Proposal for joint rules on sickness insurance for officials of the European Communities
Date: 2004-04-28
Institutions: European Commission
Subjects: European official, health insurance













EUR-Lex - 52004SC0480 - EN






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52004SC0480

Proposal for joint rules on sickness insurance for officials of the European Communities  /* SEC/2004/0480 final */  









Proposal for JOINT RULES on sickness insurance for officials of the European Communities(presented by the Commission)EXPLANATORY MEMORANDUMPart 1 General provisionsTitle I - ScopeIn Article 1 on the scope of the Rules, a sentence is introduced referring to the general implementing provisions, which are adopted by a special procedure in accordance with the third subparagraph of Article 72(1) of the new Staff Regulations. This addition is in accordance with Opinion No 11/2001 of the CGAM.Title II - MembersUnder this Title are set out the provisions laid down in Articles 2, 3 and 4 of the current Rules.The presentation aims to:* make the provisions clearer and more transparent,* fill gaps in the present text, which has been found to be incomplete on a number of points,* incorporate the new provisions provided for in the new Staff Regulations.Chapter 1 - Joint provisionsArticle 2 - Membership* In paragraph 1, contract staff are added (Article 72(1) of the Staff Regulations, Article 93 of the Conditions of Employment of Other Servants).* In paragraph 2, the European Ombudsman and the European Data Protection Supervisor and Assistant Supervisor are added.* As regards the members of the Institutions, a specific reference is made to the provisions relating to their emoluments, certain of which differ from those applicable under the new Staff Regulations to officials and temporary and contract staff. The same applies to the surviving spouse or surviving recognised partner of a member of an Institution.* In the second indent of paragraph 3, those employed for more than three years as contract staff and now in receipt of a retirement pension are added.* In the fourth and fifth indents of paragraph 3, persons leaving the service under Regulations (EC) Nos 2688/95, 2689/95 and 1746/2002 on termination of service are added.* The new condition laid down in Article 72(2a) of the new Staff Regulations is added, i.e. the absence of gainful employment for recipients of an early retirement pension or a deferred retirement pension and people on CCP (Article 40(3) of the Staff Regulations and Articles 17 and 88 of the Conditions of Employment of Other Servants).Article 3 - Contribution* In paragraph 1, the allowance provided for in Regulation (EC) No 1746/2002 is added as a basis for calculating the contribution to the Scheme.* In paragraph 2, the provisions applicable in the event of parental or family leave are added (second paragraph of Article 42a and Article 42b of the Staff Regulations and Articles 16 and 88 of the Conditions of Employment of Other Servants).Article 4 - Compulsory membership of another sickness insurance schemeAddition of contract staff.Chapter 2 - Specific provisions applicable to officialsThis Chapter sets out all the special provisions applicable exclusively to officials in the following situations:* Unpaid secondment (Article 5).* Non-active status and retirement under Articles 41 and 50 of the Staff Regulations (Article 6).* Termination of service (Article 7).* Loss of remuneration in the event of unauthorised absence or disciplinary measures (Article 8).* Dismissal for incompetence under Article 51 of the Staff Regulations (Article 9).Chapter 3- Specific provisions applicable to temporary staff and contract staffThis Chapter sets out all the special provisions applicable exclusively to temporary staff and contract staff in the following situations:* Resignation and end of contract under Articles 18 and 93 of the Conditions of Employment of Other Servants (Article 10).* Unemployment under Articles 28a and 94 of the Conditions of Employment of Other Servants (Article 11).Title III - Persons covered by members' insuranceChapter 1- Spouse and recognised partnerArticle 12 - Persons coveredThe recognised partners of members are added on the conditions laid down in the Staff Regulations (the condition laid down, in particular for receipt of the household allowance, in the final indent of Article 1(2)(c) does not have to be fulfilled for sickness insurance cover).Article 13 - Primary coverArticle 14 - Supplementary coverThese two Articles lay down the conditions for cover under the Scheme as set out under Article 3 of the current rules and in the interpretative provisions.Article 15 - Divorce -termination of partnershipAddition of recognised partners whose status of non-marital partner is lost and the new condition of the absence of gainful employment (Article 72(1b) of the Staff Regulations).Chapter 2- DependantsThis Chapter lays down the rules on cover for dependants:* Children (Article 16).* Other dependants (Article 17).* The rules on the extension of cover on the new condition of not being gainfully employed laid down in Article 72(1b) of the Staff Regulations (Article 18).Part 2 ReimbursementTitle I - PrincipleArticle 19 - Free choiceThis Article sets out the provisions contained in Article 9(1) of the existing Rules with the addition of provisions on their interpretation with regard to the restrictions on the application of the principle of free choice (restriction on the reimbursement of travel expenses and supplementary cover only after all the possibilities offered by the primary scheme have been exhausted).Title II - RulesThe content of the Articles under this Title constitutes an important innovation in that previously most of the provisions limiting reimbursements have been contained in the Annexes or in the provisions interpreting them.Inserting the principles regarding reimbursements, and the rules governing them, within the body of the Staff Regulations gives them a solid and enforceable legal basis.Article 20 - General rules on reimbursementThis Article introduces no new element to the existing Rules and practices. It is intended to provide a legal basis for the different rules on the limitation of reimbursements, which, furthermore, have been confirmed by the case law of the Court of Justice (for example, the judgments of 12 July 1991 in Case T-110/89, Pincherle, and of 26 October 1993 in Cases T-55/92 and T-6/92, Reinarz).* Principle of reimbursement ceilings (paragraph 1).* That part of expenses considered excessive in the case of treatments not subject to ceilings on reimbursement (paragraph 2).* Expenses in respect of treatment considered ineffective or unnecessary (paragraph 3).* Expenses in respect of items not mentioned in the rules but nevertheless reimbursable (paragraph 4).* Legal basis for the parity coefficients intended to take account of differences in the cost of health care among the Member States. It should be noted that those coefficients apply only within the EU. Treatment paid for in Switzerland is now excluded from this mechanism and the rules for non-EU countries laid down in Article 21 apply (paragraph 5).* Reimbursement at the rate of 100% in the case of serious illnesses (detailed list and the general criteria applicable), screening tests and confinements and the establishment of special reimbursement ceilings (paragraph 6).* Exclusion from reimbursement at the rate of 100% where Article 73 of the Staff Regulations on occupational diseases and accidents applies (paragraph 7).Article 21 - Special rules on the reimbursement of treatment outside the European UnionThis new Article constitutes an important change in the Rules, although the basis of the provision is not entirely new.Under the current framework, the interpretative provisions and practice as regards reimbursement have tended to limit the growth of expenses incurred in non-member countries in which medical treatment is expensive, given that the level of contributions is predicated on the cost of health care in the Member States.The mechanisms established have been found to have shortcomings, in both legal terms (no provision or principle laid down in the current Rules provides a legal basis for these limits on reimbursements ) and practical terms (the limits are not applied on a general basis and there is a lack of transparency for members as regards the actual rates of reimbursement).* The mechanism proposed in paragraph 1 is intended to reduce expenses incurred in non-member countries in which the cost of health care is particularly high to a level comparable to the average in the Member States and to apply the rate of reimbursement laid down in the Rules to that lower amount.This is achieved by applying a reimbursement-level coefficient determined by comparing indices of purchasing power parity in the health sector (public and private sectors combined). The reference would be provided by the data regularly published by the OECD.Example:Index for EUR 15: 100Index for USA: 200  //  Reimbursement-level coefficient = Index for EUR 15/Index for USA, i.e. 0.5Expenditure incurred in the USA: $ 1 000 or EUR1 000 (assumption: $ 1 = EUR1)Comparable amount in the EUR 15 = Expenditure incurred in the USA x reimbursement-level coefficient,or EUR1 000 x 0.5 = EUR500Calculation of the reimbursement (assuming a rate of reimbursement of 80%)Comparable amount in the EUR 15 x 80%, i.e. EUR500 x 80% = EUR400 (actual rate of reimbursement 40%)This mechanism has numerous advantages:- it maintains the financial balance of the Scheme in line with the level of contributions;- simplicity and objectivity by the use of official indices of purchasing power parity;- transparency, permitting members to know in advance the actual rate of reimbursement;- preservation of the principle of free choice irrespective of the geographical location in which health care is provided.* Where expenses are less than or equal to the reimbursement ceiling, the reimbursement-level coefficient is not applied in order to guarantee actual reimbursement equal to the ceiling (paragraph 2).* Where that part of the expenses not reimbursed following application of the reimbursement-level coefficient is high and represents a considerable cost to the beneficiary, supplementary reimbursement is made to bring the actual rate of reimbursement up to 50%. This guaranteed reimbursement does not apply to treatments to which a reimbursement ceiling applies, in order to ensure that such treatment is dealt with in the same way as provided for within the EU (paragraph 3).In the example cited above, a supplementary reimbursement of EUR100 would be paid.This mechanism replaces that established by the provisions interpreting Article 8 of the existing Rules.* In the case of serious illness and where no equivalent therapeutic treatment is available within the EU, after consultation of the Medical Officer, the reimbursement-level coefficient is not applied (paragraph 4).It should be stressed that the proposed mechanism will have no effect on the rate of reimbursement of medical or hospitalisation expenses of officials or other servants working in Delegations in non-member countries, who are fully reimbursed under Article 24 of Annex X to the Staff Regulations for expenses incurred.Article 22 - Reimbursements from another sickness insurance schemeThis Article lays down the rules of application of Article 72(4) of the Staff Regulations. The mechanism is unchanged from that laid down in Article 6 of the existing Rules. Certain details set out in the interpretative provisions have however been included in the interests of clarity.Article 23 - Non-reimbursement of certain expensesThis remains unchanged apart from the addition of contract staff.Article 24 - Special reimbursementsThis Article lays down the rules for the application of Article 72(3) of the Staff Regulations. The calculation method is identical to that currently used. Paragraphs 1 and 4 take account of both the provisions of Articles 20 and 21 of the new Rules and those of Article 8 of the existing Rules.&gt;TABLE POSITION&gt;Article 25 - Flat-rate allowance towards funeral expensesSince this is a flat-rate allowance, this has been specified.Title III - ProceduresThe procedures have not been amended, other than for the addition of provisions resulting from:* the amendments to the Staff Regulations: the inclusion of partners whose partnership has been dissolved as regards the right to submit claims for medical expenses and applications for prior authorisation (Article 29), unified appeals procedure under Title VII of the Staff Regulations (Article 35);* the new provisions of the Financial Regulation concerning the procedure for informing the accounting officer where debts are waived (Article 30);* current management practices, such as:- the original detailed statement of reimbursements received from another scheme (Article 28),- the recovery of advances from all sums due to the member under the Scheme (Article 30);* the need for simplification so as to permit applications for reimbursement to be submitted within 18 months of the date of treatment (Article 32).Part 3 Organisation of the SchemeThe role and tasks of the various management and supervisory bodies have not been altered, with the exception of:* more detailed rules on:- the extension of the principle of confidentiality to members of the Management Committee (Article 37),- specification in its rules of procedure of who may attend meetings of the Management Committee without voting rights and the rules governing its discussions and the issuing of opinions (Article 38(5)),- the role of the Central Office in the negotiation of tariffs with representatives of the medical profession (Article 39(2)(e)),- the performance of the tasks entrusted to staff of the settlements offices in accordance with the instructions of and under the supervision of the Head of the Central Office (Article 40(2));* the updating of the composition of the Management Committee, with the addition of representatives of the Administration and of staff representatives for the European Ombudsman and the European Data Protection Supervisor, placed on the same footing as the other Institutions, and the Agencies (Article 38(1));* the extension of the opinions and proposals that the Management Committee may issue to include general implementing provisions, linked to the amendment of the third subparagraph of Article 72(1) of the Staff Regulations (Article 38(6));* as requested by the Management Committee, entrusting the Central Office with the task of negotiating, where possible, agreements with primary schemes in order to simplify the procedures applicable to members of the Scheme (Article 39(2)(f)).Part 4 Financial ProvisionsTitle I - ManagementFollowing the entry into force of the new Financial Regulation on 1 January 2003 and the disappearance of the Financial Controller, the rules on the authorisation of payments and the monitoring of the Joint Sickness Insurance Scheme were updated in order to bring the internal monitoring mechanisms within the Central Office and the settlements offices.* The receipts and payments authorised must be subject to prior verification by staff other than those initiating the transaction (Article 43(2)).* The Central Office must carry out or have carried out ex post checks to ensure:- the legality and correctness of the transactions carried out by the settlements offices and observance of the principles of sound financial management (the first indent of Article 43(3)).- that the contributions to be paid tally with the revenue received (the second indent of Article 43(3)).It is also laid down that the Central Office must inform the Management Committee of internal monitoring mechanisms and of the results of checks carried out (Article 43(4)).Title II - AccountsThe principal amendment made under this Title is the provision, requested by the Management Committee during the examination of the accounts for the 2002 financial year, that the annual financial statements be the subject of an accounts certification procedure (Article 45(5)).Another important amendment concerns the frequency of interim closures. In the interests of rationalisation and in order to comply with this provision, in future the accounts will be closed on a six-monthly basis rather than every quarter (Article 45(3)).The other amendments are technical adjustments or adjustments to accounting terminology:- the Commission's internal auditor is to be informed rather than the Financial Controller,- "operating accounts" replaced by "profit-and-loss accounts",- "the sum totals for previous financial years" replaced by "reserve".Title III - Financial information and financial balance of the SchemeIn addition to the technical adjustments and adjustments to accounting terminology referred to in the previous Title, two important additions have been made relating to the management of the financial balance of the Scheme.As regards management of the reserve, a new provision is introduced obliging the department responsible for managing investments (DG ECFIN - SOF) to provide a management report on the policy and strategy employed for investing funds held in reserve (the first subparagraph of Article 51(2)).With regard to the measures to be taken to ensure the continued financial balance of the Scheme, it is laid down that the general implementing provisions may also be amended (the final subparagraph of Article 51(3)).Part 5 Final provisionsThe principal amendment concerns the provisions for implementing the new third subparagraph of Article 72(1) of the Staff Regulations, which lays down that the Institutions may entrust to one of their number the power to determine, by general implementing provisions, the rules governing the reimbursement of expenses.These rules are currently laid down in an Annex to the Rules.Given that the Commission is responsible for managing the Scheme, it is proposed to entrust it with this task (Article 52(1)).As regards the general implementing provisions for the Joint Sickness Insurance Scheme, the Management Committee must be asked for its opinion in the same way as the Staff Regulations Committee (Article 52(2)).As a transitional measure and pending adoption of the general implementing provisions, the Annexes to the repealed Rules continue to apply (the second and third subparagraphs of Article 54).Finally, the Management Committee may propose amendments to the Rules (Article 53(1)).Proposal for JOINT RULES on sickness insurance for officials of the European CommunitiesTHE INSTITUTION [1],[1]  These rules have been adopted by all the Institutions, common accord having been recorded by the President of the Court of Justice of the European Communities on 28 August 1987.Having regard to the Staff Regulations of Officials and the Conditions of Employment of Other Servants of the European Communities laid down by Regulation (EEC, Euratom, ECSC) No 259/68 [2], as last amended by Regulation (EEC, Euratom, ECSC) No 3736/90 [3], and in particular Article 72 of those Staff Regulations and Article 28 of those Conditions,[2]  OJ L 56, 4.3.1968, p. 1.[3]  OJ L 360, 22.12.1990, p. 1.Having regard to the Rules on sickness insurance for officials of the European Communities, and in particular Article 30 thereof,Having regard to the opinion of the Staff Regulations Committee,Having regard to the opinion of the Management Committee for the Joint Sickness and Insurance scheme,Whereas:It is the responsibility of the Institutions of the European Communities to draw up by agreement rules on insurance against the risk of disease applicable to officials of the Communities,Having regard to the common accord between the institutions of the European Communities1,HAS ADOPTED THESE RULES [4]:[4]  Rules amended by the rules adopted by all the Institutions, common accord having been recorded by the President of the Court of Justice of the European Communities on 5 December 1990 and 28 November 1991.Part 1 General provisionsTitle I - ScopeArticle 1Under Article 72 of the Staff Regulations, a Sickness Insurance Scheme common to the institutions of the European Communities is hereby set up. Within the limits and on the conditions set forth in these Rules and under the general implementing provisions adopted on the basis of Article 52 of these Rules, the Scheme shall guarantee to the persons covered by it the reimbursement of expenses incurred as a result of illness, accident or confinement and the payment of an allowance towards funeral expenses.The Scheme shall apply to its members and to persons covered under them.References to the institutions in these Rules shall be understood to include the Community agencies.Title II - MembersChapter 1 - Common provisionsArticle 2 Membership1. The following shall also be members of this Scheme:- permanent officials,- temporary agents,- contract agents who have not applied for their sickness insurance cover to be maintained in the country in which they were last covered in accordance with Article 112 of the Conditions of Employment of Other Servants.2. The following shall be members of the Scheme under the rules determining their emoluments, whether they are in activity or after they have ceased their employment:- the President, Vice-Presidents and Members of the Commission,- the President, Judges, Advocates-General and Registrar of the Court of Justice,- the President, Members and Registrar of the Court of First Instance,- the President and Members of the Court of Auditors,- the European Ombudsman,- the European Data Protection Supervisor and Deputy Supervisor.3. The following shall also be members of this Scheme:- former officials and temporary staff in receipt of a retirement pension,- former contract agents in receipt of a retirement pension provided that they have been employed for more than three years as contract agents,- persons in receipt of an invalidity pension or disability allowance,- persons whose service has been terminated under Regulations 259/68, 2530/72, 1543/73, 2150/82, 1679/85, 3185/85, 2274/87, 1857/89, 2688/95 or 2689/95,- persons whose service has been terminated under Council Regulations 1746/02, 1747/02 or 1748/02 provided they are not in receipt of income from gainful employment,- persons in receipt of an early or deferred retirement pension provided they are not in gainful employment,- permanent officials, temporary staff and contract agents on unpaid leave on personal grounds, at their request and provided they are not in gainful employment.4. The following shall also be members of this Scheme:- surviving spouses or surviving recognised partners in receipt of a survivor's pension,- surviving spouses or surviving recognised partners of persons as referred to in paragraph 2 under the rules determining their emoluments,- surviving divorced spouses in receipt of a survivor's pension,- persons in receipt of an orphan's pension at their request or at the request of their legal representative where they cannot be covered by a member's insurance.Article 3 Contribution1. The amount of the contribution to this Scheme shall be 5.1% of the basic salary, retirement pension, invalidity pension, disability allowance, survivor's or orphan's pension, or the allowance provided for in Council Regulations 1746/02, 1747/02 or 1748/02, at the rate of one-third to be paid by members and two-thirds to be paid by the institutions or agencies concerned.If a person is in receipt of a retirement or survivor's pension the contribution may not be less than that calculated by reference to the basic salary for grade 1, step 1 [5].[5]  For the period from 1 May 2004 to 30 April 2006: grade D*1, step 1.2. In the case of full-time parental or family leave, the entire contribution shall be calculated by reference to the most recent basic salary and shall be borne by the institution or agency concerned.In the case of half-time parental or family leave, the contribution borne by the institution or agency concerned shall be calculated as the difference between the full basic salary and the basic salary reduced proportionately.In respect of the portion of the basic salary actually paid, members' contributions shall be calculated by applying the same percentages as if they were working full-time.3. In the case of part-time work, the contribution shall be calculated by reference to the full basic salary of the member according to the proportions provided for in paragraph 1.4. In the case of unpaid leave on personal grounds, members may continue to be covered by this Scheme provided they pay half the contribution to the Scheme, calculated by reference to the most recent updated basic salary for their grade, in the first year and the full contribution from the second year on.5. In the case of leave for military service, members shall not be covered by the Scheme. However, persons covered under them shall continue to be covered by the Scheme as provided below:- in the case referred to in the second subparagraph of Article 42 of the Staff Regulations, without members having to pay contributions;- in the case referred to in the third subparagraph of Article 42 provided members pay their contribution calculated by reference to the most recent updated basic salary for their grade and step.Article 4 Compulsory membership of another sickness insurance schemeWhere permanent officials, temporary staff or contract agents are employed in a country in which they are required by the law of that country to join a compulsory scheme of sickness insurance, the contributions due under that scheme shall be paid in full from the budget of the institution to which the persons concerned belong. In this event, Article 22 of these Rules shall apply.Chapter 2 - Special provisions applying to permanent officialsArticle 5 Unpaid secondmentPermanent officials on unpaid secondment under Article 39(f) of the Staff Regulations may continue to be covered by the Scheme until they are required to resign, provided they pay all the contributions calculated by reference to the updated basic salary for their grade and step.Article 6 Non-active status and retirement in the interests of the service1. Officials in receipt of the allowance provided for in Articles 41 or 50 of the Staff Regulations may continue to be covered by this Scheme provided that they:- are not gainfully employed, and- pay one third of the contribution to this Scheme calculated by reference to the updated basic salary for their grade and step.Officials may recommence cover under this Scheme on duly justified written application when all gainful employment has ceased.2. Officials not in receipt of the allowance provided for in Articles 41 or 50 of the Staff Regulations or of a pension may continue to be covered by this Scheme provided that they:- are not gainfully employed, and- pay one half of the contribution to this Scheme calculated by reference to the updated basic salary for their grade for the first six months and the full contribution from the seventh month on.Officials may recommence cover under this Scheme on duly justified written application when all gainful employment has ceased.Article 7 Final termination of serviceOfficials whose service has been terminated may continue to be covered by this Scheme for a maximum period of six months provided that they:- are not gainfully employed, and- pay one half of the contribution to this Scheme calculated by reference to the updated basic salary for their grade and step.Application for cover must be made before the end of the first month following the date of final termination of employment.The above conditions do not apply in the case of serious or protracted illness contracted before termination of employment and notified to the institution before expiry of the six-month period provided for in the first paragraph, provided that the person concerned undergoes a medical examination arranged by the institution. Arts.Article 8 Forfeiture of remunerationOfficials forfeiting the right to remuneration as a result of unauthorised absence or disciplinary measures may, at their written request in the month after the date of the decision, continue to be covered by this Scheme provided they pay one third of the contribution calculated by reference to the updated basic salary for their grade and step. Arts.Article 9 Dismissal for incompetenceOfficials in receipt of the allowance provided for in Article 51 of the Staff Regulations may continue to be covered by this Scheme during payment of the allowance provided that they:- are not gainfully employed, and- pay one half of the contribution to this Scheme calculated by reference to the updated basic salary for their grade and step.Chapter 3 - Special provisions applying to temporary staff and contract agentsArticle 10 Resignation - end of contractServants who have resigned or reached the end of their contract may continue to be covered by this Scheme for a maximum of six months provided they:- can prove that they cannot obtain reimbursement under another legal or statutory sickness insurance scheme,- pay one half of the contribution to this Scheme calculated by reference to the updated basic salary for their grade and step.Application for cover must be made before the end of the first month following the date of resignation or of the end of the contract.The above conditions do not apply in the case of serious or protracted illness contracted before termination of employment and notified to the institution before expiry of the six-month period provided for in the first paragraph, provided that the person concerned undergoes a medical examination arranged by the institution. Arts.Article 11 UnemploymentServants in receipt of Community unemployment benefit shall be covered by this Scheme while that benefit is being paid.This top-up cover does not require a contribution.Servants may benefit from primary cover under this Scheme on duly justified written application if they cannot obtain cover under another legal or statutory sickness insurance scheme. Arts.Title III - Persons covered by members' insuranceChapter 1 - Spouses and recognised partnersArticle 12 Insured personsThe following are covered by members' insurance under the conditions set out in Articles 13 and 14:- spouses, unless they are already full members of the Scheme,- recognised partners of members of the Scheme even if they do not satisfy the last indent of Article 1(2)(c) of Annex VII to the Staff Regulations,- spouses or recognised partners taking unpaid leave on personal grounds as provided for in the Staff Regulations.Article 13 Primary coverInsured persons shall benefit from primary cover under this Scheme if they have no income of their own from gainful employment or if such income is so low that they cannot be covered by another compulsory legal or statutory sickness insurance scheme.Income from gainful employment shall be understood to mean any salaries, fees, emoluments, benefits, allowances or pensions arising from current or former gainful employment, excluding allowances towards costs.Article 14 Top-up cover1. If insured persons are in receipt of income from gainful employment they may benefit from top-up cover under this Scheme provided:- their annual taxable income, before tax and after deduction of social welfare contributions and professional charges, does not exceed the basic annual salary of an official in the first step of grade 2 [6] multiplied by the correction coefficient for the country in which the income is received, and[6]  For the period from 1 May 2004 to 30 April 2006: grade C*2, step 1.- they are fully covered for the same risks under any other legal or statutory provisions.2. In order for insured persons to continue to benefit from top-up cover under this Scheme members must provide, in the first half of each year, proof of income received by their spouse or recognised partner for the previous fiscal or calendar year.3. Members are obliged to report any changes in the employment circumstances of their spouse or recognised partner which may give rise to changes in entitlements under this Scheme.Article 15 Divorce - dissolution of partnership1. Divorced spouses of members or their recognised partners whose non-marital partnership status is dissolved may be covered under this Scheme for a maximum of twelve months from the date of decree absolute of the divorce or dissolution of the partnership provided they are not in gainful employment.2. In the event of the member's death, if the recognised partner covered by the member's insurance is not entitled to a survivor's pension he/she shall continue to be covered by this Scheme under the conditions set out in paragraph 1.Chapter 2 - DependantsArticle 16 Dependent children1. Dependent children within the meaning of Article 2 of Annex VII to the Staff Regulations shall be covered by this Scheme.If dependent children are eligible for reimbursement of medical care under another legal or statutory sickness insurance scheme, the Community Scheme shall provide top-up cover.2. The age limit and exceptions to recognition of dependent children shall be as defined in Article 2(3)(b) and (5) of Annex VII to the Staff Regulations.3. Dependent children shall not be covered by this Scheme during their civil or military service.Dependent-child cover may be granted after the age of 26 for a period equivalent to that of the civil or military service provided that the allowances provided for in Article 2 of Annex VII to the Staff Regulations have been granted to the child.Article 17 Other dependent personsPersons recognised as dependent on the member within the meaning of Article 2(4) of Annex VII to the Staff Regulations may be covered by this Scheme provided they cannot be covered by another legal or statutory sickness insurance scheme.Article 18 ExtensionProvided they do not exercise any gainful employment, beneficiaries may continue to be covered by this Scheme for a maximum of twelve months from the date on which:- they cease to be dependent children or persons treated as dependent children;- they lose entitlement to an orphan's pension.Part Two ReimbursementTitle I - Basic principleArticle 19 Freedom of choice1. Persons covered by this Scheme shall be free to choose their practitioners and hospitals or clinics.2. The principle of freedom of choice does not automatically imply reimbursement of any resulting travel costs; the rules for reimbursing this type of cost are set out in the general implementing provisions.3. Freedom of choice shall apply to beneficiaries of top-up cover only after the possibilities offered by the primary scheme have been exhausted.Title II - RulesArticle 20 General reimbursement rules1. For the purpose of protecting the financial equilibrium of the Joint Sickness Insurance Scheme and respecting the principle of social security cover forming the basis for Article 72 of the Staff Regulations, reimbursement ceilings for certain benefits may be set in the general implementing provisions.If the costs claimed by the member are lower than the ceiling, reimbursement shall be calculated on the basis of costs claimed.2. In the case of benefits for which no reimbursement ceiling has been set, the proportion of the costs deemed excessive by comparison with normal costs in the country where the costs have been incurred shall not be reimbursed. The portion of the costs deemed excessive shall be determined on a case-by-case basis by the Settlements Office after consulting the Medical Officer.3. The cost of treatments deemed to be non-functional or unnecessary by the Settlements Office after consulting the Medical Officer shall not be reimbursed.4. The cost of benefits not provided for in the general provisions implementing these Rules may be covered up to a rate of 80% after the opinion of the Medical Officer of the Settlements Office has been obtained. Members are regularly notified of such information.5. In order to ensure equality of treatment for benefits paid for in any of the Member States of the European Union, parity coefficients shall be adopted at least once every two years by the Heads of Administration after consulting the Management Committee. Members shall be notified of the coefficients.6. In accordance with Article 72(1) of the Staff Regulations, costs shall be reimbursed in full in the case of tuberculosis, poliomyelitis, cancer, mental illness and other illnesses recognised by the appointing authority as of comparable seriousness after consulting the Medical Officer of the Settlements Office.The Medical Officer's opinion shall be delivered on the basis of general criteria laid down in the general implementing provisions after consultation of the Medical Council.The costs linked to early detection screening provided for in the general implementing provisions and to confinement shall also be reimbursed in full.However, for the purpose of protecting the financial stability of the Joint Sickness Insurance Scheme and respecting the principle of social security cover forming the basis for Article 72 of the Staff Regulations, special ceilings for reimbursing certain benefits may in exceptional circumstances be set in the general implementing provisions.7. Reimbursement in full shall not apply in cases of occupational disease or injury resulting in the application of Article 73 of the Staff Regulations.Article 21  Special reimbursement rules for benefits received outside the European Union1. Expenses incurred in a country outside the European Union where costs are particularly high shall be reduced by applying a reimbursement-level coefficient enabling reimbursement rates to be applied to costs made comparable to the average in the European Union.The coefficients shall be established on the basis of official health cost indices comparable among the various countries. They shall be reviewed periodically and notified to the members.2. The reimbursement-level coefficient shall not be applied where the amount of the costs incurred to be reimbursed is lower than or equal to the reimbursement ceiling provided for in Article 20(1) and the fourth subparagraph of Article 20(6).3. If, after application of the reimbursement-level coefficient the portion of the costs not reimbursed by the Scheme results in a high financial burden to the beneficiary, a top-up reimbursement shall be paid so that the actual payment amounts to 50% of the total cost actually incurred.The top-up reimbursement shall not apply to benefits which are subject to the reimbursement ceilings provided for in Article 20(1) and the second subparagraph of Article 20(6).4. In the event of a serious illness as provided for in Article 20(6) where there is no equivalent medical treatment in the European Union, the reimbursement-level coefficient shall not be applied by the Settlements Office, after consultation of the Medical Officer as required for prior authorisation.Article 22 Reimbursements from another sickness insurance scheme1. Where a member or a person covered by his insurance may claim reimbursement of expenses incurred under any other legal or statutory sickness insurance, the member shall:(a) notify the office responsible for settling claims;(b) in the first instance apply, or have the person concerned apply, for reimbursement under the other scheme;However, if obliged to pay into two schemes, members of this Scheme may choose the scheme to which they apply for reimbursement of the benefits they have received in the knowledge that the Community Scheme will be available as a top-up scheme in cases where it does not act as the primary scheme;(c) attach to any application for reimbursement made under this Scheme a detailed original statement, together with supporting documents, of reimbursements which the member or the person covered by his insurance has obtained under the other scheme.2. The Community Scheme shall act as a top-up scheme for reimbursement of benefits provided the other scheme has previously reimbursed the benefits covered by it.If a benefit is not covered by the primary scheme but is covered by the Community Scheme the latter shall act as the primary scheme.3. If the total reimbursements received by members or by persons covered under him/her exceeds the reimbursement provided for in this Scheme, the difference shall be deducted from the amount to be reimbursed by the latter.Reimbursements obtained from a private top-up health insurance scheme intended to cover that portion of the costs not reimbursed by this Scheme shall not be included in this calculation.Article 23 Exclusion of certain costs from reimbursement1. Where, as a result of the medical examination on recruitment, it is decided in accordance with the second subparagraph of Article 28 and Article 93 of the Conditions of employment of other servants that a temporary official or contract agent shall not be entitled to reimbursement of certain expenses, the result of the medical examination shall be forwarded to the medical officer of the Settlements Office; the medical officer shall inform the Office of any treatment in respect of which expenses incurred shall not be reimbursable.2. Upon expiry of a period of two years from the date on which the temporary official or contract agent is recruited, the authority empowered to conclude contracts of employment on behalf of the institution to which the person concerned belongs may remove the restriction imposed if it is the opinion of the medical officer of the institution that the sickness or invalidity has not reappeared or given rise to unusual sequelae in the course of the said period.Article 24  Special reimbursement1. Special reimbursements may be granted under Article 72(3) of the Staff Regulations for that portion of the costs which is not reimbursed provided that those costs do not exceed:- 50% of the cost corresponding to 100% of the reimbursement ceilings provided for in Article 20(1) and the fourth subparagraph of Article 20(6);- and, in the case of benefits not subject to a ceiling, 50% of the amount corresponding to 100% of the costs actually reimbursed according to the rates in force, excluding the top-up reimbursement referred to in Article 21(3) and after application of Article 20(2) and/or Article 21(1).The 50% threshold shall be calculated after application, where appropriate, of the parity coefficient provided for in Article 20(5).Certain benefits subject to a reimbursement ceiling as laid down in Article 20(1) and the second subparagraph of Article 20(6) shall be ignored in the calculation of the special reimbursement. The list of these benefits shall be laid down in the general provisions implementing these Rules.2. Where the non-reimbursable portion of costs not deemed to be excessive, covered by the scope of the general provisions implementing these Rules and incurred by members in respect of themselves or of those covered under them, exceeds half of the average monthly basic remuneration under the Staff Regulations received in any twelve-month period, the special reimbursement provided for in Article 72(3) of the Staff Regulations shall be determined as follows:The non-reimbursed portion of the above-mentioned costs which exceeds half of the average monthly remuneration under the Staff Regulations shall be reimbursed at the rate of:- 90 % in the case of a member whose insurance covers no other person;- 100 % in other cases.3. Where members are no longer entitled to a salary or allowance, the basis for the special reimbursement shall be calculated by reference to the most recent monthly basic salary received or the most recent monthly allowance received.4. Where two spouses or recognised partners are both members of this Scheme they shall by common agreement be entitled to opt for aggregation of the non-reimbursable portions of their sickness costs provided that:- this is done in respect of the member spouse or partner having the higher basic remuneration under the Staff Regulations;- the other spouse or partner waives the right to submit a separate claim for a special reimbursement;- the twelve-month period is the same for both spouses or partners.5. If members so request, the correction coefficient for their place of employment or for their place of residence in the case of those receiving a pension or allowance shall be applied to the monthly basic remuneration under the Staff Regulations.6. Decisions on requests for special reimbursement shall be taken by:- either the appointing authority of the applicant's institution, on the basis of an opinion delivered by the Settlements Office in accordance with general criteria adopted by the Management Committee after consulting the Medical Council for determining whether the expenses incurred are excessive,- or the Settlements Office, on the basis of the same criteria, where it has been empowered by the appointing authority to do so.Article 25  Allowance towards funeral expensesThe following persons shall receive an allowance towards funeral expenses, the amount of which shall be set by the general provisions implementing these Rules:(a) in the event of the death of a person covered under him/her or of a still birth: the member;(b) in the event of the death of a member: the spouse, recognised partner, children or, where there are no such persons, any other person who can prove that he/she has borne the funeral expenses.Title III - ProceduresArticle 26 Registration1. Persons covered by this Scheme shall be registered with the Central Office and with one of the Settlements Offices.2. Persons covered by this Scheme who reside in a country in which a Settlements Office exists shall normally be registered with that office.Persons covered by this Scheme who reside in a country in which no Settlements Office exists shall be registered with an office designated by the Central Office.Article 27 Prior authorisationWhere, pursuant to these Rules, reimbursement of expenses is subject to prior authorisation, the decision shall be taken by the appointing authority or by the Settlements Office designated by the appointing authority in accordance with the following procedure:(a) the application for prior authorisation, together with a prescription and/or an estimate made out by the attending dentist or doctor, shall be submitted by the member to the Settlements Office, which shall refer the matter to the dental or medical officer if need be. In the latter case, the dental or medical officer shall transmit his or her opinion to the Settlements Office within two weeks.(b) the Settlements Office shall take a decision on the application if it has been appointed to do so or shall transmit its decision and, where applicable, that of the dental or medical officer to the appointing authority for a decision. The member shall be informed of the decision forthwith.(c) applications for reimbursement of expenditure on treatment for which prior authorisation is required shall not be considered unless the authorisation is requested before the treatment begins. An exception may be made in medically justified emergencies deemed to be such by the medical officer of the Settlements Office.Article 28 Applications for reimbursementApplications shall be made by members to the Settlements Office on standard forms accompanied by the originals of the supporting documents; in the case of applications for top-up reimbursement provided for in Article 22 of these Rules, a copy of the original paid invoice accompanied by a detailed statement of the reimbursements received from another scheme must also be attached.Article 29 Divorce and dissolution of partnershipProvided that they are covered by this Scheme, divorced spouses or recognised partners whose non-marital partner status has been dissolved may submit applications for prior authorisation and reimbursement of costs directly for themselves and, where applicable, for children in their custody, under the same conditions as those in Articles 27 and 28.Article 30 Advances1. Advances may be granted to members to enable them to meet major items of expenditure. Such advances shall be allocated primarily in the form of a request for direct billing in the case of hospitalisation.2. Advances on medical expenses shall be recovered, either from any amount owed to the member under this Scheme or from the remuneration or pension or from any amount owed to the member by the institution. However, the official in charge of the Central Office may, after having informed the Commission's Accounting Officer, waive recovery of an advance in application of Article 73 of the Financial Regulation:- where the sum at stake is minimal in relation to the administrative cost of the operation, or- where it proves impossible to effect recovery, in particular following the death of a member.3. Regularisation of the advance must in principle take place at the latest within three years of the date when the advance is granted.Article 31 Subrogation of rightsWhere an accident or illness is caused by a third party, the rights of action of the person concerned or of those entitled under him or her against the third party shall, within the limits of their obligations under these Rules, vest in the Communities, in accordance with Article 85a of the Staff Regulations.Article 32 Loss of entitlement1. Where members have not applied for reimbursement of expenses incurred by them or by persons covered under them during a period of eighteen months following the date of treatment, they shall cease to be entitled to reimbursement save where force majeure is duly established.2. Application for the special reimbursement referred to in Article 24 shall be made within 12 months of the date on which the expenses last incurred in respect of treatment within the 12-month period in question are reimbursed.Article 33 Recovery of undue paymentsUnder Article 85 of the Staff Regulations, any undue payment shall be recovered if the recipient was aware of the irregular nature of the payment or if this was so obvious that he/she could not fail to be aware of it.Article 34 FraudNotwithstanding Article 33 of these Rules, a member or recipient who fraudulently obtains or attempts to obtain reimbursement of benefits for himself/herself or for a person covered under him/her shall automatically cease to be entitled to reimbursement of such benefits and shall be liable to disciplinary action.Article 35 Remedy1. All persons referred to in these Rules shall be entitled to remedy as provided for in Title VII of the Staff Regulations.2. Before taking a decision on a complaint introduced on the basis of Article 90(2) of the Staff Regulations the appointing authority or, as the case may be, the Administrative Board shall request the opinion of the Management Committee.The Management Committee may instruct its Chairman to make further investigations. Where the point at issue is of a medical nature, the Management Committee may seek expert medical advice before giving its opinion. The cost of the expert opinion shall be borne by the Scheme.The Management Committee must give its opinion within two months of the request being received. The opinion shall be transmitted simultaneously to the appointing authority and to the person concerned.Should the Management Committee fail to deliver an opinion within the period prescribed above, the appointing authority or, as the case may be, the Administrative Board may take its decision.Part Three Organisation of the SchemeTitle I - PrinciplesArticle 36 OrgansThe Scheme shall operate through a Management Committee, a Central Office, Settlements Offices and a Medical Council.Article 37 Medical confidentialityThose working in the Settlements Offices and the Central Office, members of the Management Committee and anyone attending meetings of the Management Committee shall be bound by medical confidentiality with regard to information and/or documents to which they have access in the performance of their duties.They shall continue to be so bound after termination of their employment in those offices or the Management Committee.Title II - Operation of the organsArticle 38 Management Committee1. The Management Committee shall comprise the following full members:- four representatives of the Commission, appointed by the appointing authority;- one representative of each of the other institutions, appointed in each case by the relevant appointing authority;- one representative of the Community agencies, appointed by joint agreement among the relevant appointing authorities;- four representatives of the staff of the Commission, appointed by its Central Staff Committee;- one representative of the staff of each of the other institutions, appointed in each case by the relevant Staff Committee,- one representative of the staff of the Community agencies, appointed by joint agreement among the relevant Staff Committees.2. Alternate members shall be appointed in the same manner as provided for in paragraph 1.3. The term of office of the full and alternate members shall be two years. It shall be renewable.4. Each member, or in his or her absence an alternate member, shall be entitled to vote.5. The Management Committee shall adopt its rules of procedure by a two-thirds majority of the members who are entitled to vote.The rules of procedure shall include provisions concerning:- the election of the Chairman;- the organisation, convening and frequency of meetings;- the appointment, if need be, of a Committee to prepare its meetings.- the appointment of persons who may attend Committee meetings but may not vote,- the rules governing its deliberations and the delivery of opinions.6. The Management Committee shall:(a) ensure that these Rules are applied consistently and put to the institutions any relevant suggestion or recommendation to this effect;(b) examine the financial position of this Scheme and put to the institutions any relevant suggestion or recommendation in this connection;(c) make a detailed annual report on the financial position of this Scheme and forward it to the institutions and their Staff Committees before 1 July;(d) where appropriate, propose or recommend to the Commission the adoption or amendment of the general provisions implementing these Rules and any measure required for the proper functioning of this Scheme and present proposals as to the amount of working capital required for the Scheme to operate;(e) deliver opinions as provided for in these Rules;(f) deliver its opinion, where appropriate, on any matter arising directly or indirectly from the application of the provisions of the Staff Regulations concerning sickness insurance;(g) deliver its opinion on the level of contributions and benefits, in particular where there is an appreciable change in the cost of medical treatment.7. The work of the Management Committee shall be secret.Article 39 Central Office1. The Central Office shall be attached to the Commission.2. It shall:(a) coordinate and monitor the work of the Settlements Offices;(b) ensure that the rules concerning the payment of benefits are consistently applied;(c) provide the secretariat for the Management Committee;(d) carry out any statistical survey or analysis required for the satisfactory operation of this Scheme so as to give the Management Committee an accurate view of the extent, distribution and trend of the risks insured against and enable it to deliver opinions as provided for in Article 38(6)(g) of these Rules.(e) in liaison with the Settlements Offices, endeavour to negotiate, wherever possible, with the representatives of the medical profession and/or the competent authorities, associations and establishments, agreements specifying the rates for both medical treatment and hospitalisation applicable to persons covered by this Scheme, account being taken of local conditions and, where appropriate, the scales already in force. negotiate, as far as possible, with the Member States' primary schemes, general agreements aimed at simplifying the procedures applicable to beneficiaries of this Scheme(f) negotiate, as far as possible, with the Member States' primary schemes, general agreements aimed at simplifying the procedures applicable to beneficiaries of this Scheme.Article 40 Offices responsible for settling claims1. Settlements Offices shall be opened or closed down by the Commission wherever it considers this to be necessary, taking into account in particular the places where officials are employed.2. A Settlements Office may be opened or closed down in any other institution only with the consent of that institution and after the Management Committee has been consulted.3. Staff of the Settlements Offices shall perform the tasks provided for in these Rules in accordance with the instructions and under the supervision of the head of the Central Office.4. Medical officers and dental officers shall be seconded to each Settlements Offices and responsible for the tasks arising from these Rules and their general implementing provisions.The function of medical officer attached to Settlements Offices is incompatible with that of medical officer of an institution.5. Each Settlements Office shall:(a) accept and process applications for reimbursement of expenses submitted by members registered with it and make the relevant payments;(b) as provided for in these Rules and where matters of a medical nature connected with the payment of benefits are raised by the Management Committee or by the Central Office, consult the medical officer, who may, if need be, consult the medical officer of the institution concerned;(c) examine applications for prior authorisation and take the necessary action;(d) deliver opinions as provided for in these Rules;(e) provide secretarial services for the medical officers.Article 41 Medical CouncilThe Management Committee shall be assisted by a Medical Council composed of a medical officer from each institution and the medical officers from each Settlements Office.The Medical Council may be consulted by the Management Committee or the Central Office concerning any matter of a medical nature which arises in connection with this Scheme. It shall meet at the request of the Management Committee, of the Central Office or of the medical officers of the Settlements Offices and shall deliver its opinion within such time as may be specified.Part Four Financial provisionsTitle I - ManagementArticle 42 ContributionsThe Community institutions and agencies concerned shall pay into the accounts of the Joint Sickness Insurance Scheme (JSIS), each month no later than eight days after payment of remunerations and allowances subject to contributions to this Scheme, their own contributions and those of the members.Article 43 Authorization and checking1. Implementation of revenue and expenditure of the Joint Sickness Insurance Scheme shall be performed by analogy and in accordance with the provisions of the Financial Regulation applicable to the general budget of the European Communities, and in particular Article 60 thereof.2. Revenue and expenditure authorised by the Settlements Offices and Central Office shall be subject to ex ante verification by staff not involved in the transactions.3. The Central Office shall perform ex post checks or have them performed, with a view to- ensuring the legality and correctness of the transactions performed by the Settlements Offices and observance of the principles of sound financial management.- ensuring, if need be in conjunction with the institutions' internal auditors, that the contributions paid by the institutions tally with the revenue received for the purpose by the Joint Sickness Insurance Scheme.4. The Central Office shall notify the Management Committee of the internal checking methods and the results of such checks.Title II - AccountsArticle 44 Accounting structure1. The Commission shall, on the initiative of its Accounting Officer, establish separate ex-budget accounts for monitoring transactions relating to the Scheme.2. To that end, after consulting the Management Committee, the Commission's Accounting Officer shall adopt an accounting schedule allowing transactions to be broken down by their nature and origin and drawing a distinction between the Community institutions as a whole and the various Community bodies.This accounting schedule shall draw a distinction between outturn accounts and cash accounts.3. The financial year shall be divided into twelve accounting periods corresponding to the twelve months of the calendar year.Article 45 Accounting documents1. All transactions relating to this Scheme shall be entered in a "ledger".2. At the end of each accounting period the Accounting Officer shall publish:- a "statement of account" showing, in chronological order, all the transactions relating to a single account on which there have been movements, with the balance at the beginning and end of the period;- "lists by member" showing in chronological order, for each "advance" account and each member, the amount of transactions still not settled at the end of the accounting period;- a "general balance of accounts".3. After closure of the first half-year the Accounting Officer shall, in the light of the provisions of Article 44(2), draw up:- an "outturn account" detailing all expenditure and income in the half-year ended,- an "interim balance sheet" showing separately the total for the current financial year and the sum total for previous financial years and placed in reserve.The half-year statements shall be forwarded by the Commission to the Management Committee, the Commission's internal auditor and the institutions no later than six weeks after the end of the half-year.4. After the closure of each financial year the Commission's Accounting Officer shall publish, in view of the provisions of Article 44(2):- an "outturn account" detailing all the expenditure and income in the financial year;- a "balance sheet" showing separately the totals for the closed financial year and the sum totals for previous financial years.In addition to the above documents, the Accounting Officer may publish any other accounting document required by the Management Committee.5. These annual financial statements shall be subject to an accounts certification procedure.6. All the annual financial statements, accompanied by their certification notes, shall be forwarded by the Commission to the Management Committee and the other institutions no later than 1 May of the following financial year.Title III - Financial information and financial balance of the SchemeChapter 1 - Financial informationArticle 46 Management accountNo later than 1 May of each financial year, the Commission shall supply the Management Committee, the Commission's internal auditor and the other institutions with a "management account" comprising:- a summary table of the total income and expenditure for the whole scheme over the last five financial years, together with a forecast for the following financial year;- a table showing the changes in expenditure in the same way;- a table showing the changes in revenue in the same way;- a table showing the changes in average expenditure and revenue per member in the same way.Article 47 Financial analysisAt the end of each financial year the Central Office shall draw up, on its own responsibility, a financial analysis of the position of the Scheme. This document shall be forwarded to the Management Committee no later than 1 May of the following financial year.On the basis of this financial analysis and all the annual statements referred to in Articles 45 and 46, the Management Committee shall draw up the annual report referred to in Article 38(6)(c).Article 48 Financial managementThe Heads of Administration, each on behalf of the institution he or she represents, shall, on the basis of the annual documents referred to in Articles 45, 46 and 47 accompanied by any observations by the auditor who has certified the accounts and by the Commission's Accounting Officer and on the basis of the report by the Management Committee referred to in Article 38(6)(c), take note of the sound administration performed by the competent official of the Central Office, no later than two years after submission of the annual financial statements and the management account.Chapter 2 - Financial balance of the SchemeArticle 49 Financial balanceThe financial objective of the Scheme shall be to ensure a balance on a periodic basis between expenditure and income resulting from the application of this Scheme.Article 50 Deficit1. Where the accounting position shows a deficit which leaves the Scheme out of balance financially, the deficit shall be covered from the reserves referred to in Article 51.2. Should the reserves be insufficient to cover the deficit, the Management Committee shall immediately refer the matter to the institutions, which shall, after consulting the Staff Regulations Committee, determine what measures are to be taken to return to financial balance.Article 51 Reserves1. Where the accounting position of the Scheme shows a surplus, that surplus shall be entered under the liabilities in the Scheme's balance sheet as an account entitled "Surplus placed in reserve".2. After consulting the Management Committee, the Commission shall invest the reserves at the best terms available, subject to the cash requirements of the Scheme. The Central Office shall regularly inform the other institutions and the Management Committee of the amounts thus invested and the investment details on the basis of an annual management report drawn up by the Commission department responsible for managing the investments.Interest received on the investments shall constitute income for the Scheme for the financial year in which the investments are made.3. The main function of the reserves shall be to cover any deficit which may arise. The institutions shall examine periodically, after consulting the Management Committee and the Staff Regulations Committee, the possibility, taking account of the demographics of the membership, either of using the reserves to cover any increase in risks or of amending the provisions of these Rules.The rules governing reimbursement of costs laid down in the general implementing provisions may also be amended in accordance with the development of the financial balance of the Scheme in accordance with the rules set out in Article 52.Part Five Final provisionsArticle 52 Determining and updating the rules governing the reimbursement of costs1. Under the third subparagraph of Article 72(1) of the Staff Regulations, the institutions shall empower the Commission to lay down, by general implementing provisions, the rules governing the reimbursement of costs with a view to protecting the financial balance of the Scheme and respecting the principle of social security cover forming the basis for the first subparagraph of Article 72(1) of the Staff Regulations.2. The general implementing provisions shall be drawn up after consultation of the Staff Regulations Committee and on the opinion of the Management Committee.Article 53 Amendment1. These Rules may be amended in accordance with the first subparagraph of Article 72(1) of the Staff Regulations upon a proposal from an institution, a Staff Committee or the Management Committee.2. The Management Committee shall deliver an opinion on any proposal to amend the Rules.Article 54 RepealThe Rules on sickness insurance for officials of the European Communities, as last amended on 26 January 1999, are hereby repealed, with the exception of their annexes.The annexes to the Rules, as last amended on 26 January 1999, are hereby repealed on the date of entry into force of the general implementing provisions adopted by the Commission.For a transitional period pending adoption of those provisions, all references to "general implementing provisions" in these Rules shall be construed as referring to the annexes to the Rules referred to in the previous paragraph.Article 55 Entry into forceThese Rules shall enter into force on the first day of the month following that in which the agreement among the institutions provided for in the first subparagraph of Article 72(1) of the Staff Regulations is recorded by the President of the Court of Justice of the European Communities.They shall apply from 1 XXXX 2004.