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 2006
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:
- he/she must be covered against the same risks as those covered by
the scheme, by virtue of all other legal provisions or rules;
- 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 (future AST2), 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
F:
(see page 2).
The relevant documents are:
- if the spouse/recognised partner is in gainful employment, a
certificate from the employer(s) indicating the details of salaries
received during 2005;
- if the spouse/recognised partner is retired or in receipt of an
allowance (unemployment, sickness, maternity, ….) a certificate from the
relevant authority indicating the amounts paid in 2005;
- if the spouse/recognised partner took up employment only recently,
the most recent monthly pay slip, indicating the prospective number of
monthly payments in the year (as a new decision has to be taken at that
moment concerning the person’s right to JSIS cover);
- in respect of a self employed spouse/recognised partner, the tax
certificate relating to income received during 2004. For
spouses/recognised partners self-employed in Belgium, proof of insurance
against minor risks ("petits risques") must also be submitted.
The Administration reserves the right to request the tax certificate
relating to income received during 2004.
As from 1 July 2006, 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 1st July 2006 to 30 June 2007.
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:
- 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.
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 |
|
SC27 1/21 |
|
B-1049 BRUXELLES |
|
|
Attention: |
Pour les frais
médicaux : |
|
Karlsruhe: Bureau
liquidateur de Karlsruhe |
|
Bureau liquidateur
de Bruxelles: SC27 00/5 |
|
|
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 (VA) |
Effet 1/1/2006 |
|
|
Contrevaleur
|
PAYS |
Montant |
Devise |
Montant |
€ |
|
|
|
|
|
ALLEMAGNE |
63.676,00 |
DEM |
32557,02 |
€ |
PAYS-BAS |
78.548,53 |
NLG |
35643,77 |
€ |
DANEMARK |
328.927,54 |
DKK |
44156,68 |
€ |
ROYAUME-UNI |
31.159,94 |
GBP |
46723,55 |
€ |
FRANCE |
253.629,25 |
FRF |
38665,53 |
€ |
IRLANDE |
31.321,63 |
IEP |
39770,26 |
€ |
ITALIE |
70.337.138 |
ITL |
36326,1 |
€ |
GRECE |
10.296.647 |
GRD |
30217,6 |
€ |
ESPAGNE |
5.471.094 |
ESP |
32881,94 |
€ |
PORTUGAL |
5.960.374 |
PTE |
29730,22 |
€ |
BELGIQUE |
1.310.726 |
BEF |
32492,04 |
€ |
LUXEMBOURG |
1.310.726 |
LUF |
32492,04 |
€ |
AUTRICHE |
478.844,27 |
ATS |
34798,97 |
€ |
SUEDE |
344.514,05 |
SEK |
36521,05 |
€ |
FINLANDE |
227.383,33 |
FIM |
38243,13 |
€ |
CHYPRE |
17.143,45 |
CYP |
29892,68 |
€ |
ESTONIE |
408.237,13 |
EEK |
26091,11 |
€ |
HONGRIE |
7.242.281 |
HUF |
29242,84 |
€ |
LETTONIE |
17.217,02 |
LVL |
24726,44 |
€ |
LITUANIE |
86.497,35 |
LTL |
25051,36 |
€ |
MALTE |
12.498,15 |
MTL |
29112,87 |
€ |
POLOGNE |
107.172 |
PLN |
26448,52 |
€ |
REPUBLIQUE TCHEQUE |
884.017 |
CZK |
29437,79 |
€ |
SLOVAQUIE |
1.159.319 |
SKK |
30185,11 |
€ |
SLOVENIE |
6.457.851 |
SIT |
26968,39 |
€ |
USA |
40.923,45 |
USD |
33629,26 |
€ |
CANADA |
40.341,21 |
CAD |
24661,46 |
€ |
JAPON |
5.735.506,92 |
JPY |
43506,84 |
€ |
AUSTRALIE |
53.269,68 |
AUD |
30445,04 |
€ |
SUISSE |
58.236,91 |
CHF |
38113,16 |
€ |
USA |
40.923,45 |
USD |
33629,26 |
€ |
___________
Footnotes
(1) See Article 1§2(c) of Annex
VII 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) This means gross income minus
deductible expenses and social security contributions. |