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The AIACE-INT Bureau has requested the Sections to submit any proposals in connection with spousal cover to be sent

on to the CGA ! These are the two proposals o" the #$ Section! We understand that other Member States have problems of a similar nature to those described below and our proposals may, therefore, have application elsewhere. As the issues re"erred to in this proposal concern to date primarily wives% rather than husbands% o" #$ pensioners% we will use the "eminine pronoun where required! &! Proposal 1:

Nature of JS S cover for spouses who have made minimal contributions to the State Pension As a matter o" principle% 'SIS cover has always been e(tended to the dependants o" its members% includin) their spouses and reco)nised partners *hereina"ter re"erred to as +spouses+,! This has )enerally been e""ected throu)h the entitlement o" spouses to complementary cover! Complementary cover is intended to provide spouses with a level o" medical cover equivalent to that available to the members under primary cover! Its principle is that spouses who wor-ed at a level which required them to have their own national state sic-ness scheme *sub.ect to the de minimis principle,% de"ined by the 'SIS in the General Implementin) /rovisions *GI/, as spouses havin) +income "rom )ain"ul employment+% must "irst rely on the reimbursement o" medical costs "rom the latter scheme% be"ore claimin) any remainin) unreimbursed costs "rom the 'SIS ! These costs are then reimbursed up the the level provided under primary cover *+top up cover+,! Spouses with no such +income "rom )ain"ul employment+ are automatically entitled to primary care! The 'SIS has always assumed that the system o" complementary cover would o""er equivalence o" medical cover because it was desi)ned "or countries where medical care was provided throu)h a contributions-based insurance scheme and because it )uaranteed equality o" "inancial cover throu)h the +top up+ system! As such this seems "air% since equivalence o" treatment was meant to be assured! 0owever% two problems e(ist1 *a, the equivalence o" medical care is compromised when the primary health insurance ta-es the "orm o" a "ree health service without *or with only restricted, "reedom o" choice and there"ore with variable quality o" care *b, this is compounded "or pensioners by the "act that the de minimis rule that applies to the salaries o" o""icials does not apply to pensions% so that even tri"lin) sums in pensions that are related to earlier pro"essional activity% possibly carried out several decades earlier% e(clude the spouse "rom primary cover and - where there is a "ree health service - comparable health care! 2! *a, Equivalence o" medical care

It is the case that in a number o" ember States% particularly in the ori)inal ones% entitlement to bene"it "rom the state le)al or statutory sic-ness scheme depends on whether the individual concerned is or is not in receipt o" income "rom )ain"ul employment! In contrast to the situation in those & ember States% in the #$ entitlement to bene"it "rom the

National 0ealth Service *N0S, is "ree and universal "or all persons law"ully resident in the #$% irrespective o" income "rom )ain"ul employment or any other source! Certain other ember States have the same type o" scheme as that in the #$ and may be "acin) the same situation as is described in this Note! In contrast to the 'SIS% the N0S does not )uarantee to the patient the "ree choice o" doctor! N0S patients are treated by whichever doctor is available at the time o" treatment! #nder 'SIS primary cover a spouse can choose her own doctor! #nder complementary cover% a spouse in the #$ would have to use the N0S with no choice o" doctor! In the ma.ority o" other ember States% this choice is available under complementary cover! The problem o" "ree health care systems% such as the N0S% can be addressed by those currently in employment by ta-in) out private health insurance% because they are probably youn) enou)h to be able to do so! 0owever% it should be remembered that% when a spouse has 'SIS primary cover while she is not wor-in)% she has no requirement "or a private insurance scheme! The problem becomes acute when% on receipt o" a State /ension% she is moved into complementary cover and needs an additional insurance! 0ere the cost o" enrolment into such a scheme would be many times the "i)ure o" 3422% which is 256 o" the ma(imum annual State /ension *37&54, re"erred to below! In any event% the cover provided under such insurance would certainly not the equivalent to that provided under 'SIS primary cover! oreover% in many cases% such insurance would be unobtainable as the company would re"use cover because o" her a)e and8or previous medical history! 9! *b, De minimis provisions

The problem is e(acerbated by the absence o" a de minimis rule comparable to that which applies to those currently earnin)! The application o" such a rule to spouses in receipt o" a State /ension would eliminate the problem! The 'SIS :ules de"ine +income "rom )ain"ul employment+ as includin) pensions "rom previous )ain"ul employment without any "urther clari"ication! The main problem "or many #$ spouses is% where they have a State /ension% whether this /ension is ri)htly deemed to result "rom previous )ain"ul employment! #nder #$ law% a married woman or a "emale partner in a civil partnership can claim a basic State /ension based on her husband;s NI record i" they have both reached the statutory pension a)e! This entitlement was e(tended in 25&5 to husbands and male partners! In 25&9-25&7 the ma(imum /ension "or a spouse is <==!55 *3>?, per wee- or <9792 *37&54, per year! Thus a #$ spouse can obtain a State /ension even i" she has never wor-ed and there"ore has no +income "rom )ain"ul employment+! In this case% she is entitled to 'SIS primary cover! I"% however% she has wor-ed% any o" her own contributions% however minimal% will be counted towards her State /ension% but the entitlement to the /ension will in "act result "rom the husband;s NI record and contributions! The result there"ore is that many spouses who may only have wor-ed "or short periods% o"ten several decades a)o% now "ace bein) deprived o" their entitlement to primary cover% because they made minimal contributions that would o" themselves not have )iven rise to any pension! In one case reported to us% the spouse;s contribution "rom previous )ain"ul employment amounts to a mere 2

ten pence *<5!&5, o" her wee-ly State /ension! Is that pension% equitably or in practice% to be considered as arisin) "rom her own )ain"ul employment@ *Aor details o" how #$ State /ensions may be acquired by spouses% see the Anne( below!, The GI/% chapter 2% para)raph 2% provide "or two applications o" the de minimis rule "or spouses while they are )ain"ully employed1 &! Spouses whose income "rom )ain"ul employment is less than 256 o" the annual basic salary )rade AST28& *39=!=7?, may bene"it "rom primary cover% i" they are not covered by a national statutory insurance scheme! *The 256 "i)ure is 3>!92?! The #$ spouses; annual State /ension is 37!&54!, 2! Spouses who are )ain"ully employed may receive primary cover% i" they are unable to .oin a national stature insurance scheme% or i" the premiums are ta-in) out sic-ness insurance amounts to at least 256 o" their income "rom employment! *256 o" the State pension is 3422!, n order to implement the ori!inal intention of e"uivalence of treatment, and in e"uity, the #$ %ommittee proposes that the de minimis principle should be applied where the spouses& State Pensions do not e'ceed ().*+, -1 above. or where the spouses& State Pensions do not e'ceed (/++ -+ above.. Bith re)ard to the condition set out in both o" the above cases% namely the absence o" covera)e by a national state insurance scheme% it should be recalled that the cover provided by the #$ N0S is not equivalent to that provided under the 'SIS! General &! The moral and practical case "or proposal is stren)thened by the "act that many o" these spouses were entitled to primary cover while they were not wor-in)! 0owever% i" the State /ension described above is deemed to constitute income derived "rom )ain"ul employment% their 'SIS entitlement ris-s bein) reduced to one o" complementary cover! I" their husband predeceases them% they will o" course a)ain be entitled to primary cover as survivors! ana)in) this con"usin) situation )enerates a )reat deal o" additional wor- "or the Settlements C""ices! 2! The "act that the situation described above relates only to the wives% and not to the husbands% o" 'SIS members could open the way "or a claim on the )rounds o" )ender discrimination! 2! Proposal +1 0dditional premiums to enable JS S primary cover for spouses Cn pa)e 2= o" the 25&2 Annual :eport o" the CGA one o" the o" the ;piste de rflexions; is +revoir la possibilit de faire supporter le cot de la complmentarit par l'affili ou, dans le cas du conjoint, par une assurance complmentaire." The #$ Section% and presumably any other Section a""ected by this or similar problems% would welcome any solution that enables spouses to continue to bene"it "rom primary cover! A complementary insurance scheme would be complicated and time-consumin) to set up and mana)e! 9

We therefore propose that JS S members should be as1ed to pay an additional premium to ensure that their spouses remain entitled to primary cover or are able to opt into primary cover a!ainst payment of such an additional premium. In Aebruary 25&9 we were in"ormed by the then Director o" the / C that +As regards consumption patterns, my information is that claims by the ! based population under complementary cover amounts to around "#$.$$$." This "i)ure is a miniscule proportion o" the total 'SIS bud)et and it includes the reimbursements o" the costs o" the #$ spouses; dental and optical *spectacles% etc!, treatment! Be are o" course mind"ul o" the need "or economies within the 'SIS bud)et! 0owever% we have been in"ormed that the cost per capita o" #$ pensioners to the 'SIS is si)ni"icantly less than that o" pensioners in most other ember States% and particularly those States that have a contributionsbased system! It is the case that #$ pensioners and their spouses have always made si)ni"icant use o" the N0S "or the services o" General /ractitioners and "or all their medicines as well as "or a considerable number o" other services! Be there"ore believe that% as this use will continue% any increased demands on the 'SIS resultin) "rom the )rantin) to #$ spouses o" primary cover on payment o" an additional premium would not have a si)ni"icant adverse impact on the 'SIS bud)et! 0NN23 #nder the #$ national insurance pension scheme% the ways by which a spouse;s State /ension can be obtained are as "ollows1 contributions made by the spouse while employed or in sel"-employment voluntary contributions *Class III contributions, paid by the spouse in order that her contributions may reach the level necessary to acquire the /ension her husband;s NI record% i!e! the husband;s own contributions any combination o" the above three ways

The second and third cate)ories clearly do not derive "rom the spouse;s own income "rom )ain"ul employment! The last cate)ory raises a number o" issues! The present situation re)ardin) the spouses o" #$ pensioners is that many o" them% particularly those now in their seventies and ei)hties% only wor-ed "or a "ew years be"ore they married and started their "amily and have never wor-ed subsequently! Thus% the number o" their own contributions towards their State /ension was minimal and was not su""icient by itsel" to )ive entitlement to a State /ension! In these cases% the entitlement to the State /ension will have resulted "rom the husband;s NI record and contributions% possibly supplemented by some Class III *voluntary, contributions! It is noteworthy that% even i" the spouse had never wor-ed% she could still )et the State /ension based on her husband;s NI record and would thus be entitled to primary care under the 'SIS! 0owever% the "act that she wor-ed "or a "ew years many decades a)o may result in her bein) deprived her o" this entitlement% despite havin) been )iven primary cover "or many years!

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