WRITTEN QUESTION E-0251/03 by Sergio Berlato (UEN), Cristiana Muscardini (UEN),Mauro Nobilia (UEN), Roberta Angelilli (UEN), Roberto Bigliardo (UEN),Antonio Mussa (UEN), Sebastiano Musumeci (UEN),Adriana Poli Bortone (UEN), Mariotto Segni (UEN)and Franz Turchi (UEN) to the Commission. Health cover of Italian nationals resident in Belgium.
Date: 2003-02-05
Institutions: European Parliament, Provisional data
Subjects: Belgium, EU national, Italy, competence of the Member States, equal treatment, health expenditure, income in addition to normal pay, residence, social security

10.7.2003

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Official Journal of the European Union

C 161 E/203

Joint answer
to Written Questions E-0250/03 and E-0263/03
given by Mr Patten on behalf of the Commission

(26 February 2003)

The Commission is aware of the hunger strikes undertaken by Hamadi Yahiaoui and Zouhaier Jebali and,
through its sources, is following their state of health.

As already indicated in the answer to written questions E-2526/02, E-2597/02, E-2629/02 and E-3031/02,
the Commission is concerned at the conditions of Mr Yahiaoui and his fellow detainees being held,
particularly in the Bordj el-Amri prison.

Since it replied to those questions, the EU has again drawn the attention of the Tunisian authorities to the
case of Mr Yahiaoui and his conditions of detention.

The Honourable Member should know that at the recent EU-Tunisia Association Committee meeting, the
EU called on the authorities to cooperate with the International Committee of the Red Cross (ICRC) on
detention conditions in Tunisia.

At a different level, the Commission is helping to modernise the Tunisian justice system through a MEDA
programme which is currently in the pipeline. Under this programme measures are planned to support the
prisons administration.

The Union has also reminded Tunisia that the fight against Islamic extremism cannot be conducted to the
detriment of respect for human rights and fundamental freedoms. The matter of a general amnesty for
certain categories of prisoner has not yet been raised with the Tunisian authorities.

(2003/C 161 E/213)

WRITTEN QUESTION E-0251/03

by Sergio Berlato (UEN), Cristiana Muscardini (UEN),
Mauro Nobilia (UEN), Roberta Angelilli (UEN), Roberto Bigliardo (UEN),
Antonio Mussa (UEN), Sebastiano Musumeci (UEN),
Adriana Poli Bortone (UEN), Mariotto Segni (UEN)
and Franz Turchi (UEN) to the Commission

Subject: Health cover of Italian nationals resident in Belgium

(5 February 2003)

Under current Belgian legislation, Italian nations resident in Belgium are obliged to have adequate health
cover.

This requirement is a precondition for the recognition of certain fundamental rights, such as entry on the
population register of a Belgian municipality and subsequent registration on the register of Italians resident
abroad.

It appears that a significant number of Italian nationals are covered by the international ‘E 128’ agreement
(established under Articles 22b and 22c of Regulation (EEC) No 1408/71 (1)) which, among the various
types of health cover available, stipulates that the medical expenses of Community citizens must be borne
by their own country. In the case in point, Italy directly reimburses the INAMI, the Belgian federal
organisation.

However, pending reimbursement by the health insurance organisations of which they are members
(mutual societies), Italian nationals are asked to immediately pay in full for the healthcare they receive.

Unfortunately, Italians resident in Belgium are only reimbursed part of the costs they incur. They receive
75 % of these, calculated on the basis of an index called the ‘INAMI code number’, on a purely flat-rate
basis.

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10.7.2003

Added to this is the fact that the rates charged in practice are actually always higher than this flat-rate
amount, and that some hospitals employ doctors who are not registered with the INAMI and who
therefore charge exorbitant amounts. It should also be noted that most of those doctors who do not
charge the statutory INAMI rates do not inform the public of this by posting an appropriate notice in the
waiting room, as is required under Belgian law.

Italian nationals covered under the E 128 agreement are consequently faced with having to pay large fees
every time they require medical attention.

In the light of the above, will the Commission:

(cid:1) ask the Belgian authorities to grant Italian nationals who are resident in Belgium and covered by the

E 128 agreement complete compensation for the medical expenses they actually incur;

(cid:1) ask the Belgian authorities to establish a suitable system for monitoring the activities of doctors not
registered with the INAMI, thereby compelling them to advertise the medical fees they charge,
in
accordance with current Belgian law, in the interests of all Community citizens resident in Belgium?

(1) OJ L 149, 5.7.1971, p. 2.

Answer given by Mrs Diamantopoulou on behalf of the Commission

(12 March 2003)

The Commission informs the Honourable Members that there is no harmonisation of social security
schemes at Community level. The Court of Justice has pointed out on several occasions that ‘Community
law does not detract from the powers of the Member States to organise their social security systems. In the
absence of harmonisation at Community level, it is therefore for the legislation of each Member State to
determine, first, the conditions concerning the right or duty to be insured with a social security scheme
and, second, the conditions for entitlement to benefits. (…) Nevertheless, the Member States must comply
with Community law when exercising that power’ (1).

Accordingly, Belgium has the power to establish its own sickness scheme and to set the conditions for
granting sickness benefits. Exercising that power, Belgium has chosen a scheme commonly known as a
reimbursement scheme, under which the patients go directly to see a health care provider of their choice
to whom they pay the fees. The fees are then reimbursed on presentation of a statement of treatment,
given by the health care provider, to the mutual benefit association (2).

Agreements are made between the insurance bodies and the professional organisations representing the
medical services to set fees (standard fees) which, with regard to patients, should be respected by the
doctors who have subscribed to these agreements. Under the agreement between doctors and sickness
funds of 19 December 2002, doctors who have not given notification of their refusal to subscribe to the
agreement, post a document in the waiting-room, and for the institutions in either the waiting room, the
reception area or the registration office, which indicates whether they have subscribed to the agreement, as
well as the consultation days and hours when the prices set by the agreement apply and those when they
do not. It is also always possible to enquire at the mutual benefit association or at the National Sickness
and Disability Insurance Institute (INAMI) whether a doctor has in fact subscribed to the agreement.

The patient is reimbursed for care by the mutual benefit association at a flat rate which, in principle, for
ordinary medical aid is 75 % of the standard fees, whether or not the doctor consulted by the patient has
subscribed to the fee-setting agreements.

The choice of this scheme is within the power of the Belgian authorities and cannot be challenged.

Whilst there is no harmonisation of social security systems at Community level, Community law has,
however, instituted coordination of the national social security schemes in order to allow those people
who are moving within the Union to benefit from the best possible social protection.

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Official Journal of the European Union

C 161 E/205

Regulation (EEC) No 1408/71 (3) lays down provisions with a view to enabling people who are staying or
residing in the territory of a Member State other than the State providing insurance to obtain medical care
there. Forms have been drawn up to allow people who need medical care in the State where they are
staying or residing to obtain such care on presentation of the appropriate form. For example, form E 128,
quoted by the Honourable Members, allows people who are temporarily posted by their employer to the
territory of another Member State to obtain the necessary medical care during their stay.

As a general rule, the principles of Regulation (EEC) No 1408/71 lay down that health care is provided
according to the legislation of the Member State where the person receives treatment as if they were
insured in that country, the costs of treatment then being chargeable to the institution in the State
providing insurance for that person. In principle, this system ensures equal treatment of people residing or
staying in the territory of a Member State.

Consequently, Italian nationals resident in Belgium who present form E 128 can claim the necessary care
in Belgium, in accordance with Belgian legislation, as if they were insured there. Under the principle of
equal treatment, they should therefore benefit from the same prices as Belgians who are insured, as the
Court of Justice recently pointed out in the Ferlini judgment (4). Being subject to Belgian legislation, they
are also obliged, in the same way as those insured in Belgium, to pay the health care providers the amount
of the fees and then to apply for reimbursement from the mutual benefit association.

The Commission cannot, therefore, approach the Belgian authorities to obtain the right
for Italian
nationals to be fully reimbursed for the medical costs that they incur. Furthermore, since the sickness
scheme organisation is exclusively a matter for Belgium, the Commission cannot intervene to obtain
intervene if it turned out that doctors or
checks on doctors practising in Belgium. It could, however,
hospitals are charging people insured according to the legislation of other Member States higher prices
than they are charging those insured in Belgium.

(1)

Judgment of 28.4.1998, Case C-158/96, Kohll;
12.7.2001, Case C-157/99, Smits and Peerbooms.

judgment of 28.4.1998, Case C-120/95, Decker;

judgment of

(2) There are exceptions to this general principle, notably in the case of hospital treatment. In this case, the insurance

body pays the health care provider the amount of the entitlement directly.

(3) Regulation (EEC) No 1408/71 of the Council of 14 June 1971 on the application of social security schemes to
employed persons, to self-employed persons and to members of their families moving within the Community, last
updated by Regulation (EEC) No 118/97, OJ L 28, 30.1.1997.

(4) Case C-411/98, judgment of 3.10.2000.

(2003/C 161 E/214)

WRITTEN QUESTION P-0297/03

by Esko Seppänen (GUE/NGL) to the Commission

(4 February 2003)

Subject: Pension reform

A reform of EU civil servants’ pensions is currently in preparation. In the course of the preparations it has
become clear that the Commission will not require officials to pay the cost of pension contributions
amounting to one third of the total pension cover, as laid down in the Council regulation. Consequently
the bill for over two-thirds of these pension payments will come to the Member States. How does the
Commission justify the fact that the full amount of the pension payments is not collected from the
officials?

Answer given by Mr Kinnock on behalf of the Commission

(7 March 2003)

According to the Staff Regulations, officials are required to finance one third of the contribution necessary
for the actuarial balance of the scheme, and they always have. Nothing in the proposals made by the
Commission justifies the view expressed in the Honourable Member’s question that ‘the Commission will
not require officials to pay the cost of pension contributions amounting to one third of total pension
cover’.