Special Schemes

Integration of the Special Agricultural Scheme into the General Scheme:

Employed agricultural workers included in the REA , as well as the employers to whom they provide their services, shall be included, effective as of 01/01/12 , in the Social Security General Scheme, through the setting up of a special Scheme for said workers,  with entitlement to Social Security benefits under the same terms and conditions as in the General Scheme.

Integration of the Special Scheme for Domestic Employees into the General Scheme:

Effective as of 01/01/2012, the Special Scheme for Domestic Employees shall be included in the General Social Security Scheme, through the setting up of a special scheme for said workers, who will be entitled to Social Security benefits under the same terms and conditions as in the General Scheme .

General requirements demanded

The general requirements for entitling workers to benefits under the Special Systems are as follows:

  • To be affiliated  or in a situation equivalent to affiliation in the corresponding System.

  • To be up-to-date with payments for which workers are directly responsible, even though the benefit is awarded due to the reciprocal sum of contributions in a salaried employee system.
    • For these purposes, the payment demand mechanism provided for in |art.  28.2 of Decree 2530/1970, passed on 20 August, will be applicable for whatever Social Security system to which the applicant may belong at the time of applying for the benefit or in the system said benefit is applied for.
    • When, by deferring settlement of the payments owed, the applicant is considered up-to-date with payments for the purposes of awarding a benefit and he subsequently fails to meet the deferred payment schedule or conditions, he will no longer be considered up-to-date with payments, and the benefit he was receiving will immediately be suspended, and it will only be resumed once the debt with the Social Security has been settled in full. To this end, the benefit Management Entity may deduce the corresponding deferred debt payment from the monthly amounts accrued by the claimant.

Special Scheme for Self-Employed Workers

The benefit is recognised under the same terms and conditions as the Social Security General Scheme, with the following particular features:

Opting for and processing coverage:

  • Coverage of the economic benefit for TD derived from common contingencies will be mandatory, without prejudice to the provisions of the paragraphs below, and must be processed by a Social Security Mutual Society Partner, which will be obliged to accept all registration proposals made to it.

Self-employed workers (except TRADE or those in jobs where coverage for occupational contingencies is compulsory due to their high accident risk) who have TD benefit coverage with another Social Security scheme and are also affiliated may, for as long as they are in a situation of pluri-activity, voluntarily accept TD coverage from the RETA, or opt out from it, as the case may be.

  • For workers included in the Special scheme for self-employed agricultural workers, TD coverage will be voluntary with the following particular conditions:
    • If when requesting to join this special scheme they were already affiliated with the RETA, and as a result have compulsory coverage for TD benefit, they can opt out of this coverage in their respective application. This will take effect on the 1st day of the month after submission of the application. 
    • When workers who have not accepted TD coverage are excluded from this special scheme, and are affiliated with the RETA for the same or a different activity, coverage for the benefit will be compulsory from the date the exclusion comes into effect, unless they were entitled to said coverage by virtue of an activity carried out with another Social Security scheme.
  • Opting for this coverage, which must be processed by a Mutual Society, can be done when registering with this special scheme and will come into effect at the same time as the registration. If this option is not chosen, workers can opt to accept this coverage through written application. This must be filed before 1 October each year, and will come into effect from 1 January the following year.

    The rights and obligations arising from opting for TD benefit coverage will come into effect over a period of one calendar year and will be extended by periods of the same length.
  • Workers can opt out of coverage of the benefit via written application in the following circumstances:
  1. In general, before 1 October each year, effective from 1 January the following year.
  2. When a situation of multi-activity occurs subsequent to affiliation with the RETA, within the 30 days following registration for the new activity, effective from the 1st day of the month after opting out from the coverage. Otherwise, the provisions set out in the foregoing paragraph shall be applicable.
  3. When workers no longer meet the requirements to qualify as financial dependents or perform a job with a high accident risk, while affiliated with the RETA, effective from the first day of the month following that in which the respective contract was terminated or the aforementioned activity finished, provided that the relevant change in details is reported on time; otherwise, the coverage will continue until the final day of the month in which the aforementioned change comes into effect.

If the coverage is opted-out from in the aforementioned circumstances, it will not prevent this option from being chosen in the future, as long as a minimum of one calendar year has passed since the opt-out came into effect.

  • In the event of a change of Social Security Mutual Society partner, opting for or opting out of this coverage shall come into effect from 1 January the year after the relevant option is selected or the opt-out submitted.

  • If the worker has TD status on the date of opting into or opting out of coverage described in the foregoing rules, or the change of Social Security Mutual Society partner described in the previous paragraph comes into effect, said effects will be delayed until the first day of the month after that in which the medical discharge occurs.
  • Coverage for TD benefit, irrespective of whether or not workers have accepted it, shall become compulsory:
    • When the multi-activity situation comes to an end while workers are still affiliated with the RETA, effective from the 1st day of the month in which the multi-activity situation comes to an end.
    • When workers acquire TRADE status or carry out a professional activity with a high accident risk, effective from the 1st day of the month in which said condition is met or the aforementioned professional activity commenced.

Occupational contingencies:

  • Coverage will be voluntary, except for workers with TRADE status and workers who are required to have coverage as a result of performing a job with a high accident risk.

    Coverage for occupational contingencies will be provided by the same Mutual Society or Management organism with which the TD coverage was agreed.
  • The option for protection against these contingencies and, where appropriate, the option becoming compulsory shall be carried out in accordance with the method, time periods, conditions and with the effects established for opting for and opting out of TD protection.
  • In the event that protection for the TD benefit is chosen, coverage for occupational contingencies can be chosen at the same time and both shall come into effect simultaneously. If both options have not been selected simultaneously, protection for occupational contingencies can be requested before 1 October of each year, effective from 1 January the following year.

    In these cases, opting out of coverage for the TD benefit will under all circumstances mean opting out of coverage for occupational contingencies, although opting out of coverage for occupational contingencies will not mean opting out of TD coverage, unless this is expressly requested.
  • For workers who carry out several activities that result in a single affiliation with the RETA, coverage for work-related injuries and occupational diseases shall be for the activity with the highest applicable contribution rate of the rates listed in the current table of premiums. 

Statement of activity status:

In addition to proving the general requirements, self-employed workers (with the exception of those in the Special Scheme for self-employed agricultural workers and TRADE workers) must submit to the INSS or the Social Security Mutual Society partner that granted the TD contingency, a declaration on the official form regarding the person who directly manages the commercial, industrial or other establishment of which they are the owners or, where appropriate, the temporary or definitive end of the activity being carried out.

Deadline for submission:

  • Within 15 days after the date on which they start their leave.
  • While the TD status lasts, the worker is required to submit this declaration every six months, counting from the date on which the status began, if required.

Failure to submit the declaration, within the deadline,  will cause the suspension of the start of benefit payments, and may automatically initiate actions to verify the situation of the establishment owned by the beneficiary.

If, as a result of administrative proceedings, the beneficiary is declared to be ineligible for a benefit and, as the case may be, it has already started being collected, action will be taken to ensure the that the benefit is paid back.

The provisions set forth in the previous two paragraphs are understood without prejudice to the fact that, if the declaration is not submitted in time or, as the case may be, the benefits have been collected when ineligible, the appropriate disciplinary proceedings may be started in the cases in which the Management organism deems necessary, taking into account the concurrent circumstances as assessed by it.

Benefit amount:

The amount is obtained by applying the corresponding percentages to the base rate (BR).

Percentages:

  • If due to common disease or non-work-related injury:

    • 60% (percent), which will be paid from the fourth to the twentieth day off work, both inclusive.
    • 75%, which will be paid from the twenty-first day.
  • If it arises from a work-related injury or occupational disease, 75% of the BR will be paid from the day following signing off work, provided that the interested party had opted for coverage of occupational contingencies.

Base rate:

  • The base will be the contribution basis of the worker for the month prior to the sick leave, divided by 30. This base will remain the same throughout the illness, including any relapses, unless the interested party has opted for a lower contribution base, in which case, the latter will be used.
TD FOR SELF-EMPLOYED WORKERS WHO ARE OUT OF WORK

Amount of the benefit for being out of work:

The amount of the benefit, for the entire period it is received, shall be determined by applying 70% to the BR.

The BR is the average of the basis on which contributions have been made during the  12 continuous months immediately prior to acquiring legally out-of-work status, with the whole month in which this situation occurs being counted for these purposes.

The maximum amount of the out-of-work benefit will be 175% of the IPREM, unless the self-employed worker has one dependent child or more; in such an event, the amount will be 200% or 225% of said indicator, respectively.

The minimum amount of the out-of-work benefit will be 107% or 80% of the IPREM, depending on whether or not the self-employed worker has dependent children.

For the purposes of calculating the maximum and minimum amounts, children will be understood to be dependent if they are under the age of 26, or older if they have a degree of disability greater than or equal to 33%, do not have an income of any nature greater than or equal to the MPW not including the proportional amount of extra payments, and live with the beneficiary.

For the purposes of the maximum and minimum amounts of the out-of-work benefit, the monthly IPREM in force at the time when the entitlement begins shall be taken into account, increased by one-sixth.

For groups with a Social Security contribution basis below the minimum ordinary contribution basis for self-employed workers, the minimum amount for the out-of-work benefit will not apply.

Acquiring out-of-work status while being a worker with TD status:

When the triggering event for the out-of-work protection occurs while the worker has TD status, they will continue to receive the TD benefit. The amount of the TD benefit will be the same as the out-of-work benefit, until it expires, at which time they will start to receive, as long as they meet the legally established requirements, the corresponding out-of-work benefit. In this case, the time for which they have had TD status will be subtracted from the period for collecting unemployment benefit and counted as having been used up, starting from the date that legally out-of-work status was acquired.

.The self-employed worker will be required to communicate and prove their out-of-work status to the management organism paying the TD benefit within 15 days of acquiring out-of-work status. 

The application for cessation of activity protection must be made after TD status has expired, proving the legal cessation of activity status to the management organism or organisation with which the worker has coverage for work-related injuries and occupational diseases  (Social Security Mutual Society Partners, ISM or the SPEE if said protection is covered by the INSS) in the 15 working days following the date on which TD status expired.  

Effects of the new TD amount:

If a self-employed worker who begins TD while registered in the Special Scheme for Self-employed Workers (RETA) subsequently withdraws from this scheme due to being out of work and has occupational contingencies covered with the INSS, they shall continue to receive the direct payment TD benefit but the amount received in this case will be 70% of the base rate of the out-of-work benefit (average of the 12 bases prior to becoming out of work, including the last month). The rate shall be maintained throughout the benefit and will be paid as of the first day of the month immediately after the causal event of becoming out of work - deregistration from RETA - (from 01/01/2015 to 29/07/2015 the effects were set as of the second month after the causal event - Final provision two of Law 35/2014, of 26 December).

Final provision six of Law 25/2015, of 28 July.

Acquiring TD status while receiving the out-of-work benefit:

The period for receiving out-of-work benefit will not be extended as a result of the worker acquiring TD status. During said situation, the management organism of the benefit will be responsible for making Social Security contributions, under the terms provided for in article 4, paragraph 1, letter b), until the benefit to which the self-employed worker was entitled has been used up.

  • In the event that the TD is a relapse of a previous process that started before acquiring legally out-of-work status, the worker will receive a TD benefit equal to the amount of the out-of-work benefit. In this case, and in the event that the self-employed worker continues to have TD status after the period initially set for the out-of-work benefit has come to an end, the worker will continue to receive the same amount of TD benefit that they had received previously.
  • When the TD status is not a relapse of a previous process that started before acquiring legally out-of-work status, the worker will receive a TD benefit equal to the amount of the out-of-work benefit. In this case, and in the event that the self-employed worker continues to have TD status after the period initially set for the out-of-work benefit has come to an end, the worker will continue to receive a TD benefit equal to 80% of the monthly IPREM.

    This guarantee of a minimum amount will not apply to groups with a Social Security contribution basis below the ordinary contribution basis set for self-employed workers. 

The provisions of the above paragraphs will apply to workers included in the Special scheme for self-employed agricultural workers, who meet the requirements set out in art. 330 the Consolidated Text of the General Social Security Act, with the special provisions provided for in   additional provision five of RD 1541/2011, of 31 October, section 5 of which establishes that said workers will start contributions from 01/01/12 onwards.

More information on this Scheme:

Special Scheme for Coal Mining

The benefit is granted under the same terms and conditions as for the General Scheme of the Social Security, with the following particular condition:

  • Base Pension:

When the disability arises from common contingencies, it is the standardised base  that corresponds to the worker at any given time, according to the professional category that they had at the time the situation began.

More information relating to this Scheme: 

Special Scheme for Sea Workers

All workers included under the Special Scheme for Seafarers are covered against temporary disability, when caused by either common or professional contingencies.

The benefit is granted under the same terms and conditions as for the Social Security General Scheme, with the following particular conditions:

For workers in groups II and III, the Subsidy will be paid directly through the Provincial or Local Departments of the Social Marine Institute or the appropriate Mutual Insurance Society and is not delegated to companies, although they are responsible for payment from the 4th to the 15th day of sick leave.

In the case of self-employed workers:

  • To access the benefit, workers must be up-to-date with their contribution payments at the start of the sick leave, and submit a statement about the person who manages the work or, where appropriate, the temporary or permanent stoppage of this work.
  • For common contingencies, it is not possible to opt for temporary disability coverage with a Mutual.

More information on this Scheme:

Persons included in the scope of application of this Scheme, affiliation, registration and termination and contributions

Processing: Provincial Directorates and Local Offices of the ISM.

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