Cover for the spouse or recognised partner
(1) of a member of the
Joint Sickness Insurance Scheme
Update 2009
(period of cover concerned: 01/07/2009– 30/06/2010)
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 01/07/2009 to
30/06/2010.
- JSIS cover for spouses or recognised partners without income
deriving from gainful employment
(2)
As a member of the JSIS, your spouse or recognised partner benefits from
primary cover if he or she has no income of his/her own from present or
previous gainful employment, no pension or indemnity of any kind
(unemployment, disability, etc) as provided for under Article 13 of the
rules on sickness insurance for officials of the European Communities.
If your spouse or recognised partner has no such income and the
situation has not changed since last year, there is no need to do
anything. He/she continues to benefit from primary cover under the
JSIS.
If during the period of cover from 01/07/2009 to 30/06/2010 your spouse
or recognised partner ceases to engage in gainful employment, please
send the relevant supporting document(s) (for specific details, see
section (D) below) to your Administration and to the Membership
Team in your Settlements Office as quickly as possible (see
Annex 1 for addresses).
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, on condition that he/she receives no further income deriving
from this employment, such as an allowance, indemnity or pension.
- Exceptional JSIS primary cover for gainfully employed spouses2 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, until the following annual update, if he/she fulfils one of
the following three conditions:
- if his/her annual taxable income deriving from gainful employment
amounts to less than 20% of the ceiling mentioned in
Annex 2 and if he/she cannot be affiliated to a
legal or statutory sickness scheme (3);
or
- if the amount of the premiums it would cost him/her to take out
national sickness insurance represents at least 20% of his/her annual
taxable income from gainful employment(3);
or
- if there is a probation period in the national health system (for
the duration of such a period).
- Complementary top-up cover for spouses or recognised partners
with income deriving from gainful employment
If the spouse or recognised partner earns such income, he/she is
entitled to complementary top-up insurance with the JSIS, until the next
annual update, as long as both the following conditions are fulfilled:
- that his/her primary cover (under other legal or statutory
provisions) covers the same risks (sickness, maternity,
hospitalisation); and
- that his/her annual income from gainful employment, before
deduction of tax (4), 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
- If your spouse/recognised partner already benefits from
complementary cover, you must send to the Membership Team in your
Settlements Office the latest tax certificate available on 01/07/2009,
delivered by the Finance Ministry of the country concerned, even if it
relates to income received in 2007. Only in the absence of such a
document may you submit a document issued by the competent national
authorities certifying your spouse's/recognised partner's annual
taxable income. Please note that the document must be submitted in its
entirety but if you wish, you may cross out any amounts relating to
unearned income, such as income from savings or property dealings, etc
- If the spouse or recognised partner recently took up gainful
employment, he/she will no longer be entitled to primary cover.
Complementary top-up cover will only be granted 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 to the declaration.
The JSIS reserves the right to recover sums unduly reimbursed where it
transpires that the income at issue has exceeded the ceiling, on the
basis of the first taxation document available.
- If a major change occurs in your spouse's/recognised partner's
employment status in the course of the annual exercise (between
01//07/2009 and 30/06/2010), such as being made redundant, or retiring
for reasons of age or disability, which would give rise to the right
to complementary cover, please send a supporting document to the
Membership Team in your Settlements Office.
Complementary cover will be granted as from 1 July following the
change in status.
- Suspension of reimbursement of medical expenses for beneficiaries
of complementary cover pending receipt of tax certificate
Please note that from 01/07/2009 reimbursement of the medical
expenses of spouses and recognised partners currently benefiting from
complementary cover will be suspended pending receipt of the latest tax
certificate.
Please note that 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
for officials of the European Communities 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 persons covered
by their insurance.
- How to apply for reimbursement of medical expenses
- Fill out a reimbursement claim clearly mentioning the name of the
patient in the appropriate column;
- 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 health scheme;
- Sign and date your claim and send it, together with all supporting
documents to your Settlements Office (see Annex 1
for address). Please never use staples.
Annex 1: Settlements Offices
Brussels
Ms Helen JAMES |
( |
+32-2-295.8037 |
|
Fax: |
+32-2-295.2039 |
E-mail:
PMO-RCAM-BRU-AFFIL@ec.europa.eu |
|
|
Postal address: |
European Commission
PMO.3 – Settlements Office
SC27 1/35
B-1049 BRUSSELS |
Please note: for reimbursement of medical expenses:
Brussels Settlements Office: SC27 00/05
Council of Ministers
Ms Anna ZAWRONEK |
(
|
+32-2-281.51.62 |
|
Fax: |
+32-2-281.87.38 |
E-mail:
Anna.Zawronek@consilium.europa.eu |
|
|
|
Postal address: |
|
Council of Ministers
175, rue de la Loi (0370-FK-17)
B-1048 BRUSSELS |
Luxembourg
Ms Nathalie NOBLET |
( |
+352-4301-30655 |
|
Fax: |
+352-4301-36019 |
E-mail:
PMO-RCAM-LUX-AFFIL@ec.europa.eu |
|
|
Postal address: |
European Commission
PMO.5 – Settlements Office
DRB-B1/85
L-2920 LUXEMBOURG |
Ispra
Mr Paolo BARDELLI |
( |
+39-0332-789026 |
|
Fax: |
+39-0332-786384 |
E-mail:
PMO-RCAM-IPR-AFFIL@ec.europa.eu |
Postal address: |
Commissione
delle Comunità Europea
PMO.6 – (TP 483)
Via E. Fermi, 2749
I – 21027 ISPRA (VA) |
Annex 2: Weightings by country
COUNTRY |
Amount |
Currency |
|
|
|
AUSTRIA |
37,423.59 |
€ |
BELGIUM |
34,715.76 |
€ |
BULGARIA |
47,867.44 |
BGN |
CYPRUS |
30,966.46 |
€ |
CZECH REPUBLIC |
817,415.97 |
CZK |
DENMARK |
360,920.73 |
DKK |
ESTONIA |
461,706.07 |
EEK |
FINLAND |
41,589.48 |
€ |
FRANCE |
40,096.70 |
€ |
GERMANY |
34,333.89 |
€ |
GREECE |
32,979.97 |
€ |
HUNGARY |
7,779,010.30 |
HUF |
IRELAND |
42,918.51 |
€ |
ITALY |
38,708.07 |
€ |
LATVIA |
20,810.17 |
LVL |
LITHUANIA |
914,458.20 |
LTL |
LUXEMBOURG |
34,715.76 |
€ |
MALTA |
29,508.40 |
€ |
NETHERLANDS |
37,874.89 |
€ |
POLAND |
109,644.17 |
PLN |
PORTUGAL |
31,834.35 |
€ |
ROMANIA |
95,334.81 |
RON |
SLOVAKIA |
918,600.88 |
SKK |
SLOVENIA |
31,313.62 |
€ |
SPAIN |
35,271.21 |
€ |
SWEDEN |
377,309.07 |
SEK |
UNITED KINGDOM |
34,548.83 |
GBP |
|
AUSTRALIA |
63,813.56 |
AUD |
CANADA |
511,72.77 |
CAD |
SWITZERLAND |
61,190.67 |
CHF |
JAPAN |
6,177,329.28 |
JPY |
USA |
56,201.15 |
USD |
___________________
Footnotes
(1) See Articles 72(1), second
indent and 1(2)(c) of Annex VII to the Staff Regulations.
(2) Income deriving from gainful
employment: salaries, fees emoluments, benefits, allowances or pensions
arising from current or former employment.
(3) Supporting document(s) should
be sent to the Membership Team in your Settlements Office.
(4) Gross income, minus deductible
professional expenses and social security contributions. |