Cover for the spouse or recognised partner⁽¹⁾ of a member of the Joint Sickness Insurance Scheme

Application of Articles 13 and 14 of the rules on sickness insurance for officials of the European Communities

Update 2007
(period of cover concerned: 01/07/2007 – 30/06/2008)

Article 13 of the above rules provides that a member's spouse or recognised partner benefits from primary cover under that member if they have no income of their own from gainful employment. If your spouse or recognised partner is already registered in the JSIS as having no income from gainful employment, no pension and no benefits (unemployment, invalidity, etc.), you do not have to do anything.

If during the abovementioned period of cover your spouse or recognised partner ceases to engage in gainful employment and does not receive a salary, allowance or pension (no income), please send the relevant supporting document to your Administration and Settlements Office as quickly as possible. Your spouse or registered partner will be entitled to primary cover from the day on which he/she ceased to engage in gainful employment.

Spouses or recognised partners who have an income from gainful employment may exceptionally benefit from primary cover under the JSIS if they cannot be affiliated to a legal or statutory sickness scheme or if the amount of the premiums to take out sickness insurance represents at least 20% of their taxable income from gainful employment.

If they exercise such an activity⁽²⁾ or receive income from the previous exercise of such an activity (for instance a retirement pension, an invalidity pension or other allowances), they may be entitled to top up reimbursements from the Joint Sickness Insurance Scheme, provided that the following two conditions are fulfilled:

1. they are covered for the same risks under any other legal or statutory provisions (sickness, maternity, hospitalisation); and
    
2. their annual income from gainful employment is not higher than the basic annual salary of a staff member in the first step of grade AST2, weighted at the rate for the country where they receive their income from gainful employment, before deduction of tax⁽³⁾ . The amounts for the different countries are listed at the end of this document.

In order to update their files, the members concerned must send the supporting documents relating to their spouse's or recognised partner's income from current or former gainful employment to F: (see table).

Such supporting documents may take the form of:

1. for employees, self employed, unemployed and retired persons, their latest tax certificate (from the Finance Ministry of the country concerned, even if it relates to income received in 2005) or failing that, any other document issued by the competent national authorities (standard statement of annual earnings approved by the national authorities);
    
2. if the spouse or recognised partner recently took up gainful employment, he/she will no longer be entitled to primary cover. Top up cover will only be provided from the start of the gainful employment upon receipt of a sworn statement to the effect that the annual taxable income of the spouse or recognised partner is not likely to exceed the ceiling laid down. The JSIS reserves the right to recover sums unduly reimbursed where it transpires that the income at issue has exceeded the ceiling;
    
3. self employed persons in Belgium must also provide proof of insurance cover against minor risks.

From 1 July 2007 reimbursements of the medical expenses of spouses and recognised partners currently benefiting from top up cover will be suspended pending receipt of the required supporting documents.

Where their income currently exceeds the ceiling, top up cover cannot be awarded to the spouses or recognised partners during the reference period, except where they terminate their gainful employment during the year or where their professional situation changes substantially (invalidity or retirement). Such cover will be awarded for the following reference period upon presentation of the supporting tax document (see point (a) above).

Members must notify their Settlements Office of any change in the situation of the persons insured under their name, taking into account Article 22 of the rules on sickness insurance and Article 72(4) of the Staff Regulations, which provide that members must declare the amount of any reimbursements paid or which they can claim under any other sickness insurance scheme provided for by law or regulation.

For top up reimbursements, please:

1. fill out a reimbursement claim clearly mentioning the name of the patient;
    
2. attach the supporting documents in your possession:
    
   • copies of doctors' certificates and pharmacists' receipts
   • the original statement of account from the spouse's or recognised partner's primary scheme;
      
3. send all the documents to the Settlements Office.

_______________________
Footnotes

⁽¹⁾ See Articles 72§1, second indent and 1(2)(c) of Annex VII to the Staff Regulations.
⁽²⁾ Even if the gainful activity is not exercised full time or gives rise to a low income, for instance freelance workers or other self employed persons.
⁽³⁾ Gross income, minus occupational expenses and social security contributions.