We asked you to send us your stories and here is the first one. A Colleague was diagnosed with a precancerous lesion. Although probably benign, it was growing quickly, showing micro calcifications, opacities, ragged edges, and highly heterogeneous appearance. The doctors concluded that it must be removed as soon as possible as it could easily become a malignant tumour (if that was not already the case) especially considering the colleague’s age group.
The colleague decided to opt for a quick operation (who wouldn’t?) as timing in such cases can potentially make a big difference in terms of outcomes. While still recovering, she checked the response to the serious-illness-recognition request she had filed after the very first medical checks to request 100% reimbursement of the costs incurred. But, to her surprise, since the tumour was not malignant in the end (a conclusive biopsy could only be done on the removed mass, i.e. after surgery), the health issue did not meet the Commission criteria to be considered a serious condition: the colleague had to reimburse a good share of the costs (this can be even more than the normal 15% since there are ceilings for reimbursement) amounting to several thousand euros.
Unbelievable conclusion from the story:
If you have a health issue it might be cheaper for you in the long run to wait until it becomes life-threatening to ensure full reimbursement.
Of course no one would ever follow such a plan, and we do not in any way advocate for this option: there are some things which are beyond money considerations.
On this note, and since not everyone is aware (why would you be?) we take this moment to point out that all surgery that is considered neither an emergency nor a serious illness is normally reimbursed at 85% up to a predetermined ceiling. So examples of surgeries where the remaining expense to the insured person can be significant are the surgery of our colleague above and also procedures such as joint replacements (CATEGORY C2 Orthopaedic surgery 3 Total prosthesis of the hip: Reimbursement at 85 % Ceiling €5 350). What does that look like in practice? See the example below of hip replacement surgery from 2014 (note that prices have increased by >10% since then). This colleague’s complementary health insurance [*] covered the outstanding €2017.89.
It’s good to be aware of what is normal for the JSIS, particularly when you know in advance that something is particularly costly. We recommend you start with the links in this article and also ask colleagues for their reimbursement experiences.
Luxembourg-based colleagues, please note that you now need to ask the hospital for an estimate for non-emergency hospitalisation before it happens (due to the end of the agreement with the Luxembourg hospitals, 01.01.2020). Yes, just like a car repair or renovating your kitchen, ask for an estimate…
While we wish you all good health, we do understand that when colleagues are already ill it can be difficult to know what the rules are and who to talk to. We’re here to help!
Life can be surprising, and life in the Commission can be surprising too. If you have encountered an eyebrow-raising situation, please share it with us!
If still possible, we will try to help otherwise, we will anonymise the events and publish the story (we are also very happy to receive stories where you overcame all obstacles: tell us how you did it!).
So, if you are tempted to share your story, please write to us with the title ‘it happened to me’!
Keep calm, take notes and write to us!
Your Generation 2004 team
[*] ‘We also advise all JSIS members to opt for private complementary insurance to supplement the JSIS reimbursement in the event of major medical expenses (hospitalization, etc.).’ (JSIS, Practical information, 15.12.2022)