Socialezekerheidsrecht
Inhoudsopgave
1 Hoofdstuk 1: inleiding................................................................................................................................. 6
2 Hoofdstuk 2: administratieve organisatie.................................................................................................... 7
2.1 Algemene introductie tot administratieve instellingen..................................................................................7
2.2 Verschillende stelsels......................................................................................................................................8
2.2.1 Werknemers...........................................................................................................................................9
2.2.2 Zelfstandigen........................................................................................................................................12
2.2.3 Overheidspersoneel..............................................................................................................................13
2.2.4 Sociale bijstand.....................................................................................................................................13
3 toepassingsbeleid..................................................................................................................................... 15
3.1 drie beroepsgroepen....................................................................................................................................15
3.1.1 Gezag....................................................................................................................................................15
3.1.2 Contract................................................................................................................................................15
3.1.3 Gezagsverhouding en Schijnzelfstandigheid........................................................................................16
3.1.4 Territoriaal toepassingsgebied van sz stelsel.......................................................................................20
3.1.5 Uitbreiding............................................................................................................................................21
3.1.6 Uitsluiting..............................................................................................................................................21
3.2 Zelfstandigen................................................................................................................................................23
3.2.1 Beroepsbezigheid.................................................................................................................................23
3.2.2 Helper...................................................................................................................................................24
3.2.3 Meewerkende echtgenoot...................................................................................................................24
3.2.4 Deeleconomie.......................................................................................................................................24
3.3 Ambtenaren.................................................................................................................................................25
3.4 Afgeleide rechten.........................................................................................................................................25
3.5 Sociale bijstand............................................................................................................................................26
3.6 Overzicht......................................................................................................................................................26
4 Hoofdstuk 4: financiering.......................................................................................................................... 28
4.1 Werknemers.................................................................................................................................................28
4.1.1 Loon van de werknemer.......................................................................................................................28
4.1.2 Algemene omschrijving van loon..........................................................................................................30
4.1.3 Cheques................................................................................................................................................35
4.2 Zelfstandigen................................................................................................................................................44
4.2.1 Bijdragepercentages.............................................................................................................................44
4.2.2 Zelfstandige in bijberoep......................................................................................................................46
4.2.3 Student-zelfstandige.............................................................................................................................46
4.2.4 Gepensioneerde zelfstandigen.............................................................................................................47
4.2.5 Voorlopige bijdragen............................................................................................................................47
4.2.6 Vrijstelling van bedragen......................................................................................................................47
4.2.7 Crisisbijdragen......................................................................................................................................49
4.2.8 Alternatieve financiering en overheidssteun.......................................................................................49
4.2.9 Formaliteiten........................................................................................................................................50
4.3 Ambtenaren.................................................................................................................................................50
, 4.3.1 Berekeningsgrondslag..........................................................................................................................50
4.3.2 Bijdragepercentages.............................................................................................................................51
4.3.3 Ambtenarenpensioenen.......................................................................................................................51
4.3.4 Eenzijdige beëindiging..........................................................................................................................51
4.4 Sociale bijstand............................................................................................................................................52
5 Gezondheidszorg....................................................................................................................................... 54
5.1 Inleiding........................................................................................................................................................54
5.2 Rechthebbenden...........................................................................................................................................54
5.2.1 Gerechtigden........................................................................................................................................55
5.2.2 Personen ten laste................................................................................................................................56
5.3 Algemene voorwaarden...............................................................................................................................57
5.4 Soorten verstrekkingen................................................................................................................................58
5.5 Specifieke voorwaarden...............................................................................................................................59
5.6 Uitgesloten kosten.......................................................................................................................................60
5.7 Prestaties......................................................................................................................................................62
5.7.1 Accreditering.........................................................................................................................................62
5.7.2 Verhoogde tegemoetkoming................................................................................................................62
5.7.3 Globaal medisch dossier.......................................................................................................................64
5.7.4 Medische huizen...................................................................................................................................64
5.7.5 Begrippen in gezondheidszorg.............................................................................................................65
5.7.6 Bijzondere maatregelen.......................................................................................................................66
5.8 Terugbetalingstarieven................................................................................................................................67
5.8.1 Soorten geneesmiddelen......................................................................................................................69
5.9 Vaststelling tarieven.....................................................................................................................................71
5.9.1 Akkoorden.............................................................................................................................................71
5.9.2 Overeenkomsten..................................................................................................................................71
5.9.3 Gevolgen van tarieven voor zorgverstrekkers......................................................................................73
6 Arbeidsongeschiktheid: ziekte en invaliditeit............................................................................................. 76
6.1 Werknemers.................................................................................................................................................77
6.1.1 Rechthebbenden..................................................................................................................................77
6.1.2 ZIV-uitkeringen.....................................................................................................................................79
6.1.3 Gezinssituatie........................................................................................................................................81
6.1.4 Gedeeltelijke werkhervatting...............................................................................................................83
6.1.5 Moederschap........................................................................................................................................84
6.2 Zelfstandigen................................................................................................................................................87
6.2.1 Moederschap........................................................................................................................................89
6.3 Ambtenaren.................................................................................................................................................90
6.3.1 Arbeidsongeschiktheid.........................................................................................................................90
6.3.2 Verminderde prestaties........................................................................................................................92
6.3.3 Ziektepensioen.....................................................................................................................................93
6.3.4 Ouderschap...........................................................................................................................................93
6.4 Tegemoetkoming aan personen met een handicap....................................................................................93
7 Professioneel risico: arbeidsongevallen en beroepsziekte..........................................................................96
7.1 Inleiding........................................................................................................................................................96
7.2 Begrip en bewijs...........................................................................................................................................97
7.2.1 Kernelementen van de definitie...........................................................................................................98
, 7.2.2 Arbeidswegongevallen.......................................................................................................................101
7.3 Schadeloosstelling......................................................................................................................................103
7.3.1 Medische kosten.................................................................................................................................103
7.3.2 Prothesen en orthopedie....................................................................................................................104
7.3.3 Tijdelijke arbeidsongeschiktheid........................................................................................................104
7.3.4 Blijvende arbeidsongeschiktheid........................................................................................................105
7.3.5 Dodelelijk arbeidsongeval..................................................................................................................106
7.4 Burgerlijke aansprakelijkheid.....................................................................................................................107
7.5 Procedure en verzekering...........................................................................................................................108
7.6 Beroepsziekten...........................................................................................................................................109
8 Werkloosheid.......................................................................................................................................... 111
8.1 Inleiding......................................................................................................................................................111
8.2 Toelaatbaarheidsvereisten.........................................................................................................................111
8.2.1 Wachttijd.............................................................................................................................................112
8.3 Toekenningsvoorwaarden..........................................................................................................................113
8.3.1 Geen enkele vorm van arbeid verrichten...........................................................................................114
8.3.2 Onvrijwillig werkloos zijn....................................................................................................................116
8.3.3 Geen loon genieten............................................................................................................................116
8.3.4 Inschrijven als werkzoekende.............................................................................................................117
8.3.5 Passende dienstbetrekking.................................................................................................................117
8.3.6 Arbeidsgeschikt zijn............................................................................................................................118
8.3.7 Vrijstellingen van toekenningsvoorwaarden......................................................................................118
8.4 Uitkeringen.................................................................................................................................................118
8.4.1 Loon....................................................................................................................................................119
8.4.2 Familiale toestand..............................................................................................................................119
8.4.3 Werkloosheidsperiode........................................................................................................................121
8.5 Overbruggingsrecht van zelfstandigen......................................................................................................122
8.6 Nieuw Federaal regeerakkoord:................................................................................................................123
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Inhoudsopgave
1 Hoofdstuk 1: inleiding................................................................................................................................. 6
2 Hoofdstuk 2: administratieve organisatie.................................................................................................... 7
2.1 Algemene introductie tot administratieve instellingen..................................................................................7
2.2 Verschillende stelsels......................................................................................................................................8
2.2.1 Werknemers...........................................................................................................................................9
2.2.2 Zelfstandigen........................................................................................................................................12
2.2.3 Overheidspersoneel..............................................................................................................................13
2.2.4 Sociale bijstand.....................................................................................................................................13
3 toepassingsbeleid..................................................................................................................................... 15
3.1 drie beroepsgroepen....................................................................................................................................15
3.1.1 Gezag....................................................................................................................................................15
3.1.2 Contract................................................................................................................................................15
3.1.3 Gezagsverhouding en Schijnzelfstandigheid........................................................................................16
3.1.4 Territoriaal toepassingsgebied van sz stelsel.......................................................................................20
3.1.5 Uitbreiding............................................................................................................................................21
3.1.6 Uitsluiting..............................................................................................................................................21
3.2 Zelfstandigen................................................................................................................................................23
3.2.1 Beroepsbezigheid.................................................................................................................................23
3.2.2 Helper...................................................................................................................................................24
3.2.3 Meewerkende echtgenoot...................................................................................................................24
3.2.4 Deeleconomie.......................................................................................................................................24
3.3 Ambtenaren.................................................................................................................................................25
3.4 Afgeleide rechten.........................................................................................................................................25
3.5 Sociale bijstand............................................................................................................................................26
3.6 Overzicht......................................................................................................................................................26
4 Hoofdstuk 4: financiering.......................................................................................................................... 28
4.1 Werknemers.................................................................................................................................................28
4.1.1 Loon van de werknemer.......................................................................................................................28
4.1.2 Algemene omschrijving van loon..........................................................................................................30
4.1.3 Cheques................................................................................................................................................35
4.2 Zelfstandigen................................................................................................................................................44
4.2.1 Bijdragepercentages.............................................................................................................................44
4.2.2 Zelfstandige in bijberoep......................................................................................................................46
4.2.3 Student-zelfstandige.............................................................................................................................46
4.2.4 Gepensioneerde zelfstandigen.............................................................................................................47
4.2.5 Voorlopige bijdragen............................................................................................................................47
4.2.6 Vrijstelling van bedragen......................................................................................................................47
4.2.7 Crisisbijdragen......................................................................................................................................49
4.2.8 Alternatieve financiering en overheidssteun.......................................................................................49
4.2.9 Formaliteiten........................................................................................................................................50
4.3 Ambtenaren.................................................................................................................................................50
, 4.3.1 Berekeningsgrondslag..........................................................................................................................50
4.3.2 Bijdragepercentages.............................................................................................................................51
4.3.3 Ambtenarenpensioenen.......................................................................................................................51
4.3.4 Eenzijdige beëindiging..........................................................................................................................51
4.4 Sociale bijstand............................................................................................................................................52
5 Gezondheidszorg....................................................................................................................................... 54
5.1 Inleiding........................................................................................................................................................54
5.2 Rechthebbenden...........................................................................................................................................54
5.2.1 Gerechtigden........................................................................................................................................55
5.2.2 Personen ten laste................................................................................................................................56
5.3 Algemene voorwaarden...............................................................................................................................57
5.4 Soorten verstrekkingen................................................................................................................................58
5.5 Specifieke voorwaarden...............................................................................................................................59
5.6 Uitgesloten kosten.......................................................................................................................................60
5.7 Prestaties......................................................................................................................................................62
5.7.1 Accreditering.........................................................................................................................................62
5.7.2 Verhoogde tegemoetkoming................................................................................................................62
5.7.3 Globaal medisch dossier.......................................................................................................................64
5.7.4 Medische huizen...................................................................................................................................64
5.7.5 Begrippen in gezondheidszorg.............................................................................................................65
5.7.6 Bijzondere maatregelen.......................................................................................................................66
5.8 Terugbetalingstarieven................................................................................................................................67
5.8.1 Soorten geneesmiddelen......................................................................................................................69
5.9 Vaststelling tarieven.....................................................................................................................................71
5.9.1 Akkoorden.............................................................................................................................................71
5.9.2 Overeenkomsten..................................................................................................................................71
5.9.3 Gevolgen van tarieven voor zorgverstrekkers......................................................................................73
6 Arbeidsongeschiktheid: ziekte en invaliditeit............................................................................................. 76
6.1 Werknemers.................................................................................................................................................77
6.1.1 Rechthebbenden..................................................................................................................................77
6.1.2 ZIV-uitkeringen.....................................................................................................................................79
6.1.3 Gezinssituatie........................................................................................................................................81
6.1.4 Gedeeltelijke werkhervatting...............................................................................................................83
6.1.5 Moederschap........................................................................................................................................84
6.2 Zelfstandigen................................................................................................................................................87
6.2.1 Moederschap........................................................................................................................................89
6.3 Ambtenaren.................................................................................................................................................90
6.3.1 Arbeidsongeschiktheid.........................................................................................................................90
6.3.2 Verminderde prestaties........................................................................................................................92
6.3.3 Ziektepensioen.....................................................................................................................................93
6.3.4 Ouderschap...........................................................................................................................................93
6.4 Tegemoetkoming aan personen met een handicap....................................................................................93
7 Professioneel risico: arbeidsongevallen en beroepsziekte..........................................................................96
7.1 Inleiding........................................................................................................................................................96
7.2 Begrip en bewijs...........................................................................................................................................97
7.2.1 Kernelementen van de definitie...........................................................................................................98
, 7.2.2 Arbeidswegongevallen.......................................................................................................................101
7.3 Schadeloosstelling......................................................................................................................................103
7.3.1 Medische kosten.................................................................................................................................103
7.3.2 Prothesen en orthopedie....................................................................................................................104
7.3.3 Tijdelijke arbeidsongeschiktheid........................................................................................................104
7.3.4 Blijvende arbeidsongeschiktheid........................................................................................................105
7.3.5 Dodelelijk arbeidsongeval..................................................................................................................106
7.4 Burgerlijke aansprakelijkheid.....................................................................................................................107
7.5 Procedure en verzekering...........................................................................................................................108
7.6 Beroepsziekten...........................................................................................................................................109
8 Werkloosheid.......................................................................................................................................... 111
8.1 Inleiding......................................................................................................................................................111
8.2 Toelaatbaarheidsvereisten.........................................................................................................................111
8.2.1 Wachttijd.............................................................................................................................................112
8.3 Toekenningsvoorwaarden..........................................................................................................................113
8.3.1 Geen enkele vorm van arbeid verrichten...........................................................................................114
8.3.2 Onvrijwillig werkloos zijn....................................................................................................................116
8.3.3 Geen loon genieten............................................................................................................................116
8.3.4 Inschrijven als werkzoekende.............................................................................................................117
8.3.5 Passende dienstbetrekking.................................................................................................................117
8.3.6 Arbeidsgeschikt zijn............................................................................................................................118
8.3.7 Vrijstellingen van toekenningsvoorwaarden......................................................................................118
8.4 Uitkeringen.................................................................................................................................................118
8.4.1 Loon....................................................................................................................................................119
8.4.2 Familiale toestand..............................................................................................................................119
8.4.3 Werkloosheidsperiode........................................................................................................................121
8.5 Overbruggingsrecht van zelfstandigen......................................................................................................122
8.6 Nieuw Federaal regeerakkoord:................................................................................................................123
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