Inclusion in the compulsory health insurance


The basic feature of compulsory health insurance is that the rights of each individual (or each family member insured through them) are exercised by registering for insurance and paying the corresponding contribution or premium. This means that you can exercise the right to medical services or cash benefits from compulsory health insurance only if you have compulsory health insurance cover.

In the compulsory health insurance scheme in Slovenia, insured persons are the insured persons themselves and the family members insured through them.

Insured persons join the compulsory health insurance scheme in accordance with the insurance bases defined in the Healthcare and Health Insurance Act, which specify the persons responsible for registering for insurance and those responsible for paying the contribution, the amount and the type of the contribution, and the scope of the rights afforded by compulsory health insurance. Family members may join the compulsory health insurance scheme through insured persons if they do not meet the conditions for being insured persons themselves.


    · Categories of insured persons in compulsory health insurance

      1. Persons in employment
The following have compulsory health insurance on the basis of employment:
    - persons in employment in Slovenia;
    - persons who are employed by an employer established in Slovenia and who are sent abroad for work or professional training, unless they have compulsory health insurance in the country to which they have been sent;
    - persons employed at foreign and international organisations and institutions and at foreign consular and diplomatic offices based in Slovenia, unless an international treaty provides otherwise;
    - persons who have permanent residence in Slovenia, are employed by a foreign employer but are not insured by a foreign health insurance provider.

      2. Persons pursuing an independent commercial or professional activity in Slovenia
Insured persons in compulsory health insurance are persons who, as their sole or principal occupation, pursue the following on an independent basis in Slovenia:
    - a commercial activity (sole traders);
    - a professional activity (e.g. lawyers, notaries, health workers, cultural professionals, clerics, etc.).

      3. Partners of companies and founders of institutions exercising a management function as their sole or principal occupation
Insured persons in compulsory health insurance are partners of unincorporated companies, partners of limited liability companies or founders of institutions, if they are also management staff exercising a management function as their sole or principal profession.
      4. Farmers, members of their households and other persons pursuing agricultural activities in Slovenia
      5. Elite athletes and chess players who are members of physical training and chess organisations in Slovenia
      6. Unemployed persons receiving unemployment benefits
      7. Pensioners and recipients of maintenance under rules governing maintenance security for farmers
      8. Recipients of a pension from a pension insurance provider abroad
      9. Persons who have permanent residence in Slovenia and are insured by a health insurance provider abroad, but who cannot exercise those rights while residing in Slovenia
      10. The family members of a person insured by a health insurance provider abroad who have permanent residence in Slovenia and who are not insured as family members by the health insurance provider abroad
      11. Foreign nationals in education or training in Slovenia
      12. Recipients of disability benefits under the regulations governing disabled military personnel and civilians disabled in war, and beneficiaries of rights under the regulations on the protection of military veterans and victims of wartime aggression, those involved in other wars and those receiving special national benefits
      13. Recipients of a disability allowance under the law governing the social protection of persons with mental and physical disabilities
      14. Recipients of permanent financial social assistance, refugees and beneficiaries of subsidiary protection
      15. Beneficiaries of special benefits under the rules on the protection of participants in military conflict
      16. Soldiers undertaking voluntary military service
      17. Persons with permanent residence in Slovenia who do not meet the conditions for insurance on another basis
      18. Persons granted the right by a social services centre to have their compulsory health insurance contributions paid
      19. Detainees and convicted persons
      20. Persons who acquire the right under the law governing parental protection
      21. Children up to the age of 18 not insured as family members
      22. Family carers
      23. Family members
The following are insured as family members of the insured person:
    1. immediate family members:
    · a spouse, extra-marital partner, partner in a registered or unregistered partnership, divorced spouse and partner granted maintenance by judicial decision,
    · a child (born in wedlock or out of it, an adopted child and a child placed with a family for the purpose of adoption by decision of the competent authority);
    2. wider family members:
    · a stepchild;
    · a grandchild, brother, sister or other child without parents (a child without parents may also mean a child who has parents, if the parents are completely and permanently incapable of work or if, owing to other circumstances, they cannot care for and maintain their children);
    · a parent (father and mother, spouse or extra-marital partner of the father or mother, and adoptive parent).

    · Persons responsible for registering for insurance
A legal or natural person, who is, as a rule, the person responsible for paying the contribution, is obliged to file an application for insurance on behalf of an insured person. Examples:
    · an employer files an application on behalf of persons in their employ;
    · the Employment Service of Slovenia files an application on behalf of recipients of unemployment benefits;
    · the Pension and Disability Insurance Institute files an application on behalf of recipients of a Slovenian pension;
    · persons independently pursuing a gainful or professional activity file an application on their own behalf.

The insured person under whom a family member (spouse, parent of a child) is to be insured files the application for insurance on behalf of that family member.

REGISTRATION FOR COMPULSORY SOCIAL SECURITY

The registration of persons in the compulsory social security scheme, which also includes compulsory health insurance, is subject to uniform procedures. In addition to registration for insurance, the procedures also include de-registration and changes to insurance details.

The Health Insurance Institute of Slovenia performs the tasks of the registration service for compulsory social security.

STUDENTS IN SLOVENIA - Citizens of third countries

BUSINESS ENTITIES
Businesses entered in the Slovenian Business Register comprise the largest group of persons liable to register persons for compulsory social security. These are employers, sole traders and persons independently pursuing a professional activity. Employers are obliged by law to arrange registration, de-registration and changes to details on behalf of their workers.

Businesses must carry out the procedures electronically via SPOT.
In the same way, partners and founders of institutes who are management staff arrange insurance registrations and de-registrations and make changes to details on their own behalf. Insurance against injury at work and occupational disease may also be arranged via SPOT.

    · APPLICATIONS

Forms for filing applications, making changes and arranging de-registration in compulsory social security
The details required for compulsory social security, i.e. for pension and disability insurance, health insurance, parental care insurance and unemployment insurance, are sent using the M forms:
    · Obrazec+M-1_i.pdfObrazec+M-1_i.pdf M-1 form (registration of details for pension and disability insurance, health insurance, parental care insurance and unemployment insurance), together with the accompanying registration certificate;
    · Obrazec+M-3_i.pdfObrazec+M-3_i.pdfM-3 form (changes to details for pension and disability insurance, health insurance, parental care insurance and unemployment insurance), together with the accompanying certificate of changes;
    · Obrazec+M-2_i.pdfObrazec+M-2_i.pdfM-2 form (de-registration from pension and disability insurance, health insurance, parental care insurance and unemployment insurance), together with the accompanying certificate of de-registration;
    · Obrazec+M12_i.pdfObrazec+M12_i.pdfM-12 form (registration for/de-registration from insurance against injury at work and occupational disease);
    · Obrazec+MDČ_i.pdfObrazec+MDČ_i.pdfM-DČ form (registration of details of health insurance of family members).
    Each of those M forms is completed in duplicate. The first copy of the form is retained by the ZZZS or forwarded to the Pension and Disability Insurance Institute in the case of registration, a change to details or de-registration from pension and disability insurance. The second copy (certificate) is returned by the ZZZS to the person liable for registration.

    Method of filing applications, making changes and de-registering from insurance
    Where registration, de-registration or a change is filed by a natural person liable for registration, this may be done using a hard-copy form at the nearest ZZZS regional office or branch, or by post.

    Where the person liable for registration is a natural or legal person entered in the Slovenian Business Register, they file their registration, changes or de-registration in electronic form via SPOT.