EUROPEAN COMMISSION DIRECTORATE GENERAL FOR INTERPRETATION PROVISION OF INTERPRETATION DIRECTORATE Joint Management of external Conference Interpreting Staff Brussels, 12 December 2014 New sickness and accident insurance for ACI 1 January 2015 The current insurance contract signed by DG SCIC with Vanbreda International to provide accident and sickness cover for ACI expires on 31 December 2014. In order to guarantee the continuity of the insurance cover, back in May 2014 DG SCIC launched an open call for tender to select a new insurer. A working group composed of representatives of DG SCIC and DG INTE, supported by an external insurance expert, reviewed the current insurance conditions and proposed changes. When drafting the tender documentation our aim was to: align the insurance conditions to those applicable to permanent staff where possible, establish a link between the insurance contributions paid and the benefits due, improve the wording of the policy to avoid ambiguity and limit a scope of interpretation, introduce provisions to accelerate the reimbursement and update the reimbursement limits, bring the conditions closer to the market to encourage the widest possible competition. Representatives of AIIC were consulted during the preparation of the insurance policy specification and kept informed at the key stages of the procedure. Among the three tenders received, two passed the exclusion and selection criteria and were admitted to the award stage. Finally, based on the assessment provided by the evaluation committee, the authorising officer signed the contract with Vanbreda International, now called Cigna International Health Services, who presented the most advantageous offer. The new contractor will provide sickness and accident insurance for all ACI recruited by DG SCIC, the European Parliament and the Court of Justice as of 1 January 2015. Insurance premium percentage: Thanks to open competition we were able to obtain a more advantageous price for the contract. From 1 January 2015 the insurance premium will be reduced from the current 2,697% to 2,297%. As in the past, this rate applies to the daily remuneration, flat-rate allowances and nonworking days with one third of the premium borne by the ACI and two thirds borne by the Institutions. The new insurance premium percentage will remain fixed for the first two years of the contract and may be subject to a yearly revision from the third year (with the maximum change limited to 10% of the initial value). 1
The lower premium will be reflected in your net remuneration. Attached you will find a calculation of the impact of the new premium on your contributions. Taking into account the Community taxation, your daily net remuneration will increase by 0,40 1. Major changes in the insurance policy: The new insurance policy specification (link) brings a number of important changes compared to the present conditions. In order to understand the principles of the insurance coverage and know your rights, I strongly recommend you to read the policy carefully. The brief presentation of the changes below is non exhaustive. When reading the insurance policy, you will notice that the compensation for death and invalidity is now based on a new definition of the annual remuneration. To establish a link between the insurance contributions paid by an ACI and the benefits due, the annual remuneration" is now based on the insured s daily remuneration and his yearly average number of insured days over the last 3 calendar years. For the calculation of the annual remuneration, the first 40 insured days count as full days, whereas any additional day is subject to 35% reduction. This reduction is introduced to guarantee a minimum value of 40 insured days for each ACI irrespective of their actual average. The annual remuneration is then equal to the insured s daily remuneration (daily fee) multiplied by the number of insured days calculated according to the above formula. An example: For an experienced ACI with 150, 140 and 130 insured days (days when a daily fee, flatrate allowance or non-working day are paid) in 2014-2012 the annual remuneration would be equal to: Average number of insured days = (150+140+130)/3 =140 35% reduction above the minimum guarantee = 40 + 100 0,65 =105 Annual remuneration = 105 552,97 2 =58.061,85 For an experienced ACI with 10, 5 and 3 insured days in 2014-2012 the annual remuneration would be equal to: Average number of insured days = (10+5+3)/3 =6 As the above figure is below the guaranteed minimum, the calculation is based on 40 days Annual remuneration = 40 552,97 =22.118,80 The definition of the annual remuneration is in so far important as it is used to calculate the compensation. In case of death the compensation is equal to a lump sum of five times the annual remuneration (both accident and illness related). In the example above, the lump sum is 58.061,85 5 =290.309.25 for an ACI who worked an average of 140 insured days and 22.118,80 5 =110.594 for an ACI with 6 insured days average in the last three calendar years. 1 For an experienced ACI and a non local-contract. 2 Daily remuneration as on 1 December 2014 and under assumption that the same rate was valid during the entire calculation period. 2
In case of permanent total invalidity the compensation is: a lump sum of eight times the annual remuneration (both accident and illness related). In the example above, the lump sum is 58.061,85 8 =464.494.80 for an ACI who worked an average of 140 insured days and 22.118,80 8 =176.950,40 for an ACI with 6 insured days average in the last three calendar years. an annuity equal to 70% of the insured s annual remuneration paid until the age of 67. In the example above, the annuity is 58.061,85 0,7 =40.643.29 for the first ACI and 22.118,80 0,7 =15.483,16 for the second ACI. and payment of contributions to a pension scheme. In the example above, the pension contributions are 58.061,85 24,75% =14.370,31 for the first ACI and 22.118,80 24,75% =5.474,40 for the second (with the usual 1/3 deducted from the ACI annuity and 2/3 paid by the insurer on top). The new insurance policy introduces also some new reimbursement limits: for medical expenses the ceiling is multiplied nearly five times to 50.000, the maximum intervention limit per event has doubled to 50 Mio 3. In order to accelerate the reimbursement process, the insurer s decision has to be now notified to the insured within 1 month after receipt of the claim and the payments should be made within 14 calendar days. Furthermore, insured will have right to interest on late payments. Finally, based on the mediation procedure for staff members, the new policy includes precise provisions to define the role of the medical committee, applicable deadlines and cost sharing principles. Validity of the insurance cover: Firstly, as in the past, the sickness and accident insurance for ACI does not provide full insurance cover against all possible risks, valid 365 days a year. According to Article 2 and 14 of the Policy Specification the policy is valid throughout the world against the risk of sickness and accident contracted or suffered in the course of or in connection with the performance by the insured of their duties and consequent loss of income and the insurance cover is limited to days on which an ACI: (a) has a contract to supply services to the European Institutions; (b) receives a flat-rate travel allowance (Article 7 of the Agreement) or a flat-rate compensatory allowance (Article 7a of the Agreement); (c) receives remuneration for days not worked (Article 11 of the Agreement); (d) for reasons of service, is obliged, on days other than those referred to under points (a), (b) and (c) above, to remain away from his domicile because of the requirements of his contract." Consequently the Insurer will accept your claim only if you have an accident or fall ill on the days mentioned above, as attested by the medical certificate. The accident in the meaning of the insurance policy is defined as "any sudden occurrence adversely affecting the insured s bodily or mental health, the cause or one of the causes of which is external to the victim s organism". 3 This limit is not individual but it refers to the total compensation paid by the Insurer should a group of 5 or more ACI be the victim of an accident or illness resulting from a single event. 3
An illness means "any illness of the insured which manifests itself as a sudden and unexpected deterioration of health during a period covered by the policy". Should you be interested in the optional individual insurance cover for days on which you are not covered by the present insurance, please contact the Insurer for information concerning their proposal. Similarly, the Insurer may propose you a supplementary "all risk" insurance. Secondly, please note that the new policy does not include a list of events exempted from the insurance cover any longer. Article 17 of the new insurance policy specification stipulates that the policy does not apply to an accident or illness caused or traceable to the insured s own conduct and an adequate standard of behaviour. Conduct is tested against what a reasonable person in the position of the insured would have foreseen and what he could have done to avoid the damaging consequences. Finally, all claims related to contracts prior to 1 January 2015 will be processed in accordance to the old conditions. Should you have any questions concerning the interpretation of the policy provisions and the follow-up of your claim please contact the Insurer. Any practical questions concerning procedures to follow can be addressed to Ms Maria Madau at SCIC-ACI-Sickness- Insurance@ec.europa.eu. signed Pilar Moreira Ribeiro Annex: Impact of the new premium on your contributions and net remuneration. 4
The effect of the decrease of the premium on insurance contributions from 1 January 2015 (amounts in ) Experienced ACI Gross amount Premium until 31 Dec 2014 2,697% Premium from 1 Jan 2015 2,297% Difference ACIs Institutions ACIs Institutions ACIs Institutions Total premium from 1 Jan 2015 Daily remuneration 552,97 4,97 9,94 4,23 8,47-0,74-1,47 12,70 Flat rate allowance 276,49 2,49 4,97 2,12 4,23-0,37-0,74 6,35 Non-working days (Art. 11) 368,65 3,31 6,63 2,82 5,65-0,49-0,98 8,47 Beginner ACI Daily remuneration 398,14 3,58 7,16 3,05 6,10-0,53-1,06 9,15 Flat rate allowance 199,07 1,79 3,58 1,52 3,05-0,27-0,53 4,57 Non-working days (Art. 11) 265,43 2,39 4,77 2,03 4,06-0,35-0,71 6,10 The effect of the decrease of the premium on the net remuneration from 1 January 2015, taking into account the tax (amounts in ) Net until 31 Dec 2014 Net from 1 Jan 2015 Difference Experienced ACI* Daily remuneration 402,70 403,10 0,40 Flat rate allowance 201,21 201,41 0,20 Non-working days (Art. 11) 268,39 268,65 0,26 Beginner ACI* Daily remuneration 312,53 312,89 0,36 Flat rate allowance 156,13 156,32 0,19 Non-working days (Art. 11) 208,26 208,51 0,25 * Non-local contracts 5