Sickness insurance


16 November 2016

Is the reimbursement of my medical expenses guaranteed?

What about the legality of overcharging for medical treatment?

 

Yes, the Staff Regulations guarantee protection against risks of illness and accident.

The staff are reimbursed at a rate of 80 or 85 % of the expenses incurred, rising to 100% in the event of serious illness or accident.

Additional cover of the member's spouse and other dependants also applies.

Moreover, as far as the financial contribution is concerned, the Staff Regulations allow for a margin (which is not necessary for the moment) since the contribution by staff members (1/3rd of the funding), which is currently 1.7% of salary can rise to a maximum of 2% (4% by the employer).

 

SIMC: Sickness Insurance Management Committee.

This management committee - where representatives of Union Syndicale Luxembourg have a seat - ensures that the system is in long-term equilibrium.

Despite a peak in spending in recent years, the system has returned to its cruising speed, and the financial situation is currently satisfactory (12 million € surplus in 2015).

In addition, a reserve fund equivalent to about 10 months of spending is evidence of the quality of the way the scheme is managed.

 

If you are a USL member, there are even more benefits:

- Automatic cover for the services and advice, in the context of the Luxembourg health system, of the "Patiente Vertriedung"  (www.patientevertriedung.lu)

- Preferential rates and other benefits with DKV (up to 100% cover and reduced contribution: 8%) and Interfon


What about overcharging for medical expenses in Luxembourg?

Union Syndicale Luxembourg continues - in line with the case law of the European Union (Judgement by the European Court in Case C-411/98 Ferlini) - to work towards equal treatment between European officials and Luxembourg citizens as far as medical treatment is concerned as well as for hospitalisation and health care in the broadest sense.

The contractually-agreed overcharging of 15% (negotiated by the Commission acting alone with the authorities of the Grand Duchy and health care providers) needs to be renegotiated or abolished, because it is an unwarranted burden on our system (and therefore a cost to members), which in some cases goes well beyond 15%, and can be qualified as illegal having regard to the Judgement in the Ferlini case mentioned above.

 

Union Syndicale Luxembourg demands of the European Commission that it should:

- ensure effective follow-up of the case law in Ferlini;

- renounce or renegotiate with the participation of the members of the JSIS the agreements with the Luxembourg Hospitals Federation and the Association of Doctors and Dentists;

- reopen, if necessary, the infringement proceedings initiated a few years ago by Vice-President Sefcovic against the Grand Duchy of Luxembourg;

and adopt transitional measures, in favour of JSIS members (on whom it is wrong to impose agreements to which they are not party, and which are, in any case, flouted ...), with a view to compensating this excess charging which can be qualified as illegal.

If necessary, Union Syndicale Luxembourg will finance 100% of the cost of a legal challenge to rectify this 'Kafkaesque' situation.



Luxembourg, 17 March 2016

Note à l'attention de Monsieur Ungeheuer, Secrétaire général du ministère des Affaires étrangères


Monsieur le Secrétaire général,

Suite à notre entretien de ce mardi 15 mars en rapport avec la sur-tarification médicale au Luxembourg, nous souhaitons vous confirmer les plaintes que nous ont adressé beaucoup de nos membres en provenance de toutes nos institutions européennes au sujet du non-respect par les médecins-dentistes et les hôpitaux au Luxembourg des tarifs plafonnés à 15% (cf. les deux conventions souscrites entre l'Association des médecins-dentistes, la Fédération des hôpitaux luxembourgeois, la Commission européenne et le gouvernement du Grand-Duché de Luxembourg).

Il s'avère que ces conventions souscrites suite à l'arrêt Ferlini de 2000 font l'objet d'une application dépassant très très largement le plafond des 15% contractuellement établis, et ce, particulièrement lors de soins en centre hospitalier*.

Cette pratique critiquable au regard des conventions susmentionnées, et a fortiori au regard de l'arrêt Ferlini de la Cour européenne, doit absolument être mise sous contrôle. En effet, les surcoûts qui en découlent, tant pour le régime d'assurance maladie des agents de l'Union européenne que pour ces derniers, n'ont pas lieu d'être et nous souhaitons qu'un système de suivi (avec pénalités à l'appui si nécessaire) soit mis en place.

Pouvons-nous vous suggérer, Monsieur le Secrétaire général, d'intervenir auprès de l'autorité nationale compétente afin que les divers opérateurs de soins au Grand-Duché de Luxembourg fassent l'objet d'un rappel sur la substance des deux conventions dont objet.

Veuillez croire, Monsieur le Secrétaire général, en l'assurance de notre haute considération,

Ibolya Mile
Génération 2004
Présidente - Section Luxembourg
Miguel Vicente Núñez
Union Syndicale Luxembourg
Président

*De notre point de vue, les montants forfaitaires de plus de 400€ qui sont facturés en plus en cas d'hospitalisation pour chaque soin prodigué doivent évidemment être compris à l'intérieur des 15% établis.



 Luxembourg, 10 February 2016

Open note for the attention of Mrs. Georgieva - Vice-President of the European Commission


Subject: Request for an URGENT solution to the overcharging for medical and hospital treatment in Luxembourg

In the Ferlini Judgement - Case C-411/98 - the European Court expressly criticised the overcharging for medical and hospital treatment provided to EU staff assigned to Luxembourg, based on discrimination due to their nationality which this practice presupposes, having regard to Art. 6 - 1st paragraph of the EC Treaty (which after amendment became Article 12, 1st paragraph EC), in the absence of objective justification in this respect.

Notwithstanding the agreements signed between the European Commission, the Luxembourg Federation of Hospitals, the Association of Dentists and Dental Surgeons and the State of the Grand Duchy of Luxembourg, aimed at applying this case law by limiting this overcharging to 15% compared with the scale of charge applied to Luxembourg patients, the staff are compelled to conclude that these agreements are regularly breached by health care providers and hospitals: the overcharging greatly exceeds the 15% agreed contractually.

The Commission, as the guardian of the Treaties, is obliged to ensure strict compliance with the law, in this case the Ferlini Judgement and the 2 Agreements already mentioned.

If one adds this excess cost (estimated at about 1.5 million € per year) to the discrepancy in purchasing power that has been affecting the EU staff assigned to Luxembourg for many years and which can be estimated at about 10% of salary, it is easy to understand that the staff expect this situation to be put right urgently.

This overcharging particularly affects the lowest-paid staff, in particular contract staff and other colleagues who were recruited post-2004.

The undersigned trade unions know that 4 years ago, the Commission had been considering initiating infringement proceedings against Luxembourg, and that at the last minute, it preferred to seek conciliation.

That being said, we are now in early 2016 and nothing has changed: EU staff in Luxembourg continue to be subject to these practices deemed illegal by the European Court.

The undersigned trade unions now demand a solution that complies with the legal requirements, if possible, in concert with the Luxembourg authorities.
In the meantime, the undersigned unions consider that any amount charged to EU staff which is contrary to the Ferlini case law and/or the 2 agreements mentioned, must be financed exclusively by the European Commission.

A note sent to the Director of the PMO by the most representative unions and professional associations in Luxembourg in March 2015 on this same problem has not received a reply to date.

Accordingly, Madam Vice-President, we ask you to ensure that the European Commission lives up to the responsibilities ascribed to it directly by the Treaty.

E. Di Meglio
Solidarité européenne
President

M. Vicente Núñez
Union syndicale Luxembourg
President
 
Alain Clausse
FFPE
President - Section Luxembourg

Gerard Hanney Labastille
U4U
 

 

Conférence-Débat sur le RCAM du 11 novembre 2015 à la Cour de Justice : debriefing.

 


Judgment of the Court of 3 October 2000

Angelo Ferlini v Centre hospitalier de Luxembourg.

Workers - Regulation (EEC) No 1612/68 - Equal treatment - Persons not affiliated to the national social security scheme - Officials of the European Communities - Application of scales of fees for medical and hospital expenses connected with childbirth.