yesterday of the Social Security Treasury (TSS).
The decision to remove that function from the TSS arose from a proposal to modify the regulations made by the sisalril aiming reduce members’ out-of-pocket expenses, simplify the processes for granting subsidies, and increase efficiency in their administration.
The CNSS granted a period of 60 days to the sisalril, which have already been fulfilled, to make the necessary adjustments to their technological platforms for their implementation. This is why, through her Instagram account, the sisalril calls on all employers to register as a company in the Virtual Office of the organization.
“We invite all employers to register as a company in our Virtual Office after the approval of the National Social Security Council to the modifications to the regulations of Subsidies for Maternity, Breastfeeding and Common Illness that establishes Sisalril as responsible for the entire process of subsidies, from application to payment.
From now on, every employer who receives a common sickness or maternity leave from its workers must process the payment of the subsidy for this in the sisalrilas well as the lactation allowance for the children of employees who have recently given birth.
Know the regulations
Regulations on Subsidy for Common Illness
The Regulations on Common Illness Allowance Its objective is to regulate the granting of cash benefits and the registration and control of this Family Health Insurance subsidy of the Contributory Regime provided for in article 131 of Law No. 87-01, which creates the Dominican Social Security System (SDSS).
This subsidy delivered in the form of a benefit is aimed at those workers of both active sexes, contributors and affiliated to the Contributive Regime of the Dominican Social Security System, who suffer a temporary incapacity for the work they do as a result of suffering from a non-professional illness or a non-work accident.
The conditions to access this subsidy are that the worker has not less than four days of disability and that at the time of the medical leave he has contributed to the TSS at least 12 months on an interrupted basis.
To determine the amounts to be paid for this subsidy, the sisalril will take into account the following:
a) If the beneficiary receives outpatient assistance, he will be entitled to receive the equivalent of 60% of the average contributionable salary of the last six months.
b) If the beneficiary receives hospital care, he will have the right to receive 40% of the average contributionable salary for the 6 months.
Note. The regulations establish that the duration of the subsidy will be limited to 26 weeks (182 days), from the day the disability begins.
How is it calculated?
To calculate this subsidy, the following methodology will be used:
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The calculation base will be the average of the salaries subject to contributions of the last six months prior to the start date of the leave.
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The result of the base will be multiplied by 60% when the treatment is ambulatory and 40% in case of hospitalization.
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This result will be divided by 23.83.
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The amount resulting from this division will be multiplied by the working days of the disability period, counted from the day it began.
How to apply for the subsidy?
It is the employer who is responsible for managing the subsidy for the employee who has lost health using the platform that has already enabled the sisalril.
On this platform, you must provide the information contained in the employee’s medical certificate.
In order for the application for the subsidy to be formalized and completed, the employer and the worker will carry out the following procedure:
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The worker will inform his employer about his health condition by any means, in order to justify his absence from work, until he obtains the medical certificate.
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The worker must deliver to his employer the original of the medical certificate that validates his disability.
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The employer will generate, through the Sisalril platform, the Common Illness subsidy application form and must complete it with the data indicated in the medical certificate, print it, sign it and seal it.
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The employer, once the form is completed, signed and sealed, uploads it to the platform together with the medical certificate.
prescribe
According to article 14 of the regulations, the member and the employer will have a term of no more than 60 calendar days, after the termination of the disability, to claim the payment of the subsidy, being able to register it from the moment the worker notifies the your employer the medical certificate.
Regulations on Maternity Allowance and Breastfeeding Allowance
The maternity subsidy is the cash payment to the worker affiliated with the Contributory Regime equivalent to 14 weeks of quotable salary, up to the maximum quotable amount for Family Health Insurance, which is granted during the maternity leave period.
While the subsidy for lactation is also the payment in money that henceforth the sisalril will make the workers affiliated to the Contributory Regimefor children born alive, as long as they receive a salary less than or equal to three national minimum wages.
Both subsidies are granted in accordance with the conditions established in this Normative on the Maternity Allowance and Breastfeeding Allowance, in accordance with the provisions of Law No. 87-01 and it is the responsibility of the employer to carry out the necessary procedures before the sisalril with the documentation that your employee must duly deliver.
Birth and duration of the right to Maternity allowance
According to article 6 of this regulation, the pregnant worker will have the right to receive the subsidy as long as she has collected at least eight contributions to the TSS within 12 months prior to the delivery of your baby.
The worker may enjoy this subsidy subsidy for maternity licence from the seven weeks preceding the probable date of delivery or from the date of delivery, consequently, the payment period of the subsidy is established from the beginning of the maternity leave or the birth of the baby until the 14-week period, according to the provisions of article 236 of the Dominican Labor Code.
If the employee starts her maternity licence before having contributed eight months in the Social Security System, within the 12 prior to the birth, you will not be entitled to the subsidy until your baby is born.
In addition, another clarification of the regulations is that the subsidy can only be generated after 22 weeks of pregnancy.
As in common sickness benefit, it is the employer’s responsibility to inform the sisalrilthe date on which the maternity leave of the worker will begin, to initiate the corresponding administrative procedures.
In the same way, the employee is obliged to notify her employer of her pregnancy status, through a document called “Maternity Report”, which must include her information, the probable date of delivery and the name and ID of the designated person. She must also notify her of the start date of her leave.
prescribe
According to article 12, the employer will have a period of up to 12 months, after the start of the maternity licence of the worker, to complete the application for the Maternity Allowance.
Once said term has expired, you will not be able to request payment of the subsidy.
Breastfeeding allowance
The Breastfeeding Subsidy Regulation was developed in order to protect children of breastfeeding age. The beneficiaries of this cash payment are the children of employees affiliated with the Contributive Regime who earn a quotable salary.
In the case of multiple births, the mother will receive the subsidy for each baby born from the same birth.
Duration
To obtain this aid for babies, the procedures must be carried out from the date of birth of the creature. Once the subsidy has been approved by the sisalril It will last for one year and will be awarded monthly.
Prescribe. If the application for the subsidy is not made in the first twelve months of the child’s life, it can no longer be claimed.
Amount
The Breastfeeding Subsidy will be granted as follows:
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Workers with quotable salaries up to the limit of a national minimum wage will receive a subsidy corresponding to 33% of the average of the last six months of their quotable salary.
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Workers with quotable salaries up to the limit of two national minimum wages will receive a subsidy corresponding to 12% of the average of the last six months of their quotable salary.
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Workers with quotable salaries up to the maximum of three national minimum wages, will receive a subsidy corresponding to 6% of the average of the last six months of their quotable salary.
