SAMENVATTING SOCIAAL ZEKERHEIDSRECHT
INHOUDSOPGAVE
INLEIDING: SCHEMA SOCIALE ZEKERHEID ......................................................................................................... 7
BEROEPSGROEPEN: .......................................................................................................................................... 8
ZELFSTANDIGEN ......................................................................................................................................................... 8
AMBTERNAREN: ......................................................................................................................................................... 8
WERKNEMER .............................................................................................................................................................. 8
HOOFDSTUK 1: TOEPASSINGSGEBIED ............................................................................................................... 9
A. WERKNEMERS ........................................................................................................................................... 9
DRIE BEROEPSGROEPEN (CF. INLEIDING) ...................................................................................................... 9
GEZAGSVERHOUDING.................................................................................................................................... 9
TERRITORIAAL TOEPASSINGSGEBIED (SOCIALE ZEKERHEID): ...................................................................... 10
EG-VORDERING 883/2004: .......................................................................................................................... 10
SZ: IS VOOR WERKNEMERS (VAN TOEPASSING OP AL WIE EEN ARBEIDSOVEREENKOMST HEEFT) ............ 10
UITBREIDING............................................................................................................................................................. 11
UITSLUITING ............................................................................................................................................................. 11
BEPERKING ............................................................................................................................................................... 12
B. STUDENTENARBEID (TOEPASSINGSGEBIED) ........................................................................................... 12
C. AMBTENAREN (TOEPASSINGSGEBIED) ................................................................................................... 14
D. ZELFSTANDIGEN (TOEPASSINGSGEBIED): ............................................................................................... 14
ZELFSTANDIGE ............................................................................................................................................. 14
BEROEPSBEZIGHEID (BESTAAT UIT 3 ELEMENTEN): .................................................................................... 15
HELPER ......................................................................................................................................................... 16
DEELECONOMIE ........................................................................................................................................... 16
E. AFGELEIDE RECHTEN (TOEPASSINGSGEBIED): ........................................................................................ 16
RESIDUAIRE STELSELS: ................................................................................................................................. 17
HOOFDSTUK 2: FINANCIËRING SOCIALE ZEKERHEID ....................................................................................... 18
A. WERKNEMERS ......................................................................................................................................... 18
BRONNEN: ................................................................................................................................................... 18
BEREKENINGSGRONDSLAG BIJDRAGEN SOCIALE ZEKERHEID:..................................................................... 18
LOON – ALGEMEEN ..................................................................................................................................... 18
LOON – VERRUIMING- VAKANTIEGELD → ALS BIJDRAGEPLICHTIG LOON VOOR SZ! .................................. 18
LOON-BEPERKINGEN (WAT IS GEEN LOON) = GEEN SOCIALE BIJDRAGEN OP BETALEN (EXAMEN !!!) ....... 20
LOON-ANDERE AFWIJKINGEN: .................................................................................................................... 22
LOON-DIVERSEN: ......................................................................................................................................... 22
SOCIALEZEKERHEIDSBIJDRAGEN .................................................................................................................. 22
EENHEIDSBIJDRAGE ..................................................................................................................................... 22
DESONDANKS THESAURIEBEHOEFTEN →BIJDRAGEPERCENTAGES ............................................................ 23
TAXSHIFT (WERKNEMERS) ........................................................................................................................... 23
AFWIJKINGEN .............................................................................................................................................. 23
BIJKOMENDE BIJDRAGEN (geen RZS bijdragen!) ......................................................................................... 24
CRISISBIJDRAGEN ......................................................................................................................................... 24
SOLIDARITEITSBIJDRAGEN ........................................................................................................................... 24
BIJDRAGEN OP SOCIALE UITKERINGEN ........................................................................................................ 25
ALTERNATIEVE FINANCIERING ..................................................................................................................... 25
FORMALITEITEN ........................................................................................................................................... 25
B. AMBTENAREN (=DEFINITIEF BENOEMDE/STATUTAIRE PERSONEELSLEDEN) ........................................................... 26
BEREKENINGSGRONDSLAG .......................................................................................................................... 26
BIJDRAGEPERCENTAGES .............................................................................................................................. 26
CRISISBIJDRAGEN ......................................................................................................................................... 26
1
, EENZIJDIGE BEËINDIGING ............................................................................................................................ 27
C. AMBTENARENPENSIOENEN (EXAMEN) ..................................................................................................... 27
PENSIOENFINANCIERING ............................................................................................................................. 27
D. ZELFSTANDIGEN ...................................................................................................................................... 28
BEREKENINGSGRONDSLAG .......................................................................................................................... 28
BIJDRAGEPERCENTAGES .............................................................................................................................. 29
KWARTAALBIJDRAGEN 2020 ....................................................................................................................... 29
TAXSHIFT (ZELFSTANDIGEN) ........................................................................................................................ 29
ZELFSTANDIG BIJBEROEP ............................................................................................................................. 29
STUDENT-ZELFSTANDIGE ............................................................................................................................. 30
GEPENSIONEERDE ZELFSTANDIGEN ............................................................................................................ 30
VOORLOPIGE BIJDRAGEN ............................................................................................................................ 30
VRIJSTELLING BIJDRAGEN ............................................................................................................... 31
VERGELIJKING ZN EN WN !! ......................................................................................................................... 31
CRISISBIJDRAGEN ......................................................................................................................................... 31
ALTERNATIEVE FINANCIERING ..................................................................................................................... 31
FORMALITEITEN ........................................................................................................................................... 31
E. OVERHEIDSSTEUN ................................................................................................................................... 32
F. SUBSIDIAIRE FINANCIERINGSBRONNEN ................................................................................................. 32
HOOFDSTUK 3: ADMINISTARTIEVE ORGANISATIE .......................................................................................... 33
ALGEMEEN ....................................................................................................................................................... 33
A. WERKNEMERS ......................................................................................................................................... 34
INNING ......................................................................................................................................................... 34
UITVOERING ................................................................................................................................................ 34
1. ZIEKTE- EN INVALIDITEITSVERZEKERING ........................................................................................................ 34
2. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 35
3. WERKLOOSHEIDSREGERLING ..................................................................................................... 35
4. PENSIOENEN .............................................................................................................................. 36
5. ARBEIDSONGEVALLEN-EN BEROEPSZIEKTEN: ...................................................................... 36
6. RIJKSDIENST VOOR JAARLIJKSE VAKANTIE ......................... 37
OVERZICHTSSCHEMA:............................................................................................................................................... 37
B. ZELFSTANDIGEN (VALLEN SLECHTS ONDER 4 SECTOREN SZ) .................................................................. 38
INNING ......................................................................................................................................................... 38
UITVOERING ................................................................................................................................................ 38
1. ZIEKTE- EN INVALIDITEITSUITKERING ............................................................................................................. 38
2. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 38
C. OVERHEIDSPERSONEEL ........................................................................................................................... 39
INNING ......................................................................................................................................................... 39
UITVOERING ................................................................................................................................................ 39
1. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 39
2. PENSIOENEN .................................................................................................................................................. 39
= Federale Pensioendienst: ...................................................................................................................................... 39
HOOFDSTUK 4: GEZONDHEIDSZORG .............................................................................................................. 40
A. RECHTHEBBENDEN ................................................................................................................................. 40
GERECHTIGDEN ........................................................................................................................................... 40
VOORTGEZETTE VERZEKERING .................................................................................................................... 42
PERSOON TEN LASTE (= afgeleid recht op gezondheidszorg) ...................................................................... 42
2
, PERSOON TEN LASTE VOORWAARDEN: ....................................................................................................... 43
B. ALGEMENE VOORWAARDEN: ................................................................................................................. 43
1. AANSLUITEN BIJ VERZEKERINGSINSTELLING .................................................................................................. 43
2. [BEWIJS VAN] BIJDRAGEBETALING................................................................................................................. 44
C. SOORTEN VERSTREKKINGEN: .................................................................................................................. 44
SOORTEN VERSTREKKINGEN ........................................................................................................................ 44
NOMECLATUUR !!! ...................................................................................................................................... 44
GENEESMIDDELEN ....................................................................................................................................... 45
BIJZONDER SOLIDARITEITSFONDS ............................................................................................................... 45
ZORGVERNIEUWINGSPROJECTEN (minder belangerijk) .............................................................................. 46
D. SPECIFIEKE VOORWAARDEN (VOOR TERUGBETALING) .......................................................................... 46
E. UITGESLOTEN KOSTEN ............................................................................................................................ 46
F. PRESTATIES ............................................................................................................................................. 47
PRESTATIES .................................................................................................................................................. 47
ACCREDITERING ........................................................................................................................................... 47
VERHOOGDE TEGEMOETKOMING ............................................................................................................... 48
GLOBAAL MEDISCH DOSSIER (GMD) ........................................................................................................... 48
MAXIMUMFACTUUR (geldt enkel voor betaalde remgelden) ..................................................................... 49
BIJZONDERE MAATREGELEN ....................................................................................................................... 49
G. TERUGBETALINGS-TARIEVEN .................................................................................................................. 50
3 SOORTEN GENEESMIDDELEN ................................................................................................................... 50
H. VASTELLING TARIEVEN ............................................................................................................................ 52
OVEREENKOMSTEN ..................................................................................................................................... 52
HOOFDSTUK 5: ARBEIDSONGEVALLEN EN BEROEPSZIEKTEN .......................................................................... 55
ARBEIDSONGEVALLEN ...................................................................................................................................... 55
A. PRINCIPES ............................................................................................................................................... 55
HISTORISCHE CONTEXT ................................................................................................................................ 55
TOEPASSINGSGEBIED ................................................................................................................................... 55
B. BEGRIP & BEWIJS ARBEIDSONGEVAL ...................................................................................................... 55
PLOTSELINGE GEBEURTENIS (A) .................................................................................................................. 56
LETSEL (B)..................................................................................................................................................... 56
UITWENDIGE OORZAAK (C) ......................................................................................................................... 56
TIJDENS HET WERK (D) ................................................................................................................................ 56
DOOR HET WERK (E) .................................................................................................................................... 57
FOUT VAN HET SLACHTOFFER? ................................................................................................................... 57
GELIJKSTELLINGEN WERKPLAATS ................................................................................................................ 57
BEWIJS ARBEIDSONGEVAL!!!!...................................................................................................................... 57
ONGEVAL OP DE ARBEIDSWEG .................................................................................................................... 58
VERBLIJFPLAATS: ...................................................................................................................................................... 59
WERKPLAATS ............................................................................................................................................................ 59
NORMALE TRAJECT:.................................................................................................................................................. 59
RECHTSPRAAK .............................................................................................................................................. 60
WET.............................................................................................................................................................. 60
11 GELIJKGESTELDE TRAJECTEN .................................................................................................................. 60
BEWIJS ARBEIDSWEGONGEVAL: .................................................................................................................. 60
C. SCHADELOOSSTELLING ........................................................................................................................... 61
MEDISCHE KOSTEN: ..................................................................................................................................... 61
PROTHESEN EN ORTHOPEDIE ...................................................................................................................... 62
TIJDELIJKE ARBEIDSONGESCHIKT ................................................................................................................. 62
BLIJVENDE ARBEIDSONGESCHIKTHEID ........................................................................................................ 64
BAO EVALUATIE: .......................................................................................................................................... 64
RENTE (blijvende arbeidsongeschiktheid) .................................................................................................... 65
VERGOEDING HULP VAN DERDEN: .............................................................................................................. 65
HERZIENING: ................................................................................................................................................ 65
HERZIENINGSTERMIJN: ................................................................................................................................ 66
DODELIJKE ARBEIDSONGEVALLEN !! (EXAMEN) .......................................................................................... 66
3
, D. BURGERLIJKE AANSPRAAKELIJKHEID ...................................................................................................... 67
E. PROCEDURE & VERZEKERING .................................................................................................................. 68
PROCEDURE ................................................................................................................................................. 68
VERZEKERING............................................................................................................................................... 68
BEROEPSZIEKTEN .............................................................................................................................................. 69
F. VERSCHILLEN BEROEPSZIEKTEN .............................................................................................................. 69
ALGEMEEN ................................................................................................................................................... 69
VERSCHILPUNTEN ........................................................................................................................................ 69
BEGRIP “BEROEPSZIEKTE”............................................................................................................................ 69
BEWIJS ERKENDE BEROEPSZIEKTEN ............................................................................................................ 69
BLIJVENDE ARBEIDSONGESCHIKTHEID ........................................................................................................ 70
PREVENTIE ................................................................................................................................................... 70
HOOFDSTUK 6: ZIEKTE EN INVALIDITEIT ......................................................................................................... 71
A. WERKGENEMERS: ARBEIDSONGESCHIKTHEID ........................................................................................ 71
RECHTHEBBENDEN ...................................................................................................................................... 71
VOORWAARDEN .......................................................................................................................................... 71
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 71
INDIEN AAN 3 VOORWAARDEN VOLDAAN ............................................................................................................... 71
VERMOEDENS ........................................................................................................................................................... 71
EVALUATIE (IN RAAM VAN ZIEKTEVERZEKERING) .................................................................................................... 72
ZIV-UITKERINGEN ........................................................................................................................................ 72
GEZINSLAST.................................................................................................................................................. 73
HULP VAN DERDEN (VOOR GEHANDICAPTEN) ............................................................................................ 75
ZIV-UITKERINGEN: ....................................................................................................................................... 75
GEDEELTELIJKE GESCHIKTHEID: ................................................................................................................... 76
ANDERS-GESCHIKTHEID: .............................................................................................................................. 76
B. WERKGENEMERS: MOEDERSCHAP ......................................................................................................... 77
BESCHERMINGSMAATREGELEN .................................................................................................................. 77
MOEDERSCHAPSVERLOF.............................................................................................................................. 77
MOEDERSCHAPSUITKERING: ....................................................................................................................... 78
SPECIFIEK VADERSCHAPSVERLOF ................................................................................................................ 78
ALGEMEEN GEBOORTEVERLOF.................................................................................................................... 79
ADOPTIEVERLOF .......................................................................................................................................... 79
VERLOF VAN PLEEGOUDER .......................................................................................................................... 79
C. ZELFSTANDIGEN – ARBIEDSONGESCHIKTHEID ........................................................................................ 80
RECHTHEBBENDEN ...................................................................................................................................... 80
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 80
PRIMAIRE ARBEIDSONGESCHIKTHEID (A) ................................................................................................................. 80
INVALIDITEIT (B) → na 1 jaar PAO ............................................................................................................................ 80
VERMOEDENS ........................................................................................................................................................... 81
ZIV-UITKERINGEN ........................................................................................................................................ 81
PRIMAIRE ARBEIDSONGESCHIKTHEID (gezinstoestand speelt wel al een rol!! niet wij WN) .................................... 81
ZIV-UITKERINGEN (identiek vervangingsinkomen ivm PAO) .................................................................................... 81
D. ZELFSTANDIGEN: MOEDERSCHAP ................................................................................................................ 82
MOEDERSCHAP ............................................................................................................................................ 82
ANDERE GEZINSVERLOVEN .......................................................................................................................... 82
E. AMBTENAREN -ARBEIDSONGSCHIKTHEID .............................................................................................. 82
ALGEMEEN ................................................................................................................................................... 82
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 82
VERLOF VANWEGE ZIEKTE ........................................................................................................................... 83
VERMINDERDE PRESTATIES ......................................................................................................................... 84
INDIEN ZIEKTEVERLOF UITGEPUT = DISPONIBILITEIT .................................................................................. 84
INTERACTIE STATUTAIRE VERLOVEN ........................................................................................................... 85
EVALUATIE ................................................................................................................................................... 85
F. PERSONEN MET EEN HANDICAP- ARBEIDSONGESCHIKTHEID (GEEN LEERSTOF!!) ................................. 85
HOOFDSTUK 7: GEZINSBIJSLAGSREGERLING (GASTCOLLEGE) ......................................................................... 86
4
INHOUDSOPGAVE
INLEIDING: SCHEMA SOCIALE ZEKERHEID ......................................................................................................... 7
BEROEPSGROEPEN: .......................................................................................................................................... 8
ZELFSTANDIGEN ......................................................................................................................................................... 8
AMBTERNAREN: ......................................................................................................................................................... 8
WERKNEMER .............................................................................................................................................................. 8
HOOFDSTUK 1: TOEPASSINGSGEBIED ............................................................................................................... 9
A. WERKNEMERS ........................................................................................................................................... 9
DRIE BEROEPSGROEPEN (CF. INLEIDING) ...................................................................................................... 9
GEZAGSVERHOUDING.................................................................................................................................... 9
TERRITORIAAL TOEPASSINGSGEBIED (SOCIALE ZEKERHEID): ...................................................................... 10
EG-VORDERING 883/2004: .......................................................................................................................... 10
SZ: IS VOOR WERKNEMERS (VAN TOEPASSING OP AL WIE EEN ARBEIDSOVEREENKOMST HEEFT) ............ 10
UITBREIDING............................................................................................................................................................. 11
UITSLUITING ............................................................................................................................................................. 11
BEPERKING ............................................................................................................................................................... 12
B. STUDENTENARBEID (TOEPASSINGSGEBIED) ........................................................................................... 12
C. AMBTENAREN (TOEPASSINGSGEBIED) ................................................................................................... 14
D. ZELFSTANDIGEN (TOEPASSINGSGEBIED): ............................................................................................... 14
ZELFSTANDIGE ............................................................................................................................................. 14
BEROEPSBEZIGHEID (BESTAAT UIT 3 ELEMENTEN): .................................................................................... 15
HELPER ......................................................................................................................................................... 16
DEELECONOMIE ........................................................................................................................................... 16
E. AFGELEIDE RECHTEN (TOEPASSINGSGEBIED): ........................................................................................ 16
RESIDUAIRE STELSELS: ................................................................................................................................. 17
HOOFDSTUK 2: FINANCIËRING SOCIALE ZEKERHEID ....................................................................................... 18
A. WERKNEMERS ......................................................................................................................................... 18
BRONNEN: ................................................................................................................................................... 18
BEREKENINGSGRONDSLAG BIJDRAGEN SOCIALE ZEKERHEID:..................................................................... 18
LOON – ALGEMEEN ..................................................................................................................................... 18
LOON – VERRUIMING- VAKANTIEGELD → ALS BIJDRAGEPLICHTIG LOON VOOR SZ! .................................. 18
LOON-BEPERKINGEN (WAT IS GEEN LOON) = GEEN SOCIALE BIJDRAGEN OP BETALEN (EXAMEN !!!) ....... 20
LOON-ANDERE AFWIJKINGEN: .................................................................................................................... 22
LOON-DIVERSEN: ......................................................................................................................................... 22
SOCIALEZEKERHEIDSBIJDRAGEN .................................................................................................................. 22
EENHEIDSBIJDRAGE ..................................................................................................................................... 22
DESONDANKS THESAURIEBEHOEFTEN →BIJDRAGEPERCENTAGES ............................................................ 23
TAXSHIFT (WERKNEMERS) ........................................................................................................................... 23
AFWIJKINGEN .............................................................................................................................................. 23
BIJKOMENDE BIJDRAGEN (geen RZS bijdragen!) ......................................................................................... 24
CRISISBIJDRAGEN ......................................................................................................................................... 24
SOLIDARITEITSBIJDRAGEN ........................................................................................................................... 24
BIJDRAGEN OP SOCIALE UITKERINGEN ........................................................................................................ 25
ALTERNATIEVE FINANCIERING ..................................................................................................................... 25
FORMALITEITEN ........................................................................................................................................... 25
B. AMBTENAREN (=DEFINITIEF BENOEMDE/STATUTAIRE PERSONEELSLEDEN) ........................................................... 26
BEREKENINGSGRONDSLAG .......................................................................................................................... 26
BIJDRAGEPERCENTAGES .............................................................................................................................. 26
CRISISBIJDRAGEN ......................................................................................................................................... 26
1
, EENZIJDIGE BEËINDIGING ............................................................................................................................ 27
C. AMBTENARENPENSIOENEN (EXAMEN) ..................................................................................................... 27
PENSIOENFINANCIERING ............................................................................................................................. 27
D. ZELFSTANDIGEN ...................................................................................................................................... 28
BEREKENINGSGRONDSLAG .......................................................................................................................... 28
BIJDRAGEPERCENTAGES .............................................................................................................................. 29
KWARTAALBIJDRAGEN 2020 ....................................................................................................................... 29
TAXSHIFT (ZELFSTANDIGEN) ........................................................................................................................ 29
ZELFSTANDIG BIJBEROEP ............................................................................................................................. 29
STUDENT-ZELFSTANDIGE ............................................................................................................................. 30
GEPENSIONEERDE ZELFSTANDIGEN ............................................................................................................ 30
VOORLOPIGE BIJDRAGEN ............................................................................................................................ 30
VRIJSTELLING BIJDRAGEN ............................................................................................................... 31
VERGELIJKING ZN EN WN !! ......................................................................................................................... 31
CRISISBIJDRAGEN ......................................................................................................................................... 31
ALTERNATIEVE FINANCIERING ..................................................................................................................... 31
FORMALITEITEN ........................................................................................................................................... 31
E. OVERHEIDSSTEUN ................................................................................................................................... 32
F. SUBSIDIAIRE FINANCIERINGSBRONNEN ................................................................................................. 32
HOOFDSTUK 3: ADMINISTARTIEVE ORGANISATIE .......................................................................................... 33
ALGEMEEN ....................................................................................................................................................... 33
A. WERKNEMERS ......................................................................................................................................... 34
INNING ......................................................................................................................................................... 34
UITVOERING ................................................................................................................................................ 34
1. ZIEKTE- EN INVALIDITEITSVERZEKERING ........................................................................................................ 34
2. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 35
3. WERKLOOSHEIDSREGERLING ..................................................................................................... 35
4. PENSIOENEN .............................................................................................................................. 36
5. ARBEIDSONGEVALLEN-EN BEROEPSZIEKTEN: ...................................................................... 36
6. RIJKSDIENST VOOR JAARLIJKSE VAKANTIE ......................... 37
OVERZICHTSSCHEMA:............................................................................................................................................... 37
B. ZELFSTANDIGEN (VALLEN SLECHTS ONDER 4 SECTOREN SZ) .................................................................. 38
INNING ......................................................................................................................................................... 38
UITVOERING ................................................................................................................................................ 38
1. ZIEKTE- EN INVALIDITEITSUITKERING ............................................................................................................. 38
2. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 38
C. OVERHEIDSPERSONEEL ........................................................................................................................... 39
INNING ......................................................................................................................................................... 39
UITVOERING ................................................................................................................................................ 39
1. GEZINSBIJSLAGREGELING/GROEIPAKKET ....................................................................................................... 39
2. PENSIOENEN .................................................................................................................................................. 39
= Federale Pensioendienst: ...................................................................................................................................... 39
HOOFDSTUK 4: GEZONDHEIDSZORG .............................................................................................................. 40
A. RECHTHEBBENDEN ................................................................................................................................. 40
GERECHTIGDEN ........................................................................................................................................... 40
VOORTGEZETTE VERZEKERING .................................................................................................................... 42
PERSOON TEN LASTE (= afgeleid recht op gezondheidszorg) ...................................................................... 42
2
, PERSOON TEN LASTE VOORWAARDEN: ....................................................................................................... 43
B. ALGEMENE VOORWAARDEN: ................................................................................................................. 43
1. AANSLUITEN BIJ VERZEKERINGSINSTELLING .................................................................................................. 43
2. [BEWIJS VAN] BIJDRAGEBETALING................................................................................................................. 44
C. SOORTEN VERSTREKKINGEN: .................................................................................................................. 44
SOORTEN VERSTREKKINGEN ........................................................................................................................ 44
NOMECLATUUR !!! ...................................................................................................................................... 44
GENEESMIDDELEN ....................................................................................................................................... 45
BIJZONDER SOLIDARITEITSFONDS ............................................................................................................... 45
ZORGVERNIEUWINGSPROJECTEN (minder belangerijk) .............................................................................. 46
D. SPECIFIEKE VOORWAARDEN (VOOR TERUGBETALING) .......................................................................... 46
E. UITGESLOTEN KOSTEN ............................................................................................................................ 46
F. PRESTATIES ............................................................................................................................................. 47
PRESTATIES .................................................................................................................................................. 47
ACCREDITERING ........................................................................................................................................... 47
VERHOOGDE TEGEMOETKOMING ............................................................................................................... 48
GLOBAAL MEDISCH DOSSIER (GMD) ........................................................................................................... 48
MAXIMUMFACTUUR (geldt enkel voor betaalde remgelden) ..................................................................... 49
BIJZONDERE MAATREGELEN ....................................................................................................................... 49
G. TERUGBETALINGS-TARIEVEN .................................................................................................................. 50
3 SOORTEN GENEESMIDDELEN ................................................................................................................... 50
H. VASTELLING TARIEVEN ............................................................................................................................ 52
OVEREENKOMSTEN ..................................................................................................................................... 52
HOOFDSTUK 5: ARBEIDSONGEVALLEN EN BEROEPSZIEKTEN .......................................................................... 55
ARBEIDSONGEVALLEN ...................................................................................................................................... 55
A. PRINCIPES ............................................................................................................................................... 55
HISTORISCHE CONTEXT ................................................................................................................................ 55
TOEPASSINGSGEBIED ................................................................................................................................... 55
B. BEGRIP & BEWIJS ARBEIDSONGEVAL ...................................................................................................... 55
PLOTSELINGE GEBEURTENIS (A) .................................................................................................................. 56
LETSEL (B)..................................................................................................................................................... 56
UITWENDIGE OORZAAK (C) ......................................................................................................................... 56
TIJDENS HET WERK (D) ................................................................................................................................ 56
DOOR HET WERK (E) .................................................................................................................................... 57
FOUT VAN HET SLACHTOFFER? ................................................................................................................... 57
GELIJKSTELLINGEN WERKPLAATS ................................................................................................................ 57
BEWIJS ARBEIDSONGEVAL!!!!...................................................................................................................... 57
ONGEVAL OP DE ARBEIDSWEG .................................................................................................................... 58
VERBLIJFPLAATS: ...................................................................................................................................................... 59
WERKPLAATS ............................................................................................................................................................ 59
NORMALE TRAJECT:.................................................................................................................................................. 59
RECHTSPRAAK .............................................................................................................................................. 60
WET.............................................................................................................................................................. 60
11 GELIJKGESTELDE TRAJECTEN .................................................................................................................. 60
BEWIJS ARBEIDSWEGONGEVAL: .................................................................................................................. 60
C. SCHADELOOSSTELLING ........................................................................................................................... 61
MEDISCHE KOSTEN: ..................................................................................................................................... 61
PROTHESEN EN ORTHOPEDIE ...................................................................................................................... 62
TIJDELIJKE ARBEIDSONGESCHIKT ................................................................................................................. 62
BLIJVENDE ARBEIDSONGESCHIKTHEID ........................................................................................................ 64
BAO EVALUATIE: .......................................................................................................................................... 64
RENTE (blijvende arbeidsongeschiktheid) .................................................................................................... 65
VERGOEDING HULP VAN DERDEN: .............................................................................................................. 65
HERZIENING: ................................................................................................................................................ 65
HERZIENINGSTERMIJN: ................................................................................................................................ 66
DODELIJKE ARBEIDSONGEVALLEN !! (EXAMEN) .......................................................................................... 66
3
, D. BURGERLIJKE AANSPRAAKELIJKHEID ...................................................................................................... 67
E. PROCEDURE & VERZEKERING .................................................................................................................. 68
PROCEDURE ................................................................................................................................................. 68
VERZEKERING............................................................................................................................................... 68
BEROEPSZIEKTEN .............................................................................................................................................. 69
F. VERSCHILLEN BEROEPSZIEKTEN .............................................................................................................. 69
ALGEMEEN ................................................................................................................................................... 69
VERSCHILPUNTEN ........................................................................................................................................ 69
BEGRIP “BEROEPSZIEKTE”............................................................................................................................ 69
BEWIJS ERKENDE BEROEPSZIEKTEN ............................................................................................................ 69
BLIJVENDE ARBEIDSONGESCHIKTHEID ........................................................................................................ 70
PREVENTIE ................................................................................................................................................... 70
HOOFDSTUK 6: ZIEKTE EN INVALIDITEIT ......................................................................................................... 71
A. WERKGENEMERS: ARBEIDSONGESCHIKTHEID ........................................................................................ 71
RECHTHEBBENDEN ...................................................................................................................................... 71
VOORWAARDEN .......................................................................................................................................... 71
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 71
INDIEN AAN 3 VOORWAARDEN VOLDAAN ............................................................................................................... 71
VERMOEDENS ........................................................................................................................................................... 71
EVALUATIE (IN RAAM VAN ZIEKTEVERZEKERING) .................................................................................................... 72
ZIV-UITKERINGEN ........................................................................................................................................ 72
GEZINSLAST.................................................................................................................................................. 73
HULP VAN DERDEN (VOOR GEHANDICAPTEN) ............................................................................................ 75
ZIV-UITKERINGEN: ....................................................................................................................................... 75
GEDEELTELIJKE GESCHIKTHEID: ................................................................................................................... 76
ANDERS-GESCHIKTHEID: .............................................................................................................................. 76
B. WERKGENEMERS: MOEDERSCHAP ......................................................................................................... 77
BESCHERMINGSMAATREGELEN .................................................................................................................. 77
MOEDERSCHAPSVERLOF.............................................................................................................................. 77
MOEDERSCHAPSUITKERING: ....................................................................................................................... 78
SPECIFIEK VADERSCHAPSVERLOF ................................................................................................................ 78
ALGEMEEN GEBOORTEVERLOF.................................................................................................................... 79
ADOPTIEVERLOF .......................................................................................................................................... 79
VERLOF VAN PLEEGOUDER .......................................................................................................................... 79
C. ZELFSTANDIGEN – ARBIEDSONGESCHIKTHEID ........................................................................................ 80
RECHTHEBBENDEN ...................................................................................................................................... 80
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 80
PRIMAIRE ARBEIDSONGESCHIKTHEID (A) ................................................................................................................. 80
INVALIDITEIT (B) → na 1 jaar PAO ............................................................................................................................ 80
VERMOEDENS ........................................................................................................................................................... 81
ZIV-UITKERINGEN ........................................................................................................................................ 81
PRIMAIRE ARBEIDSONGESCHIKTHEID (gezinstoestand speelt wel al een rol!! niet wij WN) .................................... 81
ZIV-UITKERINGEN (identiek vervangingsinkomen ivm PAO) .................................................................................... 81
D. ZELFSTANDIGEN: MOEDERSCHAP ................................................................................................................ 82
MOEDERSCHAP ............................................................................................................................................ 82
ANDERE GEZINSVERLOVEN .......................................................................................................................... 82
E. AMBTENAREN -ARBEIDSONGSCHIKTHEID .............................................................................................. 82
ALGEMEEN ................................................................................................................................................... 82
ARBEIDSONGESCHIKTHEID .......................................................................................................................... 82
VERLOF VANWEGE ZIEKTE ........................................................................................................................... 83
VERMINDERDE PRESTATIES ......................................................................................................................... 84
INDIEN ZIEKTEVERLOF UITGEPUT = DISPONIBILITEIT .................................................................................. 84
INTERACTIE STATUTAIRE VERLOVEN ........................................................................................................... 85
EVALUATIE ................................................................................................................................................... 85
F. PERSONEN MET EEN HANDICAP- ARBEIDSONGESCHIKTHEID (GEEN LEERSTOF!!) ................................. 85
HOOFDSTUK 7: GEZINSBIJSLAGSREGERLING (GASTCOLLEGE) ......................................................................... 86
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