Covid-19, quelle couverture maladie pour les salariés en arrêt de travail ?

indemnisation salarié coronavirus

Les salariés en arrêt de travail bénéficient des indemnités journalières de la sécurité sociale sous certaines conditions. Qu’en est-il dans le cadre de l’épidémie de Covid-19 ? Zoom sur les différentes possibilité d’arrêt de travail.

1- Covid-19, adaptation des règles relatives aux arrêts de travail pour les salariés faisant l’objet d’isolement

Les personnes exposées au coronavirus bénéficient de conditions plus favorables pour le versement des indemnités journalières de sécurité sociale (IJSS).

Sont visées les personnes faisant l’objet d’une mesure d’isolement du fait :

  • d’avoir été en contact avec une personne malade du coronavirus
  • ou d’avoir séjourné dans une zone concernée par un foyer épidémique de ce même virus et dans des conditions d’exposition de nature à transmettre cette maladie.

Ces personnes peuvent bénéficier des IJSS maladie :

  • Sans que soient remplies les conditions d’ouverture de droit relatives aux durées minimales d’activité ou à un niveau de cotisations
  • Et sans délai de carence.
    Ces mesures sont entrées en vigueur le 2 février 2020.

Ces indemnités sont versées pendant 20 jours maximum.

Les médecins traitants ne sont pas à ce jour habillités à délivrer des arrêts de travail pour les cas non diagnostiqués.

Pour aller plus loin :

  • Décret n°2020-73 du 31 janvier 2020 portant adoption des conditions adaptées pour le bénéfice des prestations en espèces pour les personnes exposées au Coronavirus

2- Arrêt de travail pour les salariés contraints de garder leur enfant dans le cadre du Covid-19

Il appartient à l’employeur de solliciter un arrêt de travail pour les salariés concernés.

Dans le cadre des mesures visant à limiter la diffusion du coronavirus, les autorités publiques ont, dans certaines communes, décidé la fermeture temporaire de crèches et d’établissements scolaires, ainsi que le confinement à domicile des enfants. 

Si le parent salarié n’a pas d’autre possibilité que de s’arrêter de travailler pour en assurer la garde, il peut bénéficier d’un arrêt de travail aux mêmes conditions qu’un salarié directement mis en isolement.

Pour cela, l’employeur de ces salariés doit les déclarer par le biais du téléservice « declare.ameli.fr ». Les salariés concernés n’ont plus à passer par l’ARS (Agence régionale de santé).

Le site de l’Assurance maladie rappelle les conditions à remplir pour bénéficier d’un arrêt de travail dans ces circonstances.

  • L’enfant doit être âgé de moins de 16 ans au jour du début de l’arrêt,
  • L’enfant doit être scolarisé dans un établissement fermé.
  • Un seul parent peut se voir délivrer un arrêt de travail. Le salarié devra donc fournir à l’employeur une attestation sur l’honneur certifiant qu’il est le seul à demander l’arrêt de travail dans ce cadre,
  • L’entreprise ne doit pas être en situation de mettre, sur cette période, l’employé concerné en télétravail.

L’arrêt de travail est délivré pour une durée de 14 jours calendaires à compter de la date de début de l’arrêt déclaré. L’employeur doit alors réaliser les démarches habituelles pour le déclenchement des IJSS.

L’arrêt de travail peut être partagé entre les parents. Il est possible de le fractionner en remplissant une demande pour chacune des périodes d’arrêt.

3- Arrêt de travail pour garde d’un enfant de moins de 16 ans faisant l’objet d’une mesure d’isolement Covid-19

Les parents d’un enfant de moins de seize ans faisant l’objet d’une mesure d’isolement et qui se trouvent dans l’impossibilité de continuer à travailler peuvent percevoir des IJSS dans des conditions dérogatoires (pas de conditions de durée d’activité ou de contributivité minimales, pas de délai de carence).

Les indemnités journalières peuvent être versées pendant toute la durée de fermeture de l’établissement accueillant cet enfant.

Pour aller plus loin :

  • Décret n°2020-227 du 09 mars 2020 adaptant les conditions du bénéfice des prestations en espèces d’assurance maladie et de la prise en charge des actes de télémédecine pour les personnes exposées au Covid-19

4- Arrêt pour garde d’enfants des travailleurs non salariés

La procédure est la même que celle des salariés (déclaration sur le site ameli).

Il n’y a aucune attestation ni document à produire, l’assurance maladie se charge de récupérer les éléments de revenus professionnels. 

La procédure reste la même après le 1er mai.

Les IJSS correspondent au revenu professionnel moyen des 3 dernières années / 730 . Le revenu professionnel pris en compte est limité au plafond annuel de la sécurité sociale.

5- Le téléservice declare.ameli.fr étendu aux personnes à risque élevé

Le 3 mars dernier, l’Assurance Maladie mettait en place le téléservice « declare.ameli.fr » pour permettre aux employeurs de déclarer leurs salariés sans possibilité de télétravail et contraints de rester à domicile suite à la fermeture de l’établissement accueillant leur enfant.

Ces nouveaux arrêts maladie lié aux mesures sanitaires pour lutter contre le coronavirus Covid-19 visent à simplifier les procédures.

Dorénavant, une extension a été annoncée pour les personnes à risques.

Il s’agit des critères suivants :

  • Femmes enceintes
  • Maladies respiratoires chroniques (asthme, bronchite chronique…) ;
  • Insuffisances respiratoires chroniques ;
  • Mucoviscidose ;
  • Insuffisances cardiaques toutes causes ;
  • Maladies des coronaires ;
  • Antécédents d’accident vasculaire cérébral ;
  • Hypertension artérielle ;
  • Insuffisance rénale chronique dialysée ;
  • Diabètes de type 1 insulinodépendant et diabète de type 2 ;
  • Les personnes avec une immunodépression ;
  • Maladie hépatique chronique avec cirrhose ;
  • Obésité avec un indice de masse corporelle (IMC) égal ou supérieur à 40.

Conformément aux décisions gouvernementales, ces personnes doivent impérativement rester à leur domicile, en arrêt de travail, si aucune solution de télétravail n’est envisageable.

Afin de faciliter les démarches des personnes concernées, et de ne pas mobiliser les médecins de ville pour la délivrance de ces arrêts, l’Assurance Maladie étend, à compter du 18 mars, son téléservice de déclaration en ligne, declare.ameli.fr à cette nouvelle catégorie d’assurés.

Les personnes, dont l’état de santé le justifie, pourront ainsi se connecter directement, sans passer par leur employeur ni par leur médecin traitant, sur le site declare.ameli.fr pour demander à être mis en arrêt de travail pour une durée initiale de 21 jours.

L’assurance maladie délivrera ensuite un arrêt de travail.

Cet arrêt pourra être déclaré rétroactivement à la date du vendredi 13 mars



Mis à jour le 27 avril 2020

Rédaction : Mélanie Leleux
Expert-comptable chez Ormeo

Image par Semevent de Pixabay

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