THIS IS A TRANSLATION ONLY, IN MATTERS OF DISPUTE, PLEASE REFER TO THE ORIGINAL TEXT IN ICELANDIC.
Article 1. The name of the fund, base of operations and fund members
The fund is named Sjúkrasjóður Eflingar-stéttarfélags (The sickness fund of Efling – union). The fund’s base of operations and venue are in Reykjavík. The fund’s members are those from whose wages an agreed upon premium has been paid to the fund in accordance with the collective agreement.
Article 2. The purpose of the sickness fund named Sjúkrasjóðurinn is to serve as a mutual insurance fund for its members.
The purpose of the fund is to offer financial support to fund members who lose income or the equivalent of income because of illness or accidents by providing them with an allowance in cases of accident or illness. Also, to take preventative measures with regards to the safety and health of fund members and reimbursing fund members their sickness- and rehabilitation-costs and by contributing to the re-entry of fund members into the labor market after accidents/illness in cooperation with the rehabilitation fund (Endurhæfingarsjóður).
Article 3. The income of the fund
a) Contractual premiums from the gross pay of fund members.
b) Interest income and dividends.
c) Gifts, contributions and grants.
d) Other revenue decided on during each annual general meeting.
Article 4. The board and management
The fund’s board is to comprise five people and two reserve members. Three of the main members and two of the reserve members are to be elected by the confidential council and the two main members who occupy the position of the chairman and vice-chairman of the fund, are to be elected directly by the board of the union.
The electoral term of the fund’s board is two years. It is to be appointed during the last meeting of the confidential council and the union’s board before the annual general meeting. The electoral results are to be announced during the annual general meeting.
The fund is to be managed in accordance with common administrative rules. The board of the fund sets its own rules of procedure and further regulations regarding the allocation of grants from the fund.
The board of the fund and its employees are to treat all the applications and services of the fund as confidential.
Article 5. Accounts and audits
The accounts of the sickness funds are to be kept separate from other finances within the union. Premium payments to the fund are to be entered in the name of each fund member.
The fund’s accounts are to be presented after having been audited and signed by the inspectors of the union’s accounts and a statutory auditor before the union’s annual general meeting.
All direct costs incurred during the fund’s management are to be paid out of the fund itself.
Annual costs for the reception and office are to be agreed upon by the fund’s board and the union’s board.
The fund’s board is authorized to keep the finances of the sickness fund and the family- and support fund separate, if it is deemed necessary.
Article 6. Assessment by an independent inspector
At least every fifth year, the fund’s board is to hire an actuary or a statutory auditor to assess the future financial standing of the fund. This person is to write a report about his or her findings and submit it to the board.
In assessing the future financial standing of the fund, the operational costs and the fund’s revenues are to be outlined, as well as whether the fund will be able to fulfill its commitments. If the fund is unable to fulfill its commitments, the board of the fund are obligated to submit proposals for how to remedy the situation.
Annual accounts and actuarial valuations are to be submitted to ASÍ in accordance with the current rules of procedure and laws of the federation.
Article 7. The revenues of the fund
It is permissible to invest the fund’s money in the following ways:
a) In government bonds, in bonds which are insured by the state treasury and in bonds which are insured by secure mortgages.
b) By purchasing marketed securities.
c) In banks or savings banks.
d) In anything which is deemed by the board of the fund as secure and which yields a comparable return to the investments in items a) through c).
The board of the fund is also authorized to use the fund’s money to purchase or build social housing belonging to the union, as the fund is, in that respect, its owner.
It should always be insured that the keeping and allocating of funds not contravene the aims or tasks of the fund.
Article 8. The rights of fund members
A. Per diem allowance
Those who have contributed to the fund consistently for at least three months have earned the right to receive a per diem allowance from the fund. The sum of the allowance corresponds to the premium payments and period of contribution to the fund and is earnings-related, in accordance with article 11.
The right to receive a per diem allowance is instituted as soon as contractual or legally mandated payments of wages cease.
If premiums to the sickness fund have not been paid for a fund member, but he can prove via regularly issued pay slips that dues have been subtracted from his wages for the past six months, he is to be afforded the same rights as though the premiums to the sickness fund had been paid. The right to receive a per diem allowance is not instituted if the fund member is entitled to payments for a temporary loss of revenue, such as after having suffered a traffic accident.
The right to receive a per diem allowance lapses when/if the fund member has discontinued his employment because of illness/accident and become eligible for an old-age pension, a disability pension or a rehabilitation allowance from the State Social Security Institute (Tryggingastofnun ríkisins) and/or a pension fund.
A fund member employed by a sheltered workplace earns the right to receive payments from the fund for illness or accidents in accordance with the statements from ASÍ and Hlutverk from May 4th of 2006.
B. Other payments
The board of the fund is authorized to reimburse fund members for their sickness- and rehabilitation expenses. The board of the fund decides on the sums and conditions of reimbursements and changes are to be announced during the annual general meeting.
Reimbursements occur only after 6 months of continuous payments into the fund.
The right to receive reimbursements for the expense of cancer screenings is, however, afforded only to those for whom contributions have been made to the fund for at least 3 consecutive months.
The right to receive reimbursements lapses the moment premiums are no longer contributed to the fund. The board’s fund is, however, permitted to support a board member during the next 24 months after the end of employment because of age or disability, given that the person was a member of the fund at the end of employment and for at least five years leading up to it.
Article 9. Sickness fund communication
A board member who has earned the right to receive payments from the sickness fund of another union within ASÍ, earns the right to receive a per diem allowance from the fund because of illness or accidents after having contributed to it for one month, given that he had previously had that right with the previous fund.
If a board member is employed at more than one workplace and paid into more than one sickness fund at the time of applying for payment, he is to include information regarding to which funds he has contributed. It is permissible to delay the payment of benefits until confirmation has arrived from the other funds of the fact that the board member has not applied for payment. The fund is to seek such confirmation and provide the other funds with a report of benefits paid out to the fund member, as well as the kind of benefits and the sum. The applicant is obligated to attach to his application confirmed information regarding payments from other funds and provide all necessary information regarding wages within the specified application deadline.
Article 10. Reserved rights and authorizations
a) It is permissible to renew a fund member’s right to receive benefits once he has contributed to the fund for one month, given that he previously enjoyed full rights in accordance with article 8 and attends work training, courses or school for up to 24 months before returning to work within the union’s area of coverage. The same applies to a fund member who leaves work for illness, family reasons or for other valid reasons.
b) The union members who take their legal parental leave and have been fund members for at least six consecutive months leading up to the taking of maternity leave, maintain their earned rights if they have paid their dues to the union from their parental leave payments and begin work within the union’s area of coverage as soon as parental leave ends. If a union member is unable to work because of illness/accidents after parental leave and is still employed at his previous workplace, it is permissible to pay him a per diem allowance for up to 3 months, after having consulted the fund’s work rehabilitation counselor, given that the union member has depleted the illness rights enjoyed at his place of employment, but not the right to a per diem allowance from the sickness fund for the consecutive 12 months leading up to the parental leave.
c) The board of the fund is authorized to afford the right to receive a per diem allowance and reimbursements to a member who has been unemployed but paid his dues to the union for the minimum time period as stipulated in item A and B of this article, given that he was a fund member for at least the 6 months leading up to his termination of employment. Authorization to pay out a per diem allowance is, however, contingent on the union member not having fully exploited his right to a per diem allowance in the consecutive 12 months before losing his job, as well as on attending an active work rehabilitation program with the sickness fund counselor.
Article 11. Per diem allowance and reimbursement
A. The sums of per diem allowances
1. A per diem allowance of a fund member for whom premiums have been contributed for 6 consecutive months or longer shall correspond to 80% of his average wages in the 6 previous months, in accordance with his premiums.
2. A per diem allowance of a fund member for whom premiums have been contributed to the fund for 4 consecutive years or more is, in the same way, to correspond to 100% of his average wages in the previous 6 months. The maximum sum of a per diem according to this item is to correspond to kr. 442.250.- per month in accordance with the wage index of July 1st of 2012 and is to alter in accordance with the wage index of July 1st of each year.
3. The maximum sum of a per diem allowance to a fund member who has been a fund member for a shorter time-period than 4 years is kr. 366.875.- per month in accordance with the wage index of July 1st of 2012 and is to alter in accordance with the wage index of July 1st of each year.
4. The average wages of those who earn the right to receive payments from the sickness- and accident-payments from the sickness fund of another union in accordance with article 9 are to be determined by dividing the wages in the reference period with the number of months in which contributions have been made to the sickness fund of Efling.
5. The average wages of those who have not had the right to receive payments from the sickness fund of another union are to be calculated by dividing the wages in the reference period by 6 months, even though the period in which contributions were made is shorter than 6 months.
6. The combined payments from the sickness fund, the State Social Security Institute (Tryggingastofnun ríkisins) or other parties are not to exceed the average wages of the fund member in the previous 6 months.
7. For the maintenance of the right to receive payments from the union’s other funds, 0,7% of the per diem allowance of the fund member is deducted as dues to the union.
B. The period of per diem allowances
1. A per diem allowance in the cases of inability to work because of accidents or illnesses are to be paid out for up to 180 days (6 months), given that 1% of the fund member’s wages has been contributed to the fund or another union within ASÍ for 6 consecutive months, for up to 150 days (5 months) given that contributions were made for 5 months, for up to 120 days (4 months) given that contributions were made for 4 months and for up to 90 days (3 months) given that contributions were made for up to 3 months.
2. A fund member employed by the state, a municipality, a private institution or another employer which pays a lower contractual premium than 1% to the fund, is to be paid in accordance with article 11 of item A for up to 90 days, or up to 30 days if the employer’s illness rights extend to 360 days.
3. The payment period is not to exceed the period of inability to work or the period of illness. If the wages of the fund member have changed significantly in the previous 6 months it is permissible to further assess the income, and then over a longer time-period.
4. The board of the fund is authorized to pay out a per diem allowance for up to 180 additional days once the right to receive a wage related per diem allowance has been exhausted, in consultation with the fund’s work rehabilitation counselor and/or company doctor, given that a 1% premium has been contributed to the fund. It is permissible to pay out, in the same way, to a fund member who has contributed a smaller premium than 1%, for up to 90 days. Payments in accordance with these paragraphs are to correspond to the minimum income as stipulated by the collective agreement at each time.
5. It is permissible to determine a per diem retroactively for up to 3 months after the fund received the application.
6. The right to receive a per diem allowance is renewed every 12 months, in proportion with how it is utilized, counting from the day after which per diem allowance payments end and the payment of premiums resumes.
7. Illness or accidents of spouse or children
A fund member has a right to receive a per diem allowance in accordance with article 11, item A, for up to 180 days for each period of 12 months for the illness or accidents suffered by his children and for up to 90 days for serious illness or accidents suffered by his spouse.
C. Death compensation and reimbursements for expenses
1. a) It is permissible to pay death compensation to the estate of a fund member who dies while employed, is younger than 70 years old and leaves behind a spouse and children. A one-off payment of death compensation to an active and contributing fund member is to amount to no less than kr. 360.000.- per month and is to be paid out in proportion to the member’s employment ratio, given that premiums have been paid for at least 6 consecutive months before his demise. The sum of the death compensation according to this item is calculated in accordance with the consumer price index of January 1st of 2017 (base period index 438,4) and is to change in accordance with changes in the consumer price index on January 1st of each year.
b) Death compensation for an active, contributing member, for whom premiums have been paid for at least 4 continuous years, is not to exceed kr. 450.000.- given the consumer price index of January 1st of 2017 (base period index 438,4) and is to change in accordance with changes in the consumer price index on January 1st of each year. The compensation is to be paid out relative to the employment ratio.
After six months have passed from the end of employment to the demise of the fund member, kr. 13.628.- are deducted, given the consumer price index of January 1st of 2017 (base period index 438,4) and is to change in accordance with changes in the consumer price index on January 1st of each year, for each missing month, though, see article 11.C.2. Other death compensation.
c) If the fund member is not survived by a spouse or children, it is permissible to conduct the payments to the estate in the same fashion if other heirs have given the deceased his funeral and taken on his assets and debts.
2. Other death compensation
At the time of demise of a member who is not in the labor market but was a fund member at the end of employment, the board of the fund is authorized to pay part of the death compensation into the estate of the deceased. The payment is contingent on the deceased having been a fund member for the last 5 consecutive years before his end of employment. The sums in this item are to be determined by the board of the fund.
3. Costly medical procedures abroad
The board of the fund is authorized to reimburse a fund member for expenses related to medical procedures abroad. The reimbursement referred to in this article is not to exceed the per diem allowance amount afforded to those with a minimum wage – according to the current collective agreement of Efling – for up to 90 days.
4. Prevention and rehabilitation grants
The board of the fund is authorized to reimburse the fund members for their expenses related to prevention and rehabilitation. The sums and criterion are to be determined by the board of the fund. The fund is to prioritize the reimbursement of expenses related to cancer screenings and heart screenings, physiotherapy, retraining and treatment and rehabilitation with healthcare providers and training centers.
5. Other authorizations
The board of the fund is authorized to establish other grants in the form of life insurance, death compensation, accident insurance and other health-related insurance.
Article 12. The support fund of Efling – union.
1. Reimbursements and grants
The support fund of Efling is a division of the sickness fund of Efling – union. The fund of the support fund consists of the same individuals who comprise the board of the union’s sickness fund. The board is to decide on reimbursements and grants from the fund. In other respects, the operation of the division is to be run by the official rules of the sickness fund wherever possible. An employee of the sickness fund is also to be an employee of this division. The aim of the fund is to allocate grants and reimburse medical costs and rehabilitation expenses in cases where the members of the sickness fund of Efling do not have a right to a per diem allowance. Reimbursements may only be paid out of the fund if a fund member is facing serious financial difficulties, has not been fully employed for 6 months or has a serious, prolonged illness, is disabled or decrepit.
Furthermore, the fund is authorized to support institutions or organizations who handle matters related to healthcare, humanitarianism or human rights.
2. The board of the sickness fund of Efling is to spend 5% of the premiums of the fund in the previous year to the support fund. The board of the sickness fund is authorized to contribute an additional sum to the support fund if its financial standing should call for it.
Article 13. The duties of fund members, applications for payments and information
Applications are to be submitted in the form decided on by the board of the fund, along with the necessary medical certificates to prove the validity of the payments.
The applicant is, if necessary, obliged to grant the fund’s company doctor authorization to ascertain the validity of the submitted medical certificates and conduct a medical examination if that is called for. A fund member who has been unemployed because of illness/accident is to attend an interview with the fund’s work rehabilitation counselor or submit to a medical examination by the fund’s company doctor or by another medical professional appointed by the fund, should the board of the fund request it. The board of the fund is authorized to support a board member who goes into work rehabilitation. Should the requisite paperwork and data not be sent in by the applicant, the board of the fund is to reject the application for the time being. A fund member who has submitted wrong or misleading information or hidden information regarding his circumstances, foregoes his right. It is permissible to recall all payments thus obtained from a fund member.
Article 14. Nullification
The right to a per diem allowance and reimbursements from the sickness fund detailed in this body of regulations lapses if the application is not submitted to the fund within 12 months from its initiation.
Article 15. Repayment of premiums
Premiums to the sickness fund are non-refundable.
Article 16. Regarding the handling of cases and the duties of the fund
Cases are to be handled in accordance with the pertinent administrative procedures. The board of the fund is obligated to inform fund members of their rights to receive assistance by publishing pamphlets or brochures, in the union’s newsletter and on the union’s website.
Article 17. The right of appeal
Disagreements regarding allocations may be appealed to the union’s board.
Article 18. Register
The board of the fund is to always keep a register over per diem allowances, repayments and accepted applications.
Article 19. Several clauses
Should plagues descend, the board of the fund can temporarily relieve the fund of its fiduciary responsibilities. The board of the fund may also decide to temporarily lower the amount of per diem allowance if the fund’s financial standing appears to be in jeopardy.
Article 20. Changes to the regulation
This regulation may only be altered during the union’s annual general meeting, provided that the announcement of the meeting includes a mention of a change in the regulation being on the schedule. Furthermore, the changes are to have been discussed beforehand during a meeting of the board and confidential council and/or during a general meeting no later than one week before the annual general meeting.
Proposals for changes to the regulation, which certain union members wish to put forth, are to be submitted to the board of the union no later than before the end of March each year.
A simple majority of votes cast is sufficient to pass a change to the regulation.
Changes to regulations which have been approved, are to be sent to the office of ASÍ.
Article 21. Duration: The regulation takes effect on May 1st of 2019
The regulation was approved during the continuation of the annual meeting of the unions Dagsbrún and Framsókn – union on November 12th of 1998, Starfsmannafélagið Sókn (The company union Sókn) on November 3rd of 1998, Félag starfsfólks í veitingahúsum (The union of restaurant workers) on November 15th of 1998 and during a meeting at Iðja, the union of factory workers on November 24th of 1999.
The regulation was changed during the annual general meetings of Efling – union in the years 2000, 2002, 2003, 2005, 2006, 2007, 2008, 2009, 2010, 2012, 2013, 2014 and 2017. The regulation was last changed during the annual general meeting of Efling – union of April 29th of 2019.
THIS IS A TRANSLATION ONLY, IN MATTERS OF DISPUTE, PLEASE REFER TO THE ORIGINAL TEXT IN ICELANDIC.