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On the duty to pay the contributions of state social insurance and those of compulsory health insurance and on the reduction of the maternity (paternity) benefits

Case No. 47/2009-131/2010

 THE CONSTITUTIONAL COURT OF THE REPUBLIC OF LITHUANIA

IN THE NAME OF THE REPUBLIC OF LITHUANIA

 RULING

ON THE COMPLIANCE OF CERTAIN PROVISIONS OF THE REPUBLIC OF LITHUANIA’S LAW ON STATE SOCIAL INSURANCE, THE REPUBLIC OF LITHUANIA’S LAW ON HEALTH INSURANCE, THE REPUBLIC OF LITHUANIA’S LAW ON SICKNESS AND MATERNITY SOCIAL INSURANCE AND THE LAW AMENDING IT WITH THE CONSTITUTION OF THE REPUBLIC OF LITHUANIA

 16 May 2013

Vilnius

The Constitutional Court of the Republic of Lithuania, composed of the Justices of the Constitutional Court Egidijus Bieliūnas, Toma Birmontienė, Gediminas Mesonis, Ramutė Ruškytė, Egidijus Šileikis, Algirdas Taminskas, Romualdas Kęstutis Urbaitis, and Dainius Žalimas

The court reporter—Daiva Pitrėnaitė

The representatives of groups of Members of the Seimas of the Republic of Lithuania, the petitioner, who were Vytenis Povilas Andriukaitis and Julius Sabatauskas, both of whom are Members of the Seimas

The representative of the Seimas of the Republic of Lithuania, the party concerned, in the part of the case subsequent to petition No. 1B-143/2010, who was Antanas Matulas, a Member of the Seimas

The Constitutional Court of the Republic of Lithuania, pursuant to Articles 102 and 105 of the Constitution of the Republic of Lithuania and Article 1 of the Constitutional Court of the Republic of Lithuania, at the Court’s public hearing, on 17 April 2013, heard constitutional justice case No. 47/2009-131/2010 subsequent to the petitions (Nos. 1B-59/2009, 1B-143/2010) of groups of Members of the Seimas of the Republic of Lithuania (those petitions were joined into one case through the Constitutional Court’s decision of 13 March 2013) requesting an investigation into whether:

– Paragraph 4 (wording of 22 July 2009) of Article 2 of the Republic of Lithuania’s Law on State Social Insurance, Paragraph 3 (wording of 22 July 2009) of Article 4 of the same law, insofar as, according to the petitioner, it provides that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments; Paragraphs 5 and 9 (wording of 22 July 2009) of Article 4 of the same law, insofar as, according to the petitioner, they provide that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by insurance on a compulsory basis, also that the persons linked with the insurance payer by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax, who, at the same time, receive income from sports activities or from performing activities from the same insurance payer, shall be covered, on a compulsory basis, by the types of social insurance established in Article 3 of the Republic of Lithuania’s Law on State Social Insurance; and Paragraphs 2, 3, and 4 (wording of 22 July 2009) of Article 7 of the same law, insofar as, according to the petitioner, they provide that the persons who receive income from sports activities and/or from performing activities shall be covered by insurance on a compulsory basis, is not in conflict with Articles 23 and 29 of the Constitution of the Republic of Lithuania and the constitutional principle of a state under the rule of law (petition No. 1B-59/2009);

– Paragraph 1 (wording of 22 September 2009) of Article 21 of the Republic of Lithuania’s Law on Sickness and Maternity Social Insurance is not in conflict with Articles 18 and 29 of the Constitution of the Republic of Lithuania and the constitutional principle of a state under the rule of law (petition No. 1B-59/2009);

– Article 2 of the Republic of Lithuania’s Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, is not in conflict with the constitutional principle of a state under the rule of law (petition No. 1B-59/2009);

– Item 1 (wording of 22 July 2009) of Paragraph 3 of Article 6, Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8, and Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 of the Republic of Lithuania’s Law on Health Insurance, insofar as, according to the petitioner, they provide that the persons who receive income under authors’ agreements, or from sports activities, or from preforming activities, as well as Paragraph 3 (wording of 22 July 2009) of Article 17 of the same law, are not in conflict with Articles 23 and 29 of the Constitution of the Republic of Lithuania and the constitutional principle of a state under the rule of law (petition No. 1B-59/2009);

– Paragraph 9 (wording of 19 February 2009) of Article 17 of the Republic of Lithuania’s Law on Health Insurance is not in conflict with Paragraph 1 of Article 53 of the Constitution of the Republic of Lithuania and the constitutional principle of a state under the rule of law (petition No. 1B-143/2010).

The Constitutional Court

has established:

I

  1. Petition No. 1B-59/2009 of a group of Members of the Seimas, a petitioner, is substantiated by the following arguments.

1.1. The provisions of the Republic of Lithuania’s Law Amending and Supplementing Articles 2, 4, 7, 8, and 9 of the Law on State Social Insurance, which was adopted on 22 July 2009, enlarged the circle of the persons covered by state social insurance on a compulsory basis, whilst, pursuant to this law, some groups of persons were covered by certain types of state social insurance for the first time.

As regards the representatives of the so-called free professions (authors, athletes, and performers), when one respects their own choice and in view of the fact that the royalties paid to authors are insured income of a different nature (the work of an author is irregular and not subject to prediction), they should not be covered by state social insurance on a compulsory basis. The state, while implementing the provisions of Article 52 of the Constitution, must create legal preconditions for these persons so that they could take care of their social well-being in cases of old age, sickness, disability etc., however, it cannot obligate them to participate in the schemes of compulsory state social insurance. While establishing the compulsory state social insurance for these categories of persons, and, on this basis, having obtained the right to demand a part of the income legally earned by the said persons, the state groundlessly redistributes their income in violation of the principle of the inviolability of ownership as entrenched in Article 23 of the Constitution. Such legal regulation is in conflict with the very essence of the legal notion of social insurance and with the constitutional principles of the equality of persons, a harmonious civil society, and a state under the rule of law.

1.2. When one takes into account the requirements of the constitutional principle of a state under the rule of law and the provision of Paragraph 1 of Article 29 of the Constitution that all persons shall be equal before the law, the court, and other state institutions and officials, the impugned legal regulation consolidated, due to the difficult economic situation in the state, through the Republic of Lithuania’s Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, according to which maternity (paternity) benefits of different amounts are established on the sole basis that children are born at different times and the right to maternity (paternity) benefits is acquired either until 30 June 2010 or as from 1 July 2010 (i.e. the amount of the maternity (paternity) benefits, awarded as from 1 July 2010 and paid until the child turns one year old, was reduced from 100 down to 90 percent, whereas the said amount, paid until the child turns 2 years old, was reduced from 85 down to 75 percent of the allowance beneficiary’s reimbursed earnings), is not grounded on any constitutional basis.

The rendering of the support, established by law, to the families that raise and bring up children at home is a constitutional duty of the state, whereas the right to receive such support is a constitutional right. Article 18 of the Constitution provides that human rights and freedoms shall be innate. Human rights may not be reduced, therefore, the payment of the smaller maternity (paternity) benefits as from 1 July 2010, in the absence of any provision for their compensation, is in conflict with the constitutional principle of a state under the rule of law.

Article 2 of the Republic of Lithuania’s Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, that established, as from 1 July 2010, the reduction in the amount of the awarded maternity (paternity) benefits, should be assessed as being in conflict with the principle of legitimate expectations, according to which, the acquired rights must be sustained and implemented in reality. The said article violated the legitimate expectation of the persons, who had not been awarded and/or paid these benefits, but which would be awarded to them as from 1 July 2010, for the receiving of the benefits in the amounts established in the valid legal acts. The term of the beginning of the application of the provisions of the law, established through the impugned provision of the law, when one takes into account the special situation, exceptional needs and social vulnerability of the parents raising children before they turn 2 years old, is too short, no conditions are created for the persons receiving maternity (paternity) benefits for the adjustment to the changed situation, so that they could take appropriate actions that would allow them to soften the impact, brought about by the reduction in the benefits, on the financial situation of families, therefore, the legal regulation established in the said article is in conflict with the principle of the equality of rights.

1.3. The Republic of Lithuania’s Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance, which was adopted on 22 July 2009, upon the prior adjustment with the provisions of the Law on State Social Insurance, established the basis for compulsory health insurance contributions for owners of individual enterprises and actual members of general partnerships, persons who engage in an individual activity, and persons receiving income under authors’ agreements, or income from sports activities, or income from performing activities, which is identical to the basis for state social insurance contributions. The impugned provisions of the Law on Health Insurance consolidated through this law, due to the same reasons as the impugned provisions of the Law on State Social Insurance, are in conflict with Articles 23 and 29 of the Constitution and the constitutional principle of a state under the rule of law.

  1. Petition No. 1B-143/2010 of a group of Members of the Seimas, a petitioner, is substantiated by the following arguments.

2.1. In view of the provisions of the official constitutional doctrine formulated in the Constitutional Court’s rulings of 14 March 2002, 26 January 2004, and 3 November 2005, a duty arises for the legislator to concretise the provision, entrenched in Paragraph 1 of Article 53 of the Constitution, that the procedure for providing medical aid to citizens free of charge at state medical establishments shall be established by law so that this provisions would be applied in reality, however, the legislator may neither limit nor deny the contents of this norm.

2.2. Prior to the entry into force of the impugned legal regulation established in Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance, both the persons who participated in the system of compulsory health insurance and those who did not participate in it used to have the right to emergency medical treatment services free of charge. However, through the impugned legal regulation, the legislator, having created a duty for the persons who do not take part in the labour market and who do not receive any insured income to participate in the system of compulsory health insurance—to pay compulsory health insurance contributions—negated the constitutional right of those persons, who previously used not participate in the system of compulsory health insurance, to medical aid free of charge at state medical establishments and violated Paragraph 1 of Article 53 of the Constitution and the constitutional principle of a state under the rule of law.

II

  1. In the course of the preparation of the part of the case, subsequent to the petitioner’s petition No. 1B-59/2009, for the Constitutional Court’s hearing, written explanations were received from the representative of the Seimas, the party concerned, who was Vincė Vaidevutė Margevičienė, a Member of the Seimas, wherein it is maintained that the impugned legal regulation consolidated in Paragraph 4 (wording of 22 July 2009) of Article 2, Paragraphs 3, 5, and 9 (wording of 22 July 2009) of Article 4, Paragraphs 2, 3, and 4 (wording of 22 July 2009) of Article 7 of the Law on State Social Insurance, Item 1 (wording of 22 July 2009) of Paragraph 3 of Article 6, Paragraphs 2, 4 (wording of 22 July 2009) of Article 8, and Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 of the Law on Health Insurance, Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, is not in conflict with the Constitution. The position of the representative of the Seimas is substantiated by the following arguments.

1.1. The duty of the state, consolidated in Article 52 of Constitution, to guarantee the right of citizens to receive old age and disability pensions, as well as social assistance in the event of unemployment, sickness, widowhood, loss of the breadwinner, and in other cases provided for by laws, also encompasses a duty to establish the groups of persons covered by state social insurance on a compulsory basis, the risks covered by social insurance, ant to establish other rules of social insurance—the social insurance period, the income on which the social insurance contributions are calculated, the amount of social insurance contributions, etc.

The impugned legal regulation, as consolidated in the Law on Social Insurance, according to which, self-employed persons, as well as the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, have been included into the circle of the persons covered by state social insurance on a compulsory basis, was established in order to implement the legislator’s duty, which arises from Article 52 of the Constitution and from the constitutional principle of social solidarity, to establish old age and disability pensions, as well as social assistance in the event of unemployment, sickness, widowhood, loss of the breadwinner, and in other cases provided for by laws, regardless of the character of the activity of the persons or the source of the income received by them, in order to help the persons to protect themselves from possible social risks and, at the same time, to create preconditions for every member of society enabling him to take care of his well-being on his own behalf (and not only to trust in the state social security), in order to seek for a balance between the duty of the state to provide social guarantees for those persons and the personal responsibility of the said persons for their own social well-being, to seek an effective overall functioning of the social security system, also to reduce the abuse in the situations where authors’ agreements, but not labour contracts, are concluded.

1.2. The character of the economic activity of the so-called free professions is an important and essential feature determining the covering of these persons by state social insurance and by compulsory health insurance. The income received from such activity is not regular, periodical, or of permanent character, therefore, those persons are most socially vulnerable.

1.3. It is doubtful whether the right of a person to receive a social insurance payment could be regarded as an innate one. The arguments submitted in the petitioner’s petition allow one to assume that it doubts as for the compliance of Paragraph 1 (22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with not Article 18 of the Constitution, but rather with the constitutional principle of a state under the rule of law.

The legal regulation consolidated in Paragraph 1 (22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance which, while heeding the constitutional principles of the protection of legitimate expectations, legal certainty, and legal security, reduced the amounts of maternity (paternity) benefits, was prospective, as it, upon the creating of the preconditions for the protection of legitimate expectations, established that it would be applicable only as from 1 July 2010 and only to newly awarded benefits.

  1. In the course of the preparation of the case, subsequent to the petitioner’s petition No. 1B-143/2010, for the Constitutional Court’s hearing, written explanations were received from Antanas Matulas and Algis Čaplikas, Members of the Seimas, wherein it is maintained that Paragraph 9 (wording of 19 February 2009) of Article 17 of Law on Health Insurance is not in conflict with Paragraph 1 of Article 53 of the Constitution. The position of the representatives of the party concerned is substantiated by the following arguments.

2.1. Under Paragraph 1 of Article 53 of the Constitution, the state has a duty to guarantee the accessibility of the services of the healthcare system to all persons and to remove the social, financial and cultural obstacles limiting the opportunities of groups of some persons of using the services of the healthcare system. Health insurance is a socially secure and rational way of guaranteeing healthcare services.

2.2. The health insurance model consolidated in the Law on Health Insurance and other legal acts is founded on the principles of generality (compulsoriness, universality) and solidarity and is based on the compulsory contributions paid from the state budget (with state funds for the insured persons), as well as on the compulsory contributions paid by the insured persons (all persons not covered by the insurance paid for with state funds) or paid by their employers. The healthcare system and the accessibility to its main services to all insured persons is not related to the amount of the contributions paid by a concrete person and is based on the general responsibility of the state and all members of society, on the duty of all persons permanently residing in Lithuania to participate in the system of compulsory health insurance and to pay the compulsory health insurance contributions. The amount of the compulsory health insurance contribution is proportionate to the character of activity and the income of the persons that pay them, however, in an insured event all insured persons have the equal right to receive all necessary medical aid (thus, the minimum financial contribution paid by the most sensitive, from the economic point of view, groups of the population protects them from the big financial hardships and from the social gulf). Only in certain cases, for example, in the case of the choice, made on one’s own initiative, of more expensive or additional medical services etc., the persons covered by compulsory health insurance are required must pay for (a part of) them.

The health insurance model based on these principles is consolidated in most Member States of the European Union, which, as well as Lithuania, have obligated to respect the common values of healthcare systems—the universality, a possibility of receiving the care of high quality, fairness, and solidarity.

2.3. A minimum amount of the compulsory health insurance was established with regard to the persons who are not engaged in any economic activity, who do not work anywhere, and are not covered by insurance paid for with state funds, i.e. who do not apply to the labour exchange, do not receive pensions or social and relief compensations, etc. The contribution of compulsory health insurance paid by a person himself is not something new. As from 1 January 2009, only the circle of persons who must pay the compulsory health insurance contributions themselves, as well as the amount and the base of such contributions, was changed.

2.4. The impugned provision of Paragraph 9 of Article 17 of the Law on Health Insurance cannot be treated as the one establishing the contribution for the emergency medical services, which, in Lithuania, under the Constitution, the Law on the Health System, and the Law on Health Insurance, were and are provided (to a significantly larger extent than in other states) free of charge to all persons regardless of whether they are the insured persons.

III

In the course of the preparation of the case for the Constitutional Court hearing, written explanations were received from Algis Sasnauskas, Director of the State Patients’ Fund under the Ministry of Health of the Republic of Lithuania, Prof. Dr. Danguolė Jankauskienė, the Vice-dean of the Faculty of Politics and Management of Mykolas Romeris University, Liutauras Labanauskas, President of the Lithuanian Union of Physicians, Laimutis Paškevičius, President of the Lithuanian Association of Private Healthcare Establishments, and Vida Augustinienė, the Chair of the Lithuanian Council of the Representatives of Patients’ Organisations.

IV

  1. At the Constitutional Court’s hearing, the representatives of the groups of Members of the Seimas, the petitioners, who were V. P. Andriukaitis and A. Sysas, virtually reiterated the arguments set forth in the petitioners’ petitions and answered the submitted questions.
  2. The representative of the Seimas of the Republic of Lithuania, the party concerned, in the part of the case subsequent to petition No. 1B-143/2010, who was A. Matulas, a Member of the Seimas, virtually reiterated the arguments set forth in his written explanations and answered the submitted questions.
  3. At the Constitutional Court’s hearing, the specialist—Vitalija Griškova, Head of the Legal Department of the State Patients’ Fund under the Ministry of Health—answered the questions given by the justices.

The Constitutional Court

holds that:

I

  1. In its petition No. 1B-59/2009, the petitioner requests an investigation into the compliance of Paragraph 4 (wording of 22 July 2009) of Article 2 of the Law on State Social Insurance, Paragraph 3 (wording of 22 July 2009) of Article 4 of the same law, insofar as, according to the petitioner, it provides that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments; Paragraphs 5 and 9 (wording of 22 July 2009) of Article 4 of the same law, insofar as, according to the petitioner, they provide that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by insurance on a compulsory basis, also that the persons linked with the insurance payer by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax, who, at the same time, receive income from sports activities or from performing activities from the same insurance payer, shall be covered, on a compulsory basis, by the types of social insurance established in Article 3 of the Republic of Lithuania’s Law on State Social Insurance; and Paragraphs 2, 3, and 4 (wording of 22 July 2009) of Article 7 of the same law, insofar as, according to the petitioner, they provide that the persons who receive income from sports activities and/or from performing activities shall be covered by insurance on a compulsory basis, with Articles 23 and 29 of the Constitution and the constitutional principle of a state under the rule of law.

1.1. It should be noted that in this petition the petitioner has not presented any concrete arguments substantiating its doubts whether the following is/was in conflict with the Constitution:

– Paragraph 4 (wording of 22 July 2009) of Article 2 of the Law on State Social Insurance, in which the notion of insured income is entrenched;

– Paragraph 9 (wording of 22 July 2009 ) of Article 4 of the Law on State Social Insurance, according to which certain persons are covered by health insurance on a compulsory basis (in addition, this paragraph was recognised as no longer valid through Paragraph 3 of Article 3 of the Republic of Lithuania’s Law Amending and Supplementing Articles 2, 3, 4, 5, 16, 17, 21, 22, 25, 26, 27, 29, 31, and 36 of the Law on State Social Insurance that was adopted on 17 October 2012 and came into force on 1 January 2013);

– Paragraphs 2, 3, and 4 (wording of 22 July 2009) of Article 7 of the Law on State Social Insurance, which consolidated the base of social insurance contributions—the income on which they are calculated.

It also needs to be noted that through those provisions of the Law on State Social Insurance the state social insurance relations, insofar as specified by the petitioner, are not regulated, i.e. the said provisions do not provide for the covering of the persons receiving income under authors’ agreements, from sports activities, or from performing activities, by state social insurance on a compulsory basis.

1.2. It should also be noted that in this petition the petitioner has not submitted any concrete arguments substantiating its doubts as to the conflict of Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, as well as Paragraph 5 (wording of 22 July 2009) of the same article, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, with Article 29 of the Constitution.

1.3. When one takes into consideration the arguments set forth in the petitioner’s petition No. 1B-59/2009, the petition requesting investigation into the compliance of Paragraph 4 (wording of 22 July 2009) of Article 2, Paragraphs 3, 5, and 9 (wording of 22 July 2009) of Article 4, and Paragraphs 2, 3, and 4 (wording of 22 July 2009) of Article 7 of the Law on State Social Insurance, to the extent specified by the petitioner, with Articles 23 and 29 of the Constitution and the constitutional principle of a state under the rule of law should be treated as a petition requesting investigation into the compliance of Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, as well as that of Paragraph 5 (wording of 22 July 2009) of the same article, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, with Article 29 of the Constitution and the constitutional principle of a state under the rule of law.

  1. It has been mentioned that in its petition No. 1B-59/2009 the petitioner requests an investigation into inter alia the compliance of Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with Articles 18 and 29 of the Constitution and the constitutional principle of a state under the rule of law.

The doubts of the petitioner as regards the compliance of this legal regulation with inter alia Article 18 of the Constitution are based on the fact that, in its opinion, human rights are innate, they may not be reduced, therefore, the payment of the smaller maternity (paternity) benefits as from 1 July 2010, in the absence of any provision for their compensation, is in conflict with the constitutional principle of a state under the rule of law. Therefore, the petition of the petitioner requesting investigation into the compliance of this legal regulation with Article 18 of the Constitution should be treated as a petition requesting investigation into its compliance with the constitutional principle of a state under the rule of law.

Thus, the petition requesting investigation into the compliance of Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with the Constitution should be treated as a petition requesting investigation into the compliance of this legal regulation with Article 29 of the Constitution and the constitutional principle of a state under the rule of law.

  1. It has been mentioned that in its petition No. 1B-59/2009 the petitioner requests an investigation into the compliance of inter alia Item 1 (wording of 22 July 2009) of Paragraph 3 of Article 6, Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8, and Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 of the Law on Health Insurance, insofar as, according to the petitioner, they provide that persons who receive income under authors’ agreements, or from sports activities, or from preforming activities are covered by the insurance on a compulsory basis, as well as the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 of the same law, with Articles 23 and 29 of the Constitution and the constitutional principle of a state under the rule of law.

3.1. It should be noted that in this petition the petitioner has not presented any concrete arguments substantiating its doubts whether the following is in conflict with the Constitution:

– Item 1 (wording of 22 July 2009) of Paragraph 3 of Article 6 of the Law on Health Insurance, according to which the persons on behalf of whom compulsory health insurance contributions are paid under procedure established by this law, and the persons who, under procedure established in this law, pay compulsory health insurance contributions, are regarded as persons covered by the compulsory health insurance;

– Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 of the Law on Health Insurance that establish the liability for failure to pay compulsory health insurance contributions (i.e. in the event of violation of the procedure for calculating and paying them, penalty charges are imposed and late payment interest is calculated).

3.2. It should also be noted that, although the petitioner requests an investigation into the compliance of Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, insofar as, according to the petitioner, they provide that persons who receive income under authors’ agreements, or from sports activities, or from preforming activities, are covered by the insurance on a compulsory basis, as well as the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 of the same law, with inter alia Article 29 of the Constitution, it has not submitted any concrete arguments substantiating its doubts as regards the conflict of this legal regulation with the said article of the Constitution.

3.3. When one takes into consideration the arguments set forth in the petitioner’s petition No. 1B-59/2009, the petition requesting investigation into the compliance of Item 1 (wording of 22 July 2009) of Paragraph 3 of Article 6, Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8, and Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 of the Law on Health Insurance, insofar as, according to the petitioner, they provide that persons who receive income under authors’ agreements, or from sports activities, or from preforming activities, are covered by the insurance on a compulsory basis, as well as the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 of the same law, with Articles 23 and 29 of the Constitution and the constitutional principle of a state under the rule of law, should be treated as a petition requesting investigation into the compliance of Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 and Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

  1. Thus, in the constitutional justice case at issue the Constitutional Court will investigate:

– the compliance of Paragraph 3 (wording of 22 December 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, with Article 23 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 5 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, with Article 23 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with Article 29 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, with the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance with Paragraph 1 of Article 53 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law;

– the compliance of Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

II

On the compliance of Paragraphs 3 and 5 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

  1. In the constitutional justice case at issue one is inter alia investigating the compliance of Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, as well as Paragraph 5 (wording of 22 July 2009) of the same article, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.
  2. In the context of the constitutional justice case at issue it should be noted that Paragraph 3 (wording of 19 December 2008) of Article 4 “Persons Covered by Social Insurance According to the Types of Social Insurance” of the Law on State Social Insurance prescribed: “Self-employed persons, with the exception of the persons engaged in individual activities under business certificates, advocates, advocates’ assistants, notaries, and bailiffs shall be covered on a compulsory basis by social insurance for a pension to receive the main and supplementary parts of the pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments (Item 2 of Article 3 of this Law). Advocates, advocates’ assistants, notaries, and bailiffs shall be covered on a compulsory basis only by social insurance for a pension to receive the main and supplementary parts of the pension (Item 1 of Article 3 of this Law).” Paragraph 5 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance prescribed: “Permanent residents of the Republic of Lithuania, who receive income under authors’ agreements from the insurance payer with which they are not linked by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax shall be covered on a compulsory basis by social insurance for a pension to receive the main and supplementary parts of the pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance (Item 2 of Article 3 of this Law) and by health insurance (Item 5 of Article 3 of this Law). Permanent residents of the Republic of Lithuania who receive income from sports activities or from performing activities, as these notions are defined in the Law on Personal Income Tax, from the insurance payer with which they are not linked by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax shall be covered on a compulsory basis by social insurance for a pension to receive the main and supplementary parts of the pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments (Item 2 of Article 3 of this Law) and by health insurance (Item 5 of Article 3 of this Law).”

Thus, according to Paragraph 3 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance, some self-employed persons began to be covered on a compulsory basis inter alia by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments, and a duty was established for them to pay the corresponding state social insurance contributions, meanwhile, according to Paragraph 5 (wording of 19 December 2008) of the same article, the persons who were not linked with the insurance payer by employment relations and who received income under authors’ agreements, or from sports activities, or from performing activities, began to be covered on a compulsory basis, inter alia, by social insurance for a pension to receive the main and supplementary parts of the pension, as well as by sickness and maternity social insurance (those who received income under authors’ agreements), or by insurance of the same type, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments (those who received income from sports activities, or from performing activities).

  1. On 22 July 2009, the Seimas adopted the Law Amending and Supplementing Articles 2, 4, 7, 8, and 9 of the Law on State Social Insurance, through Article 2 whereof (this article, according to Paragraph 1 of Article 6 of the same law, came into force on 1 January 2010 and is applied in the calculating and paying of state social insurance contributions for 2010 and subsequent years) inter alia Paragraphs 3 and 5 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance were amended.

3.1. The impugned Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance prescribed: “Self-employed persons, with the exception of the persons engaged in individual activities under business certificates, shall be covered on a compulsory basis by social insurance for a pension to receive the main and supplementary parts of the pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments (Item 2 of Article 3 of this Law), and by health insurance (Item 5 of Article 3 of this Law).”

The impugned Paragraph 5 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance prescribed: “The permanent residents of Lithuania, as they are defined in the Law on Personal Income Tax (hereinafter referred to in this Paragraph as “permanent residents of Lithuania”), who receive income under authors’ agreements from the insurance payer which is a Lithuanian entity, as this notion is defined in the Law on Personal Income Tax (hereinafter referred to in this Paragraph as the ‘Lithuanian entity’), with which they are not linked by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax, shall be covered, on a compulsory basis, by social pension insurance for the main and supplementary parts of a pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance (Item 2 of Article 3 of this Law) and by health insurance (Item 5 of Article 3 of this Law), with the exception of the cases when such income is earned in pursuit of individual activities. The permanent residents of Lithuania who receive income from sports activities or from performing activities as these notions are defined in the Law on Personal Income Tax from the insurance payer which is a Lithuanian entity and with which they are not linked by employment relations or by the relations in their essence corresponding to employment relations in the same manner as these relations are defined in the Law on Personal Income Tax shall be covered, on a compulsory basis, by social pension insurance for the main and supplementary parts of a pension (Item 1 of Article 3 of this Law), by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) benefits (Item 2 of Article 3 of this Law) and by health insurance (Item 5 of Article 3 of this Law), with the exception of the cases when such income is earned in pursuit of individual activities. The permanent residents of Lithuania pursuing appropriate (creative, performing or sports) individual activities shall be subject to the provisions of Paragraph 3 of this Article.”

3.2. Thus, the impugned Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance established that self-employed persons, with the exception of the persons engaged in individual activities under business certificates, shall be covered on a compulsory basis inter alia by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments, whilst the impugned Paragraph 5 (wording of 22 July 2009) of the same article established that the persons who receive income under authors’ agreements from the insurance payer with which they are not linked by employment relations are covered on a compulsory basis by state social insurance of certain types, with the exception of the cases when such income is earned in pursuit of individual activities and when the provisions of Paragraph 3 of this article are applicable.

Consequently, the legal regulation consolidated from the impugned aspect in Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, i.e. insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, also, from the impugned aspect, the legal regulation consolidated in Paragraph 5 (wording of 22 July 2009) of the same article, i.e. insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, was substantially analogous to the one established in Paragraphs 3 and 5 (wording of 19 December 2008) of Article 4 of this law respectively.

3.3. It should be noted that Paragraphs 3 and 5 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance have been amended, however, the legal regulation consolidated therein has not changed from the impugned aspect.

  1. While deciding whether Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, to the extent that it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, as well as Paragraph 5 (wording of 22 July 2009) of the same article, to the extent that it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, were not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law, one should note that the legislator, when it heeds the Constitution, enjoys broad discretion in the regulation of the relations of social security and social assistance (inter alia the Constitutional Court’s ruling of 26 September 2007, the decision of 20 April 2010, the rulings of 29 June 2012 and 15 February 2013).

It has been mentioned that the doubts of the petitioner regarding the compliance of this legal regulation with the Constitution are grounded on the fact that, according to the petitioner, the representatives of the so-called free professions, in view of and with respect to their own choice, should not be covered by social insurance on a compulsory basis.

4.1. As it has been held by the Constitutional Court on more than one occasion, the constitutional principle of a state under the rule of law, which is entrenched in the Constitution, in addition to other requirements, also implies that human rights and freedoms must be ensured (inter alia Constitutional Court rulings of 12 July 2001, 13 December 2004, 29 December 2004, 16 January 2006, and 7 July 2011).

The Constitutional Court has held on more than one occasion that one of the elements of the constitutional principle of a state under the rule of law is the constitutional principle of proportionality, which means that the measures provided for in a law must be in line with the legitimate objectives that are important to society, that these measures must be necessary in order to reach the said objectives, and that these measures must not restrain the rights and freedoms of the person clearly more than necessary in order to reach the said objectives (inter alia the Constitutional Court’s rulings of 17 September 2008, 31 January 2011, 29 June 2012, and 15 February 2013).

It needs to be noted that the provisions of Article 52 of the Constitution acknowledged the social maintenance as having the status of a constitutional value; every citizen has the right to social security (inter alia the Constitutional Court’s rulings of 19 April 2008, 2 September 2009, 14 December 2010, and 15 February 2013).

The provisions of Article 52 of the Constitution imply the duty of the legislator to establish the legal regulation that would create preconditions for the state for the implementation of its constitutional obligation to guarantee the citizens’ right to social security and would ensure the accumulation of the funds that are necessary for pensions and social assistance, as well as the payment of these pensions and rendering of social assistance (inter alia the Constitutional Court’s rulings of 13 December 2004 and 22 October 2007, the decision of 20 April 2010, and the ruling of 15 February 2013). The said legal regulation must create preconditions for the redistributing of the corresponding burden falling upon the state among members of society, of course, when one takes into account inter alia the constitutional principle of solidarity, the constitutional imperatives of social harmony and justice (the Constitutional Court’s rulings of 26 September 2007, 22 October 2007, and 15 February 2013).

While the legislator establishes the duty for working persons (those who pursue active economic activities) to pay state social insurance contributions, there are possibilities for various conditions that determine the appearance of this duty, as well as there are possibilities for various criteria defining these conditions (the Constitutional Court’s ruling of 15 February 2013).

4.2. As mentioned before, the legal regulation consolidated in Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, also the legal regulation consolidated in Paragraph 5 (wording of 22 July 2009) of the same article insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis was, from the impugned aspect, analogous to the one established in Paragraphs 3 and 5 (wording of 19 December 2008) of Article 4 of this law.

It should be noted that, in its ruling of 15 February 2013, the Constitutional Court inter alia recognised that Paragraph 3 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance to the extent that it provided that certain self-employed persons shall be covered on a compulsory basis inter alia by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, also that Paragraph 5 (wording of 19 December 2008) of the same article that provided that the persons who are not linked by employment relations with the insurance payer and who received income under authors’ agreement, or from sports activities, or from performing activities, shall be covered by state social insurance of certain types on a compulsory basis, were not in conflict with the Constitution.

4.3. In its ruling of 15 February 2013, the Constitutional Court held that, while making use of its discretion to regulate social security relations and assessing all circumstances, inter alia the fact that some self-employed persons, as well as the persons income under authors’ agreement, or from sports activities, or from performing activities, are an economically active part of society and can contribute to the creation of the social security system, and while establishing, in Paragraph 3 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance, a duty of some self-employed persons to obtain state social insurance on a compulsory basis by (inter alia sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments), also, while establishing, in Paragraph 5 (wording of 19 December 2008) of the same article, a duty of persons who receive income under authors’ agreements, or from sports activities, or from performing activities, to obtain, on a compulsory basis, state social insurance of certain types, where those persons are not linked with the insurance payer by employment relations, i.e. while establishing a duty for those persons to pay the corresponding state social insurance contributions, the legislator created preconditions for the accumulation of the funds necessary for the paying of the social payments and secured an objective that was necessary for society and was constitutionally grounded—to guarantee the constitutional right to social security, the right to receive the pensions and other payments of social maintenance (inter alia during maternity and paternity leave) as established in the Constitution, and the rendering of proper social assistance in the situations where those persons are unable to subsist themselves, or, for reasons established by law, they have additional expenses. The legislator, alongside, implemented the imperatives of social solidarity, social harmony and justice, according to which the burden of social security falling upon the state is distributed among all members of society. Thus, such legal regulation did not violate Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

4.4. In view of the fact that, in its ruling of 15 February 2013, the Constitutional Court acknowledged that Paragraph 3 (wording of 19 December 2008) of Article 4 of the Law on State Social Insurance, insofar as it established that some self-employed persons, including farmers and their partners, shall be covered on a compulsory basis by social insurance for a pension to receive the main and supplementary parts of a pension, by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity and maternity (paternity) payments, also Paragraph 5 (wording of 19 December 2008) of the same article that provided that the persons who are not linked by employment relations with the insurance payer and who received income under authors’ agreement, or from sports activities, or from performing activities, shall be covered, on a compulsory basis, by social insurance for a pension to receive the main and supplementary parts of a pension, by health insurance, as well as by sickness and maternity social insurance (those who receive income under authors’ agreements), or by insurance of this type where a person is insured to receive only the maternity, paternity and maternity (paternity) payments (those who receive income from sports activities, or from performing activities), were not in conflict with the Constitution, therefore, on the grounds of the analogous arguments, it needs to be held that Paragraph 3 (wording of 22 July 2009) of Article 4 of the Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, as well as Paragraph 5 (wording of 22 July 2009) of the same article, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, were not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

III

On the compliance of Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with Article 29 of the Constitution and the constitutional principle of a state under the rule of law, as well as on the compliance of Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, with the constitutional principle of a state under the rule of law.

  1. In the constitutional justice case at issue one investigates inter alia into the compliance of Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance with Article 29 of the Constitution and the constitutional principle of a state under the rule of law, as well as into the compliance of Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, with the constitutional principle of a state under the rule of law.
  2. On 21 December 2000, the Seimas adopted the Law on Sickness and Maternity Social Insurance that came into force on 1 January 2001. This law, inter alia Article 21 thereof, has been amended and/or supplemented on more than one occasion, inter alia through the Republic of Lithuania Law Amending and Supplementing Articles 3, 5, 6, 8, 10, 15, 16, 17, 18, 181, 183, 19, 20, 21 of the Law on Sickness and Maternity Social Insurance that was adopted by the Seimas on 4 December 2007 and came into force on 1 January 2008.

Article 21 (wording of 4 December 2007) titled “The Amount of Maternity (Paternity) Benefit” of the Law on Sickness and Maternity Social Insurance prescribed the following: “The amount of the maternity (paternity) benefit as from the end of the pregnancy and childbirth leave until the child reaches the age of one year shall make 100 percent of the benefit recipient’s compensatory salary, whereas until the child reaches the age of two years old—85 percent thereof.”

Thus, Article 21 (wording of 4 December 2007) of the Law on Sickness and Maternity Social Insurance established the amounts of maternity (paternity) benefits: 100 percent of the benefit recipient’s compensatory salary until the child reaches the age of one year and 85 percent thereof until the child reaches the age of two years.

  1. On 22 September 2009, the Seimas adopted the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance Article 1 whereof amended Paragraph 1 of Article 21 of the Law on Sickness and Maternity Social Insurance.

3.1. The impugned Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance prescribed: “The amount of the maternity (paternity) benefit as from the end of the pregnancy and childbirth leave until the child reaches the age of one year shall make 90 percent of the benefit recipient’s compensatory salary, whereas until the child reaches the age of two years old—75 percent thereof.”

If the legal regulation established in the impugned Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance is compared with the one established in Paragraph 1 (wording of 4 December 2007) of Article 21 of the same law, it becomes clear that the impugned legal regulation established smaller amounts of maternity (paternity) benefits: 90 percent (instead of 100 percent) of the benefit recipient’s compensatory salary until the child reaches the age of one year and 75 percent (instead of 85 percent) thereof until the child reaches the age of two years. Consequently, the legal regulation established in Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance reduced the amounts of maternity (paternity) benefits by 10 percent of the benefit recipient’s compensatory salary.

3.2. It needs to be noted that the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, was officially published in the official gazette “Valstybės žinios” and came into force on 1 October 2009, however, Article 2 of the said law, which is also impugned in the constitutional justice case at issue, provides that the provisions of this law are applicable as from 1 July 2010 with respect to newly awarded maternity (paternity) benefits.

Thus, the date of the beginning of the application of Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance—as from 1 July 2010—that was established in Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, is later in time than the official publishing (entry into force) of this legal regulation; the same article also established that the said legal regulation is applied only to the maternity (paternity) benefits newly awarded as from that date.

3.3. While summarising the impugned legal regulation established in Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, one should note that this legal regulation consolidated smaller amounts of newly awarded maternity (paternity) benefits (90 percent of the benefit recipient’s compensatory salary until the child reaches the age of one year and 75 percent of the benefit recipient’s compensatory salary until the child reaches the age of two years), having established that the application of this (amended) legal regulation would start as from 1 July 2010, i.e. after nine months from its official publishing (entry into force).

  1. While deciding whether Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, was/is not in conflict with the constitutional principle of a state under the rule of law, one should note that when the relations of the support for families raising and bringing up children at home are regulated by law, the resources of society and the state must be taken into consideration; the legislator has broad discretion in this sphere (inter alia the Constitutional Court’s rulings of 5 March 2004 and 27 February 2012).

It has been mentioned that the petitioner’s doubts about the compliance of the impugned legal regulation with the Constitution are grounded inter alia upon the fact that, after the said legal regulation had reduced the amounts of the maternity (paternity) benefits to be awarded as from 1 July 2010, the legitimate expectation of the persons to whom those benefits had not been awarded and/or paid, however, they would have been awarded as from 1 July 2010, to receive the benefits in the amounts established in the valid legal acts, was violated; the established term of the beginning of the application of the provisions of the law was too short and no conditions were created for the recipients of the maternity (paternity) benefits so that they could adapt to the changed situation.

4.1. In acts of the Constitutional Court it has been held on more than one occasion that inseparable elements of the constitutional principle of a state under the rule of law are the protection of legitimate expectations, legal certainty and legal security; these constitutional principles imply the obligation of the state to secure the certainty and stability of the legal regulation, to protect the rights of persons, to respect the legitimate interests and legitimate expectations, to fulfil undertaken obligations for a person; the persons have the right to reasonably expect that their rights acquired under the valid laws or other legal acts that are not in conflict with the Constitution will be retained for the established period of time and could be implemented in reality; the legal regulation may be changed only by following the procedure established in advance; no changes in the legal regulation are allowed to deny the legitimate interests and legitimate expectations of a person; if the protection of legitimate expectations of persons, legal certainty and legal security is not ensured, the trust of the person in the state and law is not secured.

In the Constitutional Court’s ruling of 15 February 2013 it was noted that, while one takes account of the aforementioned, the changes in the legal regulation must be made in a manner so that the persons whose legal status is affected by those changes would have a real opportunity to adapt to a new legal situation. Therefore, in order to create conditions for persons not only to familiarise with new legal regulation prior to the beginning of its validity, but also to adequately prepare for the expected changes, it might be necessary to establish a later date of the entry into force of the law (the beginning of the application thereof). While construing Paragraph 1 of Article 70 of the Constitution in the context of the constitutional principle of a state under the rule of law, in the same ruling the Constitutional Court also held that, in some situations, the legislator must provide for a sufficient vacatio legis, i.e. a time period from the official publishing of the law until its entry into force (the beginning of its application), within which the interested persons might be able to prepare themselves to implement the requirements arising from that law; the jurisprudence of the Constitutional Court has pointed out this duty of the legislator on more than one occasion, while relating this duty to the adoption of laws restructuring the system of social guarantees or individual social guarantees; the time-period that one should establish for each concrete situation must be assessed in view of a number of circumstances: the purpose of the law in the legal system and the character of the social relations regulated by that law, the circle of subjects to whom it is applied and their possibilities to prepare for the entry into force of the new legal regulation, as well as other important circumstances, inter alia those due to which the law must come into force as soon as possible.

4.2. In the context of the constitutional justice case at issue it should be noted that the financial support rendered during leave granted for raising and bringing up children at home is one of the forms, chosen by the legislator, of the care and support guaranteed by the state, under Paragraph 1 of Article 39 of the Constitution, for families raising and bringing up children at home.

It has been mentioned that the capabilities of society and the state must be taken into account when the relations of assistance given to the families that raise and bring up children at home are regulated by law. The Constitution does not establish any grounds, conditions, and length of leave for raising and bringing up children at home, nor any amounts of the financial support to be rendered during such leave—this must be established by the legislator, by paying heed to the norms and principles of the Constitution (inter alia the constitutional imperatives of a state under the rule of law, justice, reasonableness, proportionality, the protection of acquired rights, and legitimate expectations, the equality of rights, a balance among constitutional values, and social harmony) (the Constitutional Court’s rulings of 27 February 2012, 14 December 2012, and 5 March 2013).

In the context of the constitutional justice case at issue it should be noted that the legislator, while taking account of various factors, inter alia of the capabilities of society and the state, can amend the legal regulation of the relations of the financial support rendered during the leave granted for raising and bringing up children at home, inter alia can change the amount of this support. While doing so, the legislator must heed the Constitution, inter alia the constitutional principles of a state under the rule of law, legal certainty, legal security, and the protection of legitimate expectations, as well as the constitutional requirement of the providing for a sufficient vacatio legis.

4.3. It should be noted that, in the Constitutional Court’s ruling of 5 March 2013, the legal regulation established in Article 10 of the of the Republic of Lithuania’s Provisional Law on the Recalculation and Payment of Social Payments, through which the preconditions were created for inter alia the reduction, as from 1 July 2010, of the awarded maternity (paternity) benefits, which were subject to recalculation, until the child reaches the age of one year and during the period when the child is from one to two years of age, respectively, from 100 to 90 percent and from 85 to 75 percent, of the compensatory salary on the basis of which the said benefits were calculated, was assessed as being in compliance with the Constitution.

4.4. It has been mentioned that the impugned legal regulation established in Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance consolidated the amounts of the newly awarded maternity (paternity) benefits, where those amounts were analogous to the reduced amounts of the already awarded social insurance maternity (paternity) benefits (90 percent of the benefit recipient’s compensatory salary until the child reaches the age of one year and 75 percent of the benefit recipient’s compensatory salary until the child reaches the age of two years), established in Article 10 of the of the Provisional Law on the Recalculation and Payment of Social Payments, which were subject to recalculation as from 1 July 2010, thus, they were reduced by 10 percent of the benefit recipient’s compensatory salary. In addition, it was established that the application of this (amended) legal regulation would start as from 1 July 2010, i.e. after nine months from its official publishing (entry into force).

It needs to be held that, when one takes into account the character of the regulated relations, as well as a small scale of the reduction of maternity (paternity) benefits, such a vacatio legis should be assessed as a sufficient one, since it created preconditions for the persons for an appropriate preparation for the planned changes.

Consequently, the legislator, while enjoying the discretion to amend the legal regulation governing the financial support rendered during the leave granted for raising and bringing up children at home, inter alia to change the amount of this support, having established, through the impugned legal regulation consolidated in Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, the smaller amount of the newly awarded maternity (paternity) benefits, and, alongside, while establishing a sufficient term of the entry into force of the law until its application, did not deviate from the constitutional requirement for the providing for a proper vacatio legis, and did not create any preconditions for the negating of the legitimate expectations of persons.

4.5. Thus, it needs to be held that the legal regulation established in Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, did not violate the requirements stemming from the constitutional principle of a state under the rule of law, inter alia the principles of legal certainty, legal security, and the protection of legitimate expectations, as well as the constitutional requirement for the providing for a sufficient vacatio legis.

While taking account of the arguments set forth, one should draw a conclusion that Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance and Article 2 of the Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance, which was adopted on 22 September 2009, was/is not in conflict with the constitutional principle of a state under the rule of law.

  1. While deciding whether Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance was not in conflict with Article 29 of the Constitution, one should note that, as mentioned before, the said paragraph established smaller amounts of maternity (paternity) benefits: 90 percent (instead of 100 percent) of the benefit recipient’s compensatory salary until the child reaches the age of one year and 75 percent (instead of 85 percent) thereof until the child reaches the age of two years.

It has been mentioned that the doubts of the petitioner are substantiated by the fact that, according to the petitioner, the different amounts of maternity (paternity) benefits were established solely on the ground that the right to those benefits was acquired either before 30 June 2010 or as from 1 July 2010.

5.1. The Constitutional Court, while construing the provisions of Article 29 of the Constitution, has held on more than one occasion that the constitutional principle of the equality of all persons before the law requires that in law the main rights and duties be established equally to all; this principle means the innate right of a human being to be treated equally with others, it obliges one to legally assess homogenous facts in the same manner and prohibits from the arbitrary assessment of the facts that are the same in essence in a different manner, but it does not deny a different legal regulation, established by law, with respect to certain categories of persons who are in different situations. The constitutional principle of the equality of persons before the law would be violated if certain persons or groups of such persons were treated in a different manner even though there are not any differences of such a character and to such an extent between the said groups of persons so that their uneven treatment could be objectively justified (inter alia the Constitutional Court’s rulings of 29 July 2012, 14 December 2012, and 15 February 2013).

5.2. It should be noted that the persons who have acquired the right, by law, to a maternity (paternity) benefit in the amount as established in the said law, and the persons who will acquire by law the right to a maternity (paternity) benefit in the amount as established in the said law in the future, are in different situations.

Thus, there are not any legal arguments for the asserting that Paragraph 1 (wording of 22 July 2009) of Article 21 of the Law on Sickness and Maternity Social Insurance, through which the smaller amounts of maternity (paternity) benefits—90 percent (instead of 100 percent) of the benefit recipient’s compensatory salary until the child reaches the age of one year and 75 percent (instead of 85 percent) of the benefit recipient’s compensatory salary until the child reaches the age of two years—had been established, created preconditions for a violation of the constitutional principle of the equality of rights of all persons, which is consolidated in Article 29 of the Constitution.

5.3. While taking account of the arguments set forth, one is to draw a conclusion that Paragraph 1 (wording of 22 September 2009) of Article 21 of the Law on Sickness and Maternity Social was not in conflict with Article 29 of the Constitution.

IV

On the compliance of Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance with Paragraph 1 of Article 53 of the Constitution and the constitutional principle of a state under the rule of law, as well as on the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 and Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 of the same law with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

  1. In the constitutional justice case at issue one is inter alia investigating into the compliance of some provisions of the Law on Health Insurance with Paragraph 1 of Article 53 and Article 23 of the Constitution as well as with the constitutional principle of a state under the rule of law.

1.1. The constitutional grounds of health protection are consolidated in Paragraph 1 of Article 53 of the Constitution that prescribes: “The State shall take care of people’s health and shall guarantee medical aid and services for the human being in the event of sickness. The procedure for providing medical aid to citizens free of charge at State medical establishments shall be established by law.”

The health of a human being and of society is one of the most important values of society (inter alia the Constitutional Court’s rulings of 11 July 2002, 29 September 2005, and 21 June 2011). While construing the constitutional provision that the state takes care of people’s health, the Constitutional Court has held on more than one occasion that the protection of people’s health is a constitutionally important objective, a public interest, whereas looking after people’s health is a state function (inter alia the Constitutional Court’s rulings of 26 January 2004, 29 September 2005, and 21 June 2011).

The provision of Paragraph 1 of Article 53 of the Constitution that the state takes care of people’s health expresses the constitutional principle that is reflected in various aspects also in the other provisions of the Constitution (first of all, in those of the same paragraph, but also in those beyond that paragraph). Upon this principle the entire state activity related to people’s health must be grounded.

1.2. The constitutional obligation of the state to take care of people’s health, inter alia including a state duty to ensure medical aid and services in the event of sickness, is determined by the innate human right to the best possible health, which is inseparable from human dignity and the right to life, and by the social right to healthcare.

Human life and dignity are special values expressing the integrity and the singular essence of a human being (the Constitutional Court’s ruling of 9 December 1998). The state is under a constitutional obligation to protect and defend those values. The Constitutional Court has held that innate human rights are an individual’s innate opportunities that ensure his human dignity in the spheres of social life; the fact that the legislator, while regulating relations linked with the implementation of human rights and freedoms, must guarantee their proper protection constitutes one of the conditions for the ensuring of human dignity as a constitutional value (the Constitutional Court’s rulings of 29 December 2004 and 2 September 2009, as well as the decision of 20 April 2010). It is clear that human dignity, the right to life, and the right to the best possible health are so tightly interrelated that, on the one hand, in case proper health protection is not ensured, the human rights to life and the protection of human dignity will no longer be fully-fledged ones; on the other hand, the right to the sustaining and saving of life in the event when a person’s life is in danger, is an inseparable and fundamental part of the human right to the best possible health. Therefore, while construing the provisions of Paragraph 1 of Article 53 of the Constitution, one must take account of inter alia their links to Article 18 of the Constitution, wherein the principle of the acknowledging of the innate nature of human rights and freedoms is consolidated, and their links to the provisions of Articles 19 and 21 of the Constitution, through which the protection of the special constitutional values—human life and dignity—is ensured.

In this context it should be noted that the human right to the best possible health and the right to healthcare must be construed in the light of the guarantees, consolidated also in the other provisions of the Constitution, for the protection of various constitutional values, inter alia the inviolability of the private life, including the health, of a human being as ensured in Article 22 of the Constitution, the bases (and the guarantees thereof) of the national economy as consolidated in its Article 46, the right to have proper, safe and healthy conditions at work as consolidated in Paragraph 1 of its Article 48, as well as the duty of the state and each person to protect the environment from harmful influences as established in Paragraph 3 of its Article 53.

1.3. In order to implement the constitutional obligation of the state to take care of people’s health, inter alia where the state must ensure the medical aid and services for the human being in the event of sickness, one must create an efficient system of health protection and proper conditions for its activity. The Constitutional Court has noted that the state has the duty to protect human beings from threats to health (to reduce dangers to health and in certain cases, as far as possible, to prevent them) and to improve the ability of a person and society to overcome dangers to health, and to ensure access to medical services in the case of illness (the Constitutional Court’s ruling of 2 September 2009). Thus, the state must create legal and organisational preconditions for the activity of the system of health protection that would ensure the quality healthcare (not only the expressis verbis guaranteed medical aid and services for the human being in the event of sickness, inter alia the medical aid to citizens free of charge at state medical establishments, but also other healthcare services for persons and the public) accessible to everyone, as well as other health activity (as, for instance, pharmaceutical activity) that is necessary so that it could be possible to implement, in reality and efficiently, the innate human right to the best possible health.

While carrying out this constitutional function, the state institutions that form and implement this state health policy, must, among other things: take measures in order to satisfy the public need for a sufficient number of healthcare and pharmaceutical specialists of high professional qualification, inter alia predict how many of them will be needed in the future and allocate the necessary state funds for their training; create the conditions so that healthcare services would be accessible by everyone, i.e. so that the necessary infrastructure would be created and that it would operate so that the establishments (including the state-owned ones) rendering various healthcare services and the pharmacies could be distributed in a manner that would enable the timely rendering of efficient medical aid and other healthcare services; supervise health activity, exercise control over the quality of healthcare services and medicines; create the healthcare funding system that would ensure the financial accessibility to (affordability of) the necessary healthcare services and the indispensable medicines.

1.4. Paragraph 1 of Article 53 of the Constitution consolidates the guarantee of medical aid to citizens free of charge at state medical establishments. This guarantee obligates the state to ensure the necessary conditions for its implementation, i.e. not only to create the required network of state healthcare establishments, but also to cover the costs of the rendering of such medical aid by state funds. Thus, while implementing its discretion of the forming of the state health policy and that of the choosing of a model of healthcare funding, the legislator may not disregard the fact that a certain part of healthcare services, namely, the free-of-charge medical aid guaranteed to citizens, must be funded from the state budget funds.

The constitutional provision that the procedure for providing medical aid to citizens free of charge at state medical establishments shall be established by law does not define expressis verbis the amount of the guaranteed aid, but in no way does it mean that, purportedly, all medical aid (let alone other healthcare services) rendered to citizens in those establishments should be paid for with state budget funds unconditionally and without paying heed to the state’s financial capabilities, since such an interpretation would violate a balance between the constitutional values, would disregard the duty of the Seimas, stemming from the constitutional imperatives of an open, just, harmonious civil society and responsible governance, when it approves the state budget, to take into account inter alia the existing economic and social situation, the needs and possibilities of society and the state, the available and predicted financial resources as well as the state obligations. Thus, having assessed inter alia the state’s financial capabilities and paying heed to the balance between constitutional values and the constitutional principles of social harmony, responsible governance, reasonableness, the equality of rights of persons, and other constitutional imperatives, the legislator must establish the amount of the medical aid rendered free of charge to citizens, which should be covered by state budget funds. However, while doing so, the legislator may not deny the substance of this constitutional guarantee and the state’s obligation to take care of people’s health. As mentioned before, when the provisions of Paragraph 1 of Article 53 of the Constitution are construed, one must take into account inter alia their relation to the state duty to protect human life as consolidated in Article 19 of the Constitution; the right to the sustaining and saving of life in the event when a person’s life is in danger, is an inseparable and fundamental part of the human right to the best possible health. This relation between the constitutional values implies the fact that the medical aid free of charge for all citizens must be ensured insofar as it is necessary to save and preserve the life of a human being. In case a smaller extent of such aid were established, i.e. in case even no minimal, vitally important free-of-charge medical aid were established, its constitutional guarantee would in general become meaningless, alongside, also the constitutional obligations of the state to protect the life of a human being and to take care of people’s health would be violated. It needs to be emphasised that the free-of-charge medical aid guaranteed to citizens must be in line with the requirements of accessibility and quality raised for healthcare services, such aid must be rendered under the conditions and procedure heeding the human dignity.

In this context it also needs to be noted that the guarantee of free-of-charge medical aid to citizens in namely state medical establishments determines the duty of the state to ensure the rendering of vitally important medical aid in state medical establishments, inter alia the permanent operation of the needed network of the state healthcare establishments rendering such aid, however, such a guarantee may not be construed as the free-of-charge medical aid financed from the state budget funds should be confined only to those establishments. The striving for the ensuring of the best possible accessibility to vitally important medical aid is also determined by the fact that in the situations where, due to some circumstances, such aid cannot be rendered, in a timely and quality manner, in state medical establishments, it may also be rendered in other healthcare establishments that are able to render such aid in a quality and safe manner; the costs incurred by the latter establishments in the course of the rendering of such aid must be covered by state budget funds.

Thus, the provision of Paragraph 1 of Article 53 of the Constitution that the procedure for providing medical aid to citizens free of charge at state medical establishments shall be established by law, is a constitutional guarantee of the citizens’ right to receive, in a timely manner, vitally important quality medical aid free of charge in state medical establishments, the implementation of which must be ensured by state budget funding.

This guarantee is not identical to the right to healthcare, which is ensured, with regard to citizens as well as other persons, in the course of the implementation of the obligation of the state, consolidated in Paragraph 1 of Article 53 of the Constitution, to take care of people’s health and to guarantee medical aid and services for the human being in the event of sickness.

It should be noted that the state may also assume bigger financial obligations than implied by the constitutional guarantee of the free-of-charge medical aid for citizens, however, as mentioned before, in such a case one must take account of the state financial capabilities, which are not and cannot be limitless, and must pay heed to the constitutional imperatives of a balance of values, social harmony, responsible governance, and other constitutional imperatives. The state budget cannot bear the burden mismatched with the financial capabilities of the state, due to which the state would be unable to discharge its other functions or the discharging of such functions would be much more difficult.

1.5. While carrying out the its constitutional function of taking care people’s health, the state must ensure the funding of not only the free-of-charge medical aid rendered to citizens, but also of other healthcare services, it must inter alia guarantee that the healthcare services for individuals, that are not covered by the free-of-charge medical aid rendered to citizens, would be accessible to everyone according to the needs, including the most socially sensitive groups of persons, thus, the state must create such a system of the funding of such services, which would enable the accumulation of the funds necessary for the payment for the rendering of these services, otherwise, in case the persons were required to pay (the entire price) for these services, they would become unaffordable, thus, in reality, inaccessible. However, under the Constitution, it is not required that all those needs be funded from the state budget. The budget funds of the state as the organisation of the entire society that must act in the interests of the entire society so that the social harmony would be ensured must be allocated for the carrying out of various state functions and the rendering of various public services, therefore, the balance of constitutional values and social harmony would be violated if, without taking into consideration of the financial capabilities of the state, the state budget would have to bear such a healthcare funding burden due to which it would no longer be able to discharge its other functions or the discharging of such functions would be much more difficult.

Thus, when it chooses a model of healthcare funding, the legislator is bound not only by its duty to provide, in the state budget, for the funds necessary to render the free-of-charge medical aid to citizens, but also by other constitutional obligations of the state and its financial capabilities. The legislator is not allowed to establish any such model of healthcare funding that would not be based upon a balanced assessment of the needs of society and the state and the financial capabilities of the state, where the state would clearly obviously be unable to implement such a model; the establishment of such a model would violate the balance of constitutional values and would be in conflict with the constitutional imperatives of social harmony and responsible governance.

Consequently, in case it is impossible to allocate as many state budget funds as necessary in order to ensure the sufficient accessibility, irrespective of a person’s income, to the healthcare services for individuals not covered by the free-of-charge medical aid guaranteed to citizens, the legislator, while implementing the obligation of the state to take care of people’s health and to guarantee medical aid and services for the human being in the event of sickness, as consolidated in Paragraph 1 of Article 53 of the Constitution, not only may but also must provide for another method, based on the social solidarity, of the accumulating of the needed public funds, inter alia choose compulsory health insurance.

Alongside, it needs to be noted that the state duty to create a system of healthcare funding by public funds based on social solidarity, where such a system would allow one to ensure the sufficient accessibility to healthcare, may not be construed so that, purportedly, the society should bear the burden of the funding of all possible healthcare services for persons. In this sphere it is necessary to find decisions ensuring the balance between the interests of the person as a consumer of healthcare services (patient) and those of the whole society. The Constitutional Court has held on more than one occasion that the principle of solidarity in the civil society does not deny personal responsibility for one’s own fate; the recognition of mutual responsibility of a person and the society is important in ensuring social harmony, guaranteeing freedom of a person and possibility to protect oneself from difficulties which could not be overcome by one person alone (the Constitutional Court’s rulings of 12 March 1997, 26 September 2007, the decision of 20 April 2010, the rulings of 6 February 2012 and 27 February 2012). The legal regulation governing the funding of healthcare of persons should create incentives for everyone to take care of his health, to assume the obligation to contribute, as far as possible, to the health funding and to use the healthcare services in a responsible and rational manner. Thus, under the Constitution, the legislator also has the powers to establish that certain healthcare services must be paid for with the resources of private funding, as, for instance, by voluntary health insurance funds, the direct payment by the persons themselves, etc.

1.6. Having chosen the model of healthcare funding based inter alia upon compulsory health insurance, the legislator must establish the persons covered by this insurance, the amount (amounts) of the insurance contributions, the terms of payment, the sanctions for failure to pay those contributions or for overdue payment thereof, possible concessions, the period of the insurance validity, the powers of the institutions implementing the insurance, the healthcare services funded by the insurance funds, the principles of the distribution of the funds among healthcare establishments, and other substantial elements of this insurance. When it regulates the relations of compulsory health insurance, the legislator is bound by the requirement, stemming from Paragraph 1 of Article 53 of the Constitution, for the ensuring of the accessibility, equal to all, to quality healthcare services, by the constitutional imperatives of solidarity, social harmony and justice, as well as by the constitutional principles of responsible governance, reasonableness, proportionality, and the equality of rights of persons. It implies, among other things, that compulsory health insurance must be universal, i.e. it must cover all members of society, the amount of the contributions must depend on the income of persons, this amount must be such so that preconditions could be created for the accumulation of the necessary funds ensuring the sufficient accessibility to quality healthcare services. It needs to be emphasised that after the legislator has chosen compulsory health insurance, the obligation to pay the compulsory health insurance contributions as established by law is a constitutional duty; in itself, such a duty cannot be treated as a limitation of the rights of a person.

In this context it should also be noted that, while seeking to ensure the healthcare accessibility to all regardless of the income of persons, the legislator inter alia may place the burden of the compulsory health insurance of the most socially sensitive groups of persons upon the state, however, this must be done in a responsible manner, by not distorting the essence of social solidarity, without denying the incentives of persons to take care of their health and their duty to contribute, as far as possible, to the health funding, thus, this must be done in a manner so that the social harmony and the balance between the interests and responsibility of the person and society would not be disturbed.

When one takes account of the constitutional principle of social solidarity, the period of the entry into validity and the discontinuing of compulsory health insurance could depend on the length of the period during which a person’s compulsory health insurance contributions have been duly paid under procedure established by law. While regulating the relations related to the period of the entry into validity of and the discontinuing of compulsory health insurance, the legislator has some discretion, however, when implementing it, the legislator must heed, first of all, the requirements stemming from the Constitution, inter alia Paragraph 1 of Article 53 thereof, from the constitutional principles of justice, reasonableness, proportionality, and the equality of rights of persons, as well as the requirements of EU law and the international treaties of the Republic of Lithuania.

Having chosen compulsory health insurance as one of the resources of healthcare funding, the legislator must clearly define the scope of the healthcare services for persons. This can be done by specifying the services rendered to the insured persons for the funds of this insurance, or, reversely, by specifying those services the rendering of which is not paid for with the insurance funds and which must be paid for with private resources, whereas in case it is impossible to point this out precisely, sufficiently clear criteria must be established enabling one to decide in every concrete situation.

It needs to be emphasised that, after the legislator has chosen the compulsory health insurance based upon social solidarity, the purpose of such insurance is to ensure sufficient accessibility to healthcare services.

Alongside, it also needs to be emphasised that, after the legislator has chosen the model of healthcare funding based inter alia upon compulsory health insurance, the funds of this insurance may only be used for the financing of the healthcare services for the insured persons that are not covered by the free-of-charge medical aid, which must be provided from state budget funds for all citizens, regardless of whether they are insured by the compulsory health insurance. It is not allowed that the healthcare services rendered to the persons not insured by the compulsory health insurance (or to those that have not obtained such insurance themselves) be paid for with the funds of the said insurance.

1.7. Having chosen the model of the healthcare funding based inter alia upon compulsory health insurance, the legislator, while regulating the distribution of the funds of this insurance among healthcare establishments, must take into consideration the systemic ties of Paragraph 1 of Article 53 of the Constitution with Article 46 that stands at the head of Chapter IV “National Economy and Labour” of the Constitution and which consolidates the constitutional grounds of the national economy.

Lithuania’s economy shall be based on the right of private ownership, freedom of individual economic activity and initiative (Paragraph 1 of Article 46 of the Constitution). The Constitutional Court has held that the obligation of the state to support the efforts and initiative that are useful to society and which are based on private ownership is one of the rules for regulating this country’s economy (the Constitutional Court’s rulings of 27 October 1998 and 13 May 2005). The state, while regulating economic activity so that it serves the general welfare of the nation, must co-ordinate the interests of the person and of society, and not deny the principle of fair competition and other principles of Lithuania’s economy, which are entrenched in the Constitution (the Constitutional Court’s ruling of 17 March 2003).

The Constitutional Court has also held on more than one occasion that, as a rule, regulation of economic activity is linked with the establishment of conditions for economic activity, the regulation of certain procedures, the control of economic activity, as well as with certain limitations on and prohibitions against this activity (inter alia the Constitutional Court’s rulings of 13 May 2005, 29 April 2009, 26 February 2010, and 29 June 2012). The legislator, while taking account of the peculiarities of economic activity, may regulate economic activity in a differentiated manner, however, while doing so, it may not deny the fundamentals of Lithuania’s economy, which are consolidated in the Constitution (the Constitutional Court’s ruling of 17 March 2003).

The activity of healthcare establishments is related to the implementation of one of the most important innate humane rights, therefore, it must be regulated and supervised by the state. According to the Constitution, the state must regulate the economic activity in this sphere so that, without denying the constitutional values upon which the national economy is based—the private ownership right, a person’s freedom of economic activity and a person’s initiative—it would ensure the appropriate execution of its constitutional function of taking care of people’s health and the proper implementation of the innate human right to the best possible health and the right to healthcare.

As mentioned before, while carrying out this constitutional function, the state institutions that form and implement the state health policy have a duty to ensure the existence an adequately distributed and continually operating sufficient network of establishments rendering various healthcare services, among them—the state medical establishments specified expressis verbis in Paragraph 1 of Article 53 of the Constitution. The state must also supervise the activities of all healthcare establishments and control the quality of the services rendered by them.

The specific character of healthcare as a sphere of economic activity is determined by the fact that most of healthcare services are funded by public funds that can also be accumulated if the legislator chooses to establish compulsory health insurance. The state, which has a duty to create a system of healthcare funding by public funds based on social solidarity, must, under the Constitution, inter alia the constitutional principle of responsible governance, take care of the fact that those funds should be used in a responsible and rational manner. Because of the fact that, due to the increasing demand for healthcare services and their increasingly higher standards, due to the more complex and more expensive healthcare technologies, the costs of the rendering of those services are constantly increasing, whilst the funds, inter alia the compulsory health insurance funds, allocated for covering such costs, are limited, the legislator is faced with a duty to establish the legal regulation governing the funding of healthcare services by the compulsory health insurance funds that would create preconditions for the state so that it could plan the funding and distribute the funds among the healthcare establishments in a manner where, without denying the obligation of the state to support the economic efforts and initiative that are useful to society and are based on private ownership, the fair competition between healthcare establishments, and the right of the consumer of healthcare services (patient) to choose a healthcare establishment, one would ensure high quality of healthcare services funded by those funds and sufficient accessibility to the said services, i.e. their adequate distribution, as well as the continual operation of the needed network of state healthcare establishments.

Thus, while being bound by the duty to ensure rational distribution of the limited funds of compulsory health insurance among the establishments rendering healthcare services, the legislator may establish the conditions and limitations of the funding of such services, inter alia such a procedure for the distribution of those funds, according to which they would be allocated to cover the costs of the healthcare services rendered only by those institutions that have concluded a corresponding agreement with an institution authorised by the state, under conditions established by law, regarding the rendering of the services funded from the compulsory health insurance funds. The procedure for concluding such agreements should be grounded on objective and non-discriminatory criteria, known in advance, that would not deny freedom of fair competition and the other principles of Lithuania’s economy consolidated in the Constitution. One must follow those principles also when regulating other aspects of the funding of the healthcare services funded by the compulsory health insurance funds, as, for instance, when the economically grounded tariffs for the healthcare services are established. Alongside, it needs to be noted that the legal regulation governing the funding of healthcare services by the compulsory health insurance funds should induce not only the fair competition between healthcare establishments, but also their joint work in order to ensure the continuity of healthcare, high quality services, the rational and efficient use of resources.

1.8. The Constitutional Court has held on more than one occasion that the protection of legitimate expectations, legal certainty and legal security are inseparable elements of the principle of a state under the rule of law. The constitutional principles of the protection of legitimate expectations, legal certainty and legal security imply the obligation of the state to secure the certainty and stability of the legal regulation, to secure the rights and freedoms of the human being, to protect the rights of persons, and to respect the legitimate interests and legitimate expectations.

One of the elements of the constitutional principle of a state under the rule of law is the constitutional principle of proportionality, which means that the measures provided for in a law must be in line with the legitimate objectives that are important to society, that these measures must be necessary in order to reach the said objectives, and must not restrain the rights and freedoms of the person clearly more than necessary in order to reach the said objectives (inter alia the Constitutional Court’s rulings of 17 September 2008, 31 January 2011, 29 June 2012, and 15 February 2013).

1.9. Article 23 of the Constitution enshrines the inviolability of property and its protection. The Constitutional Court has held that the constitutional imperative of social harmony, the constitutional principles of justice, reasonableness and proportionality, as well as other provisions of the Constitution, imply that the inviolability of property and protection of the subjective rights of ownership that are entrenched in the Constitution cannot be interpreted as grounds for opposing the rights and interests of the owner to the public interest, as well as opposing them to the rights, freedoms and legitimate interests of other persons (the Constitutional Court’s rulings of 13 May 2005, 14 March 2006, and 15 February 2013).

  1. It has been mentioned that in the constitutional justice case at issue inter alia the compliance of Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance with Paragraph 1 of Article 53 of the Constitution and the constitutional principle of a state under the rule of law and the compliance of Paragraph 3 (wording of 22 July 2009) of Article 17 and Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law are investigated.
  2. In the context of the constitutional justice case at issue it needs to be noted that the national health system of Lithuania and the grounds of the organisation of healthcare are regulated through the Republic of Lithuania’s Law on the Health System adopted by the Seimas on 19 July 1994, which was amended and set forth in its new wording through the Republic of Lithuania’s Law Amending the Law on the Health System that was adopted on 1 December 1998 and came into force on 23 December 1998.

3.1. According to the Law on the Health System (wording of 1 December 1998), the executive bodies of the national health system of Lithuania are state and municipal, budgetary and public healthcare establishments, state and municipal enterprises possessing licences for healthcare or pharmaceutical activities, other enterprises and establishments that have concluded contracts with inter alia the State or Territorial Patients’ Funds (Article 8). The said executive bodies of the national health system of Lithuania provide healthcare services financed from the Compulsory Health Insurance Fund, state or municipal budgets or the funds of the municipal special programmes for public health support, and paid healthcare services which must be paid for by their recipients (Paragraph 2 (wording of 9 November 2004) of Article 11).

Thus, the healthcare services paid from the Compulsory Health Insurance Fund may be rendered by state and municipal establishments and enterprises as well as by the private establishments and enterprises that have concluded contracts with inter alia the State or Territorial Patients’ Funds.

3.2. Article 38 of the Law on the Health System (wording of 1 December 1998) establishes the resources of the financing of healthcare: inter alia the state or municipal budget funds, the funds of the Compulsory Health Insurance Fund, the funds of voluntary health insurance, and the funds for directly paid services.

3.3. Thus, this law consolidates a mixed model of the funding of the national health system of Lithuania, according to which the healthcare services provided by state and municipal establishments and enterprises, as well as by private establishments and enterprises, inter alia those that have concluded contracts with the State or Territorial Patients’ Funds, are paid for from different resources.

  1. On 21 May 1996, the Seimas adopted the Law on Health Insurance that came into force on 1 January 1997 (save the provisions of some articles, which came into force on 1 July 1997). This law has been amended and/or supplemented on more than one occasion, inter alia through the Republic of Lithuania’s Law Amending the Law on Health Insurance that was adopted by the Seimas on 3 December 2002 and came into force on 1 January 2003 (save the exceptions established in Article 3 thereof), through Article 1 whereof the aforesaid law was amended and set forth in its new wording, as well as through the Republic of Lithuania’s Law Amending Article 6 of the Law on Health Insurance that was adopted on 28 April 2005 and came into force on 14 May 2005, through the Republic of Lithuania’s Law Amending and Supplementing Articles 2, 6, 8, 15, 16, 17, 18, 19 of the Law on Health Insurance that was adopted on 22 December 2008 and, pursuant to Article 10 thereof, came into force on 1 January 2009, the Republic of Lithuania’s Law Amending Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted on 19 February 2009 and came into force on 5 March 2009, the Republic of Lithuania’s Law Amending and Supplementing Articles 6, 8, 17, 18, 19 of the Law on Health Insurance that was adopted on 22 July 2009 and, pursuant to Article 6 thereof, came into force on 1 January 2010.

4.1. The Law on Health Insurance (wording of 3 December 2002) (hereinafter referred to as the Law on Health Insurance) establishes inter alia the types of health insurance and the system of compulsory health insurance: the persons covered by the compulsory health insurance, the foundations of the establishment of a budget of the Compulsory Health Insurance Fund and the compensation of the costs related to individual healthcare services and medicines and medical aid equipment from the budget of the Compulsory Health Insurance Fund, as well as the grounds for additional (voluntary) health insurance (Article 1 “Purpose of the Law”).

According to Paragraph 5 (wording of 22 December 2008) of Article 2 “Main Definitions Used in this Law”, “compulsory health insurance” means a state-defined system of individual healthcare and economic measures, which, on the basis and under the conditions set out by this law, in the case of the insured event, i.e., under Article 5 of this law, the health disorders or the state of health of the persons covered by the compulsory health insurance, which have been diagnosed by a medical doctor, guarantees, for the persons covered by the compulsory health insurance the provision of healthcare services and compensation of the costs related to the provided services, medicines and medical aid equipment from the Compulsory Health Insurance Fund Budget.

4.2. In the context of the constitutional justice case at issue it needs to be mentioned that, according to Paragraph 1 of Article 2 of the Law on Health Insurance, “persons covered by the compulsory health insurance” means all persons subject to the compulsory health insurance, who, in the manner prescribed by this law, pay themselves the contributions in the amount set by this law or on behalf of whom such contributions are paid.

4.3. Article 6 “Persons Subject to the Compulsory Health Insurance and Persons Covered by the Compulsory Health Insurance” (wordings of 19 February 2009 and 22 July 2009) of the Law on Health Insurance lists the persons subject to the compulsory health insurance. The same article also provides for the cases when persons are treated as the insured.

According to Paragraphs 1 and 2 of Article 6 of the Law on Health Insurance, the persons subject to the compulsory health insurance are:

– citizens of the Republic of Lithuania and foreign nationals permanently residing in the Republic of Lithuania; foreign nationals temporarily residing in the Republic of Lithuania, provided that they are legally employed in the Republic of Lithuania, as well as under-age members of their families; the foreign nationals specified in Items 17 and 18 of Paragraph 4 of Article 6 of this law (i.e. the following persons are covered by the insurance paid for with state funds under procedure established by this law: unaccompanied under-age foreign nationals, as well as the foreign nationals who have received additional or temporary protection in the Republic of Lithuania—persons under 18 years of age, persons for whom the illness or body condition, entered on the list approved by the Ministry of Health, has been diagnosed, single parents raising under-age children, women during pregnancy 70 days before child birth (after 28 pregnancy weeks and further) and 56 days after child birth, persons who have reached the pensionable age as established by the laws of the Republic of Lithuania) (Paragraph 1 (wording of 28 April 2005) of Article 6);

– citizens of the Republic of Lithuania, permanently or temporarily residing in the countries which have concluded with the Republic of Lithuania the international agreements regarding the compulsory health insurance, as well as citizens of these countries, permanently or temporarily residing in the Republic of Lithuania, shall be covered by the compulsory health insurance in accordance with the procedure laid down by the said agreements (Paragraph 2 of Article 6).

According to Paragraph 3 (wordings of 19 February 2009 and 22 July 2009) Article 6 of the Law on Health Insurance, the persons covered by the compulsory health insurance are:

– persons who, under procedure established by this law, pay the compulsory health insurance contributions specified in Article 17 of this law;

– persons who, under procedure established by this law, pay the compulsory health insurance contributions specified in Article 17 of this law and on behalf of whom such contributions are paid by the insurance payers;

– the persons, insured with state funds, who are listed in Paragraph 4 (wordings of 19 February 2009 and 22 July 2009) of Article 6 of this law, wherein 19 categories of such persons (in case they do not receive any income on which, under the provisions of Article 17, the compulsory health insurance contributions must be paid) are specified, also, to the said persons one should ascribe the persons specified in Paragraph 5 (wording of 28 April 2005) of this article, whose healthcare is paid for with state funds.

Thus, according to the aforesaid legal regulation consolidated in Article 6 of the Law on Health Insurance, virtually all persons, save those covered by the insurance with state funds as enumerated in Paragraphs 4 and 5 of Article 6 of this law, must, under procedure established by this law, pay themselves the compulsory health insurance contributions in the amount set by this law, whilst on behalf of some of those persons part of the contributions must be paid also by the insurance payers.

4.4. According to Item 1 of Article 38 “The Rights of the Persons Subject to the Compulsory Health Insurance when Applying the Compulsory Health Insurance” of the Law on Health Insurance, all persons subject to the compulsory health insurance have the right to choose, in accordance with the procedure laid down by law and other legal acts, an individual healthcare establishment wherewith the Territorial Patients’ Fund has concluded a contract, and to receive individual healthcare services as guaranteed by the compulsory health insurance.

  1. Article 17 “Compulsory Health Insurance Contributions” (wording of 19 February 2009) of the Law on Health Insurance established the amounts of the compulsory health insurance contributions for separate groups of persons who must, under procedure established by this law, pay themselves the compulsory health insurance contributions, as well as for separate groups of persons who must, under procedure established by this law, pay themselves a part of the compulsory health insurance contributions and on behalf of whom the insurance payers must pay the other part of those contributions as established in this article:

– Paragraphs 1 and 2 of this article—for the persons who work under employment contract, hold elective positions on membership basis in elective organisations, work in partnerships, agricultural companies or cooperative organisations, as well as who are state servants of public administration (Item 1 of Paragraph 1), as well as for state politicians, judges and candidates to judges, officials of prosecutors’ offices, the chairman of the Board of the Bank of Lithuania, his deputies, members of the Board, the heads of state institutions or establishments and other officials appointed by the Seimas or the President of the Republic, the chairmen of state (standing) commissions and councils appointed by the Seimas or the President of the Republic, chairmen of other state (standing) commissions and councils, their deputies and members, as well as the officials of the commissions or councils set up under special laws, provided they receive remuneration for their work (Item 2 of Paragraph 1)—established the compulsory health insurance contributions in the amount of 6 percent (subject to payment by the said persons) and in the amount of 3 percent (subject to payment by their insurance payers) on the income calculated for a person in accordance with the procedure laid down by the Law on State Social Insurance, on the basis of which social insurance contributions are calculated;

– Paragraphs 3–8 of this article—for categories of other persons: for the persons receiving income under authors’ agreements, income from sports activities or performing activities established the compulsory health insurance contributions in the amount of 6 percent and, for the insurance payers of those persons, established such contributions in the amount of 3 percent on the income calculated for a person, on the basis of which social insurance contributions are calculated (Paragraph 3), for the natural persons who engage in certain individual activities established the compulsory health insurance contributions, which must be paid by those persons themselves, in the amount of 9 percent on the income (subject to the personal income tax) from individual activities received within a calendar year (Paragraph 4), for the natural persons who conduct individual activities under a business certificate established the compulsory health insurance contributions, which must be paid by those persons themselves, in the amount of 9 percent of the minimum monthly wage (Paragraph 5), for the members of partnerships and owners of individual enterprises established the compulsory health insurance contributions, which must be paid by those persons themselves, equalling to 9 percent of the income received from the taxed profit of such partnership or individual enterprise during a calendar year (Paragraph 6), for the persons who do not fall within the above categories of persons and not insured with state funds, who possess holdings or farms of certain sizes established the compulsory health insurance contributions, which must be paid by those persons themselves, in the amount of 3 percent of the minimum monthly wage (Paragraph 7), for the permanent residents of Lithuania as defined in the Law on Personal Income Tax, who receive income other than that mentioned above, from which the income tax of individuals must be exacted and/or paid, with the exception of the payments which are paid upon the expiration or termination of a life insurance or pension accumulation contract established the compulsory health insurance contributions, which must be paid by those persons themselves, in the amount of 6 percent of their income (Paragraph 8);

– Paragraph 9 of this article—for all other persons not specified in Paragraphs 1-8 of this article and not insured with state funds, established the compulsory health insurance contributions, which must be paid by those persons themselves, in the amount of 9 percent of the minimum monthly wage.

It should be noted that Paragraph 10 of Article 17 (wording of 19 February 2009) of the Law on Health Insurance provides that the annual contribution of the compulsory health insurance of the persons specified in Paragraphs 2–6, 8, 9 of this article may not be less than 9 percent, whereas the annual contribution of the compulsory health insurance of the persons listed in Paragraph 7 of this article may not be less than 3 percent of 12 minimum monthly wages valid on the last day of each appropriate month of that year.

Paragraph 11 of the same article provides as to how the annual contribution of the compulsory health insurance of the persons engaged in a certain individual activity must be calculated.

Thus, according to the aforesaid legal regulation, all persons specified in Paragraphs 1–8 of this article, in case they are not insured by the compulsory health insurance with state funds, must, under procedure established in Article 17 of this law, pay themselves the compulsory health insurance contributions in the amount established by this law and depending on the type of the income received, whilst on behalf of some of those persons part of such contributions must also be paid by the insurance payers.

It should be noted that the Law on Health Insurance does not contain any provisions to the effect that the persons covered by the insurance due to the reasons not determined by their health disorders or their state of health would be rendered healthcare services to a different extent in view of the amount of the compulsory health insurance contributions paid by them or the period during which such contributions were paid.

Thus, according to the Law on Health Insurance, in the event insured against by the compulsory health insurance, all insured persons (or those who obtained such insurance themselves) are rendered healthcare services to the same extent without taking account of the amount of the compulsory health insurance contributions and the period during which they were paid.

5.1. It has been mentioned that in the constitutional justice case at issue one investigates whether inter alia Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance is not in conflict with the Constitution. The said paragraph prescribes: “Persons who do not fall within the categories referred to in Paragraphs 1–8 of this Article and Paragraph 4 of Article 6 of this Law, shall, each month, pay for themselves the compulsory health insurance contributions in the amount of 9 percent of the minimum monthly wage valid on the last day of the month for which the contribution is paid.”

As mentioned before, Paragraphs 1–8 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance point out the persons who, under procedure established in Article 17 of this law, must pay themselves the compulsory health insurance contributions in the amount established by this law and depending on the type of the income received, whilst on behalf of some of those persons part of such contributions must be paid by the insurance payers.

Paragraph 4 (wording of 19 February 2009) of Article 6 of this law points out 19 categories of persons who are covered by the compulsory health insurance with state funds if they do not receive the income on which the compulsory health insurance contributions must be paid under Paragraphs 1–6 and 8 (wording of 19 February 2009) of Article 17:

“1) persons who receive any type of pension or relief compensation set by laws of the Republic of Lithuania;

2) unemployed persons of working age who are registered with the employment service of their place of residence as willing and able to accept suitable work;

3) unemployed persons of working age who have the law-defined state social pension insurance record required for receiving the state social insurance old-age pension;

4) women who are granted a maternity leave and unemployed women during the period of pregnancy 70 days before child birth (after 28 pregnancy weeks and further) and 56 days after child birth;

5) one of the parents (adoptive parents) raising a child under 8 years of age, as well as one of the parents (adoptive parents) raising two or more under-age children;

6) persons under the age of 18 years;

7) full-time pupils and students of schools of general education, vocational, post-secondary and higher education, as well as citizens of the Republic of Lithuania and foreign nationals and stateless persons, permanently residing in the Republic of Lithuania, who are full-time students of schools of higher education of the member states of the European Union;

8) persons supported by the State who receive social benefit;

9) one of the parents (adoptive parents), guardians or curators, nursing a person at home for whom a disability level is established (disabled child) or a person who was recognised as having incapacity for work (before 1 July 2005—a person with group I disability) before he reached the age of 24, or a person who before he reached the age of 26 was recognised as having incapacity for work (before 1 July 2005—a person with group I disability) because of the illness which occurred before he reached the age of 24, or a person for whom a special need of permanent nursing care is established (before 1 July 2005—total disability);

10) persons who have been recognised as disabled in accordance with the procedure laid down by legal acts;

11) persons ill with publicly dangerous communicable diseases which are entered on the list defined by the Ministry of Health;

12) participants of the opposition (resistance)—volunteer soldiers, participants of fights for freedom; rehabilitated political prisoners and persons equated to them, deportees and persons equated to them, and persons who suffered injuries during the events of January 13th, 1991 and other events while defending Lithuania’s independence and statehood;

13) persons who contributed to the liquidation of the consequences of the nuclear accident at the Chernobyl nuclear power plant;

14) former inmates of the ghetto and juvenile prisoners of the fascist forced confinement places;

15) clergymen of traditional religious associations recognised by the State, students of the schools preparing clergymen, novices undergoing monastic formation in novitiates;

16) persons for whom the legal status of participants of the war in Afghanistan is recognised in accordance with the procedure laid down by the law;

17) unaccompanied under-age foreign nationals;

18) foreign nationals who have received additional or temporary protection in the Republic of Lithuania: persons under 18 years of age, persons for whom the illness or body condition, entered on the list approved by the Ministry of Health, has been diagnosed, single parents raising under-age children, women during pregnancy 70 days before child birth (after 28 pregnancy weeks and further) and 56 days after child birth, persons who have reached the pensionable age;

19) the President’s of the Republic spouse who has not reached the pensionable age and does not have insured income—for the duration of the term of office of the President of the Republic.”

Thus, Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance established, for the persons that do not receive the income that is received by the persons specified in Paragraphs 1–8 of the same article (wording of 19 February 2009) and for the persons not covered, according to Paragraph 4 (wording of 19 February 2009) of Article 4 of the same law, by the insurance with state funds, the duty to pay the compulsory health insurance contributions in the amount of 9 percent of the minimum monthly wage valid on the last day of the month for which the contribution is paid.

5.2. It needs to be mentioned that the legal regulation consolidated in the impugned Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance is not something that was completely newly established, since this legal regulation is analogous to the one previously consolidated in Paragraph 7 (wording of 22 December 2008) of Article 17, save the legal regulation consolidated for a certain group of persons in Paragraph 7 (wording of 22 December 2008), which was later established in Paragraph 7 (wording of 19 February 2009) of the same article. Thus, from the impugned aspect, the legal regulation consolidated in Paragraph 9 (wording of 19 February 2008) of Article 17 of this law remained identical to the one previously consolidated in Paragraph 7 (wording of 22 December 2008) of the same article.

5.3. It also needs to be mentioned that the amount of the compulsory health insurance contributions as established for the persons pointed out in the impugned Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance is analogous to the amount of the compulsory health insurance contributions established for the persons specified in Paragraph 7 (wording of 22 December 2008) of the same article—9 percent of the minimum monthly wage—and is smaller than the one established even before for this category of persons in Paragraph 6 (wording of 3 December 2002) of Article 17, which was applied until 31 December 2008, and which used to be 10 percent of the average monthly wage in the national economy during the quarter before last, as announced by the Department of Statistics under the Government of the Republic of Lithuania.

5.4. It should be noted that even though the Law on Health Insurance has subsequently been amended inter alia through the said Law Amending and Supplementing Articles 6, 8, 17, 18, 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009, the impugned Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance has afterwards not been amended and/or supplemented.

5.5. While deciding whether Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance is not in conflict with the Constitution, one should note that this paragraph consolidates a duty of the persons who do not receive the income received by the persons specified in Paragraphs 1–8 (wording of 19 February 2009) of the same article and who are not insured with state funds to pay the compulsory health insurance contributions.

It has been mentioned that the petitioner impugns this legal regulation from the aspect to the effect that after a duty had been established for the persons who do not take part in the labour market and who do not receive any insured income to participate in the system of compulsory health insurance—to pay compulsory health insurance contributions—the said persons’ right to medical aid free of charge at state medical establishments as consolidated in Paragraph 1 of Article 53 of the Constitution was negated and the constitutional principle of a state under the rule of law was violated.

5.5.1. It has been mentioned that, while implementing the obligation of the state to take care of people’s health, inter alia to guarantee medical aid and services for the human being in the event of sickness, as consolidated in Paragraph 1 of Article 53 of the Constitution, and having chosen the model of healthcare funding based inter alia upon compulsory health insurance, the legislator must establish inter alia the persons covered by this insurance, the amount (amounts) of the insurance contributions, and the terms of payment. It has also been mentioned that, when it regulates the relations of compulsory health insurance, the legislator is bound by the requirement, stemming from Paragraph 1 of Article 53 of the Constitution, for the ensuring of the accessibility, equal to all, to quality healthcare services, by the constitutional imperatives of solidarity, social harmony and justice, as well as by the constitutional principles of responsible governance, reasonableness, proportionality, and the equality of rights of persons; it implies, among other things, that compulsory health insurance must be universal, i.e. it must cover all members of society, also that the amount of the insurance contributions must be such so that preconditions could be created for the accumulation of the necessary funds ensuring the sufficient accessibility to quality healthcare services. It has also been mentioned that the obligation to pay the compulsory health insurance contributions as established by law is a constitutional duty; in itself, such a duty cannot be treated as a limitation of the rights of a person.

Thus, it needs to be held that the legislator, having established, through Paragraph 9 of Article 17 (wording of 19 February 2009) of the Law on Health Insurance, a duty of the persons who do not receive the income received by the persons specified in Paragraphs 1–8 (wording of 19 February 2009) of the same article and who are not insured with state funds to pay the compulsory health insurance contributions, created preconditions for the accumulation of the necessary funds in order to ensure the sufficient accessibility to quality medical services and implemented the obligation of the state to take care of people’s health and to guarantee medical aid and services for the human being in the event of sickness as consolidated in Paragraph 1 of Article 53 of the Constitution.

5.5.2. It has also been mentioned that, after the legislator has chosen the model of healthcare funding based inter alia upon compulsory health insurance, it is not allowed that the healthcare services rendered to the persons not insured by this insurance (or to those that have not obtained such insurance themselves) be paid for with the funds of the said insurance; however, the citizens not insured by this insurance (or those that have not obtained such insurance themselves), as well as all the other citizens, have the right, as guaranteed in Paragraph 1 of Article 53 of the Constitution, to the medical aid free of charge at state medical establishments in the amount established by law.

Thus, it needs to be held that the legislator, having established, through Paragraph 9 of Article 17 (wording of 19 February 2009) of the Law on Health Insurance, a duty of the persons who do not receive the income received by the persons specified in Paragraphs 1–8 (wording of 19 February 2009) of the same article and who are not insured with state funds to pay the compulsory health insurance contributions, did not negate the guarantee, consolidated in Paragraph 1 of Article 53 of the Constitution, for the free-of-charge medical aid for citizens at state medical establishments and did not violate the requirements stemming from the constitutional principle of a state under the rule of law.

5.5.3. Taking account of the arguments set forth, one should draw a conclusion that Paragraph 9 (wording of 19 February 2009) of Article 17 of the Law on Health Insurance is not in conflict with Paragraph 1 of Article 53 of the Constitution and the constitutional principle of a state under the rule of law.

  1. It has been mentioned that in the constitutional justice case at issue one investigates inter alia the compliance of Paragraph 3 (wording of 22 February 2009) of Article 17 of the Law on Health Insurance with the Constitution.

Paragraph 3 (wording of 22 February 2009) of Article 17 of the Law on Health Insurance was amended through Paragraph 3 of Article 3 of the Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009 and came into force on 1 January 2010.

The impugned Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance prescribed: “Persons receiving income under authors’ agreements, income from sports activities, and income from performing activities, with the exception of the persons who engage in an appropriate individual activity, shall pay compulsory health insurance contributions in the amount of 6 percent, and the insurance payers—compulsory health insurance contributions in the amount of 3 percent on the income on the basis of which social insurance contributions are calculated.”

Thus, the impugned Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance consolidated a duty of the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities, with the exception of the persons who engage in an appropriate individual activity, and a duty of their insurance payers, to pay the compulsory health insurance contributions.

6.1. It should be noted that the duty of the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities to pay the compulsory health insurance contributions had also been consolidated in the previously valid Paragraph 6 (wording of 3 December 2002) of Article 17 of this law, without a separate indication of this group of persons, but with an established duty to pay, for themselves, the compulsory health insurance contributions in the amount of 10 percent of the average monthly wage in the national economy during the quarter before last, as announced by the Department of Statistics under the Government of the Republic of Lithuania. The duty of those persons, already with an indication that they were a separate group, to pay the compulsory health insurance contributions, was consolidated for the first time in Paragraph 3 (wording of 22 December 2008) of Article 17 of the same law, which, upon the amendment of the procedure for the compulsory health insurance contributions and upon the reduction of their amount) prescribed: “Persons receiving income under authors’ agreements, income from sports activities, and income from performing activities, shall pay compulsory health insurance contributions in the amount of 6 percent, and the insurance payers—compulsory health insurance contributions in the amount of 3 percent on this income.” An analogous legal regulation was consolidated also in Paragraph 3 of the same article (wording of 19 February 2009).

6.2. If the impugned legal regulation consolidated in Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance is compared with the one consolidated in Paragraph 3 (wordings of 22 December 2008 and 19 February 2009) of this article, it should be noted that also those persons receiving income under authors’ agreements, or income from sports activities, or from performing activities, with the exception of the persons engaged in an appropriate individual activity as specified in Paragraph 4 (wording of 22 July 2009) of the same article, must pay the compulsory health insurance contributions in the specified amount. Thus, the legal regulation consolidated in Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance that established the duty for the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities and the duty of their insurance payers to pay the compulsory health insurance contributions remained identical to the one entrenched previously in Paragraph 3 (wordings of 22 December 2008 and 19 February 2009) of the same article.

6.3. It should be noted that, when Article 17 (wording of 22 July 2009) of this law was subsequently amended or supplemented, inter alia when Paragraph 3 of Article 17 was subsequently amended (supplemented), the legal regulation, from the impugned aspect, i.e. insofar as the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities are covered by the insurance in a compulsory manner, has remained the same.

6.4. While deciding whether Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance was not in conflict with the Constitution, one should note that this paragraph consolidated the duty of certain persons receiving income under authors’ agreements, or income from sports activities, or from performing activities and the duty of their insurance payers to pay the compulsory health insurance contributions.

It has been mentioned that the petitioner’s doubts about the compliance of this legal regulation with the Constitution are substantiated by the fact that, after the duty to pay the compulsory health insurance contributions has been established for authors, athletes, and performers, the nature of whose income (since such income can be irregular and not subject to prediction) is different from that of other insured income, the state groundlessly redistributes their income in violation of the principle of the inviolability of ownership as entrenched in Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

6.4.1. It has been mentioned that, while implementing the obligation of the state to take care of people’s health, inter alia to guarantee medical aid and services for the human being in the event of sickness, as consolidated in Paragraph 1 of Article 53 of the Constitution, and having chosen the model of healthcare funding based inter alia upon compulsory health insurance, the legislator must establish inter alia the persons covered by this insurance, the amount (amounts) of the insurance contributions, and the terms of payment. It has also been mentioned that, when it regulates the relations of compulsory health insurance, the legislator is bound by the requirement, stemming from Paragraph 1 of Article 53 of the Constitution, for the ensuring of the accessibility, equal to all, to quality healthcare services, by the constitutional imperatives of solidarity, social harmony and justice, as well as by the constitutional principles of responsible governance, reasonableness, proportionality, and the equality of rights of persons; it implies, among other things, that compulsory health insurance must be universal, i.e. it must cover all members of society, also that the amount of the insurance contributions must be such so that preconditions could be created for the accumulation of the necessary funds ensuring the sufficient accessibility to quality healthcare services.

6.4.2. While assessing whether the impugned legal regulation that established the duty to pay the compulsory health insurance contributions was not in conflict with Article 23 of the Constitution, one should note that, according to Item 15 of Article 67 of the Constitution, the Seimas shall establish state taxes and other compulsory payments; under Paragraph 3 of Article 127 of the Constitution, taxes, other payments to the budgets, and levies shall be established by the laws of the Republic of Lithuania.

As mentioned before, the obligation to pay the compulsory health insurance contributions as established by law is a constitutional duty, which, in itself, cannot be treated as a limitation of the rights of a person, thus, neither can it be treated as a violation of the principle of the inviolability of property that is consolidated in Article 23 of the Constitution.

Thus, it needs to be held that the legislator, having established, through Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance, the duty of certain persons receiving income under authors’ agreements, or income from sports activities, or from performing activities and the duty of their insurance payers to pay the compulsory health insurance contributions, created preconditions for the accumulation of the necessary funds in order to ensure the sufficient accessibility to quality medical services and implemented the obligation of the state to take care of people’s health and to guarantee medical aid and services for the human being in the event of sickness as consolidated in Paragraph 1 of Article 53 of the Constitution and did not violate any requirements stemming from the principle of the inviolability of property consolidated in Article 23 of the Constitution and from the constitutional principle of a state under the rule of law.

6.4.3. Taking account of the arguments set forth, one is to draw a conclusion that Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance was not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

  1. It has been mentioned that in the constitutional justice case at issue one investigates inter alia the compliance of Paragraphs 2 and 4 (wording of 22 July 2009) of the Law on Health Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

7.1. It should be noted that after Paragraphs 2 and 4 (wording of 22 July 2009) of the Law on Health Insurance had been amended through Article 2 of the Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009 and came into force on 1 January 2010, the legal regulation consolidated in the said paragraphs virtually remained identical to the one established previously.

7.2. Article 8 “Validity of the Compulsory Health Insurance” (wording of 22 July 2009) of the Law on Health Insurance prescribed:

“1. The compulsory health insurance of the persons referred to in Paragraphs 1 and 2 of Article 17 of this Law shall become effective as of the day on which compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions.

  1. The compulsory health insurance of the persons referred to in Paragraphs 3–7 and 9 of Article 17 of this Law shall become effective in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or as of the day that these persons have paid a contribution equal to 3 minimum monthly wages. The payment of a contribution in the amount of 3 minimum monthly wages does not release one from the duty to pay the contributions in the amount set in Article 17 of this Law.
  2. The persons referred to in Paragraph 4 of Article 6 of this Law shall be regarded as the insured as of the day they acquire the status specified in Paragraph 4 of Article 6 of this Law until the day they lose this status.
  3. The persons referred to in Paragraph 4 of Article 6 and Paragraphs 1–7 and 9 of Article 17 of this Law shall receive the services, compensated medicines and medical aid equipment, which are referred to in Articles 9–12 of this Law and the costs of which are covered from the budget of the Compulsory Health Insurance Fund, one more month after the end of the payment of the compulsory health insurance contributions on behalf of them or after they themselves stopped paying such contributions. This guarantee shall not release one from the duty to pay the contributions in the amount set in Article 17 of this Law.
  4. The payers of the contributions set in Paragraphs 1–9 of Article 17 of this Law shall pay a Territorial Patients’ Fund for the individual healthcare services, paid from the budget of the Compulsory Health Insurance Fund (with the exception of the emergency medical treatment services), which are rendered to the persons who are not regarded as the insured.
  5. If a Territorial Patients’ Fund establishes that a person eligible for the compulsory health insurance has been within a calendar month rendered the individual healthcare services the costs of which exceed 100 basic social payments, an appropriate state tax inspectorate and/or an administrative body of the State Social Insurance Fund shall, on the advice of that Territorial Patients’ Fund, check whether the person has paid all compulsory health insurance contributions. Other persons shall be checked for choice.
  6. The costs related to the provision of healthcare services and the unpaid compulsory health insurance contributions shall be exacted from the persons in accordance with the procedure laid down by this Law as well as other laws and legal acts.”

Thus, Paragraph 2 (wording of 22 July 2009) and Paragraphs 1 and 3 (wording of 22 December 2008) of Article 8 of the Law on Health Insurance established a different period of the entry into effect of compulsory health insurance for the persons who are covered by this insurance and who are pointed out in the corresponding paragraphs of Article 17 (wording of 22 July 2009) and Paragraph 4 (wording of 22 July 2009) of Article 6 of the same law. In addition, with regard to all those persons, Paragraph 4 (wording of 22 July 2009) of Article 8 of the same law established the equal one-month term after the end of the payment of the compulsory health insurance contributions on behalf of them or after they themselves stopped paying such contributions, during which they are still rendered the services that are covered from the budget of the Compulsory Health Insurance Fund. It should be noted that, according to Paragraph 2 (wording of 22 July 2009) of Article 8 of this law, a person, after he has paid the contribution in the amount of 3 minimum monthly wages, is not released from the duty to pay the payments in the amount set in Article 17 of this law, also, according to Paragraph 4 (wording of 22 July 2009) of Article 8 of the same law, the compulsory health insurance contribution in the corresponding amount must be paid for one month during which the services covered from the budget of the Compulsory Health Insurance Fund are continued to be rendered to the person.

Paragraph 5 (wording of 19 February 2009) of Article 8 of the Law on Health Insurance provides that the persons who are not regarded as the insured must pay a Territorial Patients’ Fund for the individual health care services with the exception of the emergency medical treatment services. Paragraph 6 of the same article provides that in some instances checks on whether a person has paid all compulsory health contributions are mandatory, whilst Paragraph 7 thereof provides that the costs related to the provision of healthcare services and the unpaid compulsory health insurance contributions shall be exacted from the persons in accordance with the procedure laid down by law.

7.3. The impugned legal regulation consolidated in Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance should be construed in the context of Paragraphs 1 and 3 (wording of 22 December 2008) of the same article and in the context of Paragraph 4 (wording of 22 July 2009) of Article 6, Articles 9–11 (wording of 5 July 2005), Article 12, and Articles 17 and 19 (wording of 22 July 2009) of the same law.

7.3.1. Paragraph 2 of Article 1 of the Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009 and came into force on 1 January 2010 amended Paragraph 4 (wording of 19 February 2009) of Article 6 of the Law on Health Insurance that pointed out the persons of 19 categories covered by the compulsory health insurance with state funds (save the persons who receive the income on which, under the provisions of Article 17 of the same law, the compulsory health insurance contributions must be paid), however, the legal regulation consolidated in Paragraph 4 (wording of 22 July 2009) of Article 6 of the same law remained identical to the one that had been established previously.

7.3.2. Articles 9–11 (wording of 5 July 2005) and Article 12 of the Law on Health Insurance, which are in the Second Chapter “Compulsory Health Insurance Services and Reimbursement of Their Costs” of the same law regulate the reimbursement for the individual healthcare services paid for from the budget of the Compulsory Health Insurance Fund and the reimbursement for the costs sustained by the insured.

7.3.3. After Article 3 of the Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009 and came into force on 1 January 2010 had supplemented Paragraph 1 of Article 17 (wording of 19 February 2009) of the Law on Health Insurance with Item 3, had amended Paragraphs 2, 3, 4, 6, 7, 8 and had recognised Paragraph 6 thereof as no longer valid, the legal regulation consolidated in Article 17 (wording of 19 February 2009) of the same law from the aspect disputed by the petitioner did not change.

Article 17 (wording of 22 July 2009) of the Law on Health Insurance established the amounts of the compulsory health insurance contributions for the separate groups of persons who must, under procedure established by this law, pay themselves the compulsory health insurance contributions, as well as on behalf of some of such persons their insurance payers must pay a part of those contributions:

– Paragraphs 1 and 2 of this article established the said amounts for the persons who work under employment contract, hold elective positions on membership basis in elective organisations, work in partnerships, agricultural companies or cooperative organisations, as well as who are state servants of public administration (Item 1 of Paragraph 1, Paragraph 2), for state politicians, judges and candidates to judges, officials of prosecutors’ offices, the chairman of the Board of the Bank of Lithuania, his deputies, members of the Board, the heads of state institutions or establishments and other officials appointed by the Seimas or the President of the Republic, the chairmen of state (standing) commissions and councils appointed by the Seimas or the President of the Republic, chairmen of other state (standing) commissions and councils, their deputies and members, as well as the officials of the commissions or councils set up under special laws, provided they receive remuneration for their work (Item 2 of Paragraph 1, Paragraph 2), owners of sole proprietorships and full members of partnerships (Item 3 of Paragraph 1, Paragraph 2), officials of the system of the internal service, the system of the State Security Department, the Special Investigation Service and the Prisons Department under the Ministry of Justice of the Republic of Lithuania as well as the officials of the establishments and enterprises subordinate thereto, servicemen in professional military service of the system of national defence and the statutory servants in civilian national defence service at the Second Investigation Department under the Ministry of National Defence (Paragraph 2), as well as for the insurance payers for all the above persons (Paragraph 1);

– Paragraphs 3–8 of this article established the said amounts for categories of other persons: for the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities and their insurance payers (Paragraph 3), for the natural persons engaged in a certain individual activity (Paragraph 4), for the natural persons who conduct individual activities under a business certificate (Paragraph 5), for the persons who do not fall within the above categories of persons, who are not insured with state funds and who possess holdings or farms of certain sizes (Paragraph 7), the permanent residents of Lithuania as defined in the Law on Personal Income Tax, who receive, from the budget of the State Social Insurance Fund, the benefits, specified in the Law on Sickness and Maternity Social Insurance, which are subject to the personal income tax (Paragraph 8);

– Paragraph 9 of this article established the said amounts for all other persons that do not fall within the categories of persons specified in Paragraphs 1–8 of this article and not insured with state funds.

7.3.4. It needs to be mentioned that, under Paragraphs 1 and 2 (wording of 22 July 2009) of Article 19 “Responsibility for Payment of Compulsory Health Insurance Contributions” of the Law on Health Insurance, in the event of violation of the procedure for calculating and paying the compulsory health insurance contributions, penalty charges are imposed and late payment interest is calculated in accordance with the procedure laid down by law.

7.3.5. Thus, while construing the legal regulation, consolidated in the impugned Paragraphs 2 and 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, in the context of Paragraphs 1 and 3 (wording of 22 December 2008) of the same article as well as other provisions of this law, one should note the following:

– the compulsory health insurance of the persons specified in Paragraph 2 (wording of 22 July 2009) of Article 8 of this law, i.e. those listed in Paragraphs 3–7 and 9 (wording of 22 July 2009) of Article 17 thereof, inter alia of the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities, differently from the compulsory health insurance of the persons specified in Paragraphs 1 and 3 (wording of 22 December 2008) of Article 8 thereof, becomes effective in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or as of the day that these persons have paid a contribution equal to 3 minimum monthly wages; thus, if those persons do not pay the contribution in the amount of 3 minimum monthly wages, their compulsory health insurance becomes effective only in the fourth month from the beginning of the paying of the compulsory health insurance contributions, whereas Paragraph 1 (wording of 22 December 2008) of this article established that the compulsory health insurance of the persons referred to in Paragraphs 1 and 2 (wording of 22 July 2009) of Article 17 of this law shall become effective as of the day on which compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, whilst Paragraph 3 (wording of 22 December 2008) of Article 8 established that the persons insured with state funds shall be regarded as the insured as of the day they acquire the corresponding status;

– with regard to all the persons specified in Paragraph 4 (wording of 22 July 2009) of Article 8 of this law who have been insured (or those that have obtained such insurance themselves), i.e. with regard to the persons listed in Paragraphs 1–7 and 9 of Article 17 (wording of 22 July 2009) of this law, who must pay themselves the compulsory health insurance contributions (on behalf of some of them such contributions must also be paid by their insurance payers), inter alia with regard to the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities, and with regard to the persons listed in Paragraph 4 (wording of 22 July 2009) of Article 6 of the same law, i.e. the persons insured with state funds, one established the equal one-month term correspondingly after they themselves stop paying compulsory health insurance contributions for themselves or, for some of them, their insurance payers stop paying such contributions, or they lose the status of persons covered with the insurance with state funds, during which they are still rendered the services that are covered from the budget of the Compulsory Health Insurance Fund, thus, one established the same period of the discontinuance of the validity of the compulsory health insurance for all insured persons (for those that have obtained such insurance themselves).

7.4. While deciding whether Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance was not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law, one should note that the said paragraph had established that the compulsory health insurance of the persons specified in Paragraphs 3–7 and 9 (wording of 22 July 2009) of Article 17 of this law, inter alia of the persons receiving income under authors’ agreements, or income from sports activities, or from performing activities, becomes valid as of the day that they pay a contribution equal to 3 minimum monthly wages, or in the fourth month from the beginning of the paying of the compulsory health insurance contributions.

7.4.1. It has been mentioned that the petitioner impugns the compliance of Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on State Social Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law only from the aspect that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, are covered by the insurance on a compulsory basis.

After it has been held that Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance that established the duty of the persons who receive income under authors’ agreements, or from sports activities, or from performing activities to pay the compulsory health insurance contributions was not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law, there are not any arguments substantiating the prohibition of the establishment of the entry into effect of such persons’ compulsory health insurance through Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance.

7.4.2. One should assess in a different manner the fact that the compulsory health insurance of all the aforesaid persons specified in Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance becomes valid as of the day that they pay a contribution equal to 3 minimum monthly wages, or in the fourth month from the beginning of the paying of the compulsory health insurance contributions, differently from the entry into effect of the compulsory health insurance of the persons specified in Paragraph 1 (wording of 22 December 2008) of this article, which become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions.

It has been mentioned that, having chosen the model of healthcare funding based inter alia upon compulsory health insurance, the legislator must inter alia establish the persons covered by this insurance, the amount (amounts) of the insurance contributions, the terms of payment, and the period of the insurance validity. As mentioned before, when regulating the relations related to the period of the entry into effect of the compulsory health insurance, one must heed the requirements stemming from the Constitution, inter alia Paragraph 1 of Article 53 thereof, the constitutional principles of social solidarity, justice, reasonableness, proportionality, and the equality of persons.

It has also been mentioned that the constitutional principle of the equality of all persons before the law, as entrenched in Article 29 of the Constitution, requires that in law the main rights and duties be established equally to all; this principle means the innate right of a human being to be treated equally with others, it obliges one to legally assess homogenous facts in the same manner and prohibits from the arbitrary assessment of the facts that are the same in essence in a different manner, but it does not deny a different legal regulation, established by law, with respect to certain categories of persons who are in different situations; the constitutional principle of the equality before the law would be violated if certain persons or groups thereof were treated in a different manner, even though there are not any differences of such a character and to such an extent between the said groups of persons so that their uneven treatment could be objectively justified.

As mentioned before, the Law on Health Insurance has established the duty both to the persons specified in Paragraph 1 (wording of 22 December 2008) of Article 8 thereof and the persons specified in Paragraph 2 (wording of 22 July 2009) of the same article to pay the compulsory health insurance contributions themselves, whilst on behalf of some of them part of the contributions must be paid by their insurance payers.

Thus, from the standpoint of their duty to pay the compulsory health insurance contributions, there are not any differences of such a character and to such an extent between the persons specified in in Paragraph 1 (wording of 22 December 2008) of Article 8 of the Law on Health Insurance and the persons specified in Paragraph 2 (wording of 22 July 2009) of the same article, so that their uneven treatment—the different period of the entry into force of the compulsory health insurance—could be objectively justified.

It should be noted that, while heeding the requirements stemming from Paragraph 1 of Article 53 of the Constitution and the constitutional principles of social solidarity, justice, reasonableness, proportionality, and the equality of rights of persons, the legislator enjoys the discretion to establish the period of entry into effect of the compulsory health insurance, however, the establishment of a different period of entry into effect of the compulsory health insurance of certain groups of persons, even though there are not any differences of such a character and to such an extent between the said groups of persons so that their uneven treatment could be objectively justified, is not allowed.

Thus, it needs to be held that the legislator, having established, in Paragraph 1 (wording of 22 December 2008) of Article 8 of the Law on Health Insurance, that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, and having established, in Paragraph 2 (wording of 22 July 2009) of the same article, a different, less favourable period of entry into effect of the compulsory health insurance of the persons specified in the said paragraph, disregarded the prohibition, stemming from Article 29 of the Constitution, against the uneven treatment of certain persons or groups thereof, when there are not any differences of such a character and to such an extent between the said groups of persons so that their uneven treatment could be objectively justified.

While taking account of the arguments set forth, one should draw a conclusion that Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, insofar as, after the legislator had established that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, was in conflict with Article 29 Constitution.

7.5. Article 2 of the Law Amending and Supplementing Articles 6, 8, 17, 18, and 19 of the Law on Health Insurance that was adopted by the Seimas on 22 July 2009 and came into force on 1 January 2010 amended Paragraph 1 (wording of 22 December 2008) and Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, by pointing out in Paragraph 1 (wording of 13 December 2011) of Article 8 of the Law on Health Insurance, but not in Paragraph 2 (wording of 13 December 2011) of the same article, the period of the entry into effect of the compulsory health insurance of the persons listed in Paragraph 6 (wording of 13 December 2011) of Article 17 of the Law on Health Insurance—as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions.

It should be noted that the legal regulation consolidated in Paragraphs 1 and 2 (wording of 13 December 2011) of Article 8 of the Law on Health Insurance, with the exception of the aforesaid amendments, was identical to the one consolidated respectively in Paragraph 1 (wording of 22 December 2008) and Paragraph 2 (wording of 22 July 2009) of Article 8 of the same law.

Thus, having held that Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, insofar as, after the legislator had established that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, was in conflict with Article 29 Constitution, on the grounds of the analogous arguments one should hold that Paragraph 2 (wording of 13 December 2011) of Article 8 of the Law on Health Insurance, insofar as, after the legislator had established that that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, was in conflict with Article 29 Constitution.

7.6. Article 1 of the Republic of Lithuania’s Law Amending and Supplementing Articles 8, 17, and 18 of the Law on Health Insurance that was adopted by the Seimas on 13 November 2012 and came into force on 1 April 2013 amended Paragraph 2 (wording of 13 December 2011) of Article 8 of the Law on Health Insurance, by establishing therein the aforesaid duration of the entry into effect of the compulsory health insurance also with regard to the persons listed in Paragraph 91 (wording of 13 November 2012) of Article 17 of the Law on Health Insurance, i.e. with regard to the renderers of agricultural and forestry services rendered under a service receipt established by law (the recipients of those services pay the compulsory health insurance contributions for the renderers of such services), however, from the aspect investigated in the case at issue, the legal regulation consolidated in Paragraph 2 (wording of 13 November 2012) of Article 8 of the Law on Health Insurance is identical to the one consolidated in Paragraph 2 (wording of 22 July 2009) of Article 8 of this law.

Thus, having held that Paragraph 2 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance, insofar as, after the legislator had established that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, was in conflict with Article 29 Constitution, on the grounds of the same arguments one should hold that Paragraph 2 (wording of 13 November 2012) of Article 8 of the Law on Health Insurance, insofar as, after the legislator had established that that the compulsory health insurance of some persons shall become effective as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, is in conflict with Article 29 Constitution.

7.7. While deciding whether Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance is not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law, one should note that that this paragraph established for all insured persons (or those who obtained insurance themselves) the same period of the discontinuance of the compulsory health insurance—the equal one-month term correspondingly after they themselves stop paying compulsory health insurance contributions for themselves or, for some of them, their insurance payers stop paying such contributions, or they lose the status of the persons covered with the insurance with state funds, during which they are rendered the services that are still covered from the budget of the Compulsory Health Insurance Fund.

7.7.1. It should be noted that the petitioner impugns the compliance of Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on State Social Insurance with Article 23 of the Constitution and the constitutional principle of a state under the rule of law only from the aspect that this paragraph establishes the period of the discontinuance of the validity of the compulsory health insurance of the persons receiving income under authors’ agreements, or from sports activities, or from performing activities, who should not be covered by the insurance in a compulsory manner.

After it has been held that Paragraph 3 (wording of 22 July 2009) of Article 17 of the Law on Health Insurance that established the duty of the persons who receive income under authors’ agreements, or from sports activities, or from performing activities to pay the compulsory health insurance contributions was not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law, there are not any arguments substantiating the prohibition of the establishment of the discontinuance of the validity of such persons’ compulsory health insurance through Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance.

7.7.2. It has been mentioned that Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance established for all insured persons (or those who obtained insurance themselves) the same period of the discontinuance of the compulsory health insurance—the one-month term of the rendering of the services that are covered from the budget of the Compulsory Health Insurance Fund after the insured persons themselves stop paying compulsory health insurance contributions for themselves or, for some of them, their insurance payers stop paying such contributions, or they lose the status of persons covered with the insurance with state funds.

As mentioned before, having chosen the model of healthcare funding based inter alia upon compulsory health insurance, the legislator must inter alia establish the persons covered by this insurance, the amount (amounts) of the insurance contributions, the terms of payment, and the period of the insurance validity. It has also been mentioned that, when regulating the relations related to the period of the discontinuance of the validity of the compulsory health insurance, one must heed the requirements stemming from the Constitution, inter alia Paragraph 1 of Article 53 thereof, from the constitutional principles of social solidarity, justice, reasonableness, proportionality, and the equality of persons.

It needs to be held that, in itself, the aforesaid period of the discontinuance of the validity of the compulsory health insurance established in Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance may not be assessed as insufficient, unreasonable, and as creating preconditions for a violation of the requirements stemming from the Constitution.

7.7.3. Taking account of the arguments set forth, one is to draw a conclusion that Paragraph 4 (wording of 22 July 2009) of Article 8 of the Law on Health Insurance is not in conflict with Article 23 of the Constitution and the constitutional principle of a state under the rule of law.

Conforming to Articles 102 and 105 of the Constitution of the Republic of Lithuania and Articles 1, 53, 54, 55, and 56 of the Law on the Constitutional Court of the Republic of Lithuania, the Constitutional Court of the Republic of Lithuania passes the following

ruling:

  1. To recognise that Paragraph 3 (wording of 22 July 2009; Official Gazette Valstybės žinios, 2009, No. 93-3981) of Article 4 of the Republic of Lithuania’s Law on State Social Insurance, insofar as it provided that self-employed persons shall be covered on a compulsory basis by sickness and maternity social insurance, where a person is insured to receive only the maternity, paternity, and maternity (paternity) payments, was not in conflict with the Constitution of the Republic of Lithuania.
  2. To recognise that Paragraph 5 (wording of 22 July 2009; Official Gazette Valstybės žinios, 2009, No. 93-3981) of Article 4 of the Republic of Lithuania’s Law on State Social Insurance, insofar as it provided that the persons who receive income under authors’ agreements, or from sports activities, or from performing activities, shall be covered by state social insurance on a compulsory basis, was not in conflict with the Constitution of the Republic of Lithuania.
  3. To recognise that Paragraph 1 (wording of 22 September 2009; Official Gazette Valstybės žinios, 2009, No. 117-4992) of Article 21 of the Republic of Lithuania’s Law on Sickness and Maternity Social Insurance was not in conflict with the Constitution of the Republic of Lithuania.
  4. To recognise that Article 2 of the Republic of Lithuania’s Law Amending Article 21 of the Law on Sickness and Maternity Social Insurance (Official Gazette Valstybės žinios, 2009, No. 117-4992) is not in conflict with the Constitution of the Republic of Lithuania.
  5. To recognise that Paragraph 9 (wording of 19 February 2009; Official Gazette Valstybės žinios, 2009, No. 25-985) of Article 17 of the Republic of Lithuania’s Law on Health Insurance is not in conflict with the Constitution of the Republic of Lithuania.
  6. To recognise that Paragraph 3 (wording of 22 July 2009; Official Gazette Valstybės žinios, 2009, No. 93-3983) of Article 17 of the Republic of Lithuania’s Law on Health Insurance was not in conflict with the Constitution of the Republic of Lithuania.
  7. To recognise that Paragraph 2 (wording of 22 July 2009; Official Gazette Valstybės žinios, 2009, No. 93-3983; wording of 13 December 2011, Official Gazette Valstybės žinios, 2011, No. 160-7564; wording of 13 November 2012, Official Gazette Valstybės žinios, 2012, No. 136-6967) of Article 8 of the Republic of Lithuania’s Law on Health Insurance, insofar as, after the legislator had established that the compulsory health insurance of some persons shall become effective only as of the day on which the compulsory health insurance contributions started to be paid on behalf of them or they themselves started paying the said contributions, this paragraph established that, with regard to the persons specified in the said paragraph, the compulsory health insurance shall become effective only in the next month following the day where the compulsory health insurance contributions were paid on behalf of them or they themselves paid the said contributions 3 months in succession, or only as of the day that these persons have paid a contribution equal to 3 minimum monthly wages, is (was) in conflict with Article 29 Constitution.
  8. To recognise that Paragraph 4 (wording of 22 July 2009; Official Gazette Valstybės žinios, 2009, No. 93-3983) of Article 8 of the Republic of Lithuania’s Law on Health Insurance is not in conflict the Constitution of the Republic of Lithuania.

This ruling of the Constitutional Court is final and not subject to appeal.

Justices of the Constitutional Court:                        Egidijus Bieliūnas

                                                                                             Toma Birmontienė

                                                                                             Gediminas Mesonis

                                                                                             Ramutė Ruškytė

                                                                                             Egidijus Šileikis

                                                                                             Algirdas Taminskas

                                                                                             Romualdas Kęstutis Urbaitis

                                                                                             Dainius Žalimas