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

Update 2008
(period of cover concerned: 01/07/2008 – 30/06/2009)

This Administrative Notice concerns those members of the Joint Sickness Insurance Scheme (JSIS) whose spouse or recognised partner benefits or could be entitled to benefit from JSIS cover, and the conditions applying under Articles 13 and 14 of the rules on sickness insurance for officials of the European Communities.

This update concerns cover during the period from 1 July 2008 to 30 June 2009.

JSIS cover for spouses or recognised partners without income.

As a member of the JSIS, your spouse or recognised partner benefits from you primary cover if he or she has no income of his/her own from gainful employment, as provided for under Article 13 of the rules on sickness insurance for officials of the European Communities. 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.), there is no need to do anything.

If during the period of cover from 1 July 2008 to 30 June 2009 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 (for specific details, see section below on "updating a spouse's or recognised partner's file") to your Administration and Settlements Office (see Annex 1 for addresses) as quickly as possible. Your spouse or registered partner will be entitled to primary cover from the day on which he/she ceases to earn income from such gainful employment.

Exceptional JSIS cover for gainfully employed spouses or recognised partners

If your spouse or recognised partner has an income from gainful employment, he or she may exceptionally benefit from primary cover under the JSIS if:

• he or she cannot be affiliated to a legal or statutory sickness scheme or
   
• the amount of the premiums it would cost him/her to take out sickness insurance represents at least 20% of his/her annual taxable income from gainful employment.

If in gainful employment ⁽²⁾ or receiving income from previous gainful employment (for instance a retirement pension, an invalidity pension, unemployment benefit or other allowance), your spouse or recognised partner may be entitled to top-up reimbursements from the Joint Sickness Insurance Scheme, provided that the following two conditions are fulfilled:

1. his/her primary cover (under other legal or statutory provisions) covers the same risks (sickness, maternity, hospitalisation); and
    
2. his/her annual income from gainful employment, before deduction of tax ⁽³⁾ , 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 the income from gainful employment is received. The amounts for the different countries are listed in Annex 2.

Updating a spouse's or recognised partner's file

In order to update your spouse's or recognised partner's file, you, as a member of the JSIS, must send to your Administration and Settlements Office (see Annex 1)  the latest tax certificate (complete and without crossings-out) delivered by the Finance Ministry of the country concerned, even if it relates to income received in 2006, or failing that, any other document issued by the competent national authorities (standard statement of annual earnings approved by the national authorities). This tax certificate is the only acceptable supporting document required.

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 (available from the JSIS website – Forms Online/Membership). A salary slip and a copy of the contract should be attached the declaration. The JSIS reserves the right to recover sums unduly reimbursed where it transpires that the income at issue has exceeded the ceiling.

Suspension of reimbursement of medical expenses for beneficiaries of top-up cover pending receipt of tax certificate

Please note that from 1st September 2008 reimbursement of the medical expenses of spouses and recognised partners currently benefiting from top up cover will be suspended pending receipt of the latest tax certificate (see above).
If your spouse or recognised partner benefits from such top-up cover, please ensure that you send his/her latest tax certificate to your Settlements Office (see Annex 1 for addresses).

Provisions governing top-up cover

Where your spouse's or recognised partner's income currently exceeds the ceiling, top up cover cannot be awarded during the reference period (1 July 2008 to 30 June 2009), except where he or she ceases to be gainfully employed (invalidity, redundancy, retirement or early retirement). Such cover will be granted for the following reference period upon presentation of the above-mentioned supporting tax document.

As a member of the JSIS, you must notify your Administration and Settlements Office of any change in the situation of the persons insured under your 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.

How to apply for reimbursement of medical expenses

To apply for reimbursements of medical expenses, please do the following:

1. fill out a reimbursement claim (available from the JSIS website – Forms Online/ Membership) clearly mentioning the name of the patient;
2. attach the following supporting documents:
   • copies of doctors' certificates and pharmacists' receipts
   • the original statement of account from your spouse's or recognised partner's primary scheme;
3. send the reimbursement claim and all supporting documents to your Settlements Office see Annex 1 for address).

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Footnotes

⁽¹⁾ See Articles 72§1, second indent and 1(2)(c) of Annex VII to the Staff Regulations.

⁽²⁾ Even if only on a part-time basis or even if the income is low, for instance freelance workers or other self employed persons.

⁽³⁾ Gross income, minus deductible professional expenses and social security contributions.