FantasticSearch

1. A staff member, his spouse, where such spouse is not eligible for benefits of the same nature and of the same level by virtue of any other legal provisions or regulations, his children and other dependants within the meaning of Article 7 of Annex IV are, during the period of service of the staff member, periods of sick leave, periods of leave on personal grounds under Article 11 and periods of unpaid leave under Article 33, insured, subject to the conditions laid down in these Articles and subject to the rules referred to in Article 1 of Annex V, against sickness up to 80 % of the expenditure incurred. This rate shall be increased to 85 % for the following services: consultations and visits, surgical operations, hospitalization, pharmaceutical products, radiology, analyses, laboratory tests and prostheses on medical prescription with the exception of dental prostheses. It shall be increased to 100 % in cases of tuberculosis, poliomyelitis, cancer, mental illness and other illnesses recognized by the Commission of the European Communities as of comparable seriousness, and for early detection screening and in cases of confinement. However, reimbursement at 100 % shall not apply in the case of occupational disease or accident having given rise to the application of Article 38a.

One-third of the contribution required to meet such insurance shall be charged to the staff member but so that the amount charged to him shall not exceed 2 % of his basic salary, the other two-thirds being borne by the Foundation. If, however, the medical examination provided for in Article 24 shows the staff member to be suffering from sickness or invalidity, the Director may decide that expenses arising from such sickness or invalidity are to be excluded from the reimbursement of expenditure provided for in the first subparagraph.

2. If he provides evidence that he cannot be covered by any other scheme of sickness insurance established by law or regulation, a staff member may, not later than one month following the expiry of his contract apply to continue, for a maximum of six months after expiry of his contract, to be insured against sickness as provided for in the first subparagraph of paragraph 1. The contribution referred to in the rules mentioned in Article 1 (2) of Annex V shall be calculated by reference to the last basis salary received by the staff member, half the contribution being borne by him.

By decision of the director, taken after consulting the doctor appointed by the Foundation, the period of one month for making application and the six months' limit specified in the first subparagraph shall not apply where the person concerned is suffering from a serious or protracted illness which he contracted during his employment and of which he notified the Centre before the end of the six months' period specified in the preceding subparagraph, provided that the person concerned undergoes a medical examination arranged by the Foundation.

3. A staff member who has remained in the service of the Foundation until the age of 60 years or who is in receipt of an invalidity pension shall be entitled to the benefits provided for in paragraph 1 after he has left the service. The amount of contribution shall be calculated on the basis of his pension.

Those benefits shall also apply to the person entitled to survivor's pension following the death of a staff member who was in active employment or who remained in the service of the Foundation until the age of 60 years, or the death of a person entitled to an invalidity pension. The amount of contribution shall be calculated on the basis of his pension.

4. The following shall likewise be entitled to the benefits provided for in paragraph 1, provided that they cannot obtain cover under any other public scheme of sickness insurance:

— former staff members entitled to retirement pensions who left the service of the Foundation before the age of 60 years;

— persons entitled to survivor's pension as a result of the death of a former staff member who left the service of the Foundation before the age of 60 years;

— where the ex-spouse of a staff member, a child who ceases to be a staff member's dependant or a person who ceases to be treated as a dependent child within the meaning of Article 7 (4) of Annex IV can provide evidence that he or she cannot be covered by any other sickness insurance scheme, he or she may continue for a maximum of one year to be insured against sickness as provided for in paragraph 1, in his or her capacity as a person covered under that staff member's insurance; this cover shall not give rise to the levy of a contribution. This one-year period shall commence on the date of the decree absolute of divorce or of the loss of status of dependent child or of person treated as a dependent child. The contribution shall be calculated by reference to the pension of the former staff member, half the contribution being borne by the person entitled. However, a person entitled to orphan's pension shall not be entitled to the benefits provided for in paragraph 1, except at his request. The contribution shall be calculated on the basis of the orphan's pension.

5. Where the total expenditure not reimbursed for any period of 12 months exceeds half the staff member's basic monthly salary or pension, special reimbursement shall be allowed by the Director of the Foundation, with the assent of the settlements office, account being taken of the family circumstances of the person concerned, in manner provided for in the rules referred to in Article 1 of Annex V.

6. Persons entitled to the foregoing benefits shall declare the amount of any reimbursements paid or which they can claim under any other sickness insurance scheme provided for by law or regulation for themselves or for persons covered by their insurance. Where the total which they would receive by way of reimbursement exceeds the sum of the reimbursements provided for in paragraph 1, the difference shall be deducted from the amount to be reimbursed pursuant to paragraph 1, with the exception of reimbursements obtained under a private supplementary sickness insurance scheme covering that part of the expenditure which is not reimbursable under paragraph 1.