COUNCIL REGULATION (EEC) No 620/82
of 16 March 1982
establishing, in the relations between the Italian institutions and the institutions of the other Member States, special measures for the reimbursement of sickness and maternity insurance benefits in kind
THE COUNCIL OF THE EUROPEAN COMMUNITIES,
Having regard to the Treaty establishing the European Economic Community, and in particular Article 51 thereof,
Having regard to the proposal from the Commission, drawn up after consulting the Administrative Commission on Social Security for Migrant Workers,
Whereas Article 36 of Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community (1), as last amended by Regulation (EEC) No 2793/81 (2), provides that the benefits in kind provided by the institution of a Member State on behalf of the institution of another shall be fully refunded, either on production of proof of actual expenditure or on the basis of lump-sum payments;
Whereas Articles 93, 94, 95 and 100 of Regulation (EEC) No 574/72 (3), as last amended by Regulation (EEC) No 2793/81, fixing the detailed rules for the application of Regulation (EEC) No 1408/71, lay down the method for determining the amounts to be refunded and for making such refunds;
Whereas the establishment of a national health service in Italy has entailed the abolition of all the sickness and maternity insurance management bodies and in particular that of the ‘Istituto nazionale per 1'assicurazione contro le malattie’ (National Sickness Insurance Institution), hereinafter referred to as the INAM, which was the liaison body and the competent institution within the meaning of Regulations (EEC) No 1408/71 and (EEC) No 574/72;
Whereas this abolition has given rise to major difficulties in carrying out the operations for checking claims submitted by the institutions of the other Member States, on the one hand, and the operations for drawing up the INAM claims vis-à-vis the said institutions, on the other hand, for the purposes of the refunds provided for in Article 36 of Regulation (EEC) No 1408/71;
Whereas it appears advisable to resolve this particular situation by a single Community method applying simultaneously to all the claims by and on the INAM so as to expedite the overall and final settlement of these claims;
Whereas this method should deviate as little as possible from the abovementioned provisions of Regulation (EEC) No 574/72 and recourse should be had to other criteria for the assessment of claims and debts or to special rules only where absolutely necessary,
HAS ADOPTED THIS REGULATION:
Article 1
By way of derogation from the provisions of Title V of Regulation (EEC) No 574/72, the reimbursements provided for in Article 36 of Regulation (EEC) No 1408/71 of sickness and maternity insurance benefits in kind provided up to 31 December 1980 by the institutions of the Member States on behalf of the INAM and by the INAM on behalf of the said institutions, which have not been effected following the abolition of the INAM, shall be determined and effected in accordance with the procedure laid down in this Regulation.
In the relations between Germany and Italy, the claims and debts of the ‘Cassa mutua provinciale di malattia di Bolzano’ shall not be covered by this Regulation.
Article 2
The amounts to be reimbursed pursuant to Article 93 of Regulation (EEC) No 574/72 shall be determined as follows:
1.
the sums which the institutions of the Member States claimed from the INAM on 30 September 1981 in respect of benefits in kind provided up to 31 December 1980 on the basis of documentary evidence shall be aggregated as such, account being taken of the accepted rejects;
2.
the sums which the institutions may still claim pursuant to Article 100 of Regulation (EEC) No 574/72 but for which no documentary evidence is available, in particular for benefits provided in 1980, shall be estimated; they shall be added to the sums referred to in point 1 above;
3.
this estimate shall for each Member State constitute a ceiling; should the documentary evidence submitted for the INAM to the Italian Ministry of Health up to 30 April 1982 - the date of the postmark being recognized as the date of despatch - correspond to an amount not exceeding this ceiling, this amount shall be reimbursed; however, if the ceiling is exceeded, the amount to be reimbursed shall be equal to this ceiling;
4.
the sums claimed by the INAM which were submitted for claims relating to the financial years 1976 and earlier shall be aggregated as such, account being taken of the accepted rejects;
5.
the amounts of the INAM claims for the financial years 1977 to 1980 shall be determined by projecting the amounts reimbursed to the INAM for the financial years 1973 to 1976; however, with regard to Germany, the amount adopted for the financial year 1977 shall be that corresponding to the amount based on the documentary evidence which the Italian Ministry has communicated to the German liaison body.
Article 3
The amounts to be reimbursed pursuant to Articles 94 and 95 of Regulation (EEC) No 574/72 shall be determined as follows:
1.
the lump sums determined for the benefits provided up to 1979 shall be aggregated as such, account being taken of the accepted rejects;
2.
the lump sums for benefits provided in 1980 shall be estimated with regard to the annual average number of families and the annual average number of pensioners covered by Articles 94 and 95 respectively of Regulation (EEC) No 574/72; these numbers shall be obtained by projecting the data relating to 1977, 1978 and 1979;
3.
in dealings between Germany and Italy, claims and debts and the deadlines for settlement shall be calculated in accordance with Annex II.
Article 4
1. The amounts of the claims determined in accordance with Articles 1 to 3 shall be aggregated for each Member State, in the currency of that State, as at 31 December 1981.
2. For the purpose of an offsetting operation, the amounts referred to in paragraph 1 shall then be converted into Italian lire to enable the Italian competent authority to know the balance payable by it.
3. The conversion shall be made on the basis of the official exchange rate as at 31 December 1981 determined by the Commission in the framework of the European monetary system.
Article 5
1. Taking account of point 3 of Article 2, the amount to be offset in accordance with Article 4 shall be expressed in the national currency of the creditor country and shall be reimbursed in that currency.
2. For the conversion of currencies for the purpose of making the reimbursements in accordance with paragraph 3, the rate of exchange to be applied shall be that valid on the day of payment.
3. The reimbursements due shall be made by the liaison bodies as follows:
-
on 31 March 1982, 15 to 20 % of the amount due,
-
on 30 June 1982, 50 % of the balance still due,
-
on 31 December 1982, the balance outstanding.
Article 6
1. The application of Articles 1 to 5 shall constitute a settlement of accounts. This settlement of accounts shall also comprise the amounts provided for by the waiver agreements or other agreements concluded or to be concluded.
2. By way of derogation from Article 100 of Regulation (EEC) No 574/72, no request for reimbursement relating to the benefits referred to in this Regulation may be submitted after 30 April 1982.
3. The competent authority of each Member State shall take the necessary measures for the application of this Regulation, in particular for proceeding from the national balance, determined at Community level, to the settlement of the accounts of the institutions concerned.
Article 7
1. The amounts of the claims for each Member State determined pursuant to the provisions of Articles 2 to 5 are listed in Annex I.
2. The procedure to be followed by the German institutions for determining the amounts to be refunded and apportioning the amounts to be paid is laid down in Annex II.
Article 8
This Regulation shall enter into force on the day of its publication in the Official Journal of the European Communities.
It shall apply from 1 March 1982.
This Regulation shall be binding in its entirety and directly applicable in all Member States.
Done at Brussels, 16 March 1982.