The Joint Sickness Insurance Scheme (JSIS), a health insurance scheme for EU staff members, is one of the most important elements of the social security coverage of EU staff. It provides health care coverage not only for staff and retired staff but also for their dependents. While it provides (re)assurance for health protection, it suffers some flaws since its conception more than 50 years ago which has a long-term effect. Over the years, many EU officials had been facing difficulties related to the Joint Sickness Insurance Scheme.
Agora #89
Pages 32 - 35
The advantage and the dysfunction of the scheme
Flashback
The creation of JSIS itself took inspiration from the affiliation of the European Coal and Steel Community (ECSC) to the social security system for civil servants and public employees in Luxembourg, created by the law of August 29, 1951. It is the first affiliation between a community staff sickness scheme to a state scheme.
When The Treaty of Rome established The European Economic Community and Euratom EEC) in1958, their Staff Regulations of 18 December 1961 already mapped out a specific sickness insurance scheme for the benefit of the staff of the two new Communities, outside the social security system of a Member State.
The founding members of the European communities decided not to link the social security coverage of their staff to a national system, whether it be the State where the communities are based or the State of origin of the official. Therefore, officials and other agents of international organisations and their dependents, have their own sickness insurance schemes, independently of the national schemes of the country of their nationality or duty. This choice aims to preserve the independence of the staff of the European Communities, in the more global context of the definition of the rights and obligations of staff.
The statute lays the foundation for a specific social security system for the benefit of European Union (EU) personnel, based on the principle of solidarity, where all the beneficiaries contribute while also sharing the advantage. The purpose of this contribution is to define the legal framework, the beneficiaries, the financing, the organization, and the benefits of the insurance scheme for EU staff.
The scheme was confirmed with the adoption of Staff Regulations of Officials of the European Communities on 29 February 1968. These provisions apply to all officials and other servants working for the three communities by that time and have not been fundamentally changed by the various revisions of the Staff Regulations even when more and more communities join and then the original EEC community dissolved and absorbed by the EU in 2009.
The joint rules on the sickness insurance cover for officials of the EC entered into force on 1 December 2005 under Article 72 of the Staff Regulations. The Sickness Insurance Scheme known as JSIS common to the institutions of the European Community covers the medical expenses of its beneficiaries resulting from illness, accidents, and confinement and contributes to funeral expenses.
The Staff Regulations also set the reimbursement ceiling for the coverage of EU staff. In the same statute, the institutions, in the framework of the Common Regulations may entrust one of them with the power to set the rules for the reimbursement of medical benefits. On this basis, Article 52 of the CR entrusts this power to the Commission, within the framework of General Implementing Provisions, adopted by the College, after obtaining the opinion of the Interinstitutional Staff Regulations Committee.
Thus, the Commission decision of 2 July 2007 laying down general implementing provisions on the reimbursement of medical expenses sets the percentages and ceilings for reimbursement, by type of treatment and medical procedure.
As with the French social security system, JSIS beneficiaries are free to choose their doctor or health care facility. Of course, reimbursement ceilings are set, and, in the case of expensive establishments, reimbursements are based on the ceilings the according to the types of procedures, regardless of the price charged to the insured.
We should highlight, that the JSIS has numerous positive points, such as
- A relatively low contribution of 1.7% of the basic salary,
- Very broad coverage, including many medical costs not covered in the Member States (for instance glasses and dental care above 18 years);
- Complete freedom of choice, allowing the affiliate to freely choose a care provider (in many Member States the freedom of choice is limited);
- Truly European coverage, making it possible to seek medical care all over the EU (in many Member States the reimbursement of cross-border care is far from easy).
Dysfunctioning Scheme
In later years, the result of the decision to separate the EC sickness scheme from the national scheme is becoming an obstacle for EU staff who has to deal with discrimination in the country of their mission. In many Member States, JSIS is regarded as a private insurance, allowing medical service providers to freely charge for their treatments. Whereas citizens affiliated with a national scheme of another Member State can benefit from the negotiated tariffs within the national security scheme of each of the Member States (see Regulation 883/2004), EU staff are confronted, on a daily basis, with higher prices for similar services.
The scheme is also facing a real challenge, linked to the decrease in the average contribution resulting from the lowering of salary levels, as well as the massive recruitment of contract agents, whose salaries are significantly lower than those of civil servants. In fact, an increase in the average contribution of staff to the Scheme has been noted to 2010, due in particular to the annual adjustment of salaries and pensions. Since 2011, the refusal by the Member States to adjust the remuneration and pensions of EU staff, due to the crisis, and then the freezing of salaries of EU officials, decided by the European Council in February 2013, for the years 2013 and 2014, has slowed the increase in the average contribution of staff while the cost of medical treatment and medicines continued to rise. In this context, the JSIS began to generate deficits that are largely related to this non-adjustment.
In addition, since 2011, the non-adjustment of EU staff salaries has had a significant impact on the average contribution level of the agents. A final aspect must also be taken into account: the decrease in the number of budgetary posts (- 5% between 2013 and 2017), decided by the European Council in February 2013, and the aging of the EU staff, with massive retirement in the coming years. At the same time, we can note an increase in health costs in all EU countries.
This imbalance is likely to worsen further, particularly because of the freeze on EU staff salaries, decided by the Council for the years 2013 and 2014.
What’s Next ?
JSIS proved to be useful but not flawless. As mentioned above, one of the big issues faced by many colleagues is the recognition of JSIS in a member state. It should formally be recognised that the JSIS, being a public social security scheme, should carry the same effects and enjoy the same treatment as public social security schemes at a national level. In order to be able to prove their insurance through the JSIS and therefore be able to enjoy the principle of equal treatment, those who are covered by the JSIS should receive an identity card proving their affiliation to the JSIS. For this card to have practical value, it must be established by a formal legal action, which has to be duly communicated to all Member States, which are in turn obliged to duly inform all national medical service providers. The European Health Insurance Card could serve as an example.
Several years ago, the Paymaster’s Office (PMO) set up a working group to revise and modernise the rules of JSIS. Union Syndicale is represented in the working group and although the process is long and laborious, the Union Syndicale is striving to achieve the following principles, common to all these schemes:
- These schemes are public and obligatory.
- Affiliates (and other beneficiaries) must enjoy access to any health care needed, wherever they are.
- Health care must be provided at the same prices as affiliates of the concerned national public health care scheme.
- The free choice of treatment must be guaranteed. (Persons covered by this Scheme shall be free to choose their practitioners and hospitals or clinics. The principle of freedom of choice does not automatically imply reimbursement of any resulting travel costs; the rules for reimbursing this type of cost are set out in the general implementing provisions. Freedom of choice shall apply to beneficiaries of top-up cover only after the possibilities offered by the primary scheme have been exhausted.
- They should be managed jointly, between employers and affiliates.
Again, the scheme has also some downsides of which Union Syndicale has, during recent years, raised on several occasions the dysfunction of the present rules.
- Outdated ceilings, meaning that for several treatments, a reimbursement of 80/85% as foreseen in the Staff Regulations is not guaranteed; The reimbursement ceilings have been set over a decade ago and are becoming more and more outdated. An adaptation to today’s medical costs is urgent and should be the priority during the negotiations. ln order for any new ceilings not to become outdated again in a few years, a mechanism to regularly adjust the ceilings to the rising cost of health care needs to be included in the rules. The ceilings are also not adjusted to the healthcare price level in the various Member States;
- Many health care providers outside Brussels are not familiar with the rules and procedures of the scheme simply because they never dealt with it or try to unduly benefit from it (overcharge);
- As foreseen in the rules, reimbursement can be refused in case a treatment is deemed not medically necessary, despite the opinion of the doctor concerned.
- The parity coefficients [1], created to ensure equal treatment of medical expenditure in the various Member States, suffer from considerable statistical flaws and therefore need to be revised in order to better reflect the real costs of medical treatment.
- The costs of supportive care and dependency are covered only to a small extent, leading to financial hardship for those with low incomes/pensions. More generous reimbursement of the non-medical part of supportive care and dependency-related expenditure has to be developed, including an own risk that depends on the incarnate/ pension of the person concerned.
- The overly restrictive application of the rules by PMO should stop, making way for a more humane and service-driven approach, whilst remaining vigilant against abuses. ln particular, all vital treatments should be fully reimbursed.
- JSIS should develop a new approach regarding preventive medicine. It is not enough to reimburse a restricted number of tests. Measures to allow early screening and preventive medicine would also be cheaper than treating avoidable illnesses.
- The reimbursement of alternative, soft medical approaches should be improved.
- The treatment of mental health issues should be improved.
- The present rules and procedures are often difficult to understand, cumbersome, and outdated. A streamlining of the rules and procedures to make them more user-friendly and transparent is unavoidable. In this framework the role of the medical council needs to be revised, giving members of the JSIS stronger rights towards the medical council.
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[1] Correction coefficients (duty stations) are used to ensure equality of purchasing power of remuneration between different locations within the European Union and Brussels. Correction coefficients are calculated as the ratio between the “economic parity” and the exchange rate to the Euro (where applicable). They operate as a percentage adjustment to remuneration expressed in local currency.
Union Syndicale is aware that the proposals will require an increase in the budget of the JSIS. Provided that the changes are a real benefit for staff, Union Syndicale is willing to accept that this increase in the budget is covered by an increase of the contributions up to the maximum foreseen in the Staff Regulations [2% of the basic salary].
Niels Bracke
About the author
President of Union Syndicale Brussels. Having started his international career in the General Secretariat of the Council (DG Justice and Home Affairs), he joined the EEAS in 2011. Presently he is full time seconded to Union Syndicale as coordinator of US in the EEAS. Being a member of the management committee of the Joint Sickness Insurance Scheme, he is dealing on a daily basis with questions related to the EU health insurance scheme.