Cover for the spouse or recognised partner¹ of a member of the Joint Sickness Insurance Scheme

Update 2010
(period of cover concerned: 01/07/2010– 30/06/2011)

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 2010 to 30 June 2011.

1. JSIS cover for spouses or recognised partners without income deriving from gainful employment²

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 1 July 2010 to 30 June 2011 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.

2. 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 scheme³ ; 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 employment³; or
   
• if there is a probation period in the national health system (for the duration of such a period).

3. 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:

1. that his/her primary cover (under other legal or statutory provisions) covers the same risks (sickness, maternity, hospitalisation); and
    
2. that his/her annual income from gainful employment, before deduction of tax⁴ , 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.

4. Updating a spouse's or recognised partner's file

1. 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 01/07/2010, delivered by the Finance Ministry of the country concerned, even if it relates to income received in 2008. 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
    
2. 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.
    
3. If a major change occurs in your spouse's/recognised partner's employment status in the course of the annual exercise (between 1 July 2010 and 30 June 2011), 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.

5. Suspension of reimbursement of medical expenses for beneficiaries of complementary cover pending receipt of tax certificate

Please note that from 1st July 2010 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 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.

6. How to apply for reimbursement of medical expenses

1. Fill out a reimbursement claim clearly mentioning the name of the patient in the appropriate column;
    
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 health scheme;

3. 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.

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Footnotes

⁽¹⁾See Articles 72(1), second indent, of the Staff Regulations 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.