Social Security in Türkiye

Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/social_security_system 

Social Security System

The social security system in Turkey is predominantly similar to Bismarck model, one of four basic insurance systems which are Continental Model (Bismarck), Liberalistic Model (Beveridge), Northern European Model and Mediterranean Model. Bismarck Model refers to a system where the premiums paid over the wages of employees according to their insurance status are collected in a joint pool and the benefits are provided based on the paid premiums only when old-age pension is entitled. The amount of the benefits to be granted to the insurance holders in cases of retirement, accident and sickness varies by the income they previously had. The main actors in this system are employees, employers and representatives in public sector. This system has more regulatory measures in labor market than liberalistic system, which hinders labor market flexibility. Concordantly, strict rules and collective bargaining mechanisms have come to the fore.
Turkish Social Security System has also some elements of the Mediterranean Model as well as Bismarck Model. The Mediterranean Model is derived from the Continental Model and bears a resemblance to this model in the sense that the paid social insurance premiums provide a basis for future social security benefits. Another aspect of the Mediterranean Model similar to Turkish Model is the wideness of informal economy. For this reason, the system does not cover many people; however social risks are tried to be eliminated through family ties. This model has brought into prominence the concepts of traditional family and agricultural society; thus people are supported by their families without considering whether the state provides benefits or not in case of revenue loss or social risks.
By this reform, a number of structural changes have been made on Turkish social security system. A transition has been realized from the system which entitles various rights to different professional groups to the system which ensures the unity of standards and norms in terms of retirement insurance.
Having the aim to ensure the sustainability of the system, these structural changes have not led to deviation from the Mediterranean Model-Continental Model.

Social Security Reform

Since 1990s, a number of financial problems have been experienced in Turkish social security system due to various reasons such as early retirement implementations, high rates of unregistered employment and income replacement and low rates of premium collection and earning subject to contribution. This system does not include the entire population and not have adequate safeguards against poverty. The provision of services by different social security institutions in nonsystematic way hinders the unity of norms regarding rights and obligations of employees. It became compulsory to make reforms in social security system as a result of all these problems and ageing tendency of the population which is one of the major factors affecting the financial sustainability of the system.
For the purpose of restructuring the social security system, a reform was realized in 2008 when the Law No. 5510 entered into force for seeking solutions to the prominent problems such as the existence of increasing deficit of the system and different implementations that the institutions had in the provision of health and insurance services.
The primary aim of the social security reform is to create an equitable, easily-accessible and financially sustainable social security system that provides more effective protection from poverty.
The social security reform consists of 4 complementary components:

1. Universal Health Insurance providing an equitable, protective and quality healthcare services for the entire population,
2. An aid system which enables all needers to access the services with the combination of non-contributory payments and social benefits provided disorganizedly,
3. A single retirement regime including short and long term insurance branches apart from health insurance,
4. A new institutional structure facilitating daily life of our citizens through modern and efficient services.

The social security reform particularly includes the regulations regarding the enhancement of the retirement system and expenses. From this point of view, a set of changes have been made on pension replacement rate, updating coefficient, number of paid premium days and age parameters and a transition period has been envisaged. As the previous rules continue to be followed until the completion of transition period, the effect of these parametric changes on social security deficit cannot be seen exactly in the short term until the 2040s.
The reforms made up to now aim at increasing the services for insurance holders as well as removing defects in the social security system. In this context, various regulations have been made in the field of both health and retirement so that insurance holders can receive services at the shortest time. A number of implementations have been put into practice to facilitate insurance holders’ access to hospital services and the relevant procedure requiring a long wait has started to be made on internet.
The primary objective in a people-oriented system is to provide services at local levels. For this reason, the system where services are provided from center has been left and Social Security Centers have been built in many districts with a view to enable insurance holders at local levels to receive services easily.

(Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/short_term_insurance 

Short Term Insurance Branches

Regarding work accident and occupational disease, sickness and maternity insurance branches, treatment benefits are provided under Universal Health Insurance while cash benefits fall within the Short Term Insurances.
The provisions relating to short term insurance branches shall not apply to the insurance holders who are civil servants during the period when they remain in this status.

1. Work Accident and Occupational Disease Insurance

Work accident is the incident which occurs;

• when the insurance holder is at workplace,
• due to the work carried out by the employer or by the insurance holder if he/she is working on behalf of own name and account,
• for an insurance holder working under an employer, at times when he/she is not carrying out his/her main work due to the reason that he/she is posted to another place out of the workplace,
• at times allocated for breastfeeding as per labor legislation,
• during insurance holder’s shuttling between the workplace and home by a vehicle provided by the employer and which causes, at short notice or later, physical or mental handicap in the insurance holder.

It is obligatory that work accident shall be reported,

• by employers, for the insurance holders subject to service contract, to local law enforcement agencies immediately and to the Institution no later than 3 workdays after accident occurs,
• by the insurance holders who are self-employed, to the Institution directly or through certified mail with work accident and occupational disease notification within 3 workdays after their health status are good enough to report, provided that this recovery period does not exceed one month.

Occupational disease refers to the temporary or permanent disease, physical or mental handicapped status, caused by a reason reiterated due to the quality of the work carried out by the insurance holder or by working conditions.

1. a) Temporary Incapacity Allowance

Based on the rest report granted by medical doctor or health committees authorized by the Institution, temporary incapacity allowance shall be paid;

• each day to the insurance holders suffering from temporary incapacity due to work accident or occupational disease,
• each day, starting from the third day of the temporary incapacity, to the insurance holders working on service contract and those subject to sickness insurance, in case they suffer from temporary incapacity due to sickness and provided that minimum 90 days of short term insurance premium is notified within one year before the starting date of the temporary incapacity,
• during the period of inpatient treatment or the period of rest report granted due to such treatment, to the insurance holders working on his/her own name and account, in cases of work accident or occupational disease or maternity and provided that any kind of premiums or debts related with premiums including universal health insurance are paid.

Temporary incapacity allowance to be paid in cases of work accident, sickness and maternity shall be half of daily earning for inpatient treatments and two thirds of the same for outpatient treatments. Where an insurance holder suffers from more than one of the cases of work accident, occupational disease, sickness and maternity, temporary incapacity benefit shall be payable at the highest level.

1. b) Permanent Incapacity Income

The insurance holders whose earning power in the profession is determined to be reduced by 10% due to the disease or disabilities caused by work accident or occupational disease shall be entitled to receive permanent incapacity income.
Permanent incapacity income shall be calculated based on the loss rate of earning power in profession of the insurance holder. In case of permanent full incapacity, the insurance holder is put on an income amounting to 70% of the monthly earning. Income to be granted to the insurance holder in case of permanent partial incapacity shall be calculated as full incapacity income and of the amount corresponding to the degree of incapacity shall be payable. Where the insurance holder is in need of permanent care of another person, income replacement rate shall be calculated as 100%.

1. c) Survivors’ Income

The right holders of the insurance holder, who passed away due to work accident, occupational disease or similar reasons, shall be put on survivors’ income at a rate of 70% of the monthly earning.
It is obligatory that the entire premium or any kind of debts related premiums, including the universal health insurance, should be paid so that the right holders of insurance holder, working on their own name and account, receive income.
Where the insurance holders passed away due to work accident or occupational disease, funeral and marriage allowance shall also be paid to his/her right holders.

1. d) Marriage Allowance

Marriage allowance shall be payable in advance, for once, at the amount of two years of pension or income they receive, upon marriage and request of the daughters, whose income or pensions should be terminated due to marriage.
In case a right holder who receives marriage allowance becomes right holder for the second time within two years following the termination date of the pension, no income or pension shall be payable until the end of two - year period; however such individuals shall be deemed to be universal health insurance holders.

1. e) Funeral Allowance

Funeral allowance shall be payable to the right holders of the insurance holder who deceased when receiving incapacity income due to work accident or occupational disease or permanent incapacity income, invalidity, duty disability or old - age pension and when his/her minimum 360 days of invalidity, old - age and survivors insurance premiums are notified for himself/herself.

2. Sickness Insurance

Sickness refers to discomfort causing the incapacity of the insurance holders, who work on service contract and on their own name and account, due to the reasons other than work accident or occupational disease.

1. a) Temporary Incapacity Allowance

Based on the rest report, in case the insurance holders working on service contract and those subject to sickness insurance suffer from temporary incapacity due to sickness, temporary incapacity allowance shall be paid to them for each day, starting from the third day of the temporary incapacity, and provided that minimum 90 days of short term insurance premium is notified within one year before the starting date of the temporary incapacity.

3. Maternity Insurance

Sickness and invalidity statuses of

• a female insurance holder or uninsured spouse of a male insurance holder working on service contract and on their own name and account,
• a female who receives income or pension due to her own works or uninsured spouse of a male insurance holder who receives income or pension, caused by the pregnancy or maternity status, starting from the date of pregnancy up to the first eight weeks or, in case of multi delivery, up to the first ten weeks following delivery, shall be considered as maternity status.

1. a)  Temporary Incapacity Allowance in Maternity Status

In case the insured women working on service contract and those working on their own names and accounts (except partners of company) do not work actually and receive rest report during maternity period, temporary incapacity allowance shall be payable -provided that minimum 90 days of short term insurance premium is notified within one year before the birth-

• for eight - week periods before and after birth,
• for each day of not working calculated by, adding another two weeks to the said eight weeks before the birth in cases of multiple birth,
• for each day added to the rest period after birth in case she works until three weeks before birth upon her request and approval of medical doctor.

1. b) Breastfeeding Benefit

Breastfeeding benefit shall be payable for each newborn -provided that the newborn lives-

• to the women who are maternity insurance holders or to the male insurance holders of uninsured spouse giving birth,
• to the female insurance holders receiving income or pension due to their works on service contract and on their own names and accounts or to the uninsured spouse of the male insurance holders receiving income or pension due to their works.

In order to pay breastfeeding benefit to female insurance holder or to male insurance holder of uninsured spouse giving birth, it is obligatory

• for the insurance holders working on service contract to notify minimum 120 days short term insurance branches premium within one year before birth,
• for the insurance holders working on their own names and accounts to deposit minimum 120 days short term insurance branches premium and to pay any kind of premiums or debts related with premiums including universal health insurance.

In case female insurance holders, who are granted the right to receive breastfeeding benefit but whose insurance status is terminated, give birth to a children within 300 days starting from the termination date, these women or their spouses shall receive breastfeeding benefit provided that minimum 120 days premium is paid within fifteen months before the date of birth.

(Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/long_term_ins 

Long term insurance branches include the services relating to invalidity, old-age and survivors’ benefits.

1. Old-Age Insurance
   Old age insurance is a mandatory and contributory social insurance that allows insurance holders to have an old age pension when they reach a specific age. Old age pension and old age single payment are the rights provided under this type of insurance.
   a) Old age pension
   For the individuals who are deemed to be insured according to the Law No: 5510 for the first time; old - age pension shall be granted provided that the individual is over 58 if the individual is woman or over 60 if the individual is male and that minimum 9000 days of invalidity, old - age and survivors insurance premiums are notified. However, the conditions necessary to receive old age pension have softened for the insurance holders working on service contract. The number of premium days shall be applied as 7200 premium days for these insurance holders at the above-mentioned ages.
   It is envisaged that the age condition stated in Law No: 5510 shall be raised to 65 gradually starting from 2036 until 2048 for both male and female insurance holders.
   Apart from specified in the law by general regulations, there are some special arrangements brought into use of older aged pensioners, those who cannot benefit from the invalidity pension due to the existing disability during his/her first work, the severely disabled, mineworkers and those with early ageing disease. Based on these arrangements, the insurance holders can receive old age pension provided that minimum 5400 days of invalidity, old - age and survivors insurance premiums are notified and 3 years are added to the above –mentioned age limits without exceeding the age of 65.
   The Law stipulates different conditions for awarding old age pension to some exceptional insurance holders who became invalid at the starting date of working, whose invalidity rate between 40% and 59%, mineworkers and those with early ageing disease.
   In case the female insurance holders with an invalid child permanently in need of another person request for retirement or old-age pension, one fourth of premium days paid after the effective date of the Law shall be added to the total number of premium days and the added days shall be deducted from the age limit of retirement.
   b) Old age single (lump-sum) payment and revival
   Among the insurance holders working on service contract and  working on their own names and accounts and the individuals who become insurance holders for the first time under civil servant status pursuant to the Law No: 5510, the insurance holders, who quits work or closes workplace for whatsoever reason and who does not have the right to receive invalidity and old -age pension although the age condition for receiving old-age pension is met, shall receive the sum of invalidity, old -age and survivors’ insurance premiums of each year paid for those working on their own names and accounts and notified for the name of those working on service contract and civil servants as single payment, being updated with the update coefficient realized each year, for the years from the year of the premium up to the date of written request.
   In case the individuals whose services are eliminated by making single payment in accordance with the Law No:5510 and whose invalidity, old - age and survivors’ insurance premiums are notified by again being subject to this Law submit a written application,- provided that they pay the amount, found by updating with the update coefficient realized each year for the years between the date of single payment and the date of written request, by the end of the month following the date of notification of such to the concerned party- these services shall be revived and considered in the execution of this Law.
   2. Invalidity Insurance
   The invalidity insurance is a mandatory social insurance with premiums that allows insurance holders to have invalidity pension provided that the status of invalidity is determined and certain conditions, are met.
   a) Invalidity pension
   In case the insurance holders who are subject to service contract and those subject to work on their own names and accounts and civil servants are determined to have lost working power or earning power in profession minimum at 60% or at a degree which does not allow him/her to carry out his/her duties due to work accident or occupational disease by Health Committee of the Institution as a result of reviewing the reports and the medical documents prepared duly by the healthcare service providers authorized by the Institution upon request of insurance holders or employers, they shall be deemed to be invalid. However, if it is determined in advance or afterwards that the insurance holder has lost 60% of the working power or earning power in profession at a degree not to allow him/her to carry out his/her duties before the date of first start to work under insurance, then the insurance holder shall not benefit from invalidity pension due to such disease or handicap.
   In order to put an insurance holder on invalidity pension, the insurance holder should;

• be deemed to be disabled as per the Law No. 5510
• be holding insurance for a period of minimum ten years and should have paid totally 1800 days or in case the insurance holder is disabled to the extent of being in need of permanent care of another person, should have notified 1800 days of invalidity, old -age or survivors’ insurance premiums, without seeking any insurance period,
• have submitted a written request to the Institution after quitting the work he/she was working under insurance or closing or transferring the workplace due to his/her invalidity. However, it is obligatory that the individuals who work on their own names and accounts should have paid entire premiums or any kind of debts related with premiums, including the universal health insurance.

3. Survivors’ Insurance
   The insurance holders’ death poses a social danger for their relatives he/she had been looking after and left behind. One of the long term insurance branches, the survivors’ insurance is a compulsory and contributory insurance branch which provides a monthly pension to survivors including spouse, children and parents in case the insurance holders deceased due to a reason other than work accident and occupational diseases. The rights provided under survivors’ insurance are survivors’ pension, death grant, marriage allowance for the girls who are receiving monthly pension and funeral allowance.
   a) Survivors’ pension
   Survivors’ pension shall be payable to the right holders upon written request in case;

• minimum 1800 days of invalidity, old age and survivors’ premiums are notified or there is an insurance status of minimum 5 years, excluding any kind of debt periods, and totally 900 days of invalidity, old - age and survivors’ premiums are paid for the insurance holders working on service contract,
• the individuals suffering from war invalidity or duty disability are entitled to invalidity, duty disability or old - age pension while already receiving invalidity, duty disability or old - age pension, however the relevant process is not completed,
• the invalidity, duty disability or old - age pensions were terminated due to the fact that the pensioner had started to work as insured.

However, in order to award pension to the right holders of individuals working on his/her own names and accounts it is obligatory that the entire premium or any kind of debts related premiums, including the universal health insurance, should be paid.
Of the pension to be calculated for the deceased insurance holder in accordance with the Law No. 5510;
a) 50% shall be payable to the widow spouse; and 75% to the childless widow spouse, who is put on pension, in case such individual is not put on income or pension due to working under this Law or under legislation of a foreign country or due to her own insurance status,
b) Among the children, who are not put on income or pension due to working under this Law or under legislation of a foreign country or due to their own insurance status;

• the ones who have not completed the age of 18, the age of 20 in case receiving education in high school or equivalent, or the age of 25 in case receiving higher education; or whose insurance premiums are notified or
• the ones who are found to be disabled by losing minimum 60% of working power based on the decision of Health Committee of the Institution; or
• the daughters, whatever the ages are, not married, divorced or widow,shall receive 25% each.

c) If there are shares left over from spouse and children who are right holders, 25% totally to mother and father, provided that the figure is less than the net amount of the minimum wage of the income obtained from any kind of earnings and revenue and that they are not put on income and/or pension excluding the income and pension rights granted due to other children; if the mother and father is over 65 years of age, they shall be entitled to totally 25%, under the above conditions, without considering the left over share,

d) 50% shall be payable to each of the children stated in item (b), who are left both motherless and fatherless or suffer such status at a later date due to death of insurance holder; whose mothers and fathers do not have marriage connection or whose fathers and mothers have marriage connection at the time of decease but mother or father is married later on and the ones who are the sole right holders receiving pension.
Children who are adopted or recognized or whose lineage connection is corrected or fatherhood is ruled on, and the children of the insurance holder born after decease shall benefit from the pension under the abovementioned principles.
The total of the pensions payable to the right holders cannot exceed the amount of the pension of an insurance holder. If necessary, proportional reductions shall be applied to the pensions of the right holders in order to observe this limit.
b) Death Grant and Revival
In case the right holders of the deceased insurance holders, who work on service contract and on their own names and accounts and who became civil servants for the first time pursuant to the Law No. 5510 are not put on survivors pension, the amount calculated as per the Law No. 5510, shall be payable to the right holders in single payment, considering the provisions of this Law and taking the date of decease as basis.
c) Marriage and Funeral Allowance
Marriage allowance shall be payable in advance, for once, at the amount of two years of pension or income they receive, upon marriage and request of the daughters, whose income or pensions should be terminated due to marriage.
In case a right holder who is receiving marriage allowance becomes right holder within two years following the termination date of the pension, no income or pension shall be payable until the end of two-year period however such individuals shall be deemed to be universal health insurance holders.
Funeral allowance shall be payable to the right holders of the insurance holder who deceased when receiving permanent incapacity income due to work accident or occupational disease, invalidity, duty disability or old - age pension or when minimum 360 days of invalidity, old - age and survivors insurance premiums are notified for himself/herself.

(Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/universal_health_ins 

Universal health insurance is described in the Law No. 5510 as an insurance which ensures, first of all, maintenance of health statuses of individuals, and the financing of costs that arise in case the individuals experience health risks.
Introduced by the Law No.5510, universal health insurance system provides all insured and uninsured individuals who live in our country with a comprehensive, fair and equitable access to healthcare services, regardless of their economic status and whether they are willing or not.
The low-income individuals received healthcare services through “green cards” before 01.01.2012. Green card is a health card that enables our helpless and uninsured citizens with domestic monthly income per capita less than one thirds of gross minimum wage to receive healthcare services free of charge. The green card policy has been removed through some regulations and all citizens have been included in universal health insurance according to the results of means tests as of 01.01.2012.
The individuals who have green cards before 01.01.2012 and whose visa (right ownership) is valid after that date shall continue to receive healthcare benefits under universal insurance until their visas expire. It is obligatory that these individuals shall apply to the Social Assistance and Solidarity Foundations (SYDV) affiliated to the Ministry of Family and Social Policy in place of residence for taking means test no later than a month following visa expiration date. The individuals who are determined to have domestic average monthly income per capita less than one thirds of gross minimum wage according to the results of means test shall benefit from healthcare services as though they have green cards provided that health insurance premiums are paid by the State. In case domestic monthly income per capita is found more than one thirds of gross minimum wage as the result of means test, the individuals shall pay universal health insurance premium in the amount of their income.

I. Scope of Universal Health Insurance

A. Individuals deemed to be universal health insurance holders

Among the individuals having residence in Turkey;

a) Active insurance holders who;

• work on service contract,
• work as civil servants,
• work permanently in a position without subject to service contract but are not deemed to be insurance holders as working on service contract by the relevant laws,
• work under a contract but are not deemed to be insurance holders as working on service contract by the relevant laws, and are delegated directly as agents,
• work on their own names and accounts without subject to service contract and are village and neighborhood headman under the Law No. 5510,

1. b) Optional insurance holders,
2. c) Of the individuals who are not deemed to be insurance holders under above items;

• citizens whose domestic income per capita is less than one thirds of the minimum wage, to be determined through the testing methods and data to be laid down by the Institution by considering their expenses, movable and immovable properties and their rights arising from such,
• heimatlos and refugees,
• individuals over the age of 65 who receive pension,
• individuals who receive honorary pension,
• individuals who receive military service planning pension,
• individuals who receive compensation in cash and pension,
• individuals who benefit free - of - charge from protection, care and rehabilitation services
• individuals who receive disabled veteran pension and who receive pension under Law on Fighting against Terrorism,
• individuals who are charged with duty pursuant to the Village Law,
• individuals who are receiving pension due to World Olympic and European Championship

d) Provided that principle of reciprocity is also taken into consideration, individuals of foreign countries who have residence permit and are not insurance holders under legislation of a foreign country,

e) Individuals who benefit from unemployment benefit pursuant to the Unemployment Insurance Law and from short work benefit pursuant to relevant laws,

f) Individuals who receive income or pension from Social Security Institution, and

g) Citizens who are out of the above items and who do not have the right to benefit from health insurance at a foreign country,
shall be deemed to be universal health insurance holders.

The individuals who are not deemed to be insurance holder in terms of implementation of the provisions of short and long term insurance branches are also included under universal health insurance.

Also;

• Foreign students studying at universities in accordance with the Higher Education Law- provided that they pay universal health insurance premium over the amount corresponding to 30 days of the lower limit of daily earning- shall be deemed to be universal health insurance holders during their study.
• Individuals who fulfill their law internship in accordance with the Legal Profession Act without being insurance holders or dependants shall be deemed to be universal health insurance holders during their internship.

B. Individuals not deemed to be universal health insurance holders

The following individuals shall not be deemed to be universal health insurance holders:

• Individuals who fulfill their military obligations as privates and enlisted specialists, and cadets of reserve officer schools,
• Among the individuals who are sent to Turkey for a job by or on behalf of an organization established in a foreign country and who document to be subject to social insurance in the foreign country, the ones who reside in Turkey less than three months and among the individuals who work in Turkey on his/her own name and account the ones who reside abroad and are subject to the social security legislation of that country,
• Among the contracted Turkish citizen personnel, who are employed in the abroad representative offices of public administrations, the ones who document that they are insured by the social security institution of the country where they reside,
• Individuals who are prisoner or sentenced in penal institutions and detention houses,
• Among the foreigners who have residence permit but are not insurance holders under the legislation of foreign country, the ones who reside in Turkey less than one year,
• Among the individuals who are put on income or pension by the Social Security Institution through crediting, the ones who do not reside in Turkey

II. Conditions for Benefiting from Healthcare Services

The individuals and cases listed below are held exempted from any condition for benefiting from healthcare services:

• Individuals under the age of 18,
• Individuals who are medically in need of another person,
• Traffic accidents and emergency cases,
• Work accident and occupational disease situations,
• Contagious diseases with notification obligation,
• Protective and preventive healthcare services against substance abuse and drug addiction,
• Inpatient and ambulatory treatment due to maternity,
• Disaster and war case,
• Strike and lockout cases.

In order to benefit from healthcare services and other rights, excluding the above mentioned cases, it obligatory to for individuals to fulfill the following conditions:

• The universal health insurance holders and their dependants pursuant to items of paragraph one of Article 60 of the Law No. 5510, excluding items (c) and (f), shall have totally 30 days of paid universal health insurance premiums within one year before the date of application to healthcare service provider,
• The universal health insurance holders working on their names and accounts, excluding the ones whose deferment and installment is ongoing, shall fulfill the conditions in the above item and shall not have any premium or premium - related debts over 60 days as of date of application to the healthcare service provider,
• Among the optional insurance holders and the foreigners with residence permit who do not have insurance under the legislation of a foreign country, the universal health insurance holders and their dependants shall fulfill the conditions in the above item, and shall not have any premium or premium - related debts at the date of application to the healthcare service provider,
• Foreign students studying at universities in accordance with the Higher Education Law shall pay the complete universal health insurance premiums belonging to one term within one month as of the beginning of the term.

However the individuals who are taken out of the scope of universal health insurance holder's dependant shall have totally 30 days of paid universal health insurance premiums within one year before the date of application to healthcare service provider in order to benefit from the healthcare services within 30 days following the date of being universal health insurance holder.
The insurance holders who work on service contract; the ones who work in public administrations and the self-employed shall benefit from universal health insurance for 10 days as of the termination date of their compulsory insurance. If such individuals have 90 days of compulsory insurance within one year before the date they lose their insurance status, then they and their dependants shall benefit from healthcare services for a period of 90 days following the date they lose their insurance status.

III. Services Provided Under Universal Health Insurance

A. Healthcare Services

1. Healthcare Services Financed by the Institution

The following healthcare services shall be financed by the Institution in order to ensure that the health of universal health insurance holders and their dependants are maintained, that they regain their health in case of sickness, that the health care services found necessary in medical terms as a result of work accident and occupational disease, sickness and maternity, and that the incapacity status is eliminated or reduced:

In case the individual loses the status of being universal health insurance holder, the healthcare services to be provided due to ongoing treatment shall continue until the said individual recovers.

2. Healthcare Services Not Financed by the Institution

The following healthcare services are not financed by the Institution:

IV. Financing of Universal Health Insurance

Healthcare services shall be provided in accordance with the Law No. 5510 and/or the conventions signed between the Institution and domestic and foreign health service providers by means of refunding the expenses of healthcare services purchased by universal health insurance holders and their dependants from non-contracted healthcare service providers.
The Social Security Institution shall finance the expenses made for healthcare services provided by health service providers through the premiums collected from the universal insurance holders.
Universal health insurance premium shall be 12.5% of earning subject to premium for individuals subject to short and long term insurance branches. 5% of this premium is insurance holder's share and 7.5% is employer's share.
Universal health insurance premium for individuals subject to only universal health insurance and for individuals receiving unemployment, short-term employment allowance and job loss compensation shall be 12% of earning subject to premium. The State contributes to the Institution, at a rate of one fourth of the invalidity, old - age and survivors’ insurances and universal health insurance premiums collected by the Institution per month.
Pursuant to the Law, premium income collected under universal health insurance shall not be used for the purposes other than administrative expenses, healthcare services and other rights provided by universal health insurance.

(Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/foreign_pension 

What are the conditions for being entitled to invalidity, old age and survivor’s pensions based on the credited periods completed abroad?
Conditions for being entitled to invalidity, old age and survivor’s pensions based on the credited periods are as follows:

• Being a returnee, (the statement of returnee represents the termination of employment abroad of the claimant and not receiving any social insurance or social benefit based on residence. The statement of absolute is not used in cases of entering into country and not going abroad any more.)
• Paying the amount equal to the corresponding minimum period/day enough for being entitled to pension over the realized debt,
• Being entitled to pension under the applicable provisions of abrogated social security law/laws or the provisions of the Law No. 5510,
• Making a written application to the Institution.

What am I required to do first in order to be entitled to invalidity, old age and survivor’s pensions based on the credited periods completed abroad?
After completion of the process of foreign service crediting these forms should be completed: Claim for Allocation and Document of Representations Warranties (link) and Document of Representation Warranties for Claimants under Law No. 3201. (link)
Claim for Allocation and Document of Representations Warranties shall be obtained from Social Security Provincial Directorates/Social Security Centres and also from the web page of Social Security Institution:
(http://www.sgk.gov.tr/wps/portal/tr/sigortalılık/form_ve_dilekceler/formlar).
I have completed the Claim for Allocation and Document of Representations Warranties and Document of Representation Warranties for Claimants under Law No. 3201. What am I supposed to do now?
The condition of making the pension applications in person has been cancelled. The necessary documents can either be submitted directly to the relevant Social Security Provincial Directorate/Social Security Centre or can be mailed from either upcountry or abroad, after being duly completed and signed.
Submission of an updated service document is required only for those who apply from abroad.
Service documents issued within one month before the date of application are accepted as up to date.
For the returnees, it is not compulsory for the service document to be up to date.
Is it compulsory to be a Turkish citizen on the date of application or receiving of the pension?
It is not compulsory to be a Turkish citizen on the date of application or receiving of the pension according to the Law No. 3201 after 08/05/2008.
I have been entitled to a pension based on the crediting of the periods completed abroad. Am I obliged to make any notification before going abroad?
People, who are entitled to invalidity, old age and survivor’s pension based on the crediting of the periods completed abroad and stayed abroad for more than six months, have to submit to the Institution the Survey Document for Pensioners under the Law No. 3201 together with the other documents indicating whether the person is employed abroad and is receiving a social insurance or social benefit based on residence, within three months from the completion of the mentioned six month’s period.
Suspension of the Pension and Succeeding Transactions
If the person fails to submit the Survey Document for Pensioners under the Law No. 3201 within the specified period, his/her pension shall be suspended without any notification until the submission of the said document.
Pensions of those who are entitled to a pension under the Law No. 3201 based on crediting of the periods completed abroad shall be terminated as from the commencement date, in case it is determined that their employment abroad has not ended as of the commencement date of the pension, because of violating the condition of leaving the job abroad for being entitled to a pension.

(Link: http://eski.sgk.gov.tr/wps/portal/sgk/en/detail/foreign_healthcare 

23 of all the social security agreements signed by our country are still in force and the agreements with following countries include healthcare insurance: Germany, Netherlands, Belgium, Austria, France, TRNC-Turkish Republic of Northern Cyprus, Macedonia, Azerbaijan, Romania, Czech Republic, Bosnia-Herzegovina, Albania, Luxemburg and Croatia.

However, the provisions on healthcare insurance in the agreements signed between Azerbaijan and Albania cannot be implemented due to the reasons stemming from their legislations.

Which persons can receive healthcare services abroad according to the social security agreements?

Unless otherwise provided in the agreement on social security, the following persons have the right to receive healthcare benefits on behalf of our Institution;

1. Insured persons (banks, insurance and reassurance companies, chambers of commerce, chambers of industry, stock markets and the workers employed in the unions constituted by them) under the scope of letter (a) of the first paragraph of Article 4 of the Law No. 5510 and of transitional Article 20 of the Law No. 506 and their dependent family members. Of the persons specified in this scope, the following can receive healthcare benefits while staying or residing in a foreign country:
   • Insured persons temporarily posted to a foreign country,
   • Persons who are permanently posted to a foreign country and their dependent family members,,
   • Dependent family members of the insured and retired persons staying abroad for educational reasons,,
   • Insured and retired persons staying abroad for touristic purposes and their dependent family members,,
   • Dependent family members of the insured persons who are permanently residing abroad and retired persons and their dependent family members,,
   • Members of universal health insurance who are sent to another country for treatment and their dependent family members.,
2. Apart from this; according to the legislation of our Institution, the following persons can avail themselves from the right to receive healthcare benefits provided by our Institution under the scope of universal health insurance on behalf of the contracted countries;
   • For temporary stay; all the persons registered on the document (formulary) of right to healthcare benefits, only in cases of emergency,
   • For permanent residence; persons specified in the social security agreements.

In this context, in order to receive healthcare benefits in our country, respective persons are required to be an insured member of universal health insurance or dependent of the insured in question.

Conditions for Receiving Healthcare Benefits for the Persons Having Foreign Insurance

Persons having foreign insurance, who either temporarily stay or permanently reside in our country, are required to get a formulary from the institution to which they are registered and submit it to the Departments of Foreign Services operating within the scope of Social Security Provincial Directorates/Social Security Centers in their place of stay or residence; or to the Social Security Centers designated by Social Security Provincial Directorates.

Through the Document of Healthcare Benefits under Social Security Agreement, they can avail themselves from right to healthcare benefits in contracted health facilities, like other insured members of universal health insurance, free of charge excluding the rates of contribution and share which have to be paid legally by the insured himself/herself.

In cases of emergency, the insured persons, coming from countries with whom a social security agreement including healthcare insurance applications has been concluded and who are temporarily staying in our country, can receive the formulary for the right to healthcare services from the “Department of Foreign Services” in their place of stay in Turkey by submitting the document issued by the social security institution in their country. Besides, these documents can be confirmed through Social Security Centers designated by Social Security Provincial Directorates.

Benefiting from Emergency Healthcare Services for the People Having Foreign Insurance

In order to receive healthcare services, foreign insured people are required to make an application to the contracted health facilities of the Ministry of Health or to the private or training health facilities with the “Document of Healthcare Benefits under Social Security Agreement.”
Only through the referral of our contracted units, services can be provided from the non-contracted health facilities. When a person applies directly to a non-contracted health facility, regardless of this regulation, his/her expenses of treatment can be covered by the Institution on condition that it is an emergency situation.

Whether the treatment is an emergency or not is determined through the inspection of the relevant submitted medical documents by the contracted health facilities.

In such a case, the insured person shall apply to the Social Security Provincial Directorate/Social Security Center together with the reports regarding his/her treatment and invoices if he/she has made the payment. If the treatment is accepted as an emergency, a reimbursement shall be made to the insured in accordance with the provisions set forth in Medical Enforcement Declaration (SUT).

Duration of Benefiting from Healthcare Services for Foreign Insured People who are Temporarily Staying in our Country and Determination of the Family Members to Receive Healthcare Benefits

People, who are temporarily staying in our country, have the right to healthcare benefits for the period specified in the documents that they brought with them. For temporary stay, people to receive healthcare benefits are determined according to the legislation of the country issuing the document.

In case healthcare benefit is needed after the expiration of the document;

• A new document for treatment period shall be requested from the contracted country by applying to the relevant unit of the Institution.
• Insured person shall directly contact with the insurance institution of the country to which he/she is subject and request a new document for treatment period. The healthcare services provided meanwhile have to be paid for.
• After the document for the extension of the period is received from the contracted country, a “Document of Healthcare Benefits under Social Security Agreement” shall be issued retrospectively and the expenses shall be reimbursed to the respective people pursuant to the provisions of Medical Enforcement Declaration (SUT).

Duration of Benefiting from Healthcare Services for Foreign Retired People who are Permanently Residing in our Country and Determination of the Family Members to Receive Healthcare Benefits

People, who are permanently residing in our country, have the right to receive healthcare benefits for the period specified in the documents issued by the institutions of the contracted countries until a notification regarding the termination of the right to healthcare benefits is received.

For the permanent residences, the people to receive healthcare benefits subject to the agreement.

In our agreements with Germany, Netherlands, Belgium, France, Czech Republic, T.R.N.C., Luxemburg and Croatia, family members are determined pursuant to the legislation of our Institution; while in our agreements with Macedonia, Romania, Azerbaijan, Bosnia-Herzegovina and Albania they are determined according to the legislation of the relevant country.

Documents of right to healthcare benefits in cases of permanent residence are sent to our Institution by the insurance institutions of contracted countries either for a long time or without specifying the date of termination of the right.

However, the rights of foreign insured people in order to receive healthcare benefits are sometimes terminated by the relevant sickness funds for various reasons.

For the purpose of checking whether foreign insured people’s rights to healthcare benefits are continuing or not, the mentioned documents are issued in every six months’ period and given to the relevant persons.

Where the Costs of Treatment can be reimbursed by Foreign Insured Persons who pay for Their Treatment without a Document of Right to Healthcare Benefits?

Foreign insured persons who pay for their treatment in our country without obtaining the document (formulary) for receiving healthcare benefits from the insurance institution to which he/she is registered shall keep their reports and invoices regarding the treatment. After returning to his/her country to which he/she is registered, he/she shall request a reimbursement by submitting the relevant reports and invoices indicating the healthcare expenses to the institution to which he/she is affiliated. In this case, if it is set forth in the agreement, the insurance institution receiving the application shall request information from our Institution on the specified cost of the treatment provided in our country by sending the relevant reports and invoices. Following the receipt of the notification on the specified cost of that treatment, institution shall reimburse the notified amount to relevant person.

Who can Receive Healthcare Benefits in Germany in Accordance with the Social Security Agreement between Germany and our Country?

Only our workers and retired workers were to avail themselves of the healthcare provisions of the Social Security Agreement signed with Germany.

By way of reaching a consensus with German liaison body, craftsmen and civil servants and people who are retired in this context and also their dependants are covered by the healthcare provisions of the Social Security Agreement between Turkey and Germany.

As a result of this regulation, all the insured and retired persons and their dependants going to Germany, have the opportunity to avail themselves of healthcare benefits.