natgillin/translations-raw huggingface dataset:
This method promotes good governance, openness, transparency and the involvement of stakeholders – at European and national levels – as a means for better policy making.
Evropska komisija ima v tem postopku ključno vlogo pri vrednotenju in svetovanju.
Your Rights to Social Security in France
Vaše pravice s področja socialne varnosti v Franciji
(the European Union, the European Economic Area and Switzerland)
(v Evropski uniji, Evropskem gospodarskem prostoru in Švici)
This brochure is based on information provided by France on 3 March 2006.
Ta brošura je bila pripravljena na podlagi informacij, ki jih je sporočila Francija 3.marca 2006.
To do this, please check with the relevant bodies and institutions, whose contact details are provided under Section 3 “Useful Addresses and Websites”.
V zvezi s tem kontaktirajte ustanove in nosilce, o katerih so podatki na voljo v točki„3. Podatki o ustanovah in koristne spletne strani“.
Introduction. . . . . . . . . . . . . . . . . . . ...............................................................................................................................
Splošno . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Useful Addresses and Websites...........................................................................................................
Podatki o ustanovah in koristne spletne strani...........................................................................
Introduction vieillesse (CNAV)), which has delegated certain of its functions to the regional sickness insurance funds.
Francoski sistem socialne varnosti je razdeljen v pet velikih skupin:
The family branch is managed by the National Family Allowance Fund (Caisse nationale des allocations familiales (CNAF)), which supervises family allowance funds.
Področje družine upravlja Nacionalni sklad za družinske dodatke (Caisse nationale des allocations familiales – CNAF), ki ima nadzor nad skladi za družinske dodatke.
•the general scheme, covering the majority of employees and other categories of people (students, recipients of certain benefits, residents) who, over the years, have joined it;
• splošni sistem, ki vključuje večino zaposlenih in druge skupine (študente, upravičence do določenih dajatev, osebe s stalnim prebivališčem), ki so se mu z leti pridružile;
•special employee schemes, some of which cover all risks and others covering only old age pension insurance (nationals covered under the general scheme for the other risks);
• posebne sisteme zaposlenih, od katerih nekateri vključujejo vsa tveganja, drugi pa samo starostno zavarovanje (državljani so zato za druga tveganja odvisni od splošnega sistema);
Contributions are collected at a local level by the Social Security and Family Allowance Contribution Collection Offices (Ursaff) which are supervised by the Central Agency for Social Security bodies (Agence centrale des organismes de sécurité sociale (ACOSS)), whose task is to monitor the cash flow for each branch in terms of allocations and actual spending shown in the accounts.
Pobiranje prispevkov izvaja na lokalni ravni prek uradov za pobiranje prispevkov za socialno varnost in družinske dodatke (unions de recouvrement des cotisations de sécurité sociale et d’allocations familiales – Urssaf), ki jih nadzoruje Centralna agencija za zavode socialne varnosti (Agence centrale des organismes de sécurité sociale – ACOSS), katere naloga je knjigovodsko spremljati načrtovane in dejanske denarne tokove.
•the agricultural scheme which covers all risks but in two separate streams: farmers and agricultural workers;
• kmetijski sistem, ki zajema vsa tveganja, a se vodi za dve ločeni skupini: nosilce dejavnosti in kmetijske delavce;
•schemes for non-agricultural selfemployed persons: three independent old age pension schemes (craft trade workers, traders and manufacturers and the professions) and a sickness insurance scheme;
• sisteme za samostojne nekmetijske delavce: trije samostojni sistemi starostnega zavarovanja (obrtniki, trgovci in delavci v industrijskem sektorju ter svobodni poklici) in en sistem zdravstvenega zavarovanja;
The contractual unemployment insurance scheme is managed by similar bodies: the Associations for Employment in Industry and Trade (Associations pour l’emploi dans l’industrie et le commerce (Assédic)), with, at their head, the National Interprofessional Union for employment in Industry and Trade (Union nationale interprofessionnelle pour l’emploi dans l’industrie et le commerce (Unedic), which are also responsible for collecting contributions.
Pogodbeni sistem zavarovanja za primer brezposelnosti upravljajo skupni organi: združenja za zaposlovanje v industriji in trgovini (Associations pour l’emploi dans l’industrie et le commerce – Assédic), na čelu katerih je Nacionalno medpoklicno združenje za zaposlovanje v industriji in trgovini (Union nationale interprofessionnelle pour l’emploi dans l’industrie et le commerce – Unedic), ki zagotavlja tudi pobiranje prispevkov.
These various schemes are the responsibility of the Ministry for Social Security, the Ministry for Agriculture and the Ministry for Labour.
Te različne sisteme nadzorujejo ministri za socialno varnost, minister za kmetijstvo in minister za delo.
The general scheme has four branches:
Splošni sistem se deli na štiri področja:
•the sickness, maternity, invalidity and death branch;
• zdravstvo, materinstvo, invalidnost in smrt;
•the accidents at work and occupational disease branch;
• nezgode pri delu in poklicne bolezni;
The basic old age pension insurance is supplemented by additional schemes which are compulsory at law and distributed between employed persons (contractual schemes provided by the Association for the Supplementary Retirement Schemes for Employed Persons (Association des régimes de retraite complémentaire des salariés (ARRCO)) and the General Association of Pension Institutions for Managerial Staff (Association générale des institutions de retraite des cadres (AGIRC)) and selfemployed persons.
Nazadnje obstajajo sistemi obveznega ali prostovoljnega dopolnilnega kolektivnega zavarovanja, ustanovljeni v poklicnem okolju (po podjetjih ali panogah), v glavnem na področju starostnega, zdravstvenega in invalidskega zavarovanja.
•the family branch;
• družina.
Finally, supplementary collective schemes exist, both compulsory and voluntary in nature, which are specific to professions (companies or sectors), and they mainly provide old age pension, sickness or invalidity insurance.
Na osebno pobudo se lahko ti različni sistemi dopolnijo z individualnimi zavarovanji.
The National Sickness Insurance Fund for Employed Persons (Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS)) manages the first two branches in different ways.
Nacionalni sklad zdravstvenega zavarovanja zaposlenih (Caisse nationale d’assurance maladie des travailleurs salariés – CNAMTS) ločeno upravlja prvi dve področji.
At a local level, and under the supervision of the CNAMTS, there are two types of bodies which are not linked hierarchically: the regional sickness insurance funds and the primary sickness insurance funds.
Na lokalni ravni in pod nadzorom tega zavoda obstajata dve vrsti ustanov: območni skladi zdravstvenega zavarovanja in skladi primarnega zdravstvenega zavarovanja, ki med seboj niso hierarhično povezani.
Individuals may take out private insurance to supplement these schemes.
Področje starostnega zavarovanja upravlja Nacionalni sklad za starostno zavarovanje (Caisse nationale d’assurance vieillesse – CNAV), ki je nekatere pristojnosti prenesel na območne sklade zdravstvenega zavarovanja.
The old age pension branch is managed by the National Old Age Insurance Fund (Caisse nationale d’assurance
Če delate za delodajalca, mora ta urediti formalnosti, potrebne za vključitev v socialno varnost, zavarovanje za primer brezposelnosti in dodatno pokojninsko zavarovanje.
You will find information concerning the relevant institutions in Section 3.
Če delate za svoj račun, morate sami urediti formalnosti prijave.
If you work for an employer, they will complete the formalities necessary for you to join the social security, unemployment insurance and supplementary pension schemes.
Znesek davkov in prispevkov za socialno varnost, ki jih morate plačevati, je enak določenemu odstotnemu deležu vaše plače.
If you are selfemployed you must complete the declaration formalities yourself.
Delodajalec te davke in prispevke odtegne od plače in jih nakaže uradu za pobiranje prispevkov.
Your employer deducts these contributions from your earnings and pays them to the authority in charge of collecting them. If you
Če ste samozaposlena oseba, morate sami nakazati davke in prispevke, izračunane od dohodka vaše poklicne dejavnosti.
If you have a dispute with your insurance fund (caisse), you may appeal to the appeals board (Commission de recours amiable (CRA)) of your insurance fund within two months of being notified of the decision with which you disagree.
V primeru spora s skladom imate pravico do pritožbe pri spravni komisiji CRAM-a, v katere pristojnost spadate, v 2 mesecih po vročitvi izpodbijane odločbe.
If the appeals board rejects your application, you can bring the case before the Social Security Court (Tribunal des affaires de sécurité sociale) within two months.
Če spravna komisija zahtevo zavrne, zadevo lahko v dveh mesecih predložite sodišču za socialno varnost.
If you do not appeal within that period, the decision of your fund’s appeals board is final.
Če se v tem času ne pritožite, postane odločba spravne komisije pri vašem skladu dokončna.
Those who are members of the general scheme on the basis of their residence, may have to pay the special CMU contribution, depending on their level of income.
Osebe, vključene v splošni sistem po merilu stalnega prebivališča, so zavezane ali ne k posebnemu prispevku splošnega zdravstvenega kritja glede na svoje dohodke.
Reimbursement of health care costs
Povračilo stroškov zdravstvenih storitev
French sickness insurance comprises benefits in kind (health care, see Article 2.1.1) and cash benefits (daily allowances, see Article 2.1.2) payable during incapacity for work owing to sickness.
V Franciji zdravstveno zavarovanje zajema storitve (zdravstveno oskrbo, glej točko 2.1.1) in denarne dajatve (dnevna nadomestila, glej točko 2.1.2), plačljive v času vaše nezmožnosti za delo zaradi bolezni.
Special maternity and paternity benefits are available (see Article 2.1.3).
Obstajajo tudi posebne dajatve za materinstvo in starševstvo (glej točko 2.1.3).
You and your dependants (spouse, children under 20 years of age, partner, dependant living in the insured person’s home) are entitled to reimbursement of health care costs.
Zavarovanec in njegovi vzdrževani člani (zakonec, otroci do starosti 20 let, izvenzakonski partner, vzdrževana oseba, ki živi pri zavarovancu doma itd.) so upravičeni do povračila stroškov zdravstvenih storitev.
Each patient over 16 years of age must choose a treating physician to oversee their care and coordinate their personal medical file.
Vsak bolnik, starejši od 16 let, mora izbrati lečečega zdravnika, ki ga bo usmerjal na njegovi zdravstveni poti in usklajeval njegov osebni zdravstveni karton.
These measures do not apply to children.
Otrok ti ukrepi ne zadevajo.
The treating physician may be a GP or a specialist; they need merely to accept the role.
Lečeči zdravnik je lahko splošni zdravnik ali specialist, zadostuje, da izbrani zdravnik sprejme to vlogo.
For health care, the general scheme covers 85% of persons employed in the private sector, civil servants and persons resident in France on a continuous and legal basis, and who are not protected by any cover elsewhere.
Lečečega zdravnika lahko zamenjate, dovolj je, da napišete novo izjavo nosilcu zdravstvenega zavarovanja.
The various basic schemes cover approximately 75% of household medical expenses.
Različni osnovni sistemi vključujejo približno 75odstot-kov zdravstvenih stroškov gospodinjstev.
The remaining expenses payable by the insured persons can be covered under the optional supplementary insurance available from mutual funds or private insurers.
Preostali stroški, ki jih morajo plačati zavarovanci, se lahko krijejo iz dodatnega prostovoljnega zavarovanja pri vzajemnih zavarovalnicah ali zasebnih zavarovateljih.
Persons with insufficient means benefit from free optional cover under the universal health cover (couverture maladie universelle (CMU)) provision.
Če zdravstvene postopke izvaja ali priporoča lečeči zdravnik, se stroški povrnejo po običajni stopnji: potek zdravljenja je torej usklajen.
If medical procedures are carried out or recommended by the treating physician, they will be reimbursed at the normal rate as you are receiving coordinated care.
Osebe, ki nimajo zadostnih prejemkov, imajo pravico do brezplačnega neobveznega kritja v okviru splošnega zdravstvenega kritja (CMU).
Persons exercising a professional activity (employed or self-employed), or those resident on French territory on a continuous and legal basis, and their dependents, are entitled to health care.
Če ne prijavite lečečega zdravnika, ali sami odidete na pregled k specialistu, se vam, nasprotno, povrne manj stroškov, znesek stroškov, ki ga krijete sami, pa je višji, kot če bi najprej obiskali lečečega zdravnika.
However, if you have not notified a treating physician, or if you consult a specialist directly, you will be reimbursed at a lower rate and the amount of costs you will have to pay will be higher than if you had been referred by the treating physician.
Do zdravstvene oskrbe so upravičene osebe, ki opravljajo poklicno dejavnost (zaposleni ali samozaposleni) ali stalno in redno prebivajo na francoskem ozemlju, ter njihovi vzdrževani člani.
Eligibility criteria
Pogoji za pridobitev pravice do dajatev
Entitlement is traditionally established on professional or similar criteria.
Vendar pa lahko v primeru nujne zdravniške oskrbe, v odsotnosti lečečega zdravnika ali njegovega namestnika in oddaljenosti od prebivališča, obiščete drugega zdravnika.
It is subject to the following prerequisites: quotas for hours worked or amounts of contributions.
Nazadnje lahko ginekologe, oftalmologe in psihiatre obiščete neposredno mimo lečečega zdravnika.
Those ceasing to fulfil the conditions for obtaining cover under a social security scheme as an insured person or as a beneficiary remain entitled to receive benefits in kind under their previous scheme for four years, until they once more fulfil the conditions for obtaining cover under a compulsory scheme.
V vsakem primeru bo zdravnik, ki vas pregleda, natančno navedel vaše posebno stanje na zdravstveni list.
Nevertheless, in the event of a medical emergency, the absence of your treating physician or their replacement, or if you are away from home, you may consult a physician other than your treating physician.
Navadno je pridobitev pravice pogojena s poklicnim ali enakovrednim merilom. Predhodni pogoji, ki morajo biti izpolnjeni, so kvote opravljenih ur dela ali zneski prispevkov.
Finally, gynaecologists, ophthalmologists and psychiatrists may be consulted directly without being referred by the treating physician.
Osebe, ki prenehajo izpolnjevati pogoje za vključenost v sistem socialne varnosti kot zavarovanci ali upravičenci, so štiri leta upravičene do ohranitve svoje pravice do
It is issued to everyone over 16 years of age and contains all the administrative information necessary for the reimbursement of treatment costs.
Izda se jo vsem osebam, starim 16 let in več, in vsebuje vse upravne podatke, potrebne za povračilo stroškov zdravstvenih storitev.
Daily allowances are granted to those who are medically certified to be incapable of exercising a professional activity.
Vse zaposlene osebe so med svojo nezmožnostjo za delo zaradi bolezni upravičene do dnevnih nadomestil od četrtega dneva odsotnosti z dela.
This enables the treatment forms to be drawn up electronically and sent directly by data transmission to your sickness insurance fund.
Brezposleni, ki prejemajo nadomestila, se lahko potegujejo tudi za dnevna nadomestila.
This procedure speeds up the reimbursement process. If the health professional has no equipment for reading the card, they will produce a treatment form in paper format which you then forward to your sickness insurance fund.
Če izgubite položaj socialnega zavarovanca, se vaše pravice do denarnih dajatev zdravstvenega zavarovanja ohranijo še eno leto, dokler se ne vključite v drug obvezni sistem zavarovanja.
Everyone in employment is entitled to a daily allowance during a period of incapacity for work owing to sickness as from the fourth day of absence from work.
To omogoča izdajo elektronskih zdravstvenih listov, ki se vašemu nosilcu zdravstvenega zavarovanja pošljejo neposredno s prenosom na daljavo.
Unemployed people on benefit may also claim a daily allowance.
Takšen postopek pospeši roke povračila.
If you lose your social insurance cover, your entitlement to sickness insurance cash benefits will be maintained for a period of one year, provided you are not covered by another compulsory scheme.
Če zdravstveni delavec nima opreme za uporabo kartice vitale, sestavi zdravstveni list na papirju, ki ga pošljete vašemu nosilcu zdravstvenega zavarovanja.
Craft trade workers, traders and manufacturers are also entitled to receive a daily allowance in the event of sickness, with the benefits granted to them differing slightly from those granted to employed persons.
Obrtniki, trgovci in delavci v industrijskem sektorju so prav tako lahko upravičeni do dnevnih nadomestil za primer bolezni, vendar pa se izplačane dajatve nekoliko razlikujejo od dajatev, izplačanih zaposlenim.
Eligibility criteria
Pogoji za izplačilo dnevnih nadomestil
Pharmaceutical products must be prescribed by the physician.
Za določene postopke ali posebno zdravljenje je potrebno predhodno soglasje nosilca zdravstvenega zavarovanja.
It is also possible to have part of the cost (pharmaceutical direct settlement) paid directly by the fund by presenting your card.
Zdravstveni delavec vas bo obvestil, kdaj je treba zaprositi za predhodno soglasje.
In that case, all you pay to the dispensing chemist is that part of the cost not covered by your sickness insurance fund.
Dnevna nadomestila se izplačajo, če so plačani prispevki in če je dopolnjeno minimalno trajanje dejavnosti.
The daily allowance is paid subject to the payment of contributions or a minimum period of activity.
V tem primeru v lekarni plačate samo del stroškov, ki jih nosilec zdravstvenega zavarovanja ne povrne.
Hospital treatment
Bolnišnično zdravljenje
You may be hospitalised in an establishment of your choice, but if this is an approved private establishment which is not regulated by agreement, you will have to pay all fees in the first instance.
Obdobja, ko ste delali (ali plačevali prispevke) v drugi državi članici, se, če je potrebno, upoštevajo pri določanju izpolnjevanja zgoraj navedenih pogojev.
Periods in which you worked (or paid contributions) in another EU Member State are, if necessary, taken into account to determine whether you fulfil the above conditions. For this purpose, you should submit form E 104 to your French sickness insurance fund.
V ta namen morate vašemu francoskemu nosilcu zdravstvenega zavarovanja poslati obrazec E 104, ki vam ga na zahtevo izda zavod za zdravstveno zavarovanje države, v kateri ste bivali pred povratkom v Francijo.
This will be issued to you on request by the sickness insurance institution of the country in which you stayed prior to coming to France.
Za več podrobnosti glej vodnik „Določbe Skupnosti o socialni varnosti – Vaše pravice med gibanjem v Evropski uniji“.
For further details see the guide “The Community provisions on social security – Your rights when moving within the European Union”.
Za bolnišnično zdravljenje lahko izberete bolnišnico po vaši izbiri, vendar stroške plačate s predplačilom, če izberete odobreno zasebno in nepogodbeno bolnišnico.
In order to receive the daily allowance, you may be required to undergo medical checks arranged by your fund.
Da bi lahko izkoristili dnevna nadomestila, vas lahko vaš nosilec zdravstvenega zavarovanja po potrebi pokliče, da opravite zdravniški pregled.
If 100% of the hospital fees are met, you will also have to pay a fixed amount (15 euros a day as from 1 January 2006 for each day you spend in a hospital or medicosocial institution).
Če se stroški bolnišničnega zdravljenja krijejo 100-odsto-tno, morate plačati dnevni pavšal (od 1. januarja 2006 15EURov na dan za vsak dan bivanja v bolnišnici ali zdravstvenosocialnem zavodu).
However, certain categories of persons are exempt from paying this fixed amount, and these include pregnant women during the four last months of their pregnancy, newborn babies, disabled children, disabled young people who attend specialist institutions for professional training or education, and persons treated following accidents at work or occupational diseases.
Vendar pa so določene skupine oseb oproščene plačevanja tega pavšala, zlasti nosečnice v zadnjih štirih mesecih nosečnosti in novorojenci, invalidni otroci, mlade invalidne osebe, ki obiskujejo posebne ustanove poklicnega usposabljanja ali izobraževanja, ali osebe, ki so se zdravile zaradi nezgod pri delu ali poklicnih bolezni.
The amount of the daily allowance represents a percentage of your previous income, subject to the social security ceiling.
Dokumenti, ki jih je treba predložiti za izplačilo dnevnih nadomestil
Documents to be provided in order to obtain the daily allowance
Ob odsotnosti z dela (začetna odsotnost ali nadaljevanje), morate:
If you stop working (initial illness or extension of stoppage), you must:
• izpolniti tiskovino o odsotnosti z dela, ki vam jo predloži zdravnik in
You may opt to cover that proportion of health care costs not reimbursed by the compulsory scheme by taking out supplementary insurance with a mutual fund, welfare institution or insurance company.
Za stroške zdravstvenih storitev, ki jih ne krije obvezni sistem, lahko sklenete dodatno zdravstveno zavarovanje pri vzajemni zavarovalnici, skrbstvenem organu ali zavarovalnici.
If you have limited means, depending on the amount you have, you may be able to receive financial aid to obtain supplementary health cover or you may be able to benefit from free sup-
Če imate nizke prejemke, lahko glede na njihov znesek dobite pomoč za dodatno zdravstveno kritje ali pa brezplačno izkoristite dodatno zdravstveno kritje splošnega zdravstvenega kritja.
•fill in the form issued by the physician and
2.1.3 Dajatve za materinstvo in starševstvo
•within 48 hours you must send the first two pages of the document to your sickness insurance fund and the third page to your employer if you are employed.
Zavarovanje za materinstvo krije vse stroške, povezane z nosečnostjo, brez soplačila.
Agricultural and non-agricultural selfemployed workers may also claim cash benefits in respect of maternity or paternity. These are fixed-rate allowances or daily allowances.
Dajatve, ki se izplačujejo samostojnim kmetijskim delavcem ali samostojnim nekmetijskim delavcem, so enake dajatvam splošnega sistema.
The daily allowance amounts to average daily earnings for the preceding three months, subject to the social security ceiling. Compulsory statutory and agreementbased contributions and the general social contribution are deducted.
Nezgodno zavarovanje in zavarovanje za poklicne bolezni krije nezgode pri delu, ki izvirajo iz vašega dela, ali jih leto povzroča, nezgode na poti na delo in z dela ter bolezni, za katerimi se zboli pri delu in so na uradnih seznamih poklicnih bolezni, ali jih neposredno povzroči običajno delo, po strokovnem mnenju odbora za priznavanje poklicnih bolezni.