Note for the attention of Commissioner Hahn Johannes
RE : The Joint Sickness Insurance Scheme and COVID-19 – time to act.
While providing a rather generous coverage, the Joint Sickness Insurance Scheme (JSIS) also foresees high payments for its affiliates: 15% to 20% of the health care cost, limited further by specific ceilings.
The only mitigation is contained in Article 72(3) of the Staff Regulations: the affiliates payments over a 12 month period cannot exceed a half month basic salary. In case of serious illness all costs are covered 100% of the costs, up to 150% of any specific ceiling. The only problem: serious illness has to be recognized individually by the settlements office thorough the medical council and the criteria are rather strict.
Whether COVID-19 (Corona virus) falls under the definition of serious illness is not clear and can dependents on the particular situation of the person affiliated to the JSIS. It is quite likely that Corona virus is not recognized as a serious illness in all cases, leaving the affiliate to face substantial payments.
JSIS has a high reserve, that could easily absorb the extra costs in case the criteria for serious illness are applied in a liberal way when it comes to Corona.
General Implementation Provisions for JSIS are negotiated under the framework agreements between the Unions and the Commission followed by an opinion of the Central Staff Committee.
The Unions and the Central Staff Committee are asking that under the framework agreement, the Commission decides that Covid-19 is recognized as serious illness and that therefore all costs related to Corona as testing, first line medical care, hospital transfers, hospital care and revalidation benefit from full reimbursement.
We furthermore insist to apply the rules in an un-bureaucratic way, allowing all those who have incurred medical costs related to Corona to declare these costs as serious illness without having to go through individual assessments by the Medical council. We would like also that a clear decision and information on that subject is sent to the affiliates of RCAM.