Part II – Medical care
The contingency covered shall comprise the need for medical care of a curative nature and, under prescribed conditions, the need for medical care of a preventive nature.
1. The persons protected shall comprise:
a. all employees, including apprentices, together with their dependent spouses and their children; or
b. all economically active persons together with their dependent spouses and their children; or
c. all residents.
2. Notwithstanding the provisions of the foregoing paragraph, any Party may exclude from the application of this part:
a. classes of employees constituting in all no more than 5% of all employees; or
b. classes of the economically active population constituting in all no more than 10% of the total economically active population; or
c. classes of residents constituting in all no more than 10% of all residents.
3. Where either sub-paragraph a or b of paragraph 1 of this article applies, persons receiving any of the following benefits or applying for one of the benefits provided for under sub-paragraphs a or b of this paragraph:
a. invalidity, old-age or survivors' benefit;
b. benefit for permanent disablement to a prescribed degree or survivors' benefit, in the case of a work accident or occupational disease;
c. unemployment benefit,
together with their dependent spouses and their children, shall continue, under prescribed conditions, to be protected.
4. Any Party may derogate from the provisions of paragraphs 1 to 3 of this article if its legislation requires medical care to be guaranteed:
a. to prescribed classes of employees constituting in all at least 80% of all employees; or
b. to prescribed classes of the economically active population constituting in all at least 75% of the total economically active population; or
c. to prescribed classes of residents constituting in all at least 70% of all residents, and in the case of illness requiring prolonged treatment, to all residents.
1. Medical care shall comprise:
a. general practitioner care and specialist care, inside or outside hospitals, including the necessary diagnoses and tests, as well as domiciliary visits;
b. care provided by a member of a profession legally recognised as allied to the medical profession, under the supervision of a medical or other qualified practitioner;
c. the provision of the necessary pharmaceutical supplies on prescription by a medical practitioner or other qualified practitioner;
d. maintenance in a hospital or any other medical institution;
e. dental care including the necessary dental prostheses;
f. medical rehabilitation, including the supply, maintenance and renewal of prosthetic and orthopaedic appliances as well as medical aids as may be prescribed;
g. transport of the patient as may be prescribed.
2. Where a Party's legislation requires the beneficiary or the beneficiary's breadwinner to share in the cost of medical care, the rules governing such cost-sharing shall be such as not to impose hardship or render medical and social protection less effective.
3. Medical care shall aim at preserving, restoring or improving the health of the person protected and his ability to work and to meet his personal needs.
Where a Party's legislation makes entitlement to medical care conditional on the completion of a qualifying period, that period shall be no longer than is considered necessary to prevent abuse.
1. Medical care shall be provided throughout the contingency covered.
2. Where either sub-paragraph a or b of paragraph 1 of Article 9 applies, the right to medical care shall subsist under prescribed conditions for anybody ceasing to belong to one of the classes of persons protected.