RÉGIME COMMUN D'ASSURANCE MALADIE
COMMUNIQUÉ DU BUREAU CENTRAL
Cover for member' spouse
Application of Articles 3 and 6 of the Rules on Sickness Insurance for
Officials of the European Communities
Updating for 2003
Article 3 of the Rules on Sickness Insurance provides that a member's
spouse is to receive primary cover under the member's insurance, provided
that the spouse is not gainfully employed.
If the spouse is gainfully employed
1 or in receipt of income deriving from previous gainful
employment (for example a retirement or invalidity pension or some other
allowance), he or she may be entitled to supplementary reimbursement under
the Joint Sickness Insurance Scheme, provided that both the following
conditions are fulfilled:
- he or she must be covered against the same risks as those covered by
the scheme, by virtue of some other legal provisions or rules;
- his or her annual income from such employment before tax 2
must not exceed the basic annual salary of an official in
the first step of Grade C5, subject to the weighting for the country
in which he or she receives that income from gainful employment. The
relevant amounts for the various countries are set out at the end of
the document.
In order to enable their records to be updated, all members concerned must
send documentary evidence of their spouse's income from present or
previous gainful employment to F: (see page
2).
The relevant documents are:
- if the spouse is employed or retired, the tax certificate relating
to income received during the previous year or, pending the
availability of such certificate, a certificate from the employer
indicating the details of the income received during 2002. If the
spouse took up employment only recently, the most recent monthly pay
slip should be produced, indicating the prospective number of monthly
payments in the year;
- in respect of a self-employed spouse, the tax certificate relating
to income received during 2002 or, pending the availability of such
certificate, the certificate relating to 2001.
As from 1 July 2003, reimbursement of medical expenses for spouses
currently receiving supplementary cover will be suspended pending receipt
of the requisite documentary evidence.
Save in cases where the spouse stops working during the course of the year
or where there is a significant alteration in the circumstances of his or
her employment (e.g. switching from full-time to half-time work and vice
versa), the decision providing supplementary cover will be valid from
1st July 2003 to 30 June 2004.
Members must notify the relevant office responsible for settling claims of
any change in the circumstances of any person covered by their insurance,
having regard to Article 6(1) of the Rules and Article 72(4) of the Staff
Regulations, which provide that members must declare the benefits which
those persons can claim and which are received by them under any other
sickness insurance scheme provided for by law or regulation.
If your spouse has no professional income from gainful employment, pension
or allowances, you do not have to do anything.
To make a claim for a complementary reimbursement members should:
- complete a claims form, clearly indicating the name of the patient;
- attach all supporting documents:
- copies of doctors' statements and the originals of chemists'
receipts,
- the statement of reimbursements provided by the mutuelle;
- send the claim to the Claims Office.
Austria |
|
30.120,98EUR |
Belgium |
|
27.864,00 EUR |
Denmark |
279.211 DKK |
|
Finland |
|
33.994,08 EUR |
France |
|
33.074,57 EUR |
Germany |
|
28.978,56EUR |
Greece |
|
25.105,46 EUR |
Ireland |
|
34.774,27 EUR |
Italy |
|
29.368,66 EUR |
Luxembourg |
|
27.864,00 EUR |
Netherlands |
|
32.573,02 EUR |
Portugal |
|
25.105,46 EUR |
Spain |
|
27.139,54 EUR |
Sweden |
300.358 SEK |
|
United Kingdom |
26.892 GBP |
|
Switzerland |
51.588 CHF |
|
United States |
33.607 USD |
|
Japan |
5.209.083 JPY |
|
Australia |
45.484 AUD |
|
Bruxelles
|
Commission-Comité économique et social-Comité des
Régions
|
|
|
( 32-2-295.80.37
|
|
|
Fax : 32-2-295.20.39
|
Adresse postale:
|
Commission européenne
|
|
Caisse de Maladie
|
|
B-28 3-150
|
|
B-1049 Bruxelles
|
Attention: Pour les frais médicaux:
B-28 02/180.
|
Conseil des Ministres
|
|
|
Mme Christiane Dooms
|
|
( 32-2-285.73.41
|
|
|
Fax : 32-2-285.87.38
|
Adresse postale:
|
175,rue de la Loi (0370-FK-10)
|
|
B-1048 Bruxelles
|
|
Luxembourg
|
|
|
Commission-Parlement-Cour des Comptes-Cour de
Justice
|
M. Ives Remacle
|
|
( 352-4301-36302
|
|
|
Fax : 352-4301-36019
|
Adresse postale:
|
Commission européenne
|
|
Caisse de Maladie
|
|
|
WAG C1-34
|
|
|
L-2920 Luxembourg
|
|
Ispra
|
|
Mme Valeria Maronati
|
|
( 39-0332-789109
|
|
|
Fax : 39-0332-789423
|
Adresse postale:
|
C.C.R. Euratom
|
|
Ufficio Liquidatore
|
|
TP 640
|
|
I - 21020 Ispra (Varese)
|
Karlsruhe
|
|
Frau Susanne Kretz
|
|
( 49-7247-951534
|
|
|
Fax : 49-7247-22696
|
Adresse postale:
|
Krankenkasse der Europäischen Gemeinschaften
|
|
Postfach 2340
|
|
D-76125 Karlsruhe
|
|
Footnote
1 Even if the work is not full-time or produces little income,
for example free-lance work, consultancy work or other self-employed work.
2 This means gross income minus deductible expenses and social
security contributions.
|