The EU Joint Sickness Insurance Scheme (JSIS) in brief

The EU Joint Sickness Insurance Scheme (JSIS) in brief

Agora #88
Pages 20 - 21

Two important recent developments to address some of these problems should be highlighted...

Two important recent developments to address some of these problems should be highlighted:

Recently PMO has concluded an agreement with a health insurance scheme in The Netherlands allowing affiliates to use the tariffs negotiated by the scheme, thus saving up to 40% on medical treatments and being able to benefit from the direct billing scheme applied by the scheme. A similar solution is being negotiated for Belgium. Union Syndicale fully supports these initiatives, if the use of the national scheme remains voluntary, allowing affiliates to exercise their freedom of choice.

The health insurance scheme for EU staff members, the Joint Sickness Insurance Scheme (JSIS), is one of the most important elements of the social security coverage of EU staff because it provides health care coverage not only for staff and retired staff, but also for many dependents.

The EU health insurance scheme has numerous positive points, just to mention the most important ones:

• 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).

However, the scheme has however also some downsides:

  • Outdated ceilings, meaning that for a number of treatments a reimbursement of 80/85% as foreseen in the Staff Regulations is not guaranteed ;
  • Ceilings not adjusted to the health care 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.

US has raised and will continue to raise these issues, proposing practical improvements.

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, US is striving to achieve the following main objectives:
– an update of the ceilings as well as an automatic mechanism to keep the ceilings up-to-date
– a modernisation of the rules, updating many outdated or overly complicated procedures
– a streamlining of the rules, making them easier to read and understand
– an effective procedure to adjust the ceiling for the health care prices in the various Member States and inform care providers of the existence of the EU sickness insurance scheme.

For many years US stood and will continue to stand ready to advice and support its members when confronted with difficulties related to the Joint Sickness Insurance Scheme. Yet another clear advantage of being or becoming a member of Union Syndicale Brussels.

Niels Bracke

President 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.