If you’ve entered the Joint Sickness Insurance Scheme (JSIS) online you will have been greeted with the good news of Higher reimbursement ceilings, broader access to medically assisted reproduction. There was a similar announcement on MyIntracomm AuQuotidien (see the comments below the line for suggestions and additional information). Commission Decision of 17.11.2023 (C(2023) 7673 final) is a partial update: a measured success in the ongoing general revision of reimbursement ceilings.
While this intermediate increase covers only a limited number of situations (e.g. a GP visit, dental care or fertility treatment), it is welcome and we look forward to seeing the full revision completed! Ideally we are looking not just for the ceilings to be raised but also for the range of treatments reimbursed via the JSIS to better match those available in national health systems; colleagues should not have to go to court to have treatment paid and be sure of their rights.
If you already have complementary health insurance then this changes nothing for you: you should continue to receive reimbursement of the part not paid by the JSIS. The only change there is the distribution of the costs between the JSIS and the insurance provider.
This is the outcome of almost 4 years of discussions which started within the Working Group of CGAM – Management Committee for the JSIS. Generation 2004 worked hard there and in the corresponding social dialogue which finished not long ago. Generation 2004 proposed to increase all ceilings by an additional 5%, in order to compensate for the ongoing high inflation, a proposal which was accepted. We had similar luck with the 18-month retroactivity for IVF treatment: meaning that if your treatment started before the entry date of the new Decision, you will still have the right to be reimbursed with the new ceilings (this is exceptional and contrary to the text itself with says new ceilings apply only as of the day of publication: please don’t miss out! Use what you are entitled to!).
We would like to thank our colleagues and counterparts in the other trade unions and staff associations (OSPs) for their support in this specific fight for our staff’s right for a decent ceiling increase as well as a change in the rules, to make the treatment more inclusive. We thank also HR for the fruitful and constructive negotiations. We know that especially for some countries the ceilings are still far below the current prices. Be assured that the negotiations are not over. Only last week (05.12.2023) we started a new round of social dialogue negotiations to reform the whole system, and to include e.g. an automatic ceiling increase in the future as well as to reform the parity coefficient in order to assure a just price for all, regardless of location.
As always, we would love to hear from you. Please do not hesitate to get in touch with us or leave a comment below.
If you appreciate our work, please consider becoming a member of Generation 2004.
Update 04.01.2024 Paxlovid reimbursement process is explained here.
