How are medical costs reimbursed?
Medical bills that you settle on the spot must be sent to the
appropriate Settlements Office, together with the relevant supporting
documents and proof of payment. The costs will then be reimbursed up to
the maximum level, in the same way as the reimbursement of standard
medical expenses.
If you need to be hospitalised, first of all call on your travel
insurance company, if you have one. In fact, these companies pay all the
costs on the spot while the JSIS only pays directly if you are in
hospital for at least two nights.
To obtain a letter of direct billing from the JSIS; contact your
Settelements Office:
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Brussels:
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Tél.: (+ 32) 2.295.98.56
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- Fax: (+ 32) 2.295.97.01
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Luxembourg:
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Tél.: (+ 352) 4301.36103/36406
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- Fax: (+ 352) 4301.36019
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Ispra:
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Tél.: (+ 39) 0332.789966/5757
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- Fax: (+ 39) 0332.789423
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Karlsruhe:
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Tél.: (+ 49) 7247.951-534
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- Fax: (+ 49) 7247.22696
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European Parliament :
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Tél.: (+ 352) 4300.23976
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- Fax: (+ 352) 43.49.69
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Council:
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Tél.: (+ 32) 2.285.63.47
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- Fax: (+ 32) 2.285.87.38.
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For those people (spouses, children, ...) who have their primary
insurance with a national system, find out before you leave about the
procedures to be followed in case of treatment in another country (for
example the E111 form for EU member states, some other document in case
of a bilateral agreement, etc ...).
be careful of incurring high medical expenses, especially in
countries outside the european union!
The cost of medicine is so high in some countries (USA, Japan, South
American, etc.) that even after the sickness scheme’s reimbursement,
you could be left with a very large amount to pay yourself.
This is obvious for those expenses subjected to a maximum
reimbursable amount, but is also true for those whose reimbursements are
not limited by the Sickness Rules (for example X-ray costs, laboratory
analyses, certain hospitalisation costs, etc). In these cases, the
reimbursements could be limited by the Settlements Office to the tariffs
pratised in Europe. These limits could also be applied in the case of a
serious illness.
A special reimbursement (cf. Article 72§3 of the Staff Regulations)
is foreseen when these expenses reach a certain level, but some are not
taken into consideration during the calculation of this reimbursement.
If you are hospitalised for at least two days, you are advised to pay
nothing directly to the hospital, but to ask for a letter of direct
billing.
If you plan to stay in one of these expensive countries, you are
advised to take out extra insurance in accordance with your personal
situation.
Which transport costs are covered by the Sickness Insurance scheme?
If you fall sick or have an accident while outside your country of
residence, the cost of your transport home is never reimbursed by the
sickness insurance scheme (except under certain conditions for people
posted outside the Community). To cover such eventualities it is
advisable to take out private travel insurance (for example, from your
credit card providers, if you have paid for your trip in this way).
The coverage provided by the sickness insurance scheme is limited
exclusively to transport costs in emergencies caused by sickness or
accident (road accidents, sporting accidents, etc.), regardless of the
type of transport used (ambulance, helicopter, etc.). The scheme covers
only the cost of the journey from the place where you are staying or
where the accident happened to the nearest hospital, and the cost of a
transfer to the nearest hospital with the correct equipment for treating
you if this hospital cannot provide the appropriate treatment. The cost
of travel back home is not generally reimbursed.
Procedure to be followed if you have private insurance
If you fall ill, have an accident or are hospitalised, we advise you
to first contact your private insurance company. In this way, if you
need medical care during your stay abroad, the cost will generally be
settled directly by your private insurers. In fact, in most cases,
private insurance companies will pay your bills for you and will later
recuperate from the Settlements Office the amount it would have
reimbursed you, without you making any payment at all.
Coverage provided by the accident insurance scheme
All serving officials and temporary officials have world-wide
coverage for accidents both at the workplace and in their private life,
with the exception of those resulting from sports regarded as dangerous
(parachuting, boxing, karate, speleology, underwater fishing and
exploration with breathing equipment including containers for the supply
of air or oxygen).
Members of the families of officials and temporary officials, and
retired officials are excluded from such coverage. However the medical
expenses incurred by accidents involving these people will be reimbursed
by the sickness insurance scheme on the same conditions and at the same
rates as for standard medical expenses.
In all cases, if the accident is the fault of a third party, you
should send a note to the Accident Sector, recounting the details, as
well as giving the contact details of the person(s) responsible. The
sickness scheme will claim back from the person responsible any
reimbursements it has had to make.
The accident declaration form is available on the Institutions'
intranet at the following address:
http://intracomm.cec.eu-admin.net/guide/assmal/formulaire/formulaires_en.htm
This form must be sent within ten working days of the date on which
the accident occurred to the following address:
For officials of the Commission, the Agencies, the Court of Auditors,
the Committee of the Regions and the Economic and Social Committee:
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Brussels
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European Commission
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Unit PMO/3
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Accident and Occupational Disease Sector
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Building B-28 3/126
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B-1049 Brussels
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E-mail address: accidents-maladies-prof@ec.europa.eu
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Tel.: 02 296.05.95
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Luxembourg
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European Commission
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Caisse de Maladie
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Unit PMO/5
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(Wagner C2/02)
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Plateau du Kirchberg
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L-2920 Luxembourg
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Ispra C.C.R.
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Ufficio liquidatore
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Unit PMO/6
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TP 640
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I-21020 Ispra (Varese)
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Court of Justice:
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Court of Justice
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Personnel Division
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Erasmus Building
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L-1046 Luxembourg
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Council:
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General Secretariat of the Council of Ministers
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"Accident Insurance" Service
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Building "Justus Lipsius" 03 70 FK 30
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175, rue de la Loi
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B-1048 Brussels
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Fax: 02 285.64.92
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European Parliament and European Ombudsman:
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Mrs Woillot
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KAD 2D 016
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Plateau du Kirchberg
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L-2929 Luxembourg
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Tel.: (+ 352) 4300.22528 - Fax: 434969
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If you suffer an accident and are not able to have the doctor
who provides the initial treatment fill out an accident declaration
form, you can send in the declaration form and, at a later date, submit
the initial accident report, completed and signed by your doctor and
specifying the nature of the injuries, your previous medical history
where relevant to the injuries and the probable medical consequences of
the accident. If you were examined on the spot (X-rays, CT scanner,
etc.), ask for a copy of the report to send in for your file (and keep
the pictures yourself).
Which departments do you have to inform?
In the event of sickness or accident during your holiday, you must
notify both the Medical Service at your institution and your department.
If you are sick while on annual leave, you can recuperate these leave
days by faxing to your Medical Service a copy of your medical
certificate which should indicate the beginning (and if possible the
end) date(s) of your illness. This should be done during the first few
days of your illness. Mention also the address where you are staying.
The precise rules in this respect (documents to be submitted, timescale
permitted) may vary slightly from Institution to Institution.
Medical services at the Commission (including the Court of Auditors):
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Brussels:
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Tél.: (+ 32) 2.295.69.83/4
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- Fax: (+ 32) 2.299.20.56
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Luxembourg:
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Tél.: (+ 352) 4301.34146/32588
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- Fax: (+ 352) 4301.34711
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Ispra:
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Tél.: (+ 39) 033278.9965
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- Fax: (+ 39) 033278.9051
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Karlsruhe:
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Tél.: (+ 49) 7247.951444
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- Fax: (+ 49) 7247.951591
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