Only employees aged under 60 are eligible for disability. As an exception, this age limit can be increased to 62 if the employee is not entitled to a retirement pension (basic or supplementary scheme) in Monaco, France or Italy.
Contact the Medical Benefits department for more information about this particular situation.
This eligibility occurs most frequently at the fund's instigation, when the insured has exhausted their entitlement to benefits as a result of a work interruption due to sickness (maximum duration for a continuous period not working is 3 years with the possibility of extending this duration by a year in some cases).
However, you can be registered as disabled at any time, either at the fund's instigation or at the request of the interested party, once it has been established:
- that the employee's state of health has stabilised,and
- that this person has a permanent physical disability, making it impossible to obtain, in any occupation whatsoever, earnings higher than 1/3 the remuneration received by employees in the same professional category.
To be entitled to a pension, on the start date of the work interruption, the disabled employee must also prove:
- 12 months of valid registration during the fifteen months prior to the date that the work interruption began,
- 800 salaried working hours or equivalent over the 12 previous months, including 200 during the last 3 months or 800 working hours or equivalent over the 4 previous calendar quarters, including 200 during the last calendar quarter.
The disability pension is always provided on a temporary basis. It is liable for revision depending on developments in the disability of the interested party.
Amount and revision of the pension
The amount of the disability pension is calculated based on the average gross monthly salary for the 60 months prior to the start date of the work interruption.
The monthly pension amount is equal:
- to 30 % of the average monthly salary determined as indicated above for disabled people able to carry out paid work,
- to 50 % of this same average monthly salary for disabled people absolutely unable to carry out any occupation whatsoever,
subject however to compliance with the minimum and maximum amounts set by ministerial decree.
The pension is paid at the end of each calendar quarter.
At the start of March, June, September and December, you must send a quarterly statement to theMedical Benefits Department.
Premium for third person assistance
A disabled person who is unable to carry out an occupation and who needs the assistance of a third person in their everyday life can claim a third person benefit, the amount of which is set at 40 % of the disability pension that the person receives, but not less than an amount set by Ministerial Decree.
Combining disability and retirement
The disability pension can be retained beyond the age of 60, even if the insured person claims their pension entitlement.
However, the combining of retirement and disability pensions is governed by certain rules, which vary depending on whether the disabled person is aged under or over 65.
It should be noted that pensions paid by supplementary schemes, as well as reversionary pensions are not subject to the following rules:
If the disabled person is aged under 65
Retirement pensions, excluding those paid by the C.A.R. and the C.A.R.T.I. for the Self-Employed), are deducted from the disability pension amount.
The disability pension, the amount of which has potentially been reduced, is paid as a priority over retirement pensions owed by the C.A.R. or C.A.R.T.I., with these institutions paying only the difference between the disability pension and the old age pension when the latter is higher.
If the disabled person is aged over 65
Retirement pensions are paid as a priority over disability pensions owed by the C.C.C.S.S., this scheme only potentially paying the difference between the disability pension and the total amount of the retirement pensions paid to the disabled person.
- Where necessary, this benefit supplements the disability pension to ensure the disabled person has an income equal to two thirds the minimum wage, which is from January 1, 2023
- Only disabled people under the age of 65 can qualify.
- The amount of the supplement is equal to the difference between the quarterly amount indicated above and the disabled person's total income, excluding family benefits and relief payments.
To qualify, in the last month of every quarter, the disabled person must complete the appropriate section on the income declaration. The fund will perform any investigation it deems necessary.
- The income guarantee is paid at the same time as the disability pension.
Reimbursement of medical expenses
The Fund covers 100% of the responsibility tariff for disabled people, i.e. they are exempt from patient contribution.
For more detailed information about the reimbursement procedures for medical expenses, please refer to the section on Health Insurance.