Saturday, June 23, 2012

Health Costs - Europe June 2012



Posted by Brian Cave (lefourquet@gmail.com)
I have had correspondence  with  the EU officials on this subject and the response is not helpful.
My letter of February 22nd 2012 to Commissioner Andor can be read here
The reply from Jackie Morin [Head of Unit on Social Security Co-ordination]
of June 22nd can be read here.

Below I  transcribe relevant extracts from the EU Regulations relating to Health provision and costing for British Pensioners in France under EU law.
These regulations consist of  two kinds - the Basic and the Implementing.   The Implementing Regulations are dated 2009.  The Basic - 2004.  Both have the full power of Law.
The Implementing Regulations explain in detail how the Basic are to be used. The wording of the implementing regulation is very precise
I have coloured in portions – to make them easier to understand.
Greyed areas-  are of no interest, but given because they are referenced elsewhere.
Purple entries are added by myself by way of explanation.
N.B. The Basic regulations have been in operation (in a similar form but began under other Regulation headings -1408/1971 and 574/1972)  for many years.  The more recent Implementing regulation came into force on May 1st 2010.  From 1973 to the present day, payment was made via a formula laid down in Article 95 of the the Reg 574/1972 and not on 'actual amounts'. The current Implementing Regulations are more precise and definitive than the previous.
The UK joined the EU in 1973.
It seems to me obvious that  the currant regulations are not being implemented to the letter.
I leave it to the reader to comment – I should reply to Jackie Morin but  await  any views before so doing.   Views of people with a legal background would be helpful.   Brian Cave.
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REGULATION (EC) No 883/2004 OF THE EUROPEAN PARLIAMENT
AND OF THE COUNCIL
of 29 April 2004
on the coordination of social security systems
Article 24
No right to benefits in kind under the legislation of the Member State of residence
British Pensioners who have NEVER  paid  into the French Social Care system have no right to benefits under French Legislation.
1. A person who receives a pension or pensions under the legislation of one or more Member States and who is not entitled to benefits in kind under the legislation of the Member State of residence shall nevertheless receive such benefits for himself and the members of his family, insofar as he would be entitled thereto under the legislation of the Member State or of at least one of the Member States competent in respect of his pensions, if he resided in that Member State  (i.e the UK). The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of that Member State.
2. In the cases covered by paragraph 1, the cost of benefits in kind shall be borne by the institution as determined in accordance with the following rules:
(a) where the pensioner is entitled to benefits in kind under the legislation of a single Member State, the cost shall be borne by the competent institution of that Member State (i.e. the Dept. of  Health/NHS)
(b) where the pensioner is entitled to benefits in kind under the legislation of two or more Member States, the cost thereof shall be borne by the competent institution of the Member State to whose legislation the person has been subject for the longest period of time; should the application of this rule result in several institutions being responsible for the cost of benefits, the cost shall be borne by the institution applying the legislation to which the pensioner was last subject.
Article 35
Reimbursements between institutions
1. The benefits in kind provided by the institution of a Member State on behalf of the institution of another Member State under this Chapter shall give rise to full reimbursement.
 2. The reimbursements referred to in paragraph 1 shall be determined and effected in accordance with the arrangements set out in the Implementing Regulation, either on production of proof of actual expenditure, or on the basis of fixed amounts for Member States the legal or administrative structures of which are such that the use of reimbursement on the basis of actual expenditure is not appropriate.
3. Two or more Member States, and their competent authorities, may provide for other methods of reimbursement or waive all reimbursement between the institutions coming under their jurisdiction.


CHAPTER 2
Benefits in respect of accidents at work and occupational diseases
-----------------------------
Article 41
Reimbursements between institutions
1. Article 35 shall also apply to benefits falling within this Chapter, and reimbursement shall be made on the basis of actual costs.

REGULATION (EC) No 987/2009 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL
of 16 September 2009
laying down the procedure for implementing Regulation (EC) No 883/2004
on the coordination of social security systems
TITLE IV           FINANCIAL PROVISIONS
Chapter I
Reimbursement of the cost of benefits in application of Article 35 and Article 41 of the basic Regulation
SECTION 1
REIMBURSEMENT ON THE BASIS OF ACTUAL EXPENDITURE
Article 62
Principles
1. For the purposes of applying Article 35 and Article 41 of the basic Regulation, the actual amount of the expenses for benefits in kind, as shown in the accounts of the institution that provided them, shall be reimbursed to that institution by the competent institution (i.e the DoH/NHS), except where Article 63 of the implementing Regulation is applicable.

SECTION_ 2
REIMBURSEMENT ON THE BASIS OF FIXED AMOUNTS
Article 63
Identification of the Member States concerned
1. The Member States referred to in Article 35(2) of the basic Regulation, whose legal or  administrative structures are such that the use of reimbursement on the basis of actual  expenditure is not appropriate, are listed in Annex 3 to the implementing  Regulation.

Annex 3
France is not listed in Annex 3  and therefore will ask for repayment (for any British pensioners in France)  from the UK on the basis of ‘actual costs’.
The UK is listed and will ask France for repayment (for any French pensioners in the UK) on the basis of a fixed amount.
This annex 3 lists the following nations which will seek payment of health costs for foreign  EU pensioners on their territory by means of fixed sums.  Thus health payment provided in Britain for a French pensioner will be made via a 'fixed sum'.  All other countries (including France) will demand the 'actual amount' as defined above -so it seems!

IRELAND, SPAIN, ITALY, MALTA, THE NETHERLANDS, PORTUGAL, FINLAND, SWEDEN, UNITED KINGDOM

I was informed some time ago by the Department of Health that France will henceforth seek repayment of actual costs.