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Social Institutions Support Programme

Format For reporting on the present state and future of social

security in the countries participating in the SISP

Local project officer:Tanja Kalovska

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ANNEX 1

BLUE BOOK PATTERN I Introduction: Concept and sources of the social security law The social security system (System na socijalna sigurnost) in Macedonia consists of: Social insurance (socijalno osiguruvanje), social protection (socijalna zastita) and family benefits schemes (detska zastita). Social insurance is covering three basic types of insurance: health insurance, pension and invalidity insurance and health insurance. Social protection is an organized activity by the state, in order to prevent and help overcoming the basic social risks to which the citizen, family or groups of population are exposed during their lives.

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The social insurance is used to define the system of contributions and services provided for the employees, self-employees and members of their families in case of certain risks. The main schemes within the social insurance (socijalno osiguruvanje) are: -insurance in case of unemployment (osiguruvanje vo slucaj na nevrabotenost), -- pension and invalidity insurance (penzisko I invalidsko osiguruvanje) comprising the insurance for (old age, death and invalidity), -health insurance (zdravstveno osiguruvanje) and health protection (zdravstvena zastita) (short term incapacity –sickness or injury and health care) Certain areas of insurance are regulated by special laws for each type of insurance listed below, as follows:

- Health insurance: Law on Health Insurance-(Zakon za zdravstveno osiguruvanje) (Official Gazette of the RM Nos. 25/00; 34/00; 96/00; 50/01; 11/02; 31/03) and the regulations on its application;

- For pension and disability insurance: Law on Pension and Disability Insurance-(Zakon za penzisko invalidsko osiguruvanje) (Official Gazette of the RM No. 80/93) and the regulations on its application

- In case of injury at work and occupational diseases: Law on Pension and Disability Insurance (Official Gazette of the RM No. 80/93) and the Law on Health Care (Official Gazette of the RM Nos. 38/91; 46/93; 55/95; 10/04);

- For exercising the rights in cases of unemployment: the Law on Employment and Insurance in a Case of Unemployment-(Zakon za vrabotuvanje I osiguruvanje vo slucaj na nevrabotenost) (Official Gazette of the RM No. 37/97) and the

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regulations on its application. Pursuant to the Constitution of the Republic of Macedonia, the state takes care of social protection of citizens and implements it in accordance with the principle of social justice. The rights of the citizens to social protection are based on the principle of social justice and solidarity.

The social protection system has been established as an organised activity to prevent and overcome the basic social risks to which the citizen, a family or a group of population during their lifetime might be exposed to. As social risks are considered: health risks (disease, injury, and disability), age risks (old age and surviving), maternity and family risks, unemployment and professional inadaptability and risk from inadaptability to the social environment. The Constitution of the Republic of Macedonia (Ustav na Republika Makedonija), includes a detailed provisions regarding the economic and social protection of the citizens. With the fourth amendment from 16 November 2001, replacing the Preamble of the 1991 Constitution, social justice as well as the basic human rights are guaranteed to all the citizens of the Republic of Macedonia. Under Article 1 of the Constitutional Basic Provisions, Macedonia is declared as an independent, sovereign, democratic and social state, while Article 8 of the basic provisions as one of the basic Constitutional values of the Republic of Macedonia is determining the principle of social justice. The social rights can be found in Chapter 2, Part 2 of the Constitution and they include right to a health protection, social security (social insurance) and social protection (Article 32; 34;35;36;37;38; 39; 40; 41; 42). Article 34: “The citizens have right to a social security and social insurance determined with Law and the Collective Agreements” Article 35: “The Republic is taking care about the social protection and the social security of the citizens in coordination with the principles of social righteousness” The Republic is guaranteeing help to the helpless and to the citizens incapable for work. The Republic is providing special protection to the persons with disability as well as conditions for their active inclusion in the society.” Competent Ministries in charge of administering the social security can issue binding regulations, concerning the matters for which they are authorised by law. Jurisprudence does not constitute a source of the social security law, but it can play an important role in its interpretation.

II While the main philosophy and principle of the system of social protection is citizen oriented, the main rights deriving from the social insurance system (with the exception of the health insurance system which is also universal) are employment centred. Health insurance in the Republic of Macedonia is regulated by the Law on Health Insurance. The compulsory health insurance includes almost the whole population of the

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Republic of Macedonia either as insured persons or as family members. It includes the employed persons, self-employed persons, persons doing agricultural or similar business, beneficiaries of pensions and other rights related to pension and disability insurance, veterans, temporary unemployed persons, war and civil invalids, social rights beneficiaries, etc. The insured persons covered by the compulsory health insurance have to pay contribution. Beside the compulsory health insurance, the Law also regulates the voluntary health insurance for the purpose of providing health services which are not covered by the compulsory health insurance. The obligatory pension and disability insurance that is based on the employment record, and also on the principle of social justice and generation solidarity, provides rights in the case of aging, reduction or loss of working capability, death and physical injuries. The rights from the pension and disability insurance are attained and exercised depending on the period and amount of investment in pension and disability insurance. The central activities of the unemployment insurance system are focused on protection of the unemployed - through financial compensation as well as active measures and rights until conditions and opportunities for their employment are created. The rights from unemployment insurance are attained upon the principle of solidarity and mutuality and they are derived from the labour relations. Depending on the period and amount of investment, the period and the amount of the right is determined, provided that the right to financial compensation can not be exercised if the labour relations have terminated by will or guilt of the employee.

II ADMINISTRATION OF THE SOCIAL SECURITY The social insurance in the Republic of Macedonia is governed by the following authorities:

- the Ministry of Labour and Social Policy (Ministerstvo za trud i socijalna politika): responsible for development of policy and supervision of all types of social protection, except for health care.

- the Pension and Disability Insurance Fund of the Republic of Macedonia (Fond za penzisko i invalidsko osiguruvanje) with the regional offices is an independent body, but under supervision of the Ministry of Labour and Social Policy. The Fund is responsible for implementation of the legislation on pension and disability insurance.

- The Employment Agency (Agencija za vrabotuvanje) with its local employment centres is responsible for the rights to unemployment benefits and for implementation of active measures and labour market policies. The Agency is also an independent body under supervision of the Ministry of Labour and Social Policy.

- The Ministry of Health (Ministerstvo za zdravstvo) is responsible for policy creation of health care and protection.

- The Health Insurance Fund (Fond za zdravstveno osiguruvanje) is an independent institution. Supervision of the legality of the Fund’s work is carried

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out by the Ministry of Health. The Fund is responsible for implementation of health insurance.

Health Insurance Fund of Macedonia has been established as a sole and independent financial institution effective on the entire territory of the country. The Health Insurance Fund has its branch offices in municipalities where the insured persons can exercise their health care rights. All the funds for mandatory health insurance are collected by the Health Insurance Fund and the Fund ensures the payment for the health services delivered in a uniformed way, as well as that the, health sector and the health care services covered by health insurance are financed accordingly.

The Ministry of Labour and Social Policy deals with labour relations, employment and employability, pension and disability insurance, occupational protection, financial support of the temporary unemployed, wages and standard of living; social policy; social protection of the population not capable for work and social protection of the population capable for work but financially insecure, humanitarian population policy aiming at harmonious economic development; legal marital relations, family and common law marriage; relations between parents and children, guardianship and adoption; improvement of gender equality; protection of children and underage persons; protection of youth and women; protection of persons with disabilities; protection of civil war invalids and of the families whose provider is doing military service; protection of veterans of the World War II and all wars for national liberation of Macedonia, of the war invalids, of persons prosecuted and imprisoned for the ideas of independence of the Macedonian people and the state and the members of their families who are not able to provide for their material and social existence; supervision within its competencies and other issues determined by law.

Integral parts of the Ministry of Labour and Social Policy are the Directorate for Veterans’ and War Invalids’ Issues and the State Labour Inspectorate.

Social Protection Institutions

- Social Work Centres (Centri za socijalna rabota) The Social work centres are public institutions established for the area of one or more municipalities. There are 27 inter-municipal centres for social work established in the Republic �f Macedonia with local competency for all municipalities. The social work centres provide services for the citizens, families and population groups exposed to social risk and undertake measures for social prevention, non-institutional care, institutional care, and rights to social assistance.

Pursuant to the Law on Social Protection, Social Work Centres are responsible for the following affairs within their public authorisations:

- dealing with the rights related to social welfare regulated by the Law on Social Protection

- dealing with affairs regulated by the regulations related to family law - proceeding upon affairs regulated by regulations related to penal law

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- dealing with rights regulated by the Law on Child Care such as child benefit, special allowance and assistance for a newborn child.

Under the authority of the Ministry of Labour and Social Policy there are also 11 institutions for accomodation of vulnerable groups in the sociaty such as: children without parents, elderly people etc.

In close cooperation with the Ministry the Institute for advancement of social activities (Zavod za socijalna zastita) carries out research and development functions compatible with the needs of the social protection system, monitors the problems and issues related to child care, family, groups of population exposed to social risk, and supervises the work of the social work centres and social protection institutions. The work of the Institute is regulated by the Law on Social Protection.

III PERSONAL SCOPE OF APPLICATION

Please note that the term self-employed is not used in the Macedonian legislation. Instead of term self employed the national legislation is using the term people conducting individual business.

According to the Law on health insurance, the obligatory health insurance (zdravstveno osiguruvanje), is covering: 1.employed persons; 2. persons that are elected or appointed on constant duties, public and other functions, and are receiving salary for conducting this functions; 3. citizens of the Republic of Macedonia that are employed at foreign employers, or are in service at foreign missions, organisations, foreign diplomatic representations or are in personal service at foreign citizens at the territory of the Republic of Macedonia; 4. self-employed persons; 5. people working in agriculture, 6.pensioners 7.temporary unemployed persons that are receiving an unemployment benefit, as well as unemployed persons that are registering themselves at the Agency for unemployment; 8. Participants in the Second World War, war invalids, war veterans and members of their families; 9. users of social assistance, 10.citizents of the Republic of Macedonia working abroad in case they are not insured in the specific foreign country where they are staying and working 11.foreign citizens and people without citizenship employed at foreign companies working at the territory of the Republic of Macedonia, or are in service of the international organisations, foreign diplomatic representations, or in personal service at foreign citizens enjoying diplomatic immunity;

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12.members of the family of the insured person who is conducting the regular military service within the Macedonian Army; 13.Prizoners, and juvenile delinquents 14.People working in the religious institutions; Obligatory health insurance is also provided to the family members of the insured person (in case that they are not insured upon some of the basis listed above) According to the law as family members can be considered: spouse and children). There is also a voluntary health insurance that is established for providing health services that are not covered with the obligatory health insurance. In Macedonia people entitled to a pension and invalidity insurance (penzisko i invalidsko osiguruvanje) are: -Employees in public and private sector; -Persons employed in the Army -persons elected or appointed on a public function -citizens of the Republic of Macedonia that on the territory of the Republic are employed at foreign or international organisations, institutions, representations, or are at personal service at foreign citizens; -citizens of the Republic of Macedonia employed abroad, in case for this period they are not insured in their country of employment; -citizens of the Republic of Macedonia employed at foreign employer, in a state in which they are obligatory insured, but the rights from pension and invalidity insurance can not be realised or be used outside this state; -physical persons conducting activity; - disabled persons due to labour accidents or professional diseases for the period of their prequalification or until they are waiting for their reallocation at another working place; -farmers -non-employed persons that are receiving the unemployment benefit; -independent artists in case that they have received this kind of status in accordance with the criteria determined by the Ministry of culture; -sportists that have a status of a top sportists amateurs, in case they are not insured under any other condition; The survivorship pension can be given to a family member ( spouse, children or parents). Right to the unemployment benefit (beneficii vo slucaj na nevrabotenost) has a person that has been employed at least 9 months (continuously) or 12 months (with interruptions) in the last 18 months. The entitlement to social help services and benefits depends on nationality and residence. The beneficiaries are citizens of the Republic of Macedonia and foreigners with residence permit. Under the term social help (socijalna pomos), the following categories are included: -Permanent social assistance (postojana paricna pomos) - (cash payment) to the people incapable of working and socially endangered;

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-right to a health care; -Social assistance (socijalna pomos) - (cash assistance) for people capable for work but socially endangered; -cash benefit for other care; -benefit for salary for a half working time due to the care provided to a handicapped child; -one cash payment (ednokratna paricna pomos), or benefit in kind -housing right Regarding the family benefits: one of the child’s parents who is a citizen of the Republic of Macedonia with a permanent residence attains the right to a child benefit for a child being a citizen of the Republic of Macedonia and attending full time education in the country, in cases when they are: employed; beneficiaries of a pension or of a permanent financial benefit; unemployed and receiving financial compensation; a farmer being tax payer for a revenue from agricultural activity as the only and main occupation; an artisan who is in business of an old craft or a craft in short supply. A foreign citizen with a residence on the territory of the Republic of Macedonia can attain the right to child benefit in accordance with the Law on Child Care.

IV Risks and benefits

IV.1. Old age (Starosna penzija)

In regard to the income security in the old age, a three-pillar public-private mix pension system has been adopted in the Republic of Macedonia. It is based on:

- The first pillar – the obligatory pension and disability insurance based on generational solidarity;

- The second pillar - the compulsory fully funded pension insurance based on individual capital savings;

- The third pillar - the voluntary pension insurance based on individual components.

The obligatory pension and disability insurance of the first and the second pillar, through which financial and social security for the old age are provided represent compact elements, which can be seen through the following :

- Uniform conditions and eligibility criteria (circle of beneficiaries and other conditions for admission to insurance;

- Both the first and the second pillars are obligatory; - Equal conditions for acquiring the right to age, disability and family pension; - Correlation between two pillars in the determination of the pension: when

pension from the first pillar is attained, an annuity is being attained at the same time, i.e., program drawing of the funds of the second pillar.

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The funds of the pay-as you - go system are provided by contributions and they are used for a payment of a current pension. The aforesaid pension system provides pension defined according to a prior determinate formula, and shall (from 1 January 2006) bi financed by a contribution rate 13,78%. The rates regarding pension and disability insurance are acquired in case of age, disability and death.

The obligatory fully funded pension insurance is be financed with a capital component, and a previously defined contribution. The contribution rate for the second pillar amounts 7,42% of the employee gross salary.

The pensions are calculated in accordance with the monthly wage average and contributions realised in the period from 1 January 1970 until the end of the insurance of the worker. This is the pension basis and the amount of the pension is calculated and the percentage of the pension depends of the length of the working period (the worker needs to have at least 15 years of working period in order to realise a right for a pension. The longer the working period is, the higher amount of pension the insured person receives). Only the salary earned in Macedonia is taken into account when determining the pension base, but when it comes to the percentage of the pension a working period spend in another country with whom Macedonia has a bilateral agreement on social insurance is also taken into account.

The basis of calculation and payment for contribution i.e. the basis for contribution shall not be lower than 65% of the average net salary of the employee in the Republic of Macedonia, published for the current month (except for the individual farmers)

The basis for salary and contribution collection, can not be higher than the amount of three average salaries per employee in the Republic of Macedonia published in current month.

Insured person reaching the age 64 for man, and 62 for women and at least 15 years of working record are entitled to an old age pension. Conditions for an age pension have been stiffened during the transition period, starting from 1st of September 2000, until 31st of December 2007, comparing to the conditions determinate by the Law in effect, until 31st August 2000.

Old age pension may be acquired by a insured person of 35 year of work record (women), and 40 years of working record (man) that have reached 28 years length of services (women) and 33 years of services (man), on the 1st of September, 2000. The right of an age pension by establishing work record of 35 years (women) or 40 years work record (man) may be also acquired by the insured person who work record is calculated with increased duration, latest by 1 st of September, 2005.

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IV.2. Death (Semejna penzija)

Members of the insured person family are entitled to a family pensions as follows: -after death of the pensioner; -after death of a beneficiary who had paid contribution at least 5 years or had at least 10 years of work record with paid contributions , or who had fulfilled conditions for an age or disability pension. If death occurred as a consequence as an injury at work or an occupational disease, the right shall be acquired without the condition of duration of work record.

Members of the family who attain the aforesaid right are the follow:

-The spouse (widow or widower) at the age of 45 or 55 respectively, or who is a guardian of a child , or who is unfit at work.

-A spouse who have reached the age of 40 (widow) or 50 (widower) on the date of the death of the beneficiary, acquires of a aforesaid right with the age 45, or 55 respectively.

- Divorced spouse attains the aforesaid rights if already receiving maintenance - Children to the age 15-26 in case they are in formal education. - Children supported by the deceased beneficiary and who are unfit of work. -Parents of the insured person if she/he supported them

IV.3. Incapacity for work (Nesposobnost za rabota) Sickness (boleduvanje) Salary compensation during temporary disability for work due to sickness or injury (sick leave) and salary compensation during absence from work due to pregnancy, child birth and maternity can be acquired by all employed persons, in accordance with the legislation related to labour relations, who earn the salary by working and the persons who are self-employed and earn their salary by working and were prevented to work due to sickness, injury, child expecting or newborn child care. Salary compensation may be acquired if the contribution for obligatory health insurance has been paid regularly and if the temporary disability for work has been given by a chosen doctor or a medical commission of the Fund, in cases of disability for work for periods exceeding 16 days. Base for calculating of the compensation for salary is the average monthly amount of the net salary for which the contributions for obligatory health insurance have been paid for the last six months prior to the occurrence of the case by which the right to compensation has been acquired, i.e., prior to the start of the sick leave. The amount of the salary compensation during temporary disability for work shall be determined by the employer or the Fund, depending who is providing the compensation

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(with the general legal act), but it shall amount at least 70% of the base for calculation of the salary compensation. The salary compensation amounts to 85% of the base determined in cases when it is charged to the Fund, with regards to all the other cases for which compensation is to be paid, except for injury at work and professional disease, donation of blood, tissue or an organ and absence from work due to pregnancy, child-birth and maternity when the compensation amounts to 100 % of the base thereof. Payment of the salary compensation for up to 60 days of disability for work shall be made out of the employer’s funds, and as for absence for a period longer than 60 days, out of the Health Insurance Fund, except in cases of care for a sick child up to age of three, donation of blood, tissue or an organ and absence from work due to pregnancy, child-birth and maternity being paid from the Fund as of the first day of occurrence. Payment of the salary compensation during temporary disability for work may be stopped in cases when the insured person does not arrive at the appointed medical examination and treatment, or does not observe the doctor’s recommendations consciously, if he/she works for paid income during the temporary disability for work, and if they are employers who have no other employees, but acquire incomes during that period, meaning that he/she works.

Disability. Pursuant to the Law of pension and disability insurance, disability is a permanent decrees or loss of the working ability incurred by an injury occurred out of work or by a disease, or by injury at work or an occupational disease.

In cases when disability occurred as a injury at work or as an occupational disease, the rate of disability pension shall be acquired disregarding the actual work record. The benefit will be calculated the same way as it is calculated for the old age pension, for 40 years of working period (men) or 35 years of working poeriod (women), and it will equal for 80% of the pension basis. In additional allowance for disability for disability pension attained on grounds of lost working ability incurred before the age (62) women, and (64) man is determined depending of the work record.

The demand should be launched by the employer or the employee to the branch office of the Fund for pension and disability insurance. The incapacity for work is evaluated by the Commission for evaluation of the working capacity in PDF (Fund for pension and disability insurance).

The Commission for evaluation of the working capacity is composed of: doctors specialist in various areas. There is one more Commission for revision of the work of the previously mentioned Commission that is formed by the Ministry of Labour and Social Policy and composed also by the doctors specialists in various institutions. Maternity (porodilno odsustvo) Payment of the salary compensation (the whole amount of the salary) during temporary disability for work shall be made during the period of disability for work, and the payment of the compensation during pregnancy, child-birth and maternity shall be made for a period of nine months, and in case of giving birth of more than one child, up to one year (Article 165 of the Labour Relations Law).

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IV.4. Unemployment (Nevrabotenost) The right to financial benefit in case of employment termination is provided by the Law on Employment and Insurance in Case of Unemployment (Official Gazette of the RM Nos. 37/97,25/00,101/00, 50/01; 7/02; 25/03; 37/04, 04/05).

The right to financial benefit is reserved for unemployed persons who were continuously employed for at least nine months or discontinuously employed for twelve months during the last eighteen months and whose employment has been terminated without their guilt or will.

Pursuant to Article 67 of the Law on Employment and Insurance in Case of Unemployment, the right to financial benefit is not reserved for unemployed persons whose employment has been terminated due to:

- Submission of a written statement by the worker that he/she wishes to terminate his/her employment, unless the statement has been filed because of the spouse’s change of address or due to marriage;

- Termination of employment by agreement; - Exercising employment rights against the law; - Termination of employment enforced by law, except in cases of legal entity

termination due to bankruptcy; - Unjustified absence from work for three consecutive work days or for five

discontinued work days in the course of one year; - Termination of employment on the basis of employer’s notice of violation of

working discipline or to nonfeasance of the responsibilities determined by the law, the collective agreement and the employment contract;

- Refusal to fulfil the working duties of the position they have been reassigned to in compliance with the law;

- Refusal to be reassigned with another employer by agreement, in compliance with the law;

- Refusal of training, retraining or additional training for another position with the same or different employer which has been provided to them in compliance with the law;

- Loss of working ability according to the pension and disability insurance regulations;

- Fulfilling the conditions for exercising the pension rights. Article 68 of the Law on Employment and Insurance in Case of Unemployment lays down the amount of a monthly financial benefit during unemployment at 50 % of worker’s average monthly net salary in the last 24 months for the persons entitled to financial benefit for up to 12 months, and 40% for the persons entitled to financial benefit for longer than 12 months. The financial benefit may not be higher than 80 % of the average monthly net salary in the Republic of Macedonia set out for the previous month.

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Pursuant to Article 71 of the Law on Employment and Insurance in Case of Unemployment, the financial benefit payment period depends on the period during which the unemployed person has been insured for unemployment. An unemployed person that has been insured for more than 15 years, but still lacks at least 5 years to become eligible for old-age pension, is paid a financial benefit until his/her employment, i.e. until any of the conditions for termination of the financial benefit right is not fulfilled.

Pursuant to Article 77 of the Law on Employment and Insurance in Case of Unemployment, the right to unemployment financial benefit terminates if the person:

- Commences employment; - Establishes a trade company, enterprise or other legal entity; - Carries out artisanship or another professional activity; - Refuses to report to the employer he/she has been sent to by the Employment

Agency in order to commence employment; - Refuses to commence employment with the employer he/she has been sent to by

the Employment Agency; - Refuses full-time employment or part-time employment not shorter than half of

the full-time, which is compatible to his/her education, skills and abilities; - Refuses training, retraining or additional training compatible to his/her

professional qualifications, skills and abilities, or willingly terminates training, retraining or additional training;

- Fulfils the conditions for acquiring the pension rights or retires; - If a competent service finds out that the unemployed person works or is engaged

in an illegal activity; - Loses the working ability on the day of determination of the working ability

loss; - Unjustifiably refuses temporary employment in extraordinary circumstances

(floods, earthquakes, necessary agricultural work etc.) which is organised by a competent body for elimination of consequences or prevention of occurrence;

- Refuses engagement in public works; - Refuses employment at a position requiring lower qualifications than theirs if

before the unemployment they had willingly worked at such a position or had stated that they would have accepted a job requiring lower qualifications;

- Starts serving an imprisonment sentence of more than six months; - Does not report at the Employment Agency at the set date; - Unjustifiably does not report to the Employment Agency upon an invitation; - Within eight days does not notify the Employment Agency of every change that

is a condition or grounds for acquiring, realisation or loss of the right to financial benefit.

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IV.5. Health care and care (Zdravstvena zastita) Health care The Macedonian Constitution guarantees the right to health care to all citizens of Macedonia, and the right and obligation to protection and improve their own and the health of others. Every citizen of the Republic of Macedonia is entitled to health care in accordance with the Law on Health Care (Zakon za zdravstvena zastita)-(“Official Gazette of the RM” Nos.38/91, 46/93, 55/95, 17/97, 10/04). Health care is organised at three levels of care: primary, secondary-consultative and tertiary. The primary health care is the basis of the overall health system and provides basic health care at municipality level. Health care is also delivered by the private health care organisations which most often are established as primary health care practices or as specialist practices. The number of private hospitals that provide secondary health care is very small.

The health care system of the Republic of Macedonia as defined by the Constitution and the Law on Health Care (“Official Gazette of the RM” No.38/91, 46/93, 55/95, 17/97, 10/04), represents the basis of the current system of health care delivery in Macedonia. It includes the basis of the health insurance system, the rights and responsibilities of beneficiaries and the rights and responsibilities of service providers, the organisational structure of the health care system and utilisation of health care funds. The Law also defines the areas of responsibility of individuals, employers and the Government in respect to the health status and protection of health. The Constitution of the Republic of Macedonia clearly defines the principle of universal access to health care. Law on Health Care and later a special Law on Health Insurance (Zakon za zdravstveno osiguruvanje) (“Official Gazette of the RM” Nos. 25/00, 34/00, 96/00, 50/01, 11/02 and 31/03) established mandatory health insurance which renders possibility for health insurance coverage of the entire population of the country . The rights to health care are attained in the existing health care system consisted of, public and private health care organisations. Health care is easily accessible to the population because it is carried out by a wide network of health organisations. The appropriate geographic distribution of health care institutions provides approx. 90% coverage of the population who can receive medical assistance Additional forms of health insurance were also introduced. Since 1991 the private health institutions in Macedonia have been established in parallel to the public health institutions. This means that the health care rights are exercised in the existing health care system consisted of public and private health care organisations The primary health care reform increased the possibility for selection of a doctor by the patient and established a system of payments to private doctors on the principle of capitation. By the adoption of secondary legislation on payment of capitation in the primary health care, payment of participation, and priority preventive programmes, progress has been made in these areas. Five hundred private doctors have signed contracts with the Health Insurance Fund to be paid on the capitation principle.

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Care When a person has no appropriate living conditions at their family’s, or when a family is not in a position to take care for a member thereof due to various reasons, a possibility for permanent care and accommodation thereof is being taken into consideration. Public and private institutions for social welfare and foster families are the resources for the aforesaid care. The 1997 Law on Social Protection provides for privately owned institutions of the aforesaid type. The process of deinstitutionalisation is carried out and supported actively in the Republic of Macedonia by means of alternative and additional types of care and accommodation of the beneficiaries in need of permanent care, such as expanding the day care centres network, accommodation in foster families and acceptance by the primary families. IV.6. Family

Child benefit is provided as allowance for covering part of the expenses for raising and development of a child. Procedure and method of attainment of the right to a child benefit, as well as the amount of the child benefit are regulated by the Law on Child Care, Official Gazete 113/2005-(Zakon za zastita na decata) (2000, 2003, 2004 and 2005) and by the Statutes on Conditions, Criteria and Method of Attainment of the Rights Related to Child Care (2003 and 2004). The child benefit is attained depending on the age of the child and on the financial situation of the family. One of the parents or of the guardians of a child up to the age of 18 is entitled t o a child benefit if the child attends school regularly, or the child is completely and permanently unfit for work, or is likely to stay unfit for work for a period longer than one year, or who cannot study due to illness, but not after the child reaches the age of 18. One of the parents is entitled to a child benefit for all the children they support, that follow under the following category: legitimate or illegitimate children; adopted children; grand children; brothers; sisters; as well as other children whom they support. Children that are under guardianship care are entitled to child benefit if:

- their parents are completely or permanently disabled for work, - their parent serve an imprisonment sentence, - their parents have been deprived from parental rights thereof and - their parents attend full time education.

The benefit is received by the guardian of the child. Children taken to be supported are entitled to child benefit only in case when both the parents and the children have no property or revenues for support. A child without parental care accommodated in a foster family is entitled to child support. The material situation of the family is assessed according to the total revenues and income of the family for the period of the previous year and the number of the family members.

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The limit of the average monthly revenues and income per member of family necessary for attainment of the right to a child benefit is 16% of the average salary paid per worker in the Republic of Macedonia during the first half of the previous year, and 32% per worker in the Republic of Macedonia during the first half of the previous year as for a single parent. The child benefit for children up to 15 years, i.e. for children attending primary school amounts to 4,60% of the average salary paid per worker in the Republic of Macedonia during the first half of the previous year, and for children from 15 to 18 years old, i.e. children attending full time secondary education, 7,30% of the average salary paid per worker in the Republic of Macedonia during the first half of the previous year. Special allowance A special allowance as financial compensation is provided for children with specific needs having impediments of physical or intellectual development or combined impediments in the development up to the age of 26. A child having specific needs is defined as a child with hard, acute or severe impediments in physical development, moderate, serious or profound mental disability, most serious forms of chronic diseases, highest degree of seriousness of detriment of sight, hearing or speech and combined types of developmental impediments. A person or a guardian attains the right to a special allowance for children in case they both have a permanent residence in the Republic of Macedonia and if the child is a citizen of the Republic of Macedonia. The aforesaid right shall be attained disregarding the financial situation of the family, the number of children or the whereabouts of the school the child is attending. Apart from the right to special allowance, parents who have a residence permit, may also attain the right to child benefit in case they fulfil the conditions for attainment of right to child benefit provided by the Law on Child Care. This means that people with residence permit are equal with the Macedonian citizens when it comes to the possibility of using the child benefit and special allowance. Special allowance shall amount to 27% of the average salary paid per worker in the Republic of Macedonia during the first half of the previous year. Asistance for a newborn child Right to assistance for a newborn child t shall be provided for the first newborn child as a financial compensation, and it is a one-off benefit for the family. The right shall be exercised by either of the parents who are citizens of the Republic of Macedonia having permanent residence in the country pertaining to a child born in the Republic of Macedonia. The aforesaid right is attained for every first born child and it is calculated in dependance of the average monthly income of the household, realised in the last 3 months prior to the submited request. . The assistance for a newborn child shall amount up to 25% of the average salary paid per worker in the country during the first half of the previous year. It should also be mentioned that there are 11 public institutions accommodating number of beneficiaries in the Republic of Macedonia. The mentioned institutions are accomodating: children without parents or without parental care; children having educational and social problems and juvenile delinquents; disabled children and adults; old aged people and other vulnerable categories.

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IV.7. Need

The Social Protection Law (Zakon za socijalna zastita) (Official Gazette of the RM No. 50/97, 16/00 17/03 and 65/04) provides a special system of social care. This law stipulates the following rights:

- The right to permanent financial benefit (pravo na postojana paricna pomos); The right to a permanent financial help has a person, who is socially insecure and

unable of working, and is not in condition to provide means for his/hers own existence on the basis of other sources.

- The right to one-off financial benefit and benefit in kind (pravo na ednokratna

paricna pomos); The right to a one-off financial benefit, or a benefit in kind has a person or a family, that has been exposed to a social risk, in terms of natural disaster, epidemic, longer medical tretment in the health institution , or other social crisis.

- The right to social benefit.

The system of social protection provides a right to a social assistance in the form of financial compensation for the following categories of citizens:

- permanent financial assistance to persons unfit for work and socially insecure - social financial assistance for persons capable to work and socially insecure.

According to the Law, the socially insecure is a person who does not have an income, or whose incomes from all sources, all lower than the permanent financial benefit determined by the Law. Persons who are unfit for work and socially insecure and who may not provide finances for sustenance by virtue of other regulations, have the right to a permanent financial assistance. Persons with moderate, hard and serious impediments in the intellectual development thereof, and persons with physical impediments, single mothers during the last month of pregnancy and single parents of children up to 3 years of age, children up to age 15 or up to age 26 in case they attend full time education, as well as persons older than 65, are deemed to be incapable for work. The permanent financial assistance as a fundamental financial right of a beneficiary shall be determined according to the average monthly net salary per worker paid during the last three months in the Republic of Macedonia.

- as for single beneficiaries, 20% of the aforesaid salary; as for beneficiaries with one fellow beneficiary, 28% of the aforesaid salary; and as for holders with two or more fellow beneficiaries of the right, 40% of the aforesaid salary.

Social financial assistance may be attained by persons fit for work and socially insecure who may not provide money for sustenance by virtue of other regulations. Detailed conditions, criteria, methods and procedures for establishment and attainment of the right to a social financial assistance are regulated by a Decision brought by the Government of the Republic of Macedonia.

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The social assistance for a one member household shall amount to 57% of the relative poverty line calculated. The competent Social Work Centre deals with the rights of social welfare beneficiaries in the first instance. The first admission of the citizens in the social work centres is realized by the social workers. Consideration of the application and carrying out of the procedure shall be made by a professional team using individual work with the applicant, their family, group work, family visits and other professional and administrative methods. Documents enclosed with the demand shall also be considered. An application of a citizen shall be dealt with by a decision within 30 to 60 days. The right to a financial social assistance shall be attained in accordance with the Law on Social Protection and the Decision on conditions, criteria, amount, method and procedure for determining and exercising of the right to a financial social assistance. The application shall be filed once a year and the beneficiary shall deliver documents for the family income once a trimester. Regarding the documents necessary, citizens obtain them at several institutions; therefore an institutional connection by means of an electronic network is necessary for the purpose of inter-departmental data exchange. Social work centres make inspections in the households at least two times per year. The Supervision of the legality of the work of social work centres is carried out by the Ministry, and the supervision of the professionalism with regards to the work is carried.

V Financing

Health care Health care in the Republic of Macedonia is funded by several sources. The most significant source for financing are the funds from the contributions paid by the employer or obligatory health insurance providing for more than 90% of the total funds for health care and the rights related to it. Apart from the funds from contributions, health care is also funded by revenues from the financial participation of the beneficiaries; from the Budget of the Republic; from enterprises and organisations, from citizens as users of medical services; from donations and from other sources.

The compulsory health insurance is managed by the Health Insurance Fund. In 2000, the Health Insurance Fund separated from the Ministry of Health.

Social Protection Social protection is funded by the Budget of the Republic of Macedonia. The financing of the social welfare is being carried out on the basis of an annual Programme for social welfare being passed by the Government of the Republic of Macedonia.

Pension and disability insurance Pension and disability insurance, is funded from contributions paid by the employer. The Budget of the Republic also participates in the funding of pension and disability insurance. The Budget provides funds for financing of pensions attained under more favourable conditions, as well as for covering of lack of funds of the Fund for pension and disability insurance.

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The rate of contribution for pension and disability insurance at the moment amounts to 21,2% of the gross salary. The Pension and disability insurance Fund pays a contribution for health insurance of the beneficiaries. Unemployment Sources for financing of the rights deriving from the unemployment insurance are the following:

- employment contribution being calculated and paid by employers from the gross salary of the employees;

- the Budget of the Republic of Macedonia and - other sources.

VI Judicial review

There are no specialized labour - social courts in the Republic of Macedonia.

The procedures for attainment the rights and obligations related to health insurance are provided by the Law on General Administrative Procedure. The procedure is being initiated upon an application of the insured persons or a member of their family. The application shall be filed in writing. A regional service of the Fund or the Fund is obliged to bring a decision regarding the filed application and to deliver it to the applicant thereof. The applicant has a right to a complaint to the Minister of Health in the capacity of a second instance authority against the aforesaid decision of the Fund. The complaint shall be lodged within 15 days as of date of receipt of the decision. The Minister of Health shall bring a decision and deliver it to the applicant within two months as of date of filing of the complaint at the latest. The insured person shall be provided with a judicial protection of his rights against the decision of the Minister. Judicial protection is carried out by means of administrative proceedings before the Supreme Court of Macedonia in accordance with the Law on Administrative Disputes. The rights related to pension insurance and the rights related to disability insurance are different because they are acquired depending on the period and amount of investment in the funds for pension and disability insurance. The procedure is provided through the Technical Service of the Pension and Disability Insurance Fund, having regional units throughout the country. Regarding the old age, and survivors pensions the demand should be launched at the branch office of the Fund for pension and disability insurance.

Regarding the invalidity-the demand should be launched by the employer or the employee to the branch office of the Fund for pension and disability insurance. The incapacity for work is evaluated by the Commission for evaluation of the working capacity in PDF (Fund for pension and disability insurance). In case a person wants to

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launch a complain he/she can apply to the Governmental Commission for solving the rights from the area of pension and disability insurance. The incapacity for work is evaluated by the Commission for evaluation of the working capacity in PDF (Fund for pension and disability insurance). The Commission for evaluation of the working capacity is composed of: doctors specialist in various areas. There is one more Commission for revision of the work of the previously mentioned Commission that is formed by the Ministry of Labour and Social Policy and composed also by the doctors specialists in various institutions. If the insured person is staying g in another country, then the Commission in that country is making the control, but it is submitting g the results to the Macedonian Fund for pension and invalidity insurance. Check ups are only possible in Macedonia. The same procedure applies regarding the professional diseases and labour accidents. Against the decision made by the Fund for pension and invalidity insurance for old age, survivors pension, invalidity, incapacity for work, professional disease and labour accidents, there is a possibility of appeal to the Commission formed by the Government of the Republic of Macedonia, or to the employer 15 days after the receipt of the decision by the Fund. This is the second instance, while in a further process against the second instance decision the individual can launch an administrative dispute in front of the Supreme Court. Unemployed persons exercise their rights related to insurance in case of unemployment in accordance with the Law on Employment and Insurance in Case of Unemployment and with the regulations for general administrative procedure on grounds of applications filed at the Employment Agency where the unemployed person is registered. The procedure for attainment of rights during the period of unemployment shall be conducted and the decision shall be brought by the administrator of the Employment Centre where the unemployed person is registered, which means that the rights determined by the Law on Employment and Insurance in Case of Unemployment are dealt with by the Ministry competent for labour affairs in the first instance. A complaint against the aforesaid decision does not delay the execution thereof. The right to a financial allowance is being exercised by the unemployed person by means of filing an application at the Employment Centre where they are registered as unemployed. The competent Social Work Centre deals with the rights of social welfare beneficiaries in the first instance, according to the place of permanent or temporary residence of the beneficiary. The Ministry of Labour and Social Policy deals with complaints in the second instance procedures and the judicial protection is provided by means of initialising administrative proceedings before the Supreme Court of the Republic of Macedonia. The Law on General Administrative Procedure applies for conducting of the aforesaid proceedings.

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