Project Description

Basics of JSIS
Ignazio Iacono Interview

Hello, Ignazio. First of all, would you introduce yourself in a few words and explain your function within the CGAM?

Hello Noémie, my name is Ignazio Iacono and I am an elected member of the Central Staff Committee of the European Commission, of which I was the president for 7 years. I have always been interested in social issues and more particularly in the Joint Sickness Insurance Scheme (JSIS), which is one of the social pillars of our system. I am a full member and I actively participate in the work and sometimes in the political push because, despite a routine monitoring, there is also a policy of improvement to be implemented in order to be as close as possible to the reality on the ground of all the medical systems, which colleagues in the Member States (MS) or outside the Union are confronted with. As with the Covid, for example, in order to take care of it as well as possible and to look to the future in order to define an adequate reimbursement.

The management of the health insurance fund is governed by the legal bases laid down in the statutes and in the General Implementing

Provisions. The Management Committee of the Sickness Fund (CGAM) also analyses the situations encountered by colleagues in all the places of employment of the European Institutions which are subject to the Community’s statutory regime. Members of the JSIS benefit from a free choice of doctors but are subject to certain types of restrictions/constraints which we have to follow. For example, we have colleagues posted to countries outside the EU who have to return to their country of origin in order to receive medical treatment.

How is the CGAM composed and what is its role?

The committee is composed of representatives of all the institutions. I am one of the representatives of the Commission’s Staff Committee. There are four of us and four alternates. There are also representatives of the Council, but also of the executive agencies, the Economic and Social Committee, the Committee of the Regions, the Court of Justice, and so on.

So it is a matter that affects all the EU institutions and bodies and relates to the Staff Regulations, because it is a right and an obligation to be affiliated to the JSIS.

We work as a management committee: firstly, we issue opinions to the Appointing Authority. In the end, it is always the Appointing Authority of the institutions that decides after a well-defined consultation process. For example, if a colleague goes to pre-litigation (Article 90 for a reimbursement or non-reimbursement with which he or she is not satisfied), the Settlements Office to which the colleague belongs is obliged to give the reasons why the reimbursement has not taken place and the Management Committee is invited to give its opinion on the member’s request after analysis and sometimes legal and political debate. The Article 90s submitted to us are always anonymised. It is the Appointing Authority, following the opinions we have given and those of the settlements office, who will take the final decision. The colleague then has the choice of continuing to court if he or she does not agree with the Appointing Authority’s decision or of leaving it at that.

Secondly, the meetings allow us to define, within the CGAM, the points of tension that affiliates encounter. We have noticed a decrease in pre-litigation over the last few years and this can mean two things: either colleagues are giving up or some things are working, as a whole.  In the committee, but also among the staff representatives, we point to the reimbursement rates which are significantly different from what is provided for in the Staff Regulations, and a lot of problems are arising with the reimbursement rules which are currently applied. In my opinion, the GIPs are no longer in line with the realities on the ground encountered by our colleagues, who are scattered all over the world. The Pay Master Office (PMO) applies rules which we are trying to improve and which are not very adequate. These rules have not been reviewed since 2007 and the reimbursement ceilings have not been adapted since then.

What are the most important issues being discussed at the moment?

One of the big issues we had to deal with was COVID-19, of course. The little flu at the beginning quickly turned into a pandemic and this obviously affected our health insurance. Another challenge is to redefine the notion of “serious illness”. The criteria caused quite a few problems a few years ago and we can see that COVID-19 confirms that a new definition must be applied.

Pre-litigation files are one of the prerogatives of the Management Committee. We are starting discussions on the reform of the General Implementing Provisions (GIP) which, according to staff representation, are taking too long to be launched in negotiations.

The last GIP, which concerns the rules for reimbursement (procedure, reimbursement rates), was negotiated after the 2004 Staff Regulations, and it took three years to review all these rules and update them in 2007. This means that they have been in force for 14 years and the reimbursement ceilings have not been adjusted. The reimbursement rates for certain services are no longer in line with reality (in relation to what our colleagues actually pay for treatment at present). All our legal bases provide for 80-85% reimbursement depending on the type of service (100% for serious illnesses). We have found that we are below these values (in Belgium, our colleagues see – on average – that the reimbursement rate for medical services is only 64%). There are also the equality coefficients for countries outside Brussels and the question of calculating these ceilings in the other Member States, because if the reference is Brussels, other countries are also well below the rates provided for by the Staff Regulations. The idea is to start negotiations: Union Syndicale is trying to prove to the administration that there is an urgent need for action on these various aspects.

Union Syndicale has been hitting a brick wall for two years. We would like to switch to a mechanism aligned with the remuneration method (the principle of annual updating) by modifying the legal basis so that these ceilings can be adjusted each year and regularly take into account the level of the inflation rate and therefore, in fine, the real cost of health care in the various places of employment.

As far as the potential of our resources is concerned, we have some room for manoeuvre within the Staff Regulations, i.e. we could contribute up to 2% of our salary (as opposed to 1.7% at present) to improve reimbursement levels and types of benefits. We are not going to increase our contributions because the reserves accumulated over the years (contributions in excess of reimbursements) are sufficient and are estimated at 300 million euros. 300 million. We could, in fact, use this reserve to rebalance reimbursement rates over time for our colleagues. We are trying to forecast expenditure and develop certain policies. With the help of DG ECFIN, we have a follow-up on the management of the assets (the reserve fund accumulated over time). The biggest task is to be able to bring the legal bases (GIP) into line with the reality on the ground and adequate reimbursement of health care.

Coming back to the reimbursement rate, there are large differences between Member States. In Italy, for example, the rate for dental costs is very low. We think that the bases of calculation are no longer appropriate and we would like them to be brought into line with reality. So we have 27 Member States in the EU and more than 27 different health care systems, health insurances or mutualities. A big challenge is to get the JSIS system recognised in the Member States where our colleagues work. So there are many administrative problems for our members.

At the moment, one of the most important issues is health care in Italy. The mutual insurance system is open to all citizens residing in Italy (national insurance system) and our colleagues receive a card to access health care. The Italian government has unilaterally decided to withdraw this card from colleagues from the European institutions and has asked them to pay a large membership fee to access care. This is a political but also a legal problem which is currently being discussed at the level of the Commission, DG HR and with the Member State. The CGAM is obviously pushing to resolve this issue so that our colleagues in Italy do not find themselves in a difficult situation.

In the Netherlands, the health insurance system has been completely liberalised. Private insurers now manage the relationship between the health care providers and their members. As an international organisation, we were outside this system. We have several institutions present on the territory: the JRC-Petten, EMA, the European Patent Office, Eurojust, etc. as well as EU pensioners. A problem with overcharging by hospitals was therefore quickly detected: access to care was no longer guaranteed. The PMO was asked to contact the local players in order to find a solution. An agreement was reached with these insurers, a contract was negotiated: our colleagues are now affiliated to an insurance that allows them to benefit from agreed prices and not be overcharged. They can therefore benefit from a national insurance card which gives them access to care like any other Dutch citizen and are better reimbursed according to the rules of the Joint Sickness Insurance Scheme.

In Spain, a few years ago, we had several problems in terms of access to care (as in the Netherlands). Again, the PMO managed to get agreements at regional level to insure the colleagues on site.

We are currently discussing medically assisted reproduction (MAR), for which the 2007 legal basis did not provide for reimbursement if there were no pathologies in the parents. A number of colleagues were therefore not covered by the CGAM (e.g. LGBTIQ+ couples). The CGAM would like to find a solution in order to include everyone and to guarantee the reimbursement of MAR to everyone, thus putting an end to discrimination. In addition, still concerning MAR, some reimbursement rules would need to be reviewed in the light of scientific progress.

The major challenge within the CGAM is of course to maintain quality support through the social pillar that the JSIS constitutes and to ensure its reliability. It should also be mentioned that, despite having a bad press, the PMO is doing a tremendous job. They work on many more than 27 different health systems, which can be very complicated in some cases.

What are the most common problems encountered by members?

The rules are not always clear to members. Not all of us are lawyers or have extensive knowledge of medicine. Members often do not understand the legal bases, which are therefore a constraint. There is a need to popularise the legal bases so that members understand them better. It is not only the staff members or pensioners of the institutions who are affiliated to the scheme, but also their close relatives and family members must be able to understand the ins and outs of our health system.

The overcharging that occurs in Luxembourg is also a problem. Our colleagues in Luxembourg (rightly) complain that they are overcharged in relation to the reimbursement rate. The PMO analyses each case in order to find solutions, in particular Article 20, which makes it possible to launch a procedure. It should be noted that overcharging does not only occur in Luxembourg, some cases of overcharging can be found here in Belgium (the amount of a bill can vary from one hospital to another). In Brussels, the PMO has managed to reach several agreements with hospitals. Unfortunately, it is not possible to establish such links with hospitals everywhere in Europe.

We are working to explain the reimbursement rules to our colleagues in order to avoid, for example, pre-litigation due to lack of information or understanding. We send the GIPs explaining the differences and nuancing them on a case-by-case basis, without going beyond the legal basis. In my opinion, many of the problems encountered by affiliates stem from these GIPs, which are proving to be obsolete.

Union Syndicale has proposed a resolution to the Commission’s Central Staff Committee on this issue in order to support the launch of negotiations on ceilings and equality coefficients (reimbursements differentiated according to the different Member States) as soon as possible. Indeed, these ceilings need to be raised to at least 80% compared to 64% currently in Brussels for example.

A series of benefit ceilings must therefore be reviewed and increased. It is not right that an implant costs 3 to 5 times more or less from one Member State to another and that the reimbursement rates do not provide for these levels of difference. Some colleagues do not earn enough to be able to afford certain dental treatments in some Member States.

As regards the results between income and expenditure, these are positive: we have more income than expenditure and as a ‘good housekeeper’ we have a duty to manage the reimbursements properly as provided for by the legislator. We therefore have room to improve the situation. Contrary to what is stipulated in the Staff Regulations (which provide for a higher contribution from the Member States), we do not call on the Member States to inject funds into our contributions because our system is healthy. For the time being, we want to work on the basis of contributions staying the same.

According to some projections, we risk reaching a reimbursement rate of 50% if no action is taken, which would not provide members with proper social rights. We therefore call for negotiations with the Commission to begin now, subject to the framework agreement.

Ignazio Iacono

President of the Central Staff Committee for seven years, Ignazio is a USB Bureau member.

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