If citizens living with HIV/AIDS wish it and are in need of social support, they can be classed as people with disabilities or as vulnerable population. This way, in accordance with others socio-economic criteria, they will be entitled to a variety of social benefits.
What is required in order to be qualified for the social benefits scheme is a disability evaluation process, that is the evaluation of an HIV+ person’s performance. It is conducted by the Disability Certification Centre (KEPA) and it is mainly based on the patient’s medical history.
The Disability Certification Centre (KEPA) is the organization responsible for the certification of disability and it is under the Invalidity and Occupational Medicine Directorate of the Social Insurance Institution (IKA-ETAM). KEPA examines those who apply for an invalidity pension (excepting the ones who work in the Public Sector, the Army and the Security Corps), welfare benefits or the issuance of the degree of disability in order to receive social benefits and facilitations such as tax exemptions, travel card for the forms of public transport, favorable working hours etc.
KEPA Disability Certification Process
- Submit your application to KEPA along with the necessary supporting documents and the medical record.
- In case of inability to move: a Solemn Declaration that has the authenticity of the doctor’s signature certified and reports the reasons which make movement unfeasible.
- Medical pre-inspection: if all the required documents have been provided the application is filed and a certificate of submission is issued.
- New medical evidence that may emerge from the application day to the examination day can be submitted on the examination day.
- Once the application has been electronically filed, a notification will be sent to the claimants or they will be notified by telephone about the date, time and place of the evaluation.
- KEPA provides the Disability Certificate, which can be used for all legal purposes, and verifies the condition, the degree of disability and the disability duration.
- For the period of time that the Certificate remains valid KEPA will provide copies of it, when requested.
- The claimant can lodge an appeal against the medical opinion of the Primary Health Committee (AYE) in order to request a re-examination by the Secondary Health Committee (BYE) within 10 calendar days.
Unified Disability Percentage Chart (EPPPA)
The Unified Disability Percentage Chart (EPPPA), published in the official government gazette (FEK part B 1506/4.5.12), is used as a guide for KEPA Health Committees in order to judge the degree of disability in each condition. When it comes to the HIV infection the evaluation is divided in 3 levels.
1st level – early stage (Asymptomatic patients with CD4 count >500 cells/µl)
Some patients are likely to experience progressive generalized lymphadenopathy or skin rashes, onycomycosis, recurrent mouth sores, vaginal candidiasis.
PROGNOSIS – MEDICAL SOCIAL ASSESSMENT
Intervention for the symptoms to be relieved. Constant evaluation of the chronic mental stress management.Good prognosis.
DEGREE OF DISABILITY……………………………………………………….…10-40%
2nd level – intermediate stage (CD4 count 200-500 cells/μl)
Asymptomatic patients or with constitutional symptoms ( fever, night sweats, weight loss, diarrhea), recurrent episodes of herpes zoster, οropharyngeal or recurrent vaginal candidiasis, cervical dysplasia or cervical carcinoma in situ, idiopathic thrombocytopenic purpura, pneumonia, peripheral neuropathy, neurocognitive disorders etc. Both the drop of CD4 count below 350 cells/μl and the occurrence of symptoms call for the antiretroviral therapy to begin.
PROGNOSIS – MEDICAL SOCIAL ASSESSMENT
A good prognosis is usually provided once the antiretroviral therapy along with the treatment of the other symptoms-conditions begins.
DEGREE OF DISABILITY in asymptomatic patients …………………………….…50%
DEGREE OF DISABILITY in patients with the forementioned symptoms…………67%
3rd level – advanced/late stage (CD4 count < 200 cells/μl)
At this point AIDS-indicator conditions occur such as: Pneumocystis jiroveci pneumonia, toxoplasmosis of the brain, esophageal candidiasis, cryptosporidiosis, microsporidiosis, tuberculosis, invasive cervical carcinoma, Kaposi sarcoma, lymphoma, neuropathy. During the late stage when CD4 count is less than 50 cells/μl the conditions that may occur are: disseminated cytomegalovirus disease/ retinitis, invasive candidiasis, disseminated Mycobacterium avium complex disease, cryptococcal meningitis, progressive multifocal leukoencephalopathy, wasting syndrome, dementia.
PROGNOSIS – MEDICAL SOCIAL ASSESSMENT
Extremely serious condition whose course cannot be predicted. The patient may suffer from irreversible organ damages which should be independently examined as in the case of blindness from CMV retinitis, lymphoma or neurological/mental disorders.
DEGREE OF DISABILITY
- On the occurrence of these symptoms and for as long as they last …80-over 80%
- On the occurrence of cancer ……………………….…………………………over 80%
- In the event of partial immune rehabilitation thanks to antiretroviral therapy and opportunistic infection cure……………………………………………………..…80%
- In the event of irreversible organ damages the degrees of disability are determined depending on the organ damage.
Required Documents for KEPA Evaluation
- Certified photocopy of ID card or passport. For citizens of third countries living in Greece, passport and valid residence permit or the certificate of submission until the issuance of the residence permit.
- Health booklet issued by the insurance institution (for insured citizens).
- Social Security number (AMKA) or the European Health Insurance Card.
- Concerning a request of retirement, retirement extension or any benefit granted by the insurance institution, a referral from the institution is required.
- In case there isn’t a referral, a €46,14 fee from the Financial Services of IKA-ETAM is needed. Uninsured citizens, beneficiaries of the Law 4368/2016 don’t need to present a fee. The fee is presented with a referral from KEPA administrative office after the documents’ submission.
- Authorization or warrant in case a representative submits the application or if that isn’t possible, court order for appointment of case guardian or any other legal document.
- Explanatory file which is filled by the attending – referring physician of the claimant. In the file there should be included all the conditions the applicant should be examined for by the Health Committee. The medication or any other treatment the patient receives should be reported as well.
- The conditions should be verified by medical exams, X-rays along with their findings, CT scans, MRIs, biopsies, EMG, Triplex ultrasound, EKG etc. Copies of medical exams or older laboratory tests whose results could be helpful for the accurate decision of the committee (e.g. biopsies) are also accepted.
- If the patient had been hospitalized, the number of the discharge card from the clinic or hospital should be included.
- In case of inability to attend: a Solemn Declaration of Law 1599/86 that has the authenticity of the doctor’s signature certified and reports the reasons which make the patient’s movement unfeasible. The declaration isn’t necessary if the inability of attendance is mentioned in the main medical report or in the certificate of hospitalization.
Attention! The laboratory tests should have been conducted within 4 months before the examination day in KEPA. For example if you submitted, along with your application, blood tests which were carried out on 1/1/17 and the Health Committee appointed the examination day on 1/5/17, the chairman of the Committee could postpone the examination until new blood tests were presented.
Frequently Asked Questions about KEPA
Should I go to the KEPA branch which is near my house?
You can get examined in any KEPA branch regardless of your place of residence.
Do I need to make a payment?
For KEPA’s examination you will pay a €46,14 fee which is available in the IKA offices with a referral from KEPA administrative office.
Both those who apply for a disability pension and have a referral from the insurance institution and the uninsured beneficiaries of the Law 4368/2016 are excepted.
With which degree of disability am I entitled to social benefits?
Depending on the benefits, degrees of disability vary. For example:
- For a disability pension from IKA 50% and higher, OAEE1 – OPAD2 67% and higher, OGA3 67% and higher.
- For an unemployment card from OAED4 ( vulnerable social groups) 50% and classified as “capable for working”.
- For tax exemptions, DEI5 social tariff, free travel card for public transports 67% and higher.
Do I have to undergo an examination from KEPA even if I have and older valid medical report?
Yes, in certain cases you cannot override the procedure when a KEPA examination is required by Law, even if you have a valid medical report from a Prefectural Health Committee or a disability pension characterized as permanent (e.g. the welfare benefit requires a KEPA certification).
If my health deteriorates am I entitled to a re-examination from KEPA or should the previous decision be expired?
You have the right of re-examination if 6 months have elapsed from the previous decision and the deterioration is proven by a medical certificate, or sooner than 6 months if you get hospitalized.
Is the degree of disability necessary so as to apply or to continue receiving the seropositivity benefit?
- According to article 46 of Law 4025/2011 beneficiaries of all disability benefits and welfare benefits, especially those suffering from congenital bleeding diathesis, immunodeficiency and vision loss, have to be examined by a Health Committee in order to receive the benefit.
- If you are a new beneficiary you must be examined by KEPA.
- If you are an old beneficiary at some point you will be asked to be examined by KEPA.
What should I do if I am not satisfied by the degree of disability from KEPA?
- You can find out if KEPA has misevaluated you by studying EPPPA (see chap. 2.3) or by asking information from the Social Service of the Center of Life.
- If you are misevaluated you can lodge an appeal in KEPA (within 10 days from the notification of the decision) which you must reasonably support and you will be asked to be re-examined by the Secondary Health Committee.
- If you aren’t satisfied from the decision of the Secondary Health Committee you have the right to resort to judicial remedy (Administrative Court of First Instance).