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.
- 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.
- 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).
- 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 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.
- 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
01/07/2010, 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
- 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 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.
- 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.
- 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.
______
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. |