1. INFORMATION SESSION FOR MEMBERS JUNE 2016
JSIS
INFORMATION SESSION FOR MEMBERS
JUNE 2016

2. LEGAL BASE ARTICLE 72 STAFF REGULATION COMMON RULES
GENERAL IMPLEMENTING PROVISIONS

3. GENERAL FEATURES COMPULSORY MEMBERSHIP SOLIDARITY FREE CHOICE
WORLDWIDE COVERAGE

4. RIGHTS
ALL STATUTORY STAFF (OFFICIALS, TEMPORARY AGENTS, CONTRACT AGENTS) : "PRIMARY" COVER (FULL COVERAGE)
DEPENDANTS (SPOUSE, CHILDREN) :
PRIMARY COVER OR TOP-UP COVER (depending on revenue)
Details :

5. FINANCING THE SCHEME
MEMBER'S CONTRIBUTION : 1,7% of base salary (regardless of the number of member-related beneficiaries)
EMPLOYER'S CONTRIBUTION: 3,4% of base salary
TOTAL : 5,1% OF OVERALL BASE SALARIES
TOTAL 2015 : Million EUR DISBURSEMENTS 2015 : Million EUR

6. MEMBERS AND BENEFICIARIES 1
AVERAGE 2015
Active members (contributing):
Post-active members (contributing): Total contributing members :
TOTAL : members and beneficiaries

7. MEMBERS AND BENEFICIARIES 2
Beneficiaries with top-up cover
After getting reimbursement from "primary" insurance scheme, top-up reimbursement can be granted by JSIS whenever JSIS coverage is higher than primary's.
Procedure : copies of supporting documents to be submitted tpogether with statement from primary scheme.

8. ORGANISATION 1 JSIS CENTRAL OFFICE (PMO.3) (B. FETELIAN)
PMO.3.002: JSIS FINANCE, ACCIDENTS AND OCCUPATIONAL ILLNESS INSURANCE, PREVENTIVE HEALTH CARE PROGRAMME (F.de Gaultier)
RELATIONS TO MEMBERS : (PMO.3.003) (R. Rotter)
BRUSSELS SETTLEMENT OFFICE (PMO.3.001) (A. Jacobs)
LUXEMBURG SETTLEMENT OFFICE (PMO.5.003) (S. Gerikaite)
ISPRA SETTLEMENT OFFICE (PMO.6)(A.M. Silvano)

9. ORGANISATION 2 JSIS JOINT MANAGEMENT COMMITTEE :
Monitors the implementation of the rules
Monitors the financial state of the Scheme
Annual report (public)
Issuing proposals for GIP's, financial situation, etc
Issues opinions concerning article 90 complaints …

10. PROCESS 1 No "Third Party" payments:
Guiding principle: Member pays medical expenses and claims reimbursement from his/her settlement office.
Hospitals:
Member may request direct billing from JSIS.

11. PROCESS 2 Prior authorization (PA)
In some cases, you must request authorisation before commencing treatment in order to qualify for a reimbursement. The Medical Officer will decide whether the treatment is justified on medical grounds, and depending on this decision the settlements office will authorise or refuse reimbursement.

12. PROCESS 3 Direct billing
Some treatments or hospital stays can be very expensive. You can apply to have the joint sickness insurance scheme (JSIS) pay the bills directly. Once your application is approved, the scheme will then pay your bills directly to the hospital or the practitioner once the invoice has been paid, your settlement office will determine which part will need to be charged back to you, whenever applicable. Generally, this amount will be recovered from you out of upcoming reimbursements of medical expenses. Recuperation can also take place out of salaries or pensions, or by straight reimbursement by the member.

13. PROCESS 4 SEVERE ILLNESS
You can apply for recognition of a serious illness if your illness involve, to varying degrees, the following four elements :
-a shortened life expectancy
-an illness which is likely to be drawn-out
-the need for aggressive diagnostic and/or therapeutic procedures
-the presence or risk of a serious handicap.

14. JSIS-on-line : your personal interface ("front-office") with JSIS:
PROCESS 5
JSIS-on-line : your personal interface ("front-office") with JSIS:

16. JSIS-on-line will let you:
-Claim reimbursements of your medical expenses on the basis of your scanned supporting documents (NB : watch for conformity controls !)
-Request prior authorizations
-Request direct billing
- Print certificates
- Follow-up the status of your requests and pick-up statements
… more to come in 2015

17. PMO CONTACT : https://ec.europa.eu/pmo/contact/
On-line tool for any of your questions to the PMO (accessible 24/365 worldwide)
…including JSIS-related questions that cannot –yet- be adressed by JSIS-on-line, such as invitations to preventive health examinations etc.
Questions to PMO-Contact are funneled to the competent department for enhanced speed and reliability

19. Should you be-IT resistant…
Paper-based claims for reimbursements
New 5-item form
Please attach original supporting documents

20. Supporting documents to claims
Receipts and invoices must conform to local legislation in the country of issue,
and must include the following information:
• the patient's full name
• the nature of the treatment
• the dates and fees paid for each medical treatment
• the name and official references of the healthcare provider.

21. WISHING YOU GOOD HEALTH! THE PMO TEAM