CaseT-20/91

Helmut Holtbecker

v

Commission of the European Communities

‛Official — Joint sickness insurance scheme — Spouse covered by member's insurance’

Judgment of the Court of First Instance (Fourth Chamber), 17 December 1992   II-2600

Summary of the Judgment

1. Officials — Social security — Sickness insurance — Spouse in gainful employment — Supplementary entitlement to benefits under the member's insurance — Condition — Compulsory or voluntary cover under another sickness insurance scheme

   (Staff Regulations, Art. 72(1); Rules on sickness insurance for officials of the European Communities, Art. 3(1))

2. Community law — Principles — Protection of legitimate expectations — Conditions

1.  Both Article 72 of the Staff Regulations and Article 3 of the Rules on sickness insurance for officials of the European Communities take as their starting point the idea that, as far as possible, an official's spouse who is in gainful employment must seek reimbursement of his or her medical expenses under the sickness insurance scheme which covers him or her, by virtue of his or her own employment, against the risks of sickness, since only supplementary cover is provided under the Community scheme.

   Neither Article 72(1) of the Staff Regulations nor Article 3(1) of the Insurance Rules makes the spouse's supplementary-cover under the joint scheme, where he or she is gainfully employed, subject to the condition that, by the very fact of the occupation in question, compulsory insurance against the same risks is also provided by virtue of other legal provisions or regulations. On the contrary, Article 3(1) of the Insurance Rules must be interpreted as referring to both the case where the spouse's occupation gives rise in itself, by virtue of legal provisions or regulations, to an obligation to insure against sickness and also the case where the occupation only makes it possible for him or her to benefit, by virtue of legal provisions or regulations, from voluntary insurance against the same risks.

2.  The right to rely on the principle of the protection of legitimate expectations extends to any individual who is in a situation in which it appears that the conduct of the Community administration has led him to entertain reasonable expectations.

   An official may not plead a breach of the principle of the protection of legitimate expectations unless the administration has given him precise assurances. Promises which do not take account of the provisions of the Staff Regulations cannot give rise to a legitimate expectation on the part of the person concerned.