JSIS - The Article 72(3) and how it must be applied by the PMO: For R&D fairness and solidarity are not just empty words!

The Article 72(3) and how it must be applied by the PMO:
For R&D fairness and solidarity are not just empty words! 

The Article 72(3) is one of the best “hidden secrets” of the Staff Regulations, but also one of the aspects that demon¬strates the solidarity dimension of our Staff Regulations. 

A dimension that is all too often neglected in the implementation of the statutory provisions! 

Indeed, Article 72(3) provides for an additional “special reimbursement” by the Joint Sickness Insurance Scheme (JSIS) when individual affiliates face very high medical expenses. In particular, Article 72(3) reads:

‘Where the total expenditure not reimbursed for any period of twelve months exceeds half the official's basic monthly salary or pension special reimbursement shall be allowed by the appointing authority, account being taken of the family circumstances of the person concerned, in manner provided in the rules referred to in paragraph 1.’

As it can be immediately understood, this is a very important article because it can provide additional financial support when a colleague has medical problems that involve very high costs, which is a major additional, sometimes dramatic, problem for the lowest paid colleagues.

On an almost daily basis, we come across colleagues who are indeed faced with large financial expenses and don’t really know that they may be entitled to apply for a special reimbursement.

And the Paymaster’s Office (PMO) is unwilling to provide affiliates with an automated system that automatically calculates the amount of money an individual is responsible for over the last twelve months.

It is left to individual colleagues to calculate their own expenses, to compare them with their basic salary and to decide whether or not to submit the “special reimbursement request”

For R&D, this is unacceptable, both because the PMO would easily have the tools to automatically calculate the “rolling 12-month expenditure not-reimbursed by JSIS” of each JSIS affiliate at any given time, and also because the colleagues with very high medical expenses are often not in a position to make such calculations.

R&D requests that PMO include in each individual's JSIS page an automated calculation of the rolling 12-month expenditure for medical expenses, as referred to in Art. 72(3)

R&D will continue to push for the introduction of a screen in each affiliate's personal space in JSIS (or PMO Mobile) that automatically calculates the sum of the personal expenses over the last twelve months. In this way, colleagues could easily check whether they are eligible or not.

How can someone apply for a “special reimbursement”?

If an individual Affiliate estimates that he/she has incurred medical expenses that exceed half of the basic salary, then the Affil¬iate can submit the dedicated application form1. 2 . The special reimbursement rate will then be as follows3

•  a 90% reimbursement of the amount exceeding half your basic salary if you are a member and no one else is insured under your name; for example, if you are single and have no children;
•  a 100% reimbursement of the amount exceeding half your basic salary if there is at least one other person insured in your name, such as your spouse.

When applying Article 72 (3), in order not to penalise colleagues working in the countries with low salary correction coefficients, the PMO must consider the salary actually paid, taking into account the correction coefficients

In this respect, the Court of Justice has already clarified that the basic salary to be taken into account when applying Article 72 (3) is the salary actually paid, taking into account the correction coefficient: 4
 

‘(…) 15. ’15 It follows from the foregoing that to assess correctly the extent of the financial burden placed on an official who is seeking a special reimbursement, the living conditions of the place of his employment must be taken into account and consequently the special reimbursement provided tor in Article 71 (3) of the Staff Regulations must be calculated, not solely in accordance with the salary referred to in Article 66, but on the basis of the real salary adjusted by the weighting provided for in Article 64 whose purpose is precisely to take account of the living conditions in the place of employment.” 

This is a very important aspect to consider in order to ensure fairness and solidarity!

To give an example, if a colleague works in Croatia (where the correction coefficient is 84.8%) and has a basic monthly salary of 3000 €, what this colleague actually earns each month is not 3000 € but 2544 €.
Thus, according to the abovementioned case law, Article 72(3) must be applicable to this colleague if the medical expenses for the past 12 months would be higher than 2544/2=1272 € and not if the medical expenses for the past 12 months are higher than 1500 € without applying the salary correction coefficient.

Conclusion

Disregarding the salary actually paid when applying Article 72(3), denies the solidarity and fairness at the heart of this Article, creates a situation of unequal treatment between colleagues from different places of employment and it is detrimental to those colleagues working in Member States already penalised by a salary correction coefficient below 100%.

If you are in any doubt as to how Article 72 (3) should be applied to your case, or if you are faced with decisions by the PMO that do not seem right to you, please do not hesitate to contact us for assistance from our team of specialists and Lawyers.

R&D is always at your side!
 

Cristiano Sebastiani,
Chairman
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1.  In English: https://myintracomm.ec.europa.eu/staff/Documents/health/demande-rembspecial-en.pdf
2.  In French: https://myintracomm.ec.europa.eu/staff/Documents/health/demande-rembspecial-fr.pdf
3. https://myintracomm.ec.europa.eu/staff/EN/health/reimbursement/special-rules/Pages/special-reimbursement.aspx
4. Affaire 115/83 :  eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:61983CJ0115

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