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| Dependent beneficiary, c’est quoi? |
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| Tuesday, 04 December 2007 | |
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...more problems with trans-EU semantics and another area of confusion. One matter is now in more urgent need of attention than it was before the restriction of access to French State health cover. It concerns the right of family members to basic health cover on the basis of an E121, E106 etc, held by a member of the family in the same household. This right is a cornerstone of the concept of the free movement of people and their families throughout the European Union and has existed since the EU Social Security Regulations came into force in 1971. Originally, the E form holder could make a direct claim for other members of the family using a box on the claim form provided for the purpose. This apparently worked well until 2002 when a new EU regulation (introduced in 1998) was implemented in France. This required every member of the family to have his/her own duplicate E form so that accounting could be done on an individual basis instead of by household. The first the public knew of the change was a CPAM (Caisse Primaire d’Assurance Maladie – French health cover body) refusal to pay a claim with a bald statement that everyone must now have their own E form. There was an immediate outcry and our help lines, already in operation, were jammed with calls protesting that people would never have come to France if they had known that this was going to happen. As the issue of the duplicates started automatically soon afterwards the panic subsided. A couple of years later, it was pointed out that the definition of the word ‘beneficiary’ differed widely between member states. This led to a meeting of the representatives of all member states at which it was decided that each member state should rule on the interpretation of the word under its laws in each individual case. At a stroke of a pen, Union harmonisation went out of the window. The original purpose of the regulations, to facilitate the free movement of workers and others (including their families) throughout the Union, was subverted and confusion reigned supreme. Several years on and the situation is still patchy. Only a few weeks ago, we heard of an argument between a CPAM authority and a departmental office in the UK over which should take the initiative in getting an E121 raised for a dependent beneficiary. This caused a lengthy delay in issuing the E121. Another problem arises with the definition of ‘dependent’. In France, it means financially dependent. In a recent case, a CPAM authority has ruled that a married couple, living together and with the husband covered as his wife’s Dependent Beneficiary’s E121 issued by the UK Department of Health, cannot be registered because he has a private pension and is not therefore financially dependent on his wife. Such a ruling ignores the fact that the UK authority will pay the Dependent Beneficiary’s basic State medical costs. The woman in this particular case appealed to a national-international central government authority (CLEISS). The CLEISS wrote to her local CPAM and convinced them they had no remit to ask for financial info for married or PACSed couples. This happy outcome has become an established case history. The law now appears to be that a married or PACSed couple living together cannot be denied mutual Dependent Beneficiary status and do not have to prove financial dependency to be granted it. However, unmarried couples who are not PACSed must prove that the proposed Dependent Beneficiary is totally, effectively and permanently financially dependent on the other partner. If you have any difficulty in your own particular case please let us know at Exclusive Healthcare This e-mail address is being protected from spam bots, you need JavaScript enabled to view it and we will try to help. by representing your case to the UK authority. Or refer to www.cleiss.fr Larry Fulton |
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