Healthcare is a fundamental right that should be accessible to all citizens. The state carries significant responsibility to ensure services are delivered fully and that individuals can exercise their healthcare rights. Equally important is determining who is eligible to benefit from these services. In our country, many services are provided under the leadership of the Social Security Institution (SGK), and healthcare for those covered by General Health Insurance—and for the dependents they are legally required to support—is generally funded by SGK. Some people pay their own premiums (those covered by general health insurance), and in exceptional circumstances the state may cover these premiums. If dependents are relatives of an insured person, they may also be eligible for state-provided health services. In this article, we will explain the topic of dependents covered under the Pension Fund (Emekli Sandığı).
Who Is Considered a Dependent
Dependents of a person with general health insurance are classified into specific groups, and eligibility (or loss of eligibility) for each group—such as spouse, children, mother and father—is tied to defined rules and conditions. Below we examine in detail the conditions that determine whether someone qualifies as a dependent.
Spouse of the Insured
The spouse of an insured person is included among those who can be considered a dependent under the Pension Fund. Spouses of general health insurance holders who have no independent income are entitled to use healthcare services as dependents. For a spouse to continue receiving these services, the marital relationship must remain in effect; divorce terminates dependent status. Once the divorce is officially recorded, the spouse ceases to be a dependent from that date.
Another scenario is when both spouses are insured workers. In that case, each spouse can claim health insurance rights on their own behalf, and dependent status is no longer required. If one spouse dies after having worked for a sufficient period, the surviving spouse may be entitled to a survivor’s pension. For a survivor’s pension to be granted, the deceased spouse must have completed the required number of premium payment days. In addition, a beneficiary who receives a survivor’s pension must not remarry; otherwise, eligibility for the pension and related health benefits may end.
Daughters of the Insured and the 01.10.2008 Cutoff
The law does not establish a single universal rule for daughters’ eligibility as dependents, but an important date to note is October 1, 2008. Daughters born before that date were accepted as dependents without an age limit provided they had not started working, had no income, and had not married. If a daughter loses dependent status because one of these disqualifying conditions occurs, she can regain her rights if the condition that caused the loss is later removed. Thus, daughters born before 01.10.2008 who acquired rights through their parents enjoy some advantages.
Daughters born after 01.10.2008 who did not automatically gain dependent entitlement through their parents may still access healthcare benefits for a limited period. Their eligibility is assessed similarly to that of sons. Specifically, daughters in this category can generally benefit from health services up to the age of 18, and if they continue their education, up to ages ranging from 20 to 25 depending on the circumstances.
Under Law No. 5434 governing the Pension Fund, daughters of public servants who began duty before 01.10.2008 are entitled to use healthcare services regardless of their birth date and without an age limit. However, public servants who started after that ruling and who are evaluated under the 4/c status have their daughters treated the same as sons with respect to birth date, and daughters lose eligibility by age 25 at the latest.
Sons of the Insured
The 01.10.2008 date noted above does not affect sons. Male children may remain dependents provided they have not started working, do not have insured employment or other income, and have not married. Standard age limits apply: eligibility generally continues until age 18; until age 20 if they are receiving vocational apprenticeship or trainee training under Law No. 3308; and until age 25 if they are enrolled in university. The fact that the parent who provides coverage later retires does not nullify the child’s entitlement to benefit from health services.
Disabled Children of the Insured
The state provides extensive provisions for disabled children who are considered dependents. In fact, disabled children often receive more comprehensive healthcare rights than other categories. Children recognized as disabled by the Institution’s Medical Board are regarded as dependents regardless of age and can benefit from health services through their mother or father. According to Law No. 2022, as long as the disabled status remains unchanged, their entitlement to healthcare services continues without age restrictions.
Parents of the Insured
Parents are also included among dependents under the Pension Fund if certain conditions are met. Parents may be eligible to benefit from the services accessed by the insured person based on their financial circumstances. Eligibility is determined by evaluating the insured person’s entire income and computing the per-person income within the household. If the parent’s share of household income, after subtracting the minimum subsistence amount, falls below a specified threshold, the parent can, upon request, receive healthcare services through their child who is insured.