Article written by
Ranjan Prakash Shrestha (EUDEL to Nepal)
GN Sunil Kumar (EUDEL to India) Sumeet Thakkar (EUDEL to India) and
Aminata Ongoiba (EUDEL to Mali)
The Complementary Sickness Insurance Scheme for Local Agents (CSISLA – renamed as ‘LA-Medical’) is a complementary health insurance established by the European Commission in 1996 to cover the Local Agents working for the EEAS and the Commission in non-member countries under Specific Conditions of Employment (SCE) contracts. This insurance is complementary to the local primary (public) health insurance. However, in certain countries, if the public health insurance is non-existent, not accessible to the local staff or not operational, the CSISLA may effectively become a primary/autonomous insurance. The scheme is operated with contributions from employees (1.37% of salary) and the employer (3.22%).
The healthcare sector has changed a lot since the inception of the scheme. Diseases, which had no cure earlier, can now be cured with new medications and technological innovations – diagnostic and tests methods/equipment, surgeries using digital technologies, organ transplants, drugs. However, it requires more resources to access those healthcare facilities and services.
More importantly, in spite of persistent requests from LAs to extend the medical coverage beyond retirement and bringing major improvements to the LA Medical scheme to allow access to modern medicine and meet actual costs, there have been only very limited changes made in the new LA Medical scheme. The history of Delegation claims show that LAs have been hugely frustrated with the extent of coverage and ceilings. Too many issues remain unresolved:
· rigid procedural compliances,
· a slow settlement process,
· cumbersome selection of hospitals for annual check-up,
· limitations to the list of reimbursable tests and examinations,
· differences between the reimbursement ceilings and market prices,
· and the perception of a general over-scrutiny of claims submitted.
Some of you will be astounded to learn there is a massive surplus of EUR 25-30 million in the LA-Medical, which will continue to increase in the future also as there is no new plans to use this fund more effectively. As the CSISLA/LA-Medical was created to support the medical needs of LAs, it is only normal that at least a part of the fund is utilised for improving the Scheme further. Right now the LAs are left with the trivial amount accumulated in the provident fund and a severance grant to support the rest of their life after retirement. For those LAs, who joined after 01.06.2020, even the Severance Grant will no longer be applicable.
There is therefore very little return on the investment that LAs are saving during their employment and the lack of post-retirement medical coverage can pose a real problem to Local Agents during retirement. This situation is incoherent with the values of the institution for which they work and for which they have loyally worked, and in some cases their entire life!
USHU has the following suggestions to improve the scheme, keeping in mind the increasing needs of LAs in Delegations:
· Post-retirement medical coverage for LAs. USHU urges the administration to devise a policy by which the existing scheme be extended for a longer period beyond retirement. USHU proposes that the EEAS should appoint a consultant/insurance company to do a feasibility study. The result of the study together with a few workable options could be presented to the LAs for consideration to choose a mutually convenient one.
· USHU recommends ceilings are increased progressively to match market conditions. The cost of medicines and treatments have soared so high in recent years. Though the LAs contribution to the scheme increases automatically, as the salary increases, the level of reimbursements have not been sufficient to reflect the rise in market prices – for e.g. optical and dental expenditures.
· USHU also urges the EEAS to look into better private medical healthcare. In many countries, access to better private medical healthcare is extremely expensive, and the ceilings under the LA medical scheme are neither sufficient nor adequate to cover the hospital expenses.
· Homeopathy and Ayurveda are gaining popularity and recognition in many countries, including Europe and the United States. In most countries these expenses are covered by private insurance companies, and in some, the governments have formed separate Ministries, which regulate these treatments. USHU urges the EEAS to extend cover to Ayurvedic and homeopathic medicines when prescribed by a registered practitioner and when such treatments are standard, local practice.
Clearly, the time has come to reform the CSISLA scheme to better address the new needs of the LAs with respect to medical innovations and reimbursement levels.
USHU strongly urges the EEAS to reform the CSISLA scheme further and is happy to contribute towards improvements for all Local Agents.