Keywords
Summary

Keywords

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1. Officials - Social security - Sickness insurance - Medical expenses - Reimbursement ceilings - Permissibility - Conditions

(Staff Regulations, Art. 72; Rules on Sickness Insurance for Officials, Art. 8)

2. Officials - Action - Application for assessment of the legality of a provision, in the absence of an act adversely affecting the applicant - Inadmissibility

(Staff Regulations, Art. 91)

3. Officials - Social security - Sickness insurance - Medical expenses - Reimbursement - Duties of the institutions - Compliance with the principle of equal treatment

(Staff Regulations, Art. 72)

Summary

1. Article 72 of the Staff Regulations does not confer on persons entitled to benefit under the Joint Sickness Insurance Scheme the right to obtain reimbursement of 80% or 85% of the expenses incurred, according to the type of services provided. Those rates fix the maximum reimbursable amount. They are not minimum rates and do not require the institutions to make reimbursements of the stated percentages to the persons concerned in all cases.

The fixing of upper limits of reimbursement by the implementing provisions, in order to safeguard the sickness insurance scheme' s financial balance, does not constitute an infringement of Article 72 of the Staff Regulations, since by setting those limits the Community institutions observe the principle of social insurance cover underlying that article.

The upper limits fixed by joint agreement of the institutions are not unlawful merely by reason of the fact that some reimbursements to which they apply are made at rates much lower than those laid down in Article 72 of the Staff Regulations. The Staff Regulations and the Insurance Rules, by laying down the option, for the person concerned, to request a special reimbursement where the portion of expenses not reimbursed represents a substantial financial burden, presuppose ipso facto that, in certain cases, medical expenses will not be reimbursed at a rate of 80% or 85%.

2. In the context of an action brought under Article 91 of the Staff Regulations, the Court has jurisdiction only to review the legality of an act adversely affecting the applicant, and cannot, in the absence of an individual measure, rule in the abstract on the legality of a provision of a general nature.

3. The principle of equal treatment requires the Community institutions to act in order to remedy situations involving inequality affecting the beneficiaries of the Joint Sickness Insurance Scheme who, in some Member States, bear the costs of higher medical expenses.

However, the institutions cannot be required to increase the reimbursements allowed to the officials concerned forthwith, especially since the financial equilibrium of the Scheme must be safeguarded. They are under a duty, on the other hand, to act in concert, with all due diligence, in order to undertake an appropriate revision of the Rules on Sickness Insurance, which ensures compliance with the principle of equal treatment.