Sickness benefits – conditions
To acquire the right to sickness benefits, the employer needs to have paid premiums to the fund for at least the last six months before the accident/sickness occurs.
Premium amount depends on the employer
The agreed premium amount depends on the employer. In the private labour market, employers pay a premium which is equivalent to 1% of the employee’s wages. Public institutions and companies, i.e. the state, municipal authorities and private, non-profit institutions such as nursing and residential care homes, as well as privately operated preschools, pay a lower premium to the fund. Employees of public institutions and companies are entitled to a shorter period of payments from the fund, but their sickness leave rights within the workplace are considerably more than in the private labour market.
Sickness benefits are paid to members who are without wages due to sickness or accidents, and who have made full use of their sickness rights with the employer.
Sickness benefits are income based If premiums have been paid to the fund for the past 6 consecutive months, sickness benefits can amount to up to 80% of wages. However, the total benefit amount from Efling and the Icelandic Health Insurance combined cannot exceed ISK 801.624 per month.
If premiums have been paid for a shorter period
Full rights are based on 6 months premiums to the fund. When calculating average wages, it is always done by dividing by 6 months, even if premiums have been paid for a shorter period.
Transfer of rights between unions
The transfer of rights from a different trade union within the Icelandic Confederation of Labour (ASÍ) is possible if premiums have been paid to Efling on behalf of the member for at least 1 month, and to another trade union within ASÍ for at least the 6 months prior to that.
In those cases, the divisor number is the number of months with premiums paid to the Efling Sickness Benefits Fund. Sickness benefits are calculated based on premiums to the fund, which are proportional to wages.
100% income-based
If consecutive membership has lasted for 5 years or longer, sickness benefits can amount to up to 100% of wages. However, the total benefit amount from Efling and the Icelandic Health Insurance combined cannot exceed ISK 966.319 per month.
Consecutive membership is defined as such that the member must have been paying for a total of five years or longer, and that payments must have been made to the fund for a minimum of 54 of the last 60 months before the sickness benefits period begins.
When are sickness benefits not paid?
Sickness benefits are a temporary assistance. The fund does not pay if a member is entitled to payments from the Social Insurance Administration (Tryggingastofnun) or a pension fund, such as disability benefits, rehabilitation pension or old-age pension/retirement
benefits. The fund does not pay in the case of accidents covered by insurance, such as traffic or work accidents. In such cases, the insurance company should reimburse the member for temporary work loss. The right to sickness benefits expires if it is not sought within 12 months from when the right was created.
Sickness benefits renewal
The right to sickness benefits is renewed proportionately in 12 months while working and paying to the union.
Duration of Sickness Benefits and conditions – Employees in the private labour market
Duration of Sickness Benefits Employees in the private labour market
- After 6 months of premiums to the sickness benefits fund, the fund pays up to 120 days for a member’s own sickness/accident.
- After 5 years continuous membership to the sickness benefits fund, the fund pays up to 180 days for a member’s own sickness/accident.
- For a child’s illness, the fund pays up to 180 days.
- For a spouse’s illness, the fund pays up to 90 days.
- If a mother falls ill during pregnancy, the fund pays until the end of the seventh month of pregnancy , but not longer than according to the aforementioned rules. A woman can apply for up to a two-month extension of maternity leave due to illness during pregnancy without reducing her right to maternity leave after giving birth according to Art. 95/2000.
- For alcohol or drug treatment, the fund pays up to 90 days.
Extended payments
Under special circumstances it is possible to receive extended payments for up to 120 days, if a member does not have right to payments from pension fund or Tryggingarstofnun. An application has to be presented before the funds Board in cooperation with Efling’s VIRK representative or the funds consulting physician. Extended payments cannot exceed minimum pay for full time work according to collective agreements.
Duration of Sickness Benefits and conditions – Employees in the public sector/private non-profit institutions
Employees in the public sector/private non-profit institutions (The employer pays less than 1% premium to the fund)
The fund pays up to 90 days for a member’s own sickness/accident.
- For a child’s illness, the fund pays up to 180 days.
- For a spouse’s illness, the fund pays up to 90 days.
- If a mother falls ill during pregnancy, the fund pays until the end of the seventh month of pregnancy , but not longer than according to the aforementioned rules. A woman can apply for up to a two-month extension of maternity leave due to illness during pregnancy without reducing her right to maternity leave after giving birth according to Art. 95/2000.
- For alcohol or drug treatment, the fund pays up to 90 days.
Extended payments
Under special circumstances it is possible to receive extended payments for up to 90 days, if a member does not have right to payments from pension fund or the Social Insurance Administration (Tryggingarstofnun). An application has to be presented before the funds Board in cooperation with Efling VIRK representative or the funds consulting physician. Extended payments cannot exceed minimum pay for full time work according to collective agreements.
The following documents must accompany an application for sickness benefits
– A copy of a medical certificate for sickness benefits (sjúkradagpeningavottorð)
– An employment certificate signed by the employer
– A copy of the last pay slip
– Information about whether the member would like to use his/her electronic personal tax credit with the fund
In case of long term illness doctors certificates need to be renewed every two months.
Regulations regarding doctor’s notes
- Application for sickness benefits must include a copy of a medical certificate for sickness benefits from a doctor, originating in the computer systems of the Icelandic health clinics and hospitals.
- The first medical certificate must be an Icelandic certificate for sickness benefits. Follow-up certificates must also be an Icelandic certificate for sickness benefits
- The first certificate submitted may be one of foreign origin if the union member in question suddenly contracts an illness or has an accident while abroad. The member may have to provide evidence for the fact that the vacation abroad was planned in advance.
Sickness benefits from the Icelandic Health Insurance (Sjúkratryggingar Íslands)
In addition to sickness benefits from Efling, you may be entitled to sickness or accident benefits from the Icelandic Health Insurance. We recommend that you look into what your rights are there.
Reporting Requirements
A member receiving Sickness Benefits is required to inform the fund if he is able to resume work or if he starts to receive payments from other institutions. Any overpayments a member receives from the Sickness Benefits Fund must be repaid to the Fund.
Retrospective payments
Sickness benefits can be paid retrospectively for a maximum of three months.
The right to sickness benefits can expire
The right to sickness benefits expires if it is not sought within 12 months from when the right was created.