[Q&A] "Even if not an occupational disease, you can rest if you are sick"... First introduction of sickness benefits

[Asia Economy Reporter Jo In-kyung] The government is introducing the 'Sangbyeong Soodang' (Sick Leave Allowance) system for the first time, allowing workers to take leave without worry when they are ill. The aim is to establish the state's responsibility for the 'right to rest when sick' and to foster a related social atmosphere.

The first phase pilot project, starting from the 4th, will be implemented in six regions: Bucheon-si in Gyeonggi, Pohang-si in Gyeongbuk, Jongno-gu in Seoul, Cheonan-si in Chungnam, Changwon-si in Gyeongnam, and Suncheon-si in Jeonnam. Over the course of one year, three different models will be applied to compare and analyze policy effects.

The target groups, criteria, application, and payment procedures for the Sangbyeong Soodang pilot project are summarized in a Q&A format.

What are the employment criteria for the Sangbyeong Soodang pilot project? Can special employment workers, platform workers, and self-employed persons apply?

- Not only health insurance workplace subscribers (workplace employees) but also employment insurance subscribers and self-employed persons who meet certain criteria can apply for Sangbyeong Soodang. Meeting any one of the criteria below qualifies an applicant for support.

① Health Insurance Workplace Subscribers: Maintained qualification for at least one month prior

② Employment Insurance Subscribers: Maintained qualification for at least one month prior

- Includes artists, special employment workers, platform workers, and self-employed persons (voluntary subscribers)

- For daily workers, recognition is given if they worked at least 10 days and were enrolled in employment insurance during the previous month

③ Self-employed persons: Maintained business registration for at least three months prior + monthly sales of 1.91 million KRW or more in the previous month

Can only residents of the pilot project regions apply for the Sangbyeong Soodang pilot project?

Applicants must be employed persons residing in the pilot project region as per their resident registration certificate on the application date. If the workplace is in the pilot region but the applicant resides elsewhere, the application is not applicable. However, workers employed at 'Sangbyeong Soodang cooperative workplaces' designated by local governments and the National Health Insurance Corporation branch, regardless of residence, can apply. Currently, there are a total of 105 cooperative workplaces in the six pilot regions.

Can Sangbyeong Soodang be received if paid sick leave is taken?

If paid sick leave or similar paid leave is used and wages are received from the workplace without working, Sangbyeong Soodang will not be paid during that period to prevent double income compensation. After exhausting paid sick leave, if the worker still cannot work due to injury or illness and meets the eligibility criteria, they can apply for and receive Sangbyeong Soodang.

For what types of injuries or illnesses can Sangbyeong Soodang be received?

There are no restrictions on the type or diagnosis of injury or illness, and Sangbyeong Soodang can be paid if waiting period and other requirements are met. However, considering the purpose and sustainability of the system, treatments not essential for disease recovery such as cosmetic surgery for aesthetic purposes, cases with only simple symptoms, and childbirth-related treatments without complications are excluded. Employed persons who have given birth can apply for employment insurance maternity leave benefits or maternity benefits for those not covered by employment insurance.

Is it possible to apply for Sangbyeong Soodang for work-related illness or injury?

Sangbyeong Soodang is a system that compensates income when a worker cannot work due to illness or injury unrelated to work. In cases of work-related illness or injury, workers must apply for industrial accident insurance benefits. If the work-relatedness is unclear, simultaneous applications for Sangbyeong Soodang and industrial accident insurance are possible, but if later recognized as an industrial accident, overlapping receipt of Sangbyeong Soodang, industrial accident insurance leave benefits, and injury compensation pension is not allowed.

If I have applied for and received Sangbyeong Soodang once, can I apply again if another illness or injury occurs?

If a new illness or injury prevents work after receiving Sangbyeong Soodang, reapplication is possible. However, all eligibility criteria must be met again at the time of application, and payment is only possible within the maximum coverage period. For Bucheon-si (Gyeonggi), Pohang-si (Gyeongbuk), Changwon-si (Gyeongnam), and Suncheon-si (Jeonnam), the maximum coverage period is 90 days, while for Jongno-gu (Seoul) and Cheonan-si (Chungnam), it is up to 120 days.

Where and how can the medical certificate for Sangbyeong Soodang application be issued?

The medical certificate can be issued at medical institutions located within the pilot project regions that have applied for and registered as participants in the pilot project. Medical institutions not participating in the pilot project cannot issue the certificate. The list of participating medical institutions by region can be found on the National Health Insurance Corporation website.

What is the Work Suspension Plan (Confirmation) and how is it prepared?

Sangbyeong Soodang is paid for the period during which the worker 'cannot work' due to injury or illness, so proof that the worker did not work and did not receive wages from the workplace during the payment period is required. The Work Suspension Plan is submitted when applying for Sangbyeong Soodang, and the Work Suspension Confirmation is submitted after the application review results are notified. For workplace employees, the employer prepares it; for labor providers such as special employment workers, the income payer prepares it; and for self-employed persons, they prepare it themselves.

How is the Sangbyeong Soodang payment period (period of inability to work) determined?

The National Health Insurance Corporation comprehensively reviews the appropriateness of the period of inability to work based on the doctor's medical certificate, various medical records, the applicant's Work Suspension Plan, and other evidence. Ultimately, the payment days are determined by verifying actual work suspension and wage non-payment through the Work Suspension Confirmation. The period of inability to work stated on the medical certificate for Sangbyeong Soodang application and the final payment days confirmed by the National Health Insurance Corporation may differ.