Employees: recover your benefits!
Posté le 13 December 2022 dans Labor law.
What is a benefits (prévoyance) contract?
A benefits contract provides collective support, for the benefit of employees, former employees or their dependents in addition to the benefits paid by the Primary Health Insurance Fund, for risks related to illness, accident, maternity, temporary incapacity for work, invalidity and death.
The implementation of a benefits contract for employees is most often imposed by the branch collective agreement applicable in the company.
The main feature of the corporate benefit contract lies in the fact that the employer signs the contract with an insurance organization for the benefit of her or his employees: it is therefore a tripartite relationship, in which the employee is the third party beneficiary of the contract.
The Social Security Code states, with regard to collective mutual and provident insurance contracts, that the business manager is required to provide each employee concerned with an information notice when setting up the collective contract, and that he must also inform employees in writing of any change in their rights and obligations (Article L. 932-6 of the Social Security Code).
Paragraph 3 of this article holds that it is up to the subscriber to prove that the information notice was actually given to the employee, and that she or he has informed of any changes regarding the collective contract.
The employer subscribing to a group insurance contract is bound to inform the employee of the existence of the contract and to communicate very precisely about her or his rights and obligations.
The employer is therefore responsible in case of incomplete or inaccurate information if the employee is misled on the nature, extent or starting point of his rights. In such a case, the employer should pay damages to the employee for the damages.
What are the next steps ?
The sick leave is issued by the doctor and has three sections: sections 1 and 2 are intended for the Primary Health Insurance Fund and can be transmitted online. Part 3 is intended for the employer and must therefore be sent to him by the employee.
If the employee is placed under an invalidity plan by the Primary Health Insurance Fund, she or he must in the same way inform the employer and send the notification of the invalidity pension.
Once the employer is in possession of these elements, she or he must issue a salary certificate and send it to the Primary Health Insurance Fund.
This salary certificate allows the Primary Health Insurance Fund to calculate the basic daily salary that will be used to calculate the daily social security allowances.
The employee must transmit to his employer, as and when required, the social security statements or the certificates of payment of social security benefits, who himself will send them to the insurer for the payment of additional indemnities under foresight.
How and when are pension benefits paid?
When the insurer is in possession of all the necessary elements, it pays the additional pension benefits to the employer.
The employer thus maintains the salary under the conditions provided for by the collective agreement or by the insurance contract if the latter is more favorable.
It may happen that the employee does not receive the additional pension benefits.
The employee may then be tempted to directly contact the insurer, which will systematically refuse on the grounds that the contract was signed with the employer company and not the employee, and will invite the employee to deal directly with his employer.
In the event of the employer's failure to respond, the employee is well-founded to seize the competent labor court.
Pension rights after termination of the employment contract: the portability of rights
Former employees may benefit from the maintenance of their pension rights under the following conditions:
- On termination of the employment contract, the employee must benefit from support from Pôle Emploi.
Currently, contract breaches giving rise to support by Pôle emploi are: dismissal, including for serious misconduct (but not for gross negligence), agreed conventional termination, the end of a fixed-term contract, resignation considered as legitimate by Pôle emploi, termination of the trial period giving rise to the right to unemployment compensation;
- The employee must have benefited from supplementary pension cover when he was an employee;
- The employment contract must have lasted at least 1 month.
If the employee meets these conditions, she or he can benefit from the portability of these rights for a period equal to the duration of his employment contract within the limit of twelve months and as long as she or he is supported by Pôle emploi.