Call for providers of medical and paramedical services (hospitals, clinics, laboratories, medical centres and natural persons exercising an activity in the medical or paramedical sector) and pharmacies to offer their services to the JSIS at prices applicable to JSIS members and beneficiaries
Date: 2011-07-27
Institutions: European Commission
Subjects: European official, health insurance, health service, pharmacy, reduced price








C_2011221EN.01000701.xml










27.7.2011   


EN


Official Journal of the European Union


C 221/7





Call for providers of medical and paramedical services (hospitals, clinics, laboratories, medical centres and natural persons exercising an activity in the medical or paramedical sector) and pharmacies to offer their services to the JSIS at prices applicable to JSIS members and beneficiaries
2011/C 221/06
1.   Contact point at the European Commission

European Commission, PMO/3 Bureau Central du RCAM (JSIS Central Office), for the attention of Mr Scognamiglio, Head of Unit PMO3 RCAM, 1049 Bruxelles/Brussel, Belgique/België. Tel. +32 22952799. Fax +32 22956639.
2.   Subject of the call

All officials and agents of the European Union institutions and agencies and their dependants (beneficiaries) are insured against sickness. Specifically, the Joint Sickness Insurance Scheme (JSIS) common to the institutions of the European Communities, established by mutual agreement between the institutions, guarantees beneficiaries the reimbursement of costs incurred as a result of sickness, accident or maternity subject to the limits and conditions laid down in the relevant legislation and in the general implementing provisions (DGE). Members of the scheme are also entitled to receive health screening examinations for the purposes of preventive medicine (see Annex I for the relevant programmes).
The JSIS Central Office (BC), part of the European Commission's Office for the Administration and Payment of Individual Entitlements (PMO), Sickness and Accident Insurance Unit (PMO/3), administers the JSIS.
The fundamental principle of the JSIS is freedom of choice of doctors and healthcare establishments for members and beneficiaries.
The BC intends to draw up lists of providers of medical and paramedical services (hospitals, clinics, laboratories, medical centres and pharmacies (1)) offering their services at prices applicable to the members and beneficiaries of the JSIS. Medical service providers may also draw up proposals for the preventive screening programmes attached (for all services within each programme).
The aim is to make these lists of service providers charging prices applicable to members and beneficiaries available in the eight countries listed in point 4 below.
The lists will be widely publicised amongst the JSIS members and beneficiaries.
The members and beneficiaries will retain their freedom of choice of service provider, whether or not a provider is on the proposed lists.
An information campaign will, however, alert members and beneficiaries to what is at stake for the JSIS and to the advantages of using listed centres or operators (high-quality service, applicable prices, ease of reimbursement). Those operators offering the best rates may thus reasonably be assured of increased demand for their services and early and speedy payment, particularly where the costs of hospitalisation and hospital examinations (one-day clinics) are billed directly.
Receipt of documentation from operators and the compilation of the list by the Commission will not bind the Commission or JSIS members/beneficiaries. The Commission will not sign any contract or agreement.
Operators expressing an interest in this call, by submitting their lists of prices applicable to members and beneficiaries and/or the proposed percentage discounts granted on their published prices, shall undertake to apply those prices to members and beneficiaries and, if the costs are billed directly to the Commission, to send the payment request or invoice directly to the Joint Sickness Insurance Scheme of the European Community institutions (the JSIS).
Operators wishing to take part in this call will be required to submit a list of the services offered, the proposed prices and the percentage discount to be granted to JSIS members and beneficiaries.
Members and beneficiaries using a listed service provider may:






—


pay for the services directly and subsequently apply to the JSIS for reimbursement where provided for by the JSIS rules, or










—


in the event of hospitalisation or hospital examination, ask for the invoice to be sent directly to the Commission.




By reimbursing all or part of the fees, the JSIS shall acquire by subrogation the rights of the member, including those of action against third parties, particularly where the fee charged by an establishment or clinic on the list does not match the rates or prices notified (this includes any discount applicable).
In such cases the JSIS shall reserve the right to refuse to pay the difference or to demand reimbursement from the establishment or clinic concerned, where the fee has already been paid.
The JSIS hereby informs service providers of the provisions of Article 31 of the JSIS Rules, under which, where 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 applicable to officials of the European Communities.
All operators responding to this call will be told whether or not they have been placed on the list. Any interested party not placed on the list may apply again within four years (less six months) of the date of publication of the call.
3.   Type

This notice constitutes a call for offers of services at prices applicable to JSIS members and beneficiaries.
The services and the applicable prices proposed will be entered on one or more lists (indicated in point 5) that will be valid for four years beginning on the date of receipt by the Commission.
A special list will be drawn up for screening programmes.
The closing date for submission of documents expressing an interest will be six months before the four years following the date of publication of the call have elapsed.
All operators are invited to make themselves known in accordance with this notice, naming a person responsible for contacts with the JSIS. The PMO will draw up a list of candidates meeting the criteria set out in point 7 below.
Personal data will be processed pursuant to Regulation (EC) No 45/2001 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. These and the responses given may be used only for the purposes of evaluation of the documents received by the PMO.
Details of the processing of personal data are available at:
http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf
4.   Member States

Those invited to express an interest are hospitals, clinics, laboratories, medical centres, pharmacies (in Belgium only) and authorised natural persons exercising their activities in the health sector in the following Member States:






—


Italy,










—


Belgium (2),










—


France,










—


Germany,










—


Luxembourg (3),










—


Netherlands,










—


Spain,










—


United Kingdom.




5.   List categories

The list should be broken down into the following categories:






—


hospitals — any notable specialisations of each hospital should be stated within this category,










—


private clinics,










—


laboratories performing analyses and specialist visits,










—


medical specialists (gynaecologists, paediatricians, dentists etc.),










—


general medical practitioners,










—


paramedical services,










—


pharmacies (Belgium only),










—


screening programmes.




The prices for hospital or clinic beds should be given for both single rooms (used by the majority of our beneficiaries) and double rooms.
6.   Expiry date of the list drawn up following the call for expressions of interest

All operators may submit documentation within four years less six months of the publication date of this notice.
7.   Criteria for placement on the list of operators

7.1.   Exclusion criteria







1.


Operators will be excluded if:






(a)


they are bankrupt or being wound up, are having their affairs administered by the courts, have entered into an arrangement with creditors, have suspended business activities, are the subject of proceedings concerning those matters, or are in any equivalent situation arising from a similar procedure provided for in national legislation or regulations;










(b)


they have been convicted of an offence concerning their professional conduct by a judgment which has the force of res judicata;










(c)


they have been guilty of grave professional misconduct proven by any means which the contracting authority can justify;










(d)


they have failed to fulfil obligations relating to the payment of social-security contributions or taxes in accordance with the legal provisions of the country in which they are established or of the country of the contracting authority or of the country where the service is to be rendered;










(e)


they have been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the European Union's financial interests.














2.


Operators must certify by a declaration under oath that they are not in any of the situations listed in paragraph 1.




7.2.   Selection criteria

Technical and professional capacity:






—


compliance with obligations and authorisation to engage in an activity under the law of the country in which they are established or exercise their activity.










7.2.1.


Operators must provide documentation certifying compliance with the above legislation.




8.   Documentation to be provided by operators

8.1.   Operators must provide documentary evidence of third-party liability insurance.
8.2.   Operators must also submit:






1.


a list of the healthcare services provided within their structure;










2.


a list of prices of all their services/examinations applicable to JSIS members or beneficiaries and/or the percentage discount on their published prices that will be granted to JSIS members or beneficiaries. If offering discounts, operators must also submit their list of published prices;










3.


list of pharmaceutical products and percentage price discount (for Belgium only).




8.3.   The PMO reserves the right to:






—


reject incomplete applications from operators, i.e. those not providing all the necessary information, formalities and documentation,










—


require operators to resubmit some or all of the information, formalities and documentation where, for example, supporting documents are no longer valid.




9.   Further information for operators

9.1.   The supporting documents and invoices issued by operators to JSIS members must comply with the legislation of the country in which the services are rendered.
9.2.   Operators must inform the PMO immediately of any change preventing them from meeting the criteria described in point 7.
9.3.   The prices proposed may be revised once per year.
If prices are changed, operators must submit the revised price list by 31 December of the current year. The revision will take effect from 1 February of the year following receipt of the revised prices.
9.4.   Operators wishing to be removed from the list must inform the Commission of this by registered letter addressed to the contact person indicated in point 1.
9.5.   This call for expressions of interest will be valid for four years beginning on the date on which this notice is sent to the Publications Office of the European Union.
10.   Submission procedure

Operators are invited to send their applications together with the required documentation by registered mail with acknowledgment of receipt to the following address:





PMO/3 — RCAM




Rue de la Science/Wetenschapsstraat 27 (SC27 3/054)




1049 Bruxelles/Brussel




BELGIQUE/BELGIË




For the attention of Mr SCOGNAMIGLIO




11.   Other information

All operators taking part in this procedure will be informed of the success or otherwise of their application (i.e. whether or not they will be placed on the list) within 30 calendar days of submission of the application.
The PMO reserves the right to revoke inclusion on the list for the following reasons, in which case it will inform the party concerned within 15 calendar days:






1.


failure to apply the prices proposed by the centre or service provider;










2.


failure to comply with the specific rules laid down by the Member State in which the activity is exercised.




Annexes:






—


JSIS health screening programmes






(1)  For Belgium only.

(2)  In Belgium, the price proposed may not be higher than the nationally agreed price for equivalent services and procedures (cf. the accord national médico-mutualiste 2011 (national agreement between doctors and sickness insurance funds — INAMI agreement) signed on 13 December 2010 and published in the Moniteur Belge on 17 January 2011 — point 9.1, second paragraph: ‘The Commission nationale médico-mutualiste (National Doctors and Sickness Insurance Funds Commission) points out that, pursuant to the European Treaty and to Regulation (EC) No 883/2004, rates demonstrably higher than those applicable to residents subject to the national social-security scheme may not be applied to European citizens, including staff employed by the European Union institutions’ — http://www.ejustice.just.fgov.be/cgi/article_body.pl?language=fr&caller=summary&pub_date=2011-01-17&numac=2010022524#end#end).

(3)  In Luxembourg, the percentage of discount should be based on the nationally agreed prices.


ANNEX I

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE No 1


Women under the age of 40


Frequency: every five years

(except gynaecological examination, carried out once a year)
(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Clinical examination

Including visual acuity test
2.   Frontal and lateral chest X-ray

Only if justified on medical grounds
3.   Laboratory tests







—


Blood:






—


sedimentation rate










—


leucocytes










—


differential leucocyte count










—


erythrocytes










—


platelets










—


haemoglobin










—


serum iron










—


glycaemia










—


cholesterol — high and low density lipoproteins










—


triglycerides










—


uric acide










—


urea










—


creatinin










—


serum glutamic pyruvic transaminase (ALT)










—


serum glutamic oxalo-acetic acid transaminase (AST)










—


gamma-glutamyl transpeptidase










—


HBsAg, HBcAb










—


VDRL test by immunofluorescence










—


AIDS test (with patient's consent)














—


Urine:
sugar, albumine, blood and microscope examination — tropical diseases (only for staff posted to the tropics): falciform antibodies, schistosomiasis, amibiasis et HBV antibodies

Parasitological examination of stools (straight tests and tests with bacterial culture)




4.   Electrocardiogram at rest

5.   Gynaecological examination







—


Cytology of neck of uterus and colposcopy










—


Clinical examination of the breasts










—


Mammography and echography of the breasts only if justified on medical grounds





6.   Summary report

(Updating of risk record)



ANNEX II

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE No 2


Women from the age of 40 to 59: frequency every three years


Women from the age of 60: frequency every two years

(except gynaecological examination, carried out once a year)
(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Clinical examination

2.   Complete ophthalmological examination

Visual acuity test with review of possible corrective treatment (without prescription of lenses) — Fundus — Tonometry (ocular pressure)
3.   Complete ear, nose and throat examination

(Direct fibroscopic laryngoscopy only if indirect examination is impossible)
4.   Frontal and lateral chest X-ray

Only if justified on medical grounds
5.   Laboratory tests







—


Blood:






—


sedimentation rate










—


leucocytes










—


differential leucocyte count










—


erythrocytes










—


platelets










—


haemoglobin










—


serum iron










—


glycaemia










—


cholesterol — high- and low-density lipoproteins










—


triglycerides










—


uric acide










—


urea










—


creatinine










—


serum glutamic pyruvic transaminase (ALT)










—


serum glutamic oxalo-acetic acid transaminase (AST)










—


gamma-glutamyl transpeptidase










—


alkaline phosphatase










—


potassium










—


HBsAg, HBcAb










—


VDRL test by immunofluorescence










—


AIDS test (with patient's consent)










—


electrophoresis of serum proteins (from the age of 50)














—


Urine:
sugar, albumin, blood + microscope examination — Test for blood in stools (three consecutive days) — Tropical diseases (only for staff posted to the tropics): falciform antibodies, schistosomiasis, amibiasis et HBV antibodies

Parasitological examination of stools (straight tests and tests with bacterial culture)




6.   Cardiovascular examination







—


Electrocardiogram at rest










—


Exercise electrocardiogram: cycle-ergometer (only where there are risk factors)




7.   Protoscopy

(A full colonoscopy is recommended between the age of 45 and 50; persons with a family history every three years)
Should a colonoscopy or a rectosigmoidoscopy be necessary (to be checked with your general practitioner, with your Institution's Medical Adviser or with the doctor at the health screening centre), please ask the health screening centre about how to prepare for such an examination so that it may take place under optimal condition needed for these tests.
8.   Gynaecological examination







—


Cytology of neck of uterus and colposcopy










—


Clinical examination of the breasts










—


Mammography










—


Echography of the breasts only if justified on medical grounds





9.   Abdominal and renal echography

One reference examination between the age of 45 and 50; from the age of 50: same frequency as programme
10.   Summary report

(Updating of risk record)



ANNEX III

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE No 3


Men under the age of 40


Frequency: every five years

(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Clinical examination

And visual acuity
2.   Frontal and lateral chest X-ray

Only if justified on medical grounds
3.   Laboratory tests







—


Blood:






—


sedimentation rate










—


leucocytes










—


differential leucocyte count










—


erythrocytes










—


platelets










—


haemoglobin










—


glycaemia










—


cholesterol — high- and low-density lipoproteins










—


triglycerides










—


uric acide










—


urea










—


creatinine










—


serum glutamic pyruvic transaminase (ALT)










—


serum glutamic oxalo-acetic acid transaminase (AST)










—


gamma-glutamyl transpeptidase










—


HBsAg, HBcAb










—


VDRL test by immunofluorescence










—


AIDS test (with patient's consent)














—


Urine:
sugar, albumin, blood + microscope examination — Tropical diseases (only for staff posted to the tropics): falciform antibodies, schistosomiasis, amibiasis et HBV antibodies

Parasitological examination of stools (straight tests and tests with bacterial culture)




4.   Electrocardiogram at rest

5.   Summary report

(Updating of risk record)



ANNEX IV

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE No 4


Men from the age of 40 to 59: frequency every three years


Men from the age of 60: frequency every two years

(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Clinical examination

Including manual examination of the prostate from the age of 50
2.   Complete ophthalmological examination

Visual acuity test with review of possible corrective treatment (without prescription of lenses) — Fundus — Tonometry (ocular pressure)
3.   Complete ear, nose and throat examination

(Direct fibroscopic laryngoscopy only if indirect examination is impossible)
4.   Frontal and lateral chest X-ray

Only if justified on medical grounds
5.   Laboratory tests







—


Blood:






—


sedimentation rate










—


leucocytes










—


differential leucocyte count










—


erythrocytes










—


platelets










—


haemoglobin










—


glycaemia










—


cholesterol — high- and low-density lipoproteins










—


triglycerides










—


uric acide










—


urea










—


creatinine










—


serum glutamic pyruvic transaminase (ALT)










—


serum glutamic oxalo-acetic acid transaminase (AST)










—


gamma-glutamyl transpeptidase










—


alkaline phosphotase










—


potassium










—


HBsAg, HBcAb










—


VDRL test by immunofluorescence










—


AIDS test (with patient's consent)










—


electrophoresis of serum proteins (from the age of 50)










—


PSA from the age of 50














—


Urine:
sugar, albumin, blood + microscope examination — Test for blood in stools (three consecutive days) — Tropical diseases (only for staff posted to the tropics): falciform antibodies, schistosomiasis, amibiasis et HBV antibodies

Parasitological examination of stools (straight tests and tests with bacterial culture)




6.   Cardiovascular examination







—


Electrocardiogram at rest










—


Exercise electrocardiogram: cycle-ergometer (only where there are risk factors)




7.   Protoscopy

(A full colonoscopy is recommended between the age of 45 and 50; persons with a family history every three years)
Should a colonoscopy or a rectosigmoidoscopy be necessary (to be checked with your general practitioner, with your Institution's Medical Adviser or with the doctor at the health screening centre), please ask the health screening centre about how to prepare for such an examination so that it may take place under optimal condition needed for these tests.
8.   Abdominal and renal echography

One reference examination between the age of 45 and 50; from the age of 50: same frequency as programme
9.   Summary report

(Updating of risk record)



ANNEX V

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE IN CHILDREN


Frequency: every year until the age of 16

(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Up to 5







—


Check-up specialist






—


weight/height ratio










—


checking on vaccinations and boosters









at the age of 4







—


hearing test by ENT specialist and eye test by ophthalmologist










—


summary report by general practitioner




2.   From 6 to 16







—


Dental check-up with report to dentist










—


For children living outside the Community (ACP countries or other countries outside the Community with health facilities not comparable to those in the Member States)






—


up to the age of 14: annual check-up by paediatrician










—


at 15 and 16: check-up by paediatrician or general practitioner (parents may choose)








3.   Laboratory tests







—


For children living in ACP countries





From the age of 3:







—



examination of stools:







—


straight tests










—


tests with bacterial culture














—



blood tests:







—


serum iron










—


reticulocytes










—


folic acid














—



ions:







—


calcium










—


phosphorus














—



serology:







—


IGM anti-HA for hepatitis A










—


hepatitis B antigens and antibodies










—


amibiasis antibodies










—


schistosomiasis antibodies











NB:



Once the antibodies have appeared and have stabilised, the tests will obviously not be repeated automatically every year; account will be taken of their existence in the subsequent monitoring.











ANNEX VI

EUROPEAN UNION — JOINT SICKNESS INSURANCE SCHEME


EARLY DETECTION OF DISEASE IN WOMEN


Frequency: every year

(The proposed tests and examinations being optional, any one of them may be omitted. Any supplementary tests or examinations will be at the patient's expense.)
1.   Gynaecological examination







—


Cytology of neck of uterus and colposcopy — Clinical examination of the breasts










—


Mammography and echography of the breasts (every two years) only if justified on medical grounds





2.   Summary report

(Updating of risk record)