Project Description


Being outside the box is not always a blessing…

Staff of international organizations as well as the family members are generally covered by the social insurance scheme of the respective international organization and not by the national scheme of the country of residence. This is an important part of the labour relations between the organization and its staff members, almost as important as salary.

This edition of Agora will focus on the various aspects of the social security coverage provided by international organizations, trying to provide an overview of the various schemes.

Let me use this editorial to point out that not all is well in this respect, focussing on the health insurance as example.

Having your own health insurance scheme, completely apart from the scheme of the state in which you reside, means that you are practically “out of the box”, not covered by the rules and regulations the national health care providers are used to in their daily practise. A few random examples: different forms, different reimbursement rules, prior authorizations criteria…

Without wanting to over dramatize the problems, the situation has become more and more complicated over the years. Overcharging is just one of the recurring problems; the consequences of not being connected electronically to the national scheme are however also not to be underestimated.

The covid-19 pandemic have laid bare the far-reaching consequences of not being “in the box”. For instance, in Belgium covid-19 tests are reimbursed by the national health insurance scheme, so staff from international organizations have to pay for their obligatory test. Payment is however not possible in most testing centres. Furthermore, the selection of risks patients was based on the files of the national health insurance scheme, having international civil servants and their families scrambling for alternative procedures.

In addition, I do not even want to go into the problems faced by colleagues with a special identity card without a chip, because they cannot access directly their vaccination data.

Even in non-covid times the situation in many states is becoming more and more precarious, simply because the payment of medical invoices is increasingly based on direct billing schemes, to which international staff has no access.

Personally, I fear that IT developments, linking health care providers and health insurance schemes, will make it increasing difficult maintain the stand-alone nature of the various schemes of international organizations. Especially when the organizations are addressing the problems in isolation, developing uncoordinated ad hoc solutions.

The role of staff representations and trade unions is to alert the various administrations to the problems, urging them to adopt a coordinated long-term approach in order to keep our social security systems not only strong, but also operational.

Union Syndicale has in this respect a unique position, because it brings together staff from various international organizations, allowing it to contribute to a solution that goes beyond the interest of one particular organization and the problems in one particular state. Let this Agora be a contribution to this process.

Niels Bracke

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.

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