Article 54. Insured persons and members of their families may enjoy benefit of medical services, in case of injury due to accident or illness, from the date they become subject to this law. The said medical services shall include all outpatient medical treatment, in-patient treatment, supply of required medicines, and diagnostic testing.
Article 55. Medical services covered by this law are provided in two ways:
a.The priority of treatment method goes to the direct method.
b.Utiliring the indirect method will be authorized and determined by the Organization.
Article 56. For the purpose of rehabilitation, recovery and restoration to work of insured persons who have been injured and who have lost their former jobs, the National Health Insurance Organization shall work through specialized institutions for the disabled to enable such persons to be employed in other suitable work, all pursuant to regulations proposed by the Technical Council of the above mentioned Organization and approved by the High Council of the Organization.
Article 57. In the event that the treatment of a patient necessitates his transfer from a village or district to another district, the procedure for such transfers shall be according to rules to be proposed by the National Health Insurance Organization and approved by the Technical Council of the said Organization.
Article 58. The members of the family of an insured who are entitled to the benefits stipulated in Article 54 of this law are:
- The wife of the insured.
- The husband of an insured wife provided that he is supported by her and he is over 60 years of age, or is found to be disabled according to the findings of the Medical Board referred to in Article 91 of this law,
- Children of the insured person who meet one of the following conditions:
a. Are under 18 years of age, are unmarried daughters under 20 years of age or when they are exclusively occupied as students as certified by an official educational institution,
b.Are unable to work due to illness or defect of limb as certified by the National Health Insurance Organization.
- Parents supported by the insured provided that the age of the father exceeds 60 years and that of the mother 55; or when they are disabled, according to the findings of the Medical Boards referred to in Article 91; and provided that in any event they are not receiving any pension from the Organization.
Article 59. Insured persons who are under medical treatment or are convalescent and according to the findings of the National Health Insurance Organization are temporarily unable to work, provided they are not engaged in any work and do not receive any wage or salary, shall be entitled to receive sickness benefits under the following conditions :
a.The insured is under medical treatment as a result of an accident, whether work-related or not, or as a result an occupational disease,
b. Where the insured, due to illness and according to a doctor’s certificate requires a complete rest or bed rest and on the date of his illness was working or on paid leave.
Article 60. Employment related accidents are accidents which occur to the insured in the course of performing his duties or as a result thereof. “In the course of performing his duties” refers to all times when the insured is working at the place of work or affiliated institutions or the buildings or compounds thereof or, on the instructions of the employer, is carrying out an assignment outside the limits of the place of work. Time spent in visiting a clinic, hospital or for medical or convalescent treatment and time spent by the insured in going from home to the place of work and returning thereto is considered as in the course of performing his duties, provided that the accident occurs during the normal hours of going to the place of work or return therefrom. Accidents which occur to an insured while trying to save other insured persons and assist them are considered as employment related.
Article 61. Occupational diseases shall be determined according to a schedule to be proposed by the Board of Directors and approved by the High Council of the organization. The period during which the National Health Insurance Organization is responsible for the treatment of each occupational disease after a change of work by the insured shall be as specified in the said schedule.
Article 62. The period for payment of sickness benefits during illness and the amount thereof shall be as follows:
- Sickness benefits shall be paid from the first day upon which the insured, according to the findings of the National Health Insurance Organization, is considered unable to work due to accident or occupational disease. In cases where unemployment or treatment is due to an illness, if the patient is not hospitalized, sickness benefits
will be paid from the fourth day. - Payment of sickness benefits will continue so long as the insured, as determined by the National Health Insurance Organization, is unable to work but does not qualify as disabled according to the provisions of this law.
- Sickness benefits of an insured, who has a wife or child or dependent father or mother, shall be paid at the rate of three fourths of his last daily wage or salary.
- Sickness benefits of an insured, who has no wife or child or dependent father or mother, shall be equivalent to two-thirds of his last daily wage or salary, except when the insured is hospitalized at the expense of the National Health Insurance Organization in which case the sickness benefits shall be equivalent to one half his last daily
wage or salary. - Whenever the National Health Insurance Organization transfers an insured to another district for medical treatment and he is treated as an outpatient in addition to the applicable sickness benefits, payment equivalent to one hundred percent of the daily sickness benefits shall also be made for each day of his stay. Subject to the decision of the doctor treating him, so long as the patient needs a companion, in addition to travelling expenses, the Organization shall also pay to the companion of the patient an amount equivalent to fifty percent of the salary or wages of the insured.
Article 63. In case of sickness or accidents, the last daily wage or salary of the insured for the purpose of calculating the sickness benefits for the period of sickness consists of the total amount received by the insured, on the basis of which the insurance premium has been collected during the last 90 days before the beginning of his sickness, divided by the number of working days. With regard to insured persons who receive piece work compensation, the last wage consists of the total amount received by the insured on the basis of which the insurance contribution has been collected during the last 90 days before the beginning of his sickness divided by 90, Provided that the amount of sickness benefits or this amount is not less than the sickness benefits payable on the minimum wage of an ordinary sickness laborer. Where an insured who receives piece work compensation has received sickness benefits during a part of the said three months, the average wage, which was the basis for calculating the said sickness benefits, shall be considered to be the daily wages during the period of sickness and will be considered in the calculation.
Article 64. In cases where employers in accordance with other laws and regulations are required to pay salary or wages to their insured employees who are ill, the National Health Insurance Organization shall be responsible only for their medical treatment according to the provisions of this law.
Note . In cases where employers are bound, in accordance with other laws, to pay the wages of their tubercular workers, the Organization shall be responsible only for their treatment according to the provisions of this law.
Article 65. In cases of employment related accidents, the employer is required to take the necessary initial steps to prevent worsening of the person involved in the accident, and should inform the Organization of the case within three working days. In case the employer incurs expenses for his initial actions, the National Health Insurance Organization shall repay the expenses incurred.
Article 66. If it is proved that the accident is the direct result of non-compliance with technical safety regulations, or that the sickness is due to a failure by the employer or his agent to observe sanitary and hygiene regulation and required precautions, the National Health Insurance Organization and the Organization shall pay the expenses related to the treatment, sickness benefits, pensions etc, and shall claim and collect same from the employer in accordance with Article 50 of this law.
Note 1. The party at fault may exonerate himself by paying to the Organization a sum equivalent to ten years pension mentioned in this Article.
Note 2. If the insured is covered by the regulations regarding third party insurance, in case of an accident the Organization or the National Health Insurance Organization or the other party himself may provide the insured with the assistance provided for in this law, and the insurance companies involved shall then be bound to pay the damages sustained by the Organizations within the limits of their liabilities to the third party.
Article 67.A female insured or the wife of a male insured, who has a record of paying the insurance contribution for 60 days within the one year prior to delivery, may enjoy the pregnancy and confinement benefit provided she is not working. The pregnancy and confinement benefit shall be equal to two thirds of the last wage or salary of the insured according to Article 63, and the maximum that may be paid shall not exceed a total period of 12 weeks covering the time both before and after delivery, without deducting the first three days thereof.
Article 68. A female insured or the wife of a male insured, who has a record of paying the insurance contribution for 60 days within the one year prior to delivery may enjoy the medical assistance and examinations and treatment before, during and after delivery. The National Health Insurance Organization may, on application by the insured, pay a cash amount in lieu of the above benefits. The said amount shall be determined in regulations to be prepared by the Board of Directors of the National Health Insurance Organization and approved by the High Council of the Organization.
Article 69. In case a female insured or the wife of a male insured suffers from diseases which would make it harmful for her to breast-feed her child, or if she dies after delivery, the required milk will be supplied up to the age of 18 months.
