General Social Insurance Act

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Basic data
Title: General Social Insurance Act
Long title: Federal Act of 9 September 1955 on General Social Insurance
Abbreviation: ASVG
Type: Federal law
Scope: Republic of Austria
Legal matter: social insurance
Reference: Federal Law Gazette No. 189/1955
Effective date: January 1, 1956
Last change: BGBl. I No. 5/2020
Legal text: General social security law in the RIS
Please note the note on the applicable legal version !

The General Social Insurance Act ( ASVG ) contains the central legal provisions for general social insurance in Austria . It regulates compulsory health , accident and pension insurance as well as voluntary self- insurance on a case-by-case basis. Since it came into force on January 1, 1956, it was adapted in 55 amendments to the current situation in 1999 alone and is now one of the most extensive laws in Austria.

scope

As of January 1, 1956, the ASVG summarized the health, accident and pension insurance for workers and employees in industry, mining, trade, commerce, traffic and agriculture and forestry and also regulates the health insurance of pensioners. For certain people, according to Section 2 (2) ASVG special insurance to which the ASVG is only applicable on a subsidiary basis, for example for:

  • public employees (Civil Service Health and Accident Insurance Act - B-KUVG)
  • Farmers (Farmers Social Insurance Act - BSVG)
  • commercially self-employed (Commercial Social Insurance Act - GSVG)
  • Freelancer (social insurance freelance self-employed - FSVG)
  • Notaries (Notary Insurance Act - NVG)

With the 2005 pension reform, the

  • General Pension Act (APG), the harmonization of pension systems for people born on January 1, 1955, and the pension account for periods of employment as of January 1, 2005, was introduced.

The provisions of the ASVG are mandatory and can not be waived by employment contracts to the detriment of the insured and their relatives (Section 539 ASVG).

structure

The ASVG consists of ten parts.

  1. General provisions (§§ 1–115)
  2. Health insurance benefits (Sections 116–171)
  3. Accident insurance (§§ 172–220a)
  4. Pension insurance (§§ 221-314a)
  5. Relations between the insurance carriers (the main association) and compensation payments. Employer's liability in the event of accidents at work (Sections 315–337)
  6. Relationships between the social insurance carriers (the main association) and members of the medical and dental profession, dentists, midwives and pharmacists as well as hospitals and other contractual partners / contract (§§ 338-351j)
  7. Procedure (§§ 352-417a)
  8. Structure of the administration (§§ 418-460e)
  9. Special provisions (§§ 461–506c)
  10. Transitional and final provisions (§§ 507-716)

General provisions

The ASVG regulates the general social security of persons employed in Germany, including self-employed persons who are equal to employees, as well as the health insurance of pensioners from the general social security. Certain non-compulsorily insured persons can apply for self-insurance.

The ASVG differentiates in § 4 between full insurance, partial insurance only in individual insurance branches and exclusion from full insurance.

The employers must register every person they employ and have compulsorily insured persons (fully and partially insured persons) with the responsible health insurance provider before starting work and de-register them within seven days after the end of compulsory insurance. The registration (de) registration by the employer also affects the area of ​​accident and pension insurance, provided that the person employed is compulsorily insured in these insurance policies. The health insurance providers have to transfer the accident and pension insurance premiums paid to them in one calendar month to the responsible accident and pension insurance providers. Incorrect reporting can be punished by the district administrative authority as an administrative offense (Section 111 ASVG).

There is an electronic administration system for the entire enforcement area of ​​social security, which is managed with electronic health records (ELGA).

The contributions to health and pension insurance are to be borne proportionally by the insured person and his employer. The basis for the calculation of the contributions (general contribution basis) for compulsorily insured persons is usually the earnings due in the contribution period. For those with full health insurance, the contribution rate in health insurance is a maximum of 7.65%, in accident insurance 1.3% and in pension insurance 22.8% (Section 51 of the ASVG) and may not exceed 20% of their cash benefits. The employer alone has to bear the difference as well as the contribution to the accident insurance (§ 53 ASVG). Since the contribution payments are insufficient to finance all services, the possibility of state subsidies is also provided. This is especially true for pension insurance. In all laws that affect this, the Republic of Austria also provides for default liability for all implementing social insurance carriers (PVA, VAfEuB, SVB, SVGW).

The current cash benefits from health and accident insurance are generally paid weekly in arrears, unless the statutes of the insurance carrier provide otherwise (Section 104 ASVG). For pensions from the pension insurance, which are drawn in the months of April or October, and for pensions from the accident insurance, which are drawn in the months of April or September, a special payment in the amount of a paid pension is due each (Section 105 ASVG). On January 1st of each year, the pensions from the accident insurance are increased by a legally specified revaluation factor (§§ 108g, 108h ASVG).

Individual branches of insurance

Health insurance

Insured events are illness including the consequences of an accident at work or an occupational disease (§ 119 ASVG), incapacity for work due to illness, reintegration after a long sick leave, maternity and organ donation by an insured person. In the event of benefits, mandatory benefits are granted as statutory minimum benefits and voluntary benefits based on statutory or statutory provisions to which there is no legal entitlement. Services are also provided for the early detection of diseases (Section 132b ASVG).

In the event of illness, there is a right to outpatient and inpatient treatment and, if necessary, medical home care. These benefits are provided as benefits in kind by the contractual partners and contractual institutions of the responsible insurance carriers (Section 131 ASVG) or reimbursed to the insured person in the amount of 80% of the costs that would have been incurred (Section 131 ASVG). In the event of incapacity for work due to illness or reduced ability to work, sickness benefits will be paid in the amount of 50%, from the 43rd day in the amount of 60% of the assessment base for a period of up to 52 weeks, according to the statutes also up to 78 weeks (§§ 139, 141 ASVG) or rehabilitation allowance in the corresponding amount (§ 143a ASVG), in the case of reintegration after a long sick leave, the reintegration allowance. In the case of maternity, female insured persons are granted medical assistance and a daily maternity allowance for the last eight weeks before the expected delivery, for the day of delivery and for the first eight weeks afterwards.

Relatives of an insured person without their own insurance cover are also insured (Section 123 ASVG). For this, the insured person must pay an additional contribution without the employer's involvement (Section 51d ASVG).

Accident insurance

The accident insurance covers the risks of occupational accidents and occupational diseases and their consequences (Section 174 ASVG). The benefits are provided unless there is a right to health insurance benefits (Section 191 ASVG). In addition to medical treatment, the accident insurance also provides care in health, spa and other institutions. The carrier of the accident insurance can at any time request the granting of the services otherwise to be provided by the carrier of the health insurance. The main association of Austrian social insurance institutions issues guidelines on the cooperation between the health and accident insurance institutions in the implementation of accident medical treatment (§§ 194, 31 Paragraph 5 Z 22 ASVG).

Since the accident insurance is financed exclusively from employers' contributions, the employer's liability privilege applies: The employer is only obliged to compensate the insured person for damage caused by injury to the body as a result of an accident at work or by an occupational disease if he does Has caused an accident at work or the occupational disease willfully (Section 333 (1) ASVG). In this case, the insurer also takes recourse to the injuring party (employer) with regard to the services provided to the insured (Section 334 ASVG).

Pension insurance

The pension insurance is divided into the pension insurance for workers, the salaried employees and the miners' pension insurance (§ 2 Abs. 1 ASVG). The Pension Insurance Institution (PVA) has been jointly responsible for blue-collar and white-collar workers since 2003.

Since January 1, 2005, pensions have been calculated in accordance with the General Pension Act (APG), with the ASVG for salaried employees, the Commercial Social Insurance Act (GSVG) for tradespeople and the Rural Social Insurance Act (BSVG) for farmers stipulating the contribution bases. These are important for the pension amount. The APG applies to those born after 1955; for older people only the ASVG, GSVG or BSVG apply.

Performance law

The relationships between the health insurance providers and the statutory health insurance physicians working in outpatient care, as well as other health service providers, are each regulated by general contracts. These are concluded for the health insurance providers by the main association with the locally responsible medical associations . The content includes the claims for remuneration for medical services (§§ 341, 342 ASVG). The remuneration for a minimum range of medical services is made up of, for example, basic and case-based lump sums, individual service remuneration and bonus payments for achieving the health policy goals defined in the Primary Care Act (Section 342b ASVG).

For the delivery of medicinal products , there is a reimbursement code, agreed between the Federation and the pharmaceutical industry (§ 351c et seq. ASVG).

Procedure

The procedural provisions for the implementation of the ASVG by the insurance carriers differentiate between the procedure in benefit and the procedure in administrative matters (§ 353 ASVG).

Performance matters

Benefits are, for example, the determination of the existence, the scope or the suspension of a claim to an insurance benefit, its reimbursement or the determination of disability and occupational disability (§ 354 ASVG).

The benefit entitlements are determined by the insurance carriers in the health and pension insurance on application, in the accident insurance ex officio, for example after receipt of an accident report. A notification will be issued about the application, and the applicant or beneficiary must participate in the prior investigation of the facts. Notifications of applications for health insurance benefits are to be issued within two weeks of submitting the application, and for benefits from accident and pension insurance within six months of receipt of the application. As soon as the reason for the obligation to pay has been established, an insurance carrier can advance the payment (Section 368 ASVG). In the event of the death of the claimant or beneficiary, his relatives living with him in the same household are entitled to continue the procedure (Section 408 ASVG).

Apart from certain exceptions, the provisions of the General Administrative Procedure Act (§ 360b ASVG) also apply.

Most performance matters are also social law matters and may be decided by the ordinary courts (§§ 65, 2, 7 ASGG).

Administrative matters

All other than benefit matters are administrative matters, such as the determination of the compulsory insurance, the insurance eligibility as well as the beginning and the end of the insurance or contribution matters (§§ 355, 410 ASVG).

Special provisions

For occasional or unständig workers employed in agriculture and forestry, in the era of National Socialism expatriate and persecuted persons as well as persons to whom a detention compensation has been awarded, including the ninth part of the ASVG certain social security benefits.

literature

Web links

Individual evidence

  1. ↑ Entry on General Social Insurance Act in the Austria Forum  (in the AEIOU Austria Lexicon )
  2. ↑ Federal Act of May 31, 1967 on Health and Accident Insurance for Public Employees (Official Health and Accident Insurance Act - B-KUVG) RIS , accessed on October 20, 2018
  3. ↑ Federal Act of October 11, 1978 on the social insurance of the self-employed in agriculture and forestry (Farmer Social Insurance Act - BSVG) RIS , accessed on October 20, 2018
  4. ↑ Federal Act of October 11, 1978 on the social insurance of self-employed people in the commercial sector (Commercial Social Insurance Act - GSVG) RIS , accessed on October 20, 2018
  5. ↑ Federal Act on Social Insurance for Freelance Self-Employed Persons (Freelance Social Insurance Act - FSVG) RIS , accessed on October 20, 2018
  6. ↑ Federal Act of February 3, 1972 on Pension Insurance for Notaries (Notar Insurance Act 1972 - NVG) RIS , accessed on October 20, 2018
  7. ↑ cf. Federal Ministry of Labor, Social Affairs and Consumer Protection (Ed.): Sozialstaat Österreich. Services, expenses and financing 2016 Status: June 2016
  8. ↑ Gert-Peter Reissner: Problems at the interfaces between social security and damage compensation law, industrial accident and compensation, Praktikerseminar Universität Graz 2011, p. 9 ff.
  9. ↑ Federal Ministry of Labor, Social Affairs, Health and Consumer Protection (Ed.): Basics in the Austrian pension system for the year 2018 - short version. Status: February 2018, p. 5
  10. ↑ General contracts website of the main association, accessed on October 17, 2018
  11. ↑ Barbara Hauer: General contract and individual contract March 24, 2011
  12. ↑ cf. the overview for the individual insurance carriers: Kassen website of the Austrian Medical Association , accessed on October 17, 2018
  13. ↑ Federal Act on Primary Care in Primary Care Units (Primary Care Act - PrimVG) RIS , accessed on October 17, 2018
  14. ↑ Electronic Reimbursement Code (eEKO) website of the main association, accessed on October 17, 2018
  15. ^ Benjamin Kneihs: Social Security Procedure and AVG. In: Gedenkschrift Robert Walter , Manzsche Verlags- und Universitätsbuchhandlung, Vienna 2013, pp. 271–298
  16. ↑ Federal Act of March 7, 1985 on Labor and Social Justice (Labor and Social Courts Act - ASGG) RIS , accessed on October 18, 2018