1. Joint Sickness Insurance Scheme
Finance, Accidents and Occupational Diseases
JUNE 2016

2. Joint Sickness Insurance Scheme
PMO.3.002
JSIS Finance, Accidents and Occupational Diseases
Head of Sector : Francis de Gaultier
Tel :

3. PMO.3.002 – Health Screening Programmes
Programmes are managed worldwide from PMO.3.002:
Negotiations with medical centers, clinics etc (for approved partners), invitations, processing of invoices from hospitals and medical centres, reimbursement of claims from beneficiaries.
Invoices and individual reimbursements:
PMO CONTACT (preferred) or
PMO RCAM MED PREV FACTURES

4. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (1)
Modified following the conclusions of JSIS' medical council, taking into account recent developments in medical practice and science.
Modifications cover both frequency and content of the various programmes.

5. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (2)
No longer accessible to persons under 45 in active service in an EU Institution, EU Body, EU Agency etc
Purpose : bringing an end to the overlap between H.S.P. and employers yearly medical (article 59 of the Staff regulations)

6. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (3)
Frequency:
#1 : women under 45 (not in active service): 5 years
#2 : (all) women from 45 to 59 : 4 years #2 bis : women from 45 to 59 (not in active service) : years (gyneco only)
#3 : (all) women from 60 : 2 years
#4 : men under 45 (not in active service) : 5 years
#5 : (all) men from 45 to 59 : 4 years
#6 : (all) men from 60 : 2 years
No longer accessible to children under 18

7. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (4)
Contents modifications
See:
Examples
ECG: women from the age of 60, men from the age of 45
Colonoscopy : "Virtual" (non-invasive, no anesthesia) instead of "traditional"

8. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (5)
Beneficiaries with JSIS top-up coverage :
JSIS coverage limited to the part that has not been reimbursed by primary scheme.
(=> direct billing to JSIS no longer possible : beneficiary has to advance funds)

9. PMO.3.002 – Health Screening Programmes
NEW PROGRAMMES SINCE 1 JULY 2015 (6)
INVITATIONS ("Convocations")
Requesting an invitation : JSIS-on-line (preferred, faster processing) or PMO-Contact, or telephone.
Automatic invitations : terminated
Medical centers (= direct billing to PMO.3.002) : see list by country/city on website.
Improving the choice of centers : PMO negotiations ongoing; Agencies welcome to help!!

10. ACCIDENT & OCCUPATIONAL DISEASE INSURANCE
General enquiries tel:
Fax:
Online:
By post: European Commission, Joint Sickness Insurance Scheme – Accident and Occupational Disease Sector, Office SC27 – 03/39, B-1049 Brussels (the offices are located at Rue de la Science 27)

11. ACCIDENTS Team Leader : Catherine HINDRYCKX
Tel:
Members covered from day 1 of contract.
Worldwide, 24 hours a day.
Includes private as well as work accidents.
Declarations to be sent within 10 days of event.
Family members and pensioners not covered.
sickness_insurance/accident/Pages/index.aspx

12. SUBROGATION
Team Leader : Jose SANCHEZ-PEREZ Tel: If accident incurred by family member and third party involved, send accident declaration with details of third party insurance (JSIS may be able to recover costs from third party insurance).

13. OCCUPATIONAL DISEASES
Case handler : Julia SMITH
Tel:
If disease (physical and/or psychological) arises or is aggravated in course of duties.
Data protection guidelines strictly adhered to – member’s wishes always respected.
Only medical aspect dealt with.
In event of alleged harassment, separate enquiry needs to be arranged by agency (IDOC may carry out enquiry for executive agencies).
Regulatory framework : Article 73 Staff Regulations + Common Rules + forms etc:
sickness_insurance/accident/Pages/index_mp.aspx

14. REIMBURSEMENT Claims officers : E-mails
TARIFICATION : Marta Biernaux / Juliette Van Clemputte
CONTROL : Julia Smith / Catherine Hindryckx s
Remember to tick the accident or occupational disease box and indicate date (for occupational diseases, date of request).
Supplementary reimbursement of linked medical expenses will be made once accident or occupational disease has been accepted.
If accident/occupational disease not accepted, reimbursements according to sickness insurance rules will still be made.

15. GENERAL INFO
NOT COVERED: repatriation, some sports .. (see Article 4 of Rules).
Agencies should declare any specific professional activity of staff (e.g. nuclear inspection, test flight ..) to Accident and Occupational Disease Sector.
Accident or occupational disease files can be closed following stabilisation or recovery.
Re-opening possible if aggravation established.
Appeals procedure exists, in event of disagreement with a draft decision.
Death grant, subject to certain conditions.

16. THANK YOU !