Cover for member's spouse/recognised partner⁽¹⁾

Application of Articles 3 and 6 of the Rules on Sickness Insurance for Officials of the European Communities

Updating for 2005

Article 3 of the Rules on Sickness Insurance provides that a member's spouse/recognised partner is to receive primary cover under the member's insurance, provided that the spouse/recognised partner is not gainfully employed. If your spouse/recognised partner has no professional income from gainful employment, pension or allowances (unemployment, invalidity...), you do not have to do anything.

If your spouse/recognised partner is gainfully employed⁽²⁾ or in receipt of income deriving from previous gainful employment (for example a retirement or invalidity pension or some other allowance), he/she may be entitled to supplementary reimbursement under the Joint Sickness Insurance Scheme, provided that both the following conditions are fulfilled:

1. he/she must be covered against the same risks as those covered by the scheme, by virtue of all other legal provisions or rules;
    
2. his/her annual income from such employment before tax⁽³⁾ must not exceed the basic annual salary of an official in the first step of Grade C*2, subject to the weighting for the country in which he/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/recognised partner’s income from present or previous gainful employment to : (see list).

The relevant documents are:

• if the spouse/recognised partner 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 2004. If the spouse/recognised partner 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/recognised partner, the tax certificate relating to income received during 2004 or, pending the availability of such certificate, the certificate relating to 2003. For spouses/recognised partners self-employed in Belgium, proof of insurance against minor risks ("petits risques") must also be submitted.

As from 1 July 2005, reimbursement of medical expenses for spouses/recognised partners currently receiving supplementary cover will be suspended pending receipt of the requisite documentary evidence.

Save in cases where the spouse/recognised partner stops working during the course of the year or where there is a significant alteration in the circumstances of his/her employment (e.g. switching from full-time to half-time work and vice versa), the decision providing supplementary cover will be valid from 1^st July 2005 to 30 June 2006.

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.

To make a claim for a complementary reimbursement members should:

1. complete a claims form, clearly indicating the name of the patient;
    
2. attach all supporting documents:
    
   • copies of doctors' statements and the originals of chemists' receipts,
      
   • the statement of reimbursements provided by the mutuelle;
      
3. send the claim to the Claims Office.

Bruxelles + Karlsruhe

• Commission-Comité économique et social-Comité des Régions-European Data Protection Supervisor
  
  ( 32-2-295.80.37
  Fax 32-2-295.20.39
  
  Adresse postale:
   
  • Commission européenne
    PMO/3 - Caisse de Maladie
    B-28 3-150
    B-1049 Bruxelles

  Attention : Pour les frais médicaux :
  Karlsruhe: Bureau liquidateur de Karlsruhe
  Bureau liquidateur de Bruxelles: 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
    PMO-5 - Caisse de Maladie
    WAG C1-34
    L-2920 Luxembourg

Ispra

• ( 39-0332-785757
  Fax : 39-0332-789423
   
  • Adresse postale: C.C.R. Euratom
    PMO/6 - Ufficio Liquidatore
    TP 640
    I - 21020 Ispra (Varese)

___________________
Footnotes

⁽¹⁾ See Article 72 §1 of the Staff Regulations.

⁽²⁾ Even if the work is not full time or produces little income, for example free lance work, consultancy work or other self employed work.

⁽³⁾ means gross income minus deductible expenses and social security contributions.