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Policy Terms

Policy terms Sick Leave insurance

(own risk in working days)

In your policy and in these policy terms you can read which rights you have and which duties you should fulfil with regard to the Sick Leave insurance. In case these policy terms differ from what is written in your policy, then the conditions as mentioned in your policy apply

 

1. Glossary of Terms

In these policy conditions we define the following as:

1.1 Fides Rae Insurance Company N.V. (we/our/us/ours)

The Insurance Company with whom you signed this insurance contract, as mentioned on the policy schedule.

 

1.2 Policy holder (you/your)

The person who has signed the insurance contract with us.

 

1.3 Employee

An employee is a person who has a (temporary) employment contract or employment relationship with the policyholder. For which the employee receives a wage and he/she is registered at the wage declaration for the payment of employee insurance premiums. This also refers to interns and on-call workers. A director or major shareholder(s) are not an employee and therefore not covered by this insurance.

 

1.4 Policy

The policy contains a policy schedule and policy conditions. In the policy schedule, you can find all agreements we have made with you concerning the insurance.

 

1.5 Employment incapacitated

An insured employee termed as employment incapacitated if he cannot execute the agreed work, as described in the employment contract, because of an accident, illness or an impairment. The company doctor needs to assesses this.

Pregnancy and -maternity leave is not included in the above definition. If an employee is not willing to do the agreed work or the employer does not facilitate so that the agreed work can be done, while the occupational physician’s opinion is that it is possible to work, then once again this situation does not fall under the definition of employment incapacitated.

 

1.6 Obligation to continue wage payment

As an employer you are by law obligated to continue paying the salary (or part of the salary) of an incapacitated employee for a maximum period of 104 weeks. The amount of salary depends on the agreements that were made in the employment contract and/or the collective labour agreement, which applies to the employee and the legislation in the Civil Code (in Dutch: Burgerlijk Wetboek).

 

1.7 Insured salary

The insured salary is the salary for the income taxes (in Dutch: Loon voor Loonheffing). With a coverage percentage of 100 % during the first year of employment incapacity, the maximum amount of this salary is € 125,000.00 gross per year per employee. With a percentage coverage of 70% during the second year of employment incapacity, the maximum amount of salary is € 85,500.00. If agreed to a different insured salary, then this amount is mentioned in the policy. If applicable, the mentioned maximum amounts of insured salaries include the insured employer cost. The insured amount of salary is the total of all insured employees.

 

1.8 Coverage percentage

Is the percentage of the insured salary, which we pay you when an employee is incapacitated. The coverage percentage, according to law, is not allowed to exceed the salary that you are obliged to continue to pay during employment incapacitation. In short, you are not allowed to profit financially from the situation if an employee is incapacitated. The coverage percentage is noted in the policy schedule.

 

 

1.9 Own risk period

Is the period of the first few days of which your employee incapacitation, you will not receive a damage payment for this period. For each new illness period a new own risk period applies. If an employee becomes incapacitated within 28 calendar days, after having ended the previous period of incapacitation, then both periods are added together and regarded as one illness period. We calculate one week as five working days (Monday to Friday) even if the employee works less or more per week. The own risk period is calculated in working days and is noted in the policy schedule.

 

1.10 Employer costs

You pay these costs as an employer on top of the insured salary. These expenses consist out of the following:

  • The fixed employer’s premiums for the employee insurances and for the Healthcare law (in Dutch: Zorgverzekeringswet).
  • Other employer expenses such as a variable employer’s premium for employee insurances, the employer’s part of the pension premiums and if applicable, car lease costs.

It is possible to incorporate an additional employer costs coverage in the policy. You can chose from 17.5%, 20.0% or 25.0% of the insured salary amount as co-insurance for the employer costs. If you have co-insured the employer costs are noted in the policy schedule together with the percentage.

 

1.11 Appropriate employment

Refers to the adjusted work, in all reasonableness, to be expected from an incapacitated employer. The expectations must take into account the employee’s specific situation. It is possible that appropriate work cannot be provided due to physical, psychic or social reasons.

 

1.12 Salary value

The salary, in all reasonableness, which can be ascribed to an incapacitated employee for the appropriate employment.

 

1.13 Company doctor

Is a doctor who is officially registered in the Dutch individual healthcare system (BIG-register) as a certified occupational physician. The ‘BIG-register’ belongs to the Royal Dutch society for the promotion of medicine (KNMG).

2.      The principles of your Sick Leave insurance (own risk in working days)

2.1 The information that we receive from you when you take out the insurance.

When applying for a Sick Leave insurance you will be asked several questions by your insurance intermediary and us. You are obliged to answer these questions completely and correctly. Based on your answers the insurance contract will be concluded. If you do not answer the question correctly and completely, this can have consequences. As the terms offered may differ if they had been based on the correct answers. For example, we may have offered the insurance on other terms, with a higher premium or not accepted the insurance. If based on the incorrect information then we can do the following:

  • Reduce the damage payment. If we have already paid, we can claim the damage payment back.
  • Adjust the premium and/or the conditions of the insurance.
  • Refuse the policy or terminate it. We only do this if you have provided us with the wrong and/or incorrect answers, as we would have refused the insurance based on the valid and/or complete answers.

 

2.2 When the incapacity to work of an employee is to be expected

It is possible that an employee becomes incapacitated for work within six months after the start of this insurance or his/her employment. If the former was to be expected, at the start of the insurance or at the start of the employment based on the employee’s state of health, we can temporarily or permanently refuse to fulfil damage payment or refuse partial compensation.

3.      The coverage of your Sick Leave Insurance (own risk in working days)

3.1 What is the purpose of the Sick Leave Insurance (own risk in working days)?

The purpose of the Sick Leave Insurance is to pay you as an employer a damage payment for the wages that you have to continue to pay your incapacitated employee, insofar as the employee is ill for longer than the own risk period.

 

3.2 When are you entitled to a damage payment?

You are entitled to a damage payment if all the following conditions are met:

  • The employee is insured;
  • The first day of incapacity to work of the employee falls after the start date of this insurance;
  • The insurance premium has been paid fully and in time;
  • The other policy conditions of the insurance have been met;
  • The employee is sick longer than the own risk period in working days.

 

3.3 How do we determine your right to a damage payment?

Every four months we receive the sick leave data in an overview from your Arbo service provider (Occupational Health and Safety Service provider). We use this information to determine whether you are entitled to damage payment, the amount and the length of time the damage payment will be paid out for. In addition, we test whether both you and the employee meet the policy conditions.

A certified company doctor determines to what extent your employee is incapacitated to work and to which extent the employee is unable to perform the agreed work as stated in the employment contract. If your employee falls ill abroad, we need to receive a statement from a local doctor before making a claim.

 

3.4 How do we calculate your damage payment?

First of all, the employee’s daily wages (salary) are determined by us. We do this by taking the wages of the twelve months preceding the month in which the first day of incapacity to work took place. This is the salary over which income taxes are paid and contains the fixed salary components, commissions, bonuses, the taxable addition of a company car and any pension contributions from the employer. From this salary the employee’s own pension contribution, personal contribution to a company car and the employee’s contribution to the Act of Work according to income insurance(s) (WIA) will be deducted. We divide this salary by 261 working days per year. If an employee has not been employed for a full year, we calculate the daily wages by dividing the gross wages by the actual number of working days (5 days per week). Furthermore, the amount of the damage payment depends on:

  • The own risk period: the period, counted in working days from the first day of incapacity for work, over which you do not receive damage payment.
  • The disability percentage: you receive this percentage of the daily wages per working day.
  • The number of sick days: this number of days determines the duration of the damage payment.
  • Possible co-insured employer’s costs: if applicable daily wages are increased by this percentage.

The daily wages during the first year never exceed (€ 125,000.00 / 261 working days =) € 478.93.

During the second year, the daily wages never exceed (€ 87,500.00 / 261 working days =) € 335.25.

These amounts include the co-insured employer costs, if applicable.

 

If an employee works on an occupational therapy basis, you will receive the normal benefit for a maximum of four weeks. After this period, we assume that the work can be regarded as appropriate employment. In case of appropriate employment, the company doctor determines the wage value that accompanies this work. We deduct this wage value from the insured wages. The remaining amount is taken as the daily wage for calculating the damage payment.

Finally, is the employee entitled to another statutory benefit that you can deduct from the obligation to continue to pay the wages? Then we will reduce the damage payment with this benefit.

 

If your employee dies then you are legally obliged to pay one month’s wages to the next of kin. We will pay you this monthly wage based on the principles of the insurance. No own-risk period will be deducted from this.

 

3.5 For which period will you receive damage payment?

You will receive damage payment for as long as your employee is ill, but never longer than 104 weeks. The own risk days are deducted from this period. When an employee is fully fit for work again and becomes incapacitated for work again after 28 calendar days, the 104 week period will start again.

 

Do you have a ‘Poortwachtersgarantie’ with us? Then this will be noted in the policy schedule. What does this mean? In exceptional cases, the ‘UWV’ may oblige you to continue paying the wages for a longer period than the statutory 104 weeks. In this situation, have you complied with all instructions from the Arbo service provider (and a possible reintegration company) and with the policy conditions of this insurance? Then we will continue to pay you the wages after the 104 weeks for as long as the ‘UWV’ has imposed this.

 

3.6 When do we pay you your damage payment?

We pay the damage payments quarterly. Payment of the previous quarter will be paid into your specified bank account after approximately 6 weeks. You will receive a benefit notice from us at the same time stating which benefit you will receive and for which employee. This payment notice can be used as proof of payment for your accounting department.

 

Do you have an outstanding premium payment or another outstanding payment? Then we settle this/these amounts off against the forthcoming damage payment. This settlement will be clearly stated in the benefit notice.

 

3.7 Contribution to intervention costs

Have you made intervention costs so that your employee can return to work more quickly? And, is this intervention included in your Plan of Action? Then we will contribute up to 100% of these costs. We only do so, if it is expected that intervention will lower the damage payment. Our contribution is never more than 100% of the expected savings on the damage payment(s). The Arbo service provider will request the reimbursement from us in writing. Any subsidy schemes or (private) insurance payments will be subtracted from the contribution.

We do not contribute to intervention costs which aim at adjusting an employee’s workplace or which help the employee find employment with another employer.

 

3.8 Is it possible to transfer the rights of this insurance?

No, it is not possible to transfer or pawn the rights from this insurance, or otherwise use the rights of this insurance for (financial) security.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.      Termination of the damage payment

4.1 When are you not or are no longer entitled to a damage payment?

In some cases, damage payment is stopped sooner or you will no longer be entitled to it. These cases are described below:

  • You are no longer obliged to continue paying wages. Which is possible in the following cases:
    • the employee is no longer incapacitated;
    • the employment contract with the employee has been terminated;
    • the employee has died (in this case the damage payment will be stopped one month after death);
    • your company has been declared bankrupt;
    • you have applied for a suspension of payments through the court;
    • you or one of your creditors have applied for your company’s bankruptcy via the court;
    • you have applied for or are imposed on a “debt rescheduling for natural persons”;
    • you have terminated your business activities;
    • the employee concerned is involved in an employment conflict and the company doctor has determined that there is no medically caused employment incapacity;
    • a female employee who is entitled to a pregnancy and maternity leave benefit on the base of the Work and Care Act (in Dutch: WAZO).

 

  • You are not (or are no longer) entitled to a damage payment based on the policy conditions. This applies to the following situations:
  • the employee was incapacitated for work on the commencement date of the insurance. The employee is only insured after he has been continuously and fully fit for work for 28 consecutive calendar days;
  • the employee was incapacitated for work on the date that his fixed term employment contract was to be renewed. This regulation is not valid if it can be proven that the renewal of the contract was agreed upon before the employee became incapacitated;
  • the judge has ruled that a dismissal is not legally valid. If this is the case, you will not receive any damage payment for the period that you have dismissed your employee for till the date that the judge annulled the dismissal;
  • you have not paid the full premium, did not pay in time or refuse to pay it even after we have sent you a reminder;
  • the employee is in prison, in provisional detention or has been made available to the state (in Dutch: TBS);
  • the employee has reached the agreed pensionable age (no later than the state pensionable age);
  • the maximum benefit period of 104 weeks has been reached;
  • you or your employee have not met the obligations required in case of employment incapacity;
  • you have committed fraud or deliberately misled us;
  • incapacitation to work resulted from intent or recklessness on part of you or your employee. This also applies if you or your employee have failed to prevent or reduce the incapacity for work;
  • incapacitation to work is the result of acts of molest. By risks of war we mean the following:
    • an armed conflict: countries which are at war with each other, whether or not in combination with the United Nations;
    • a civil war: inhabitants of one country are at war with each other;
    • an uprising; inhabitants of a country violently oppose the government of that country;
    • Internal domestic disturbances: groups of people use violence in different parts/places of the country;
    • riots: a group of people in one place use violence to oppose the government;
    • mutiny: a group of people violently oppose their authorities.
  • incapacitation to work as a result of an atomic reaction. We will pay damage payment for employees that have become incapacitated to work as a result of radioactive materials. The condition being that the substances according to their goal are outside the nuclear facility and that they are used there (this also applies to vessels). Further, the substances must be intended for non-military purposes. If the nuclear reaction is a result of a terrorist attack, then ‘Article 9. Terrorism’ applies.
  • you or the employee are listed on a sanction list in accordance to the Sanctions Act of 1977.

4.2 What happens to the damage payment if the insurance is terminated?

If the insurance is terminated while an employee is still incapacitated for work, we will continue to pay you the damage payment according to the policy conditions. This is referred to as an extension risk. Of course, you must comply with your obligations towards the incapacitated employee. If the employee has been reported as being better and becomes (partially) incapacitated for work again within 28 calendar days, we will regard this as a continuous period of sick leave and will resume paying the damage payment. Only when the employee has been reported as being better for 28 days and after this period becomes (partially) incapacitated for employment, we will not pay damage payment.

 

We will pay the damage payment to a new employer if the company has been taken over, merges with another company, is split or sold. Once again, this only applies if the new employer has executed the obligations with respects to the incapacitated employee.

 

5.      Keep your employee database and alterations in the disability risk up-to-date in our administration

It is important to keep the employees database up to date so that we can determine the disability risks of your employees. This way we know who is or is not insured and if the premium and/or conditions need to be adapted in case of a change in the disability risk. Below you can read which information we need and what the consequences are if you do not pass on alterations or information in time.

If your payroll is taken care of by Interfisc BV, then we will be automatically informed about changes in your workforce. If someone else does your payroll, then you are required to inform us of any changes in your workforce.

 

5.1 When is an employee not (immediately) insured

In the following situations, your employee is not (automatically) insured by this policy:

  • the employee is entitled to a ‘WAO’-or ‘WIA’- benefit which has resulted from employment within your service;
  • the employee has become incapacitated for employment in your service for less than 35% and still has no new employment contract;
  • the employee was (partially) incapacitated when coming into your service;
  • the employee was incapacitated for work on the date that his fixed term employment contract was to be renewed. This regulation does not count if it can be proven that the renewal of the contract was agreed upon before the employee became incapacitated;
  • the employee has a no-risk status and is therefore insured for incapacity to work by the Dutch government. In this case we will only compensate the part of the salary that exceeds the maximum day wage for the employee’s insurances.

 

5.2 What are the consequences if you do not pass on alterations of your employee data-base to us or do so too late?

If Interfisc BV does your payroll then we will automatically be informed about changes in your workforce. This concerns for example, termination of employment or new employment contracts. All you need to do in this case is inform Interfisc BV about any alterations ‘in time’. By ‘in time’ we mean one month. In case your payroll is done elsewhere, then you need to inform us about any alterations in your workforce within one month. If the required information of a new employee is not passed on to us in time, either via Interfisc BV or not, then this new employee is not insured. This means that you will not receive damage payment if this employee becomes incapacitated to work. Of course, this isn’t the case if you can prove that you did communicate the alterations to Interfisc BV in time.

 

The new employee is insured from the moment we receive this information. From that moment on, you owe a premium for this employee and we will pay you the damage payment if you are entitled to it.

 

 

The above also applies to changes of more than 15% in the salary. We must also receive these changes within one month. Are you not reporting a salary increase in time? In that case, the damage payment will be paid to you based on the old salary. You will still owe the premium on the increased salary.

If you do not notify us in time of a salary reduction, while we have already paid you the compensation, you will owe us the difference. This will be settled with you, as well as the overpaid premium.

 

5.3 What are the consequences if you do not pass on alterations in the disability risk or do so too late?

The employment incapacity risk with in your company can change. Therefore, you must keep us informed as this may have consequences for the insurance. For example for the premium of the policy conditions. Notifications of changes must be passed on to us at least within a month after the change has occurred. If applicable, you will receive a new insurance offer from us based on the changed situation. If you do not agree to the new offer, please let us know within one month after having received the new offer. We will then terminate the insurance from the date that the changed situation went into effect.

 

When situations arise that may affect the employment incapacity risk, you must inform us as soon as possible, at least within a month. This applies to the following situations:

  • you have taken over (a part) of another company;
  • you have merged with another company; the other company being transferred to your company;
  • your company has split, you will receive a quote for the part that continues under the same wage tax number;
  • you have sold part of your company;
  • the tax authorities have classified your company in another sector;
  • your business activities have changed.

 

5.4  What are the consequences if you do not provide us with the information we asked for or do this too late?

For example, we have asked you for a collective wage statement (in Dutch: verzamelloonstaat) or have asked your Arbo service provider for a sick leave overview? We can only determine the damage payment and transfer this payment to you if we have received the required documents. In short, you will not receive a damage payment as long as we do have not received the requested document. As soon as we have received these documents, we will transfer the damage payment into your account. If we have suspended the coverage in the meantime, we can also terminate the insurance.

 

If we only receive the sick leave overview after 3 years, or do you only supply the requested documents after three years the right to compensation will expire definitively.

 

5.5 What are the consequences if you do not pass on information to us or consciously falsify this information?

We can suspend the coverage of the insurance, terminate the insurance immediately, or offer you a new policy under other conditions if you do not report changes to us or, intentionally give us the incorrect information. Even if this is via a third party such as the Arbo service provider. This also applies to the following situation; we would not have taken out or continued the insurance if we had the correct and complete information.

Our decision in this matter depends on the seriousness of the situation and the consequences this has for the employment disability risk and/or the damage payment. Have we offered you a quote for a new policy and did you accept it? Then we will handle the existing claims from the old policy, as well as new claims, in accordance to the new policy. You need to continue paying the premium in the situations as referred to in Article 5.

 

 

 

6.      Your obligations in the case of an incapacitation of an employee

Below we will inform you of what we expect from you as an employer when one of your employees becomes incapacitated. Within this insurance framework, you have obligations as well as you do according to the law. Additionally, we will tell you what the consequences are if you do not commit to your obligations.

 

6.1 When do you report an incapacitated employee?

Do you have Interfisc Arbo as an Arbo service provider? Then you must inform them as soon as possible if one of your employee’s becomes ill or incapacitated. You must always do this within two working days. If you are registered with another Arbo service provider, then Interfisc Arbo, then you must inform them within the same time limit. When registering an employees’ illness you must mention the first day the employee was registered as being ill or incapacitated to work. Additionally, you must mention the percentage the employee is incapacitated to work and if the employee has right to a social security payment, as a result of the employment incapacity.

Does something change in the employment incapacity percentage or, the employee resumes full employment. Inform your Arbo service provider within two working days. You must also do so if your employee has started appropriate employment or therapeutically based work.

 

6.2 What are the consequences if you do not report this in time?

If your Arbo service provider receives an employee’s illness or incapacity to work report after two working days, then the day the information was passed on to the Arbo service provider will count as the first day of illness or incapacity. As of this day the own risk period will apply, which means you will receive a lower damage payment.

If you report and illness or incapacitation to work after three years, then you are not entitled to a damage payment.

 

6.3 What information do you need to provide to whom?

Do you have another Arbo service provider than Interfisc Arbo? Then it is your responsibility that we receive a sick leave overview of the employees within the first 2 weeks of each new quarter. If we receive the overview later, then you will possibly receive the damage payment later than normal.

 

You must pass on all information that we ask of you so that we can determine the damage payment. The information can vary. For example, this can be a sick leave overview, a collective wage statement, ‘UWV’ ordinances or a record of continued wage payment. Furthermore, we can ask you to have these previously mentioned documents controlled by an accountant.

 

Upon our request, you should pass on the following information about your incapacitated employees to the reintegration employees of your Arbo service provider name, gender, date of birth, address, telephone number and e-mail address of the employee. You must also do so if they request information concerning the re-integration possibilities for an incapacitated employee. Such possibilities could refer to a reintegration Plan of Action. Besides the previous mentioned documents, other documents could also be requested. We will not request or administrate information regarding your employee if we are not permitted to do so by law or codes of conduct.

 

Does your employee not comply with his re-integration obligations? And, as a result you impose a wage sanction on this employee? Then you should inform us about this within two working days after the wage sanction has been imposed.

 

6.4 What are the consequences if you do not pass on the required information or do not do this in time?

If this is the case, we will suspend the damage payment. Damage payment will be resumed once we have received the requested information and have been able to determine the due amount of damage payment. If you register an employee as being incapacitated after a period of three years, you no longer have a right to a damage payment.

 

 

 

6.5 What are your obligations as an employer when it comes to reintegrating your employee?

As an employer you have the following obligations to an incapacitated employee:

  • you agree to receiving assistance from a Arbo service provider while guiding your incapacitated employee. This means that you will commit to the advice given by the Arbo service provider or company doctor, the re-integration employees and the advice provided by other professionals hired by us;
  • you allow the company doctor to make a problem analysis in time;
  • you create a Plan of Action;
  • you assign a case manager in time;
  • you discuss regularly the Plan of Action with your employee;
  • your employee is facilitated for possible adapted work with in your company. If adapted work is not possible within your company, then you will guide your employee where necessary in order to find a suitable job with another employer.

Your incapacitated employer has the following obligations:

  • he will do everything possible to resume work as soon as possible;
  • he will cooperate in creating a Plan of Action in time;
  • he commits to the agreements made in the Plan of Action;
  • he accepts the appropriate employment that you provide him, if the company doctor sees him fit to do so.

Do you as employer not fulfil the obligations as imposed by law? And does the employee apply for a WIA-benefit? Then the UWV can oblige you to continue paying the employee’s salary after the period of two years. The WIA-benefit will commence later. You will not receive a damage payment from us over the extended period of payment, unless you have a ‘Poortwachters’ guarantee. If the guarantee applies, then you should have fully committed yourself to the advice given by the Arbo service provider and the reintegration company when it comes to the reintegration of your employee. Besides this, you should have kept to all the terms of the policy conditions.

Does an incapacitated employee not fulfil his obligations? Then you can impose a wage sanction. This implies that you will temporarily not pay the employee a wage. If this happens, you have to let us know immediately as you will not be entitled to a damage payment for this period. If the employee receives a WIA-benefit then the UWV may lower the WIA-benefit.

 

6.6 What are the consequences if you do not carry out these reintegration obligations?

If you do not commit to the reintegration obligations as mentioned above, then we can lower or terminate the damage payment. We will only do so if you should have paid less or no wages to your employee if you had fulfilled the obligations.

 

Does your employee not comply with his obligations? And, is it for this reason that you should have lowered or not given any wages? Then you will not receive a damage payment from us.

 

6.7 What do you do if someone is liable for the incapacity of your employee?

Is a third party responsible for incapacitating one of your employees? Then you have the legal right to claim the net income, which you must pay your employee, from the liable third party. You also have the right to claim any likely costs you incur to reintegrate this employee. In the above situation, you should inform us within one month that a third party is liable. Further, you should inform us if you will be claiming the damage from a third party yourself. In addition, you should inform us of the process and the result.

If you are not going to claim the damage, you also have to let us know. Then we can claim the damage payment from the third party and you will not hinder us in doing so. When we claim, we initially do so to claim the damage payment that we have already paid you. We cannot claim costs on your behalf, such as the own risk period and potential reintegration costs.

 

 

 

 

6.8 What are the consequences for the damage payment if someone is liable for the incapacitation of your employee?

If you are claiming damages from a liable third party, then any damage payment you receive from us is an advance payment. The wage that you successfully claim from a liable third party we will deduct from the advance payment.

 

If you do not claim the damages from a liable third party and do not make it possible for us to do so, then we can reduce the damage payment by the amount that we could have recovered if you had granted us the opportunity to do so. This amount will be determined in all reasonableness and you will have to pay back us that amount.

 

7.      The insurance premium (advance premium payment) and conditions

7.1 When do you need to pay the advance premium?

The premium needs to be paid within one month after the invoice date. When you take out the sick leave insurance and at the beginning of each calendar year, an advanced premium must be paid. This can be done monthly, quarterly, per half year or annually.

 

7.2 How is your advance premium payment determined?

The advanced payment for your sick leave insurance is calculated using the insured salary of your employees and multiplying this by the premium percentage valid at that time. Below you can read which information may influence both the insured salary and the premium percentage.

 

The insured wage sum of the insured employees will be determined using the following information:

  • The employee’s age. Your employee is no longer insured after obtaining the AOW-entitled age (according to article 7a of the General Old Age Act),.
  • The maximum insured wage of your employees.
  • Any co-insured employer costs. These are expressed as a percentage of insured wage sum. Employer expenses are added on top of the insured wage sum up to a total maximum of €125,000.00 gross per employee for the first year. The second year the maximum is € 87,500.00 gross per employee. Both amounts are including the employer costs.

 

The premium percentage is determined based on the following information:

  • The absenteeism percentage within your company from the previous two years.
  • The coverage percentage during the first and/or second year.
  • The own risk period in working days.

 

7.3 When is the advance premium payment determined?

When you take out a sick leave insurance, the premium is based on an estimate of the salary for the rest of the calendar year. After that, every January we determine an advance premium based on the final total wage sum off the previous year. Did the insurance commence in the previous year after the 1st of January? Then we estimate the wages that would have applied to the insurance for a whole calendar year.

At the beginning of each new calendar year, the final total wage sum for the previous year is requested and a premium settlement will follow during the first quarter of the new calendar. You will receive a note of correction from us for the difference between the advanced premium paid and the premium actually due on the base of the final wage bill of the previous calendar year. The final premium of the previous year is also used as an advanced premium for the upcoming new year. Together with the final premium settlement of the previous calendar year, the advance premium of the current year will also be settled.

 

In addition, the actual sick leave percentage within your company may determine a higher outcome for the advance premium. Does the damage payment, you received from us for two consecutive years, exceed the premium you have paid to us over these years? Then we will increase the own-risk period and possibly the premium percentage after the contract’s term. We will do so at the beginning of the new contract term. We will provide you with a written warning if the damage payment in a certain year exceeds the total amount of premiums paid by your company.

 

In the table below you can see when and how we will adjust the own-risk period and possibly the premium percentage based on the damage payment we have paid you.

 

Damage payment over a period of two consecutive years, as a percentage of the insurance premiums paid during that time interval: As the new contract term commences:
125% The own risk period will be increased by 10 or 20 working days.
150% a maximum increase in the premium percentage of 25%, possibly combined with an increase of the own risk period by 10, 20 or 30 working days.
200% a maximum increase in the premium percentage of 40%, possibly combined with an increase of the own risk period by 10, 20 or 30 working days.

 

Are the damage payments during the duration of the new contract, with the increased premium percentage, lower than the old annual premium? Then we will we will lower the own risk period and premium percentage as of the next contract term:

  • If the premium percentage was increased by 25%, then this premium percentage will be reduced by 20%.
  • If the premium percentage was increased by 40%, then this premium percentage will be reduced by 28.5%.

In both of the above situations, the new premium percentage will be the same as the premium percentage before the increase. Similarly, if applicable, the increased own risk period will be returned to its original status.

 

If you disagree with the adjustment of the advance premium, then you must let us know as soon as possible. Do so no later than a month after we have indicated the adjusted premium. Then we will terminate the insurance as of the next calendar month.

 

7.4 When can the advance premium and conditions be adjusted (interim)?

We can adjust the advance premium payment and/or policy conditions in the following interim situations:

  • If during the calendar year, there is a significant increase in the total wage sum because of an increased amount of employed employees. In this situation, we can increase the advance premium based on the latest workforce numbers and the according insured wages.
  • If the insurance coverage is adjusted or the risk changes.
  • When legislative adjustments or social changes result in the insurance no longer matching your new situation.
  • When the continuation of an unadjusted insurance policy has drastic financial implications for us.

When the premium or the policy conditions are adjusted in an interim situation as a result of the above mentioned situations, the adjustment does not only apply to your sick leave insurance but to all sick leave insurances or to all sick leave insurances of the same target group. In this case, you are not entitled to terminate the sick leave insurance interim because of a raised premium because of the mentioned situations. Nor do you if any other adjustments lead to a decreased or equal premium.

 

You can also adjust the advanced premium during the contract term. For example, you can ask us to adjust the own risk period, adjust the coverage percentage or co-insure the employer’s costs. After we have approved the request, the adjustment will be implemented as of the next calendar month. As of that month, the advance premium will be adjusted in accordance to the new agreements.

 

7.5 What are the consequences if you do not pay the premium or do not do so in time?

If you do not pay in time, we can suspend the coverage. In this case, we will inform you of the insurance suspension date if the premium is still not paid. In the event that your employee becomes incapacitated for work after this suspension date, we will not pay out damage payments. This is valid for the entire period of your employee’s incapacitation, even if you have started to pay your premiums again.

Was the employee incapacitated before the insurance suspension date? Then we will pay this damage payment. When the premium is still not paid, even after it has been suspended, then we have the right to terminate the insurance. We will inform you in advance of the insurance’s termination date if the premiums and additional administrative costs have not been paid. As of this date, we will not pay any damage payments, even for employees who were incapacitated before the suspension date.

 

7.6 For which insured employees do you not have to pay a premium?

You do not have to pay a premium for the following employees:

  • An employee who has reached the AOW-pensionable age.
  • An employee who is/was (partially) incapacitated before he joined your workforce. As soon as this employee has been registered as being no longer incapacitated for a consecutive period of 28 calendar days, then the insurance will apply to this employee. As of that moment, you also pay a premium for this employee.
  • Does your employee have a no-risk status? Then the employee will receive a sickness benefit from the UWV for the wage up to the maximum wage under the Dutch Health Law. If the employee’s wage exceeds this maximum, then you will pay a premium for the part of the wage that exceeds the maximum. When the employee no longer has a no-risk status, you will have to pay the full premium over your employee’s wage.
  • When you have received the maximum compensation for an employee who has been incapacitated for 104 weeks. When you re-employ this employee and sign a new employment contract with him, then this employee will be included in the insurance. As of that moment, you will pay a premium again for this employee.

 

8.      Termination of the insurance

8.1 When will the insurance be terminated?

The insurance will be terminated in the following cases:

  • Your company is bankrupt. The termination date will be the same as the date of bankruptcy.
  • You no longer have any employees in service. In order to terminate the insurance in this situation you must send us a wage tax return of the first calendar month that you no longer have any employees in service, referred to as a Nihil tax return (in Dutch: nihilaangifte).
  • You do not pay the premiums despite the reminders we sent you (7.5).
  • You have deliberately given us the wrong information (5.5) even if this has been passed on via a third party such as the Arbo service provider.
  • You terminate the insurance. This is possible for the first time three years after the starting date of the insurance, with effect of the contract expiry date. The contract expiry date is the date on which we yearly extend your insurance. Did you sign for the insurance after January the first? Then the term of three years will commence as of the next January the first. After the term of the first three years, the insurance can be terminated monthly with one months’ notice.

 

9.      Terrorism

Is one of your employees incapacitated because of an Act of Terrorism? Then you are entitled to a damage payment if and insofar our reserves allow us to do so. The extent and duration of these payments are restricted.

 

9.1 Glossary of terms

Under this condition we define the following terms:

 

      9.1.1 Terrorism

Any violent act and/or conduct – committed outside the scope of one of the six forms of acts of war (molest) as referred to in Article 3:38 of the Financial Supervision Act [Wet op het financieel toezicht] – in the form of an attack or a series of attacks connected together in time and intention as a result whereof injury and/or impairment of health, whether resulting in death or not, and/or loss of or damage to property arises or any economic interest is otherwise impaired, in which case it is likely that said attack or series – whether or not in any organisational context – has been planned and/or carried out with a view to effect certain political and/or religious and/or ideological purposes.

 

      9.1.2 Malicious Contamination

The spreading (whether active or not) – committed outside the scope of one of the six forms of acts of war as referred to in Article 3:38 of the Financial Supervision Act – of germs of a disease and/or substances which as a result of their (in)direct physical, biological, radioactive or chemical effect may cause injury and/or impairment of health, whether resulting in death or not, to humans or animals and/or may cause loss of or damage to property or may otherwise impair economic interests, in which case it is likely that the spreading (whether active or not) – whether or not in any organisational context – has been planned and/or carried out with a view to effect certain political and/or religious and/or ideological purposes.

 

      9.1.3 Precautionary Measures

Any precautionary measures taken by the authorities and/or insured parties and/or third parties in order to avert the imminent risk of terrorism and/or malevolent contamination or – if such peril has manifested itself – to minimise the consequences thereof.

 

 

9.2 How do we calculate your damage payment in the event of terrorism

If and insofar our financial reserves allow this, taking into account the previous mentioned terms ‘Terrorism’, ‘Malicious Contamination’ and ‘Precautionary Measures’ and within the limits of the applicable policy conditions, coverage exists for the consequences of an event that is either directly or indirectly related to:

  • Terrorism, malicious contamination or precautionary measures;
  • Act or behaviour in preparation of terrorism, malicious contamination or precautionary measures, hereafter referred to as the collective term ‘the terrorism risk’,

our obligation to pay, in respect of any submitted claim to indemnity and/or benefit, shall be limited to a maximum of 50% of the insured wage for the period of the first 52 weeks. We take into account the applicable own risk period. The damage payment will never exceed the actual suffered damage during the first 52 weeks. In case of terrorism, there is no coverage for the weeks 53 up to and including 104.

 

We will let you know in writing whether we will pay you the damage payment and the amount of the payment. We will do this as soon as we are sufficiently clear about the extent of the total damage resulting from terrorism.

 

10. Personal Data

10.1 How do we communicate with you?

When we want to inform you about your insurance, we will either send a letter or e-mail to our insurance broker Ravil Intersurance B.V. Via them you can also communicate with us.

 

 10.2 For what do we use the personal data?

We will use the personal data, which you have shared with us, with outmost discretion. Your personal data will be used for the following:

  • processing the application;
  • conclusion of the insurance contract and the execution of this contract;
  • handling damage payments;
  • to prevent fraud. For which we may also use public data found on the internet;
  • to comply with the current laws and regulations;
  • to the extent that it is permitted, sharing with business partners, advisors, Arbo service providers and debt collection agencies;
  • conducting a market research or statistical analysis;
  • maintaining or improving our relationship with you;
  • Informing you about our products and/or to make offers.

We conform to the current laws and regulations. You can read more about this in our Privacy Statement.

 

10.3 Who uses the personal data?

Our employees use the personal data and any other data for executing work activities. In some cases, we will share personal data with the Arbo service provider, the insurance agent or a debt collector’s agency.

 

11. Profit sharing

If we have made profit in a calendar year, we will reserve 3% of the net profit for profit sharing. Have you been insured via us for the full length of the calendar year? Then you are entitled to your equal share of the profit. You will receive your equal share as will the other insured. The profit share is paid out in retrospect at the end of every three year period.

 

12. Entitlements

The Dutch law applies to this insurance contract. The District Court of The Hague is competent for any disputes regarding this insurance contract.