Rules of Allocation for the Sickness Fund of the Association of Academics (BHM)

1st January, 2013

1. INTRODUCTION

As a fund member, you can read about your rights and how the BHM Sickness Fund is

organised in the Sickness Fund’s organisation record, which was agreed at the annual general

meeting on 7th May, 2004. This record came into force as an amendment to the fund’s existing

statutes which were agreed on at the annual meeting on 25th April, 1998. Under Article 7 of this

document, the fund’s board makes detailed rules of allocation (payment) and may, under certain

circumstances, may make special decisions on allocations (payments) from the fund.

2. FUND MEMBERSHIP

General rights. For a member to be entitled to payments from the fund, you (or someone

for you) need to make contributions to the Sickness Fund for a total of 6 months. This includes 3

consecutive months before you have an expenditure or loss of income which the fund covers.

However, if you are entitled to payments from the BHM Relief Fund, then you get immediate rights

when you join the BHM Sickness Fund. This is also true if you are entitled to payments from sickness

funds of other trade unions which have an agreement with the BHM’s Sickness Fund.

However, see point 4e. regarding per diem (daily) allowances if you are self-employed.

Also, see point 4b. regarding how much your daily allowance (payment) can be if you have

not paid into the fund for a full 12 month time period.

a. During maternity/paternity leave. As a fund member, if you take maternity/paternity leave

and you continue to pay your union fees during your leave, then you will keep your full rights.

b. During illness. As fund member, if you have used your rights to per diem (daily) allowances,

you may continue to enjoy other rights to the fund for up to two years, providing you do not

establish such rights somewhere else.

c. Unemployment. As a fund member, if you become unemployed then you keep your rights

to the fund for one year. This is true if you claim for a payment within one year from when you

became unemployed and you have also paid your union membership fees.

Unions are responsible for paying 1.0% of the unemployment benefit contribution to the fund from

when you first become unemployed. Therefore the unions may decide to extend your rights to a

maximum of 3 years. If the trade union is making a contribution for you, then they must give the

fund your name.

d. Membership during unpaid leave: As a fund member, you keep your rights for up to 6

months during unpaid leave. However, you have no right to payment from the fund until you have

started work again. If you are ill, you get no sickness allowance during unpaid leave.

e. Membership at the end of employment: As a fund member, you keep your rights for 12

months after you retire from work and start receiving your pension. However, sickness allowance is

not given for more than 3 months. If contributions for a member of the fund are lower than ISK

1.500 pr. month, the maximum payment foe each grant is halved.

3. APPLICATIONS AND RULES

a. Applications: Applications must be made on a special application form. Applications for

grants (payments) are processed once a month. Applications should be submitted before the 10th

day of each month. In general, payments are made on the 24-26th of each month, or the next

working day. The final date to hand in an application with the relevant data is the 9th of December

of each calendar year.

b. Processing applications: The Sickness Fund has staff who process applications. They follow

strict rules but in some cases they ask the fund committee to assess a claim and make their decision.

If a fund member is not happy to accept that decision, he/she has the right to appeal to the Board of

the BHM Sickness Fund.

c. Data: As a fund member, if you want to receive a payment from the fund then you must

show the necessary paperwork. This paperwork includes: original invoices, clearly showing each

individual item you have paid for and clearly showing your name. The invoice must be clearly

signed/stamped/labelled by the issuer and show details such as their name, title, ID number,

address or telephone number. The invoice must also state the dates and number of your treatments

or purchases of products or services for yourself only.

d. Follow-up application for per diem (daily) allowances: When you apply for another daily

sickness payment from the BHM Sickness Fund, then you must hand in a report of your disablement

for work each month. You must also hand in a certificate, issued by a recognised health

professional, for the time period that you want payments.

e. Amount of allowance: Your payment is never more than the total of the invoices which you

hand in. Tax is deducted from your payment, but grants (payments) for physical activities and

funeral allowances are free from tax.

f. Expiration of applications: Your right to payments from the fund stops if you do not apply

within 12 months from the time of expenditure or loss of income. If the board or a representative of

the fund decides to make you a payment, you will receive a letter. If you do not claim your payment

within 9 months from the date on the letter, then you lose your right to the payment.

g. Misleading or incorrect information: As a member, if you give wrong or misleading

information or neglect to give the necessary information, then you may lose the right to benefits for

up to 2 years. If you do this and get overpaid, then fund‘s board may demand full repayment of

benefit plus interest.

4. PER DIEM (DAILY) ALLOWANCE:

As a fund member you are entitled to a daily allowance if you cannot work because of illness

or injury, including illness during pregnancy, and this clearly causes you temporary loss of income:

a. Daily sickness and injury allowance is paid for up to 12 months, if your wage payments

during that time have stopped or are reduced.

b. Your daily allowance will be 80% of your basic payments into the fund over the past 12

months before your wages stopped. These payments will never be more than ISK 560,000 (wage

income ISK 740,000).

If you have paid into the fund for 12 months then you are entitled to a daily allowance for 12

months. If you have paid into the fund for less than 12 months, then you will get paid pro rata. E.g.

If you have only paid into the fund for 6 months then you are only entitled to a daily allowance for 6

months.

Tax will be taken from your daily allowance for all taxable payments from other parties, such as the

Social Insurance Administration or pension funds, if these are over 20% of the basic payments over

the past 12 months.

c. Illness of a fund member’s child. You may apply to the board of the fund for an allowance

(payment) if your child becomes ill. The fund will pay a daily allowance for a total of 3 months if

your child has a serious long-term illness. The board may lengthen this time period to 6 months.

The fund’s board will assess each case individually, taking everything into consideration, including

other compensation.

d. Illness of a fund member’s spouse: If your wife/husband or partner gets a long-term illness

and is off work, then the fund will make a daily payment for up to 2 months. However, no payment

is made for the first 10 days of illness.

e. Self-employment. If you are a self-employed member then you are entitled to the same

payments as wage earners. As a self-employed member, you wait for 3 months for you benefit

rights.

f. Discharge of rights. You are entitled to a new daily allowance when you have made

payments into the fund for 6 months following the end of your last claim. You can apply for a

maximum of 2 claims or 24 months in each 10 year period.

g. Your fund membership and your rights are the same if you work full time or part time, but

the amount of the daily allowance is based on your payments into the fund.

Authorisation provision:

h. The fund's board may extend the right to per diem (daily) allowance for a longer period of

time in special cases.

i. The fund's board may extend the right to per diem (daily) allowance for up to 45 days if the

member makes an effort to solve his/her drug problem.

5. SPECTACLES AND HEARING AIDS:

a. Spectacles, contact lenses. Money is given to buy spectacles or contact lenses once every 36

months, up to a maximum of ISK 40,000.

b. Laser. A standard grant (payment) of ISK 60,000 is given for laser treatment of one eye or

ISK 120,000 for laser treatment of both eyes.

c. Hearing aids. Money is given to buy hearing aids once every 36 months, up to a maximum of

ISK 150,000.

6. TRAVEL GRANT:

Adoption. A fixed amount of ISK 150,000 is given toward the costs of a trip abroad to pick

up an adopted child.

7. ARTIFICIAL INSEMINATION:

The fund pays 40% of costs for microscopic or in vitro fertilization treatments (not including

medicinal products). The maximum payment per calendar year is ISK 130,000.

8. DEATH BENEFITS.

a. A standard funeral allowance of ISK 300,000 is paid to the person who pays for the funeral of

a fund member.

b. Retired fund members. There is a standard funeral allowance of ISK 300,000 if a retired fund

member dies. This is available for up to 2 years from the date of retirement.

c. Temporary loss of financial support for spouse/common law spouse. When a fund member

dies, their husband/wife or partner is given a payment to cover their loss of financial support

temporarily. This payment equals the dead person’s wages for one month, based on their average

wages over the past 12 months. Plus, a payment of half the dead person’s monthly wage is given to

children aged 18 and under.

PREVENTIVE MEASURES:

9. HEALTH CARE:

Payments for physical activity are made up to a maximum of ISK 30,000 each calendar year.

10. THE ICELANDIC HEART ASSOCIATION (Hjartavernd):

The fund pays back in full costs from risk assesment at Hjartavernd research facilities.

11. CANCER SCREENING:

The fund pays back in full costs from regular breast and cervical cancer screening (checks). If

a fund member needs further checks, then the fund will cover costs up to ISK 10,000. Also, the fund

pays a maximum of ISK 10,000 for colon cancer and prostate cancer screening.

12. GRANTS FOR THE TREATMENT OF BODY AND MIND:

The fund pays back up to a maximum of ISK 60,000 for physiotherapy, occupational therapy,

treatment by a chiropractor, psychological treatment, nursing, treatment by a social worker,

nutritional advice, or comparable treatment by authorised medical professionals licensed by the

Directorate of health. The treatment should be in the field of the licensed health care provider.

13. STAY AT A RESIDENTIAL INSTITUTION OR NLFÍ CLINIC AT THE RECOMMENDATION OF A

DOCTOR:

A grant is given for a member to stay at a residential institution or NLFÍ clinic at the

recommendation of a doctor, up to a maximum of ISK 50,000 a year. This grant is cancelled from

july 1st 2013.

14. DENTAL TREATMENT:

You can get a payment of 40% of your dental costs over ISK 75,000 (per application). The

maximum payment per calendar year is ISK 200,000. Each application must include one or more

invoices for costs paid in the past 12 months. Applications can be made more than once a year, but

the maximum grant is ISK 200,000 per calendar year. Purely cosmetic work is excluded.

15. BIRTHING GRANT

The grant is ISK 150,000 for each child proportional to the parent's employment ratio.

Applications must be handed in within a year of the child's birth. The birthing grant is given

to parents on presentation of a birth certificate and a copy of a new salary slip (stating the correct

employment ratio).

16. ASSISTANCE BECAUSE OF WORK RELATED TRAUMA OR UNEXPECTED TERMINATION OF

EMPLOYMENT

The fund offers grants for up to ISK 60,000 for treatment by a professional to deal with work

related trauma or unexpected termination of employment.

17. AUTHORISATION OF PAYMENT FOR OTHER HEALTH COSTS:

a. The fund’s board may make special payments to fund members for other costs regarding

health relating to trauma, injury or illness in the same way as in the 14th article, up to a maximum of

ISK 100,000 over a two year period. In general, no payments are made regarding drug costs or other

health costs that count towards a discount card from the Icelandic health insurance.

The fund does not pay grants according to this article for costs covered in articles 5 to 16.

b. The fund’s board may decide to award fund members special payments if they, their

husband/wife or children have suffered substantial loss of income because of injury or illness, or due

to the death of a loved one.

18. VALIDITY:

These rules were last amended on the 1st of January 2013, and shall be in force until the

board of the fund makes amendments to them and publishes them, in accordance with Article 19.

19. PUBLICATION:

These rules of allocation, amendments, and new rules shall be published publicly in BHM's

forum, such as in the BHM's newsletter and/or website.