Please note that payments of reimbursement sheets processed between 6 and 13 of June will be made with a delay.
We apologise for this inconvenience.
The JSIS reimburses medical pedicure (1) treatments under certain conditions:
• The treatment has to be medically justified – reason for which a medical prescription must be attached to the claim for reimbursement – and it must start no later than six month after the date of prescription.
What should the prescription mention?
The patient's full name
The date of issue
The type of treatment (medical pedicure)
The medical motivation (pathological context)
The number of prescribed sessions
The prescriber's full name and official references
• The treatment must be carried out by a provider legally recognized by the national health authorities of the country in which the service is performed. Remember that in most countries, recognized providers are referred to as "podiatrist" (e.g. Belgium, Luxemburg, Germany …) or "pédicure-podologue" (e.g. France).
• The invoice/receipt must comply with the legislation of the country in which it was issued (e.g. attestation de soins, feuille de soins (Cerfa), reçu fiscal, Rechnung, mémoire d'honoraires, documents issued by "mutuelle/Sécu") and must include the following information:
The patient's full name
The date, details and price for each medical procedure performed by the podiatrist
The podiatrist's full name and official references
Please remember that JSIS will not reimburse any invoice/receipt issued by a non-medically recognized centre (aesthetic centre, hotel, fitness centre,…).
(1) > Maximum 12 sessions/calendar year from the 01st of January to 31st of December included.
PMO NEWSLETTER - JSIS - Costs of orthodontic treatment
JSIS reimburses the costs of orthodontic treatment for a child up to the age of 18 while the limit is generally set at the age of 15 by most national insurance schemes.
These expenses are reimbursed at a rate of 80% with a ceiling of EUR 3 300 for the overall treatment (including cephalometric analysis, study models, photos, costs of retention), on condition that prior authorisation for the treatment has been obtained from the Settlements Office, on presentation of an estimate and after consultation of the Dental Officer. The costs of X-rays will be reimbursed separately.
Adult orthodontic treatment
The treatment must begin before the patient's 18th birthday. After this date, the costs for consultation, study models and X-rays and/or other costs linked to orthodontic treatment will not be reimbursed.
The cost of orthodontic treatments for adults can be covered in the following exceptional cases only, subject to prior authorisation: serious disease of the buccal cavity, maxillofacial surgery, maxillofacial trauma or serious problems of the temporomandibular joint diagnosed by X-ray and clinical examination.
PMO NEWSLETTER - Consult your notifications in JSIS online
Consult your notifications in JSIS online
As a member of staff in active service, you will notice that the JSIS online application regularly sends you notifications, often accompanied by an email alert.
These notifications are to inform you that you have received a document from the JSIS (decision, letter, statement of expenses, etc.).
It is essential to consult them regularly, as online notification legally replaces paper correspondence.
The date of notification will therefore be binding if ever you need to submit a complaint against a decision of the JSIS.
Average reimbursement time (calendar days) by settlement office
ON LINE CLAIMS
o Brussels: the average reimbursement time* is 12 days, we are dealing with claims registered 10 June
o Luxembourg: the average reimbursement time is 17 days, we are dealing with claims registered 5 June
o Ispra: the average reimbursement time is 16 days, we are dealing with claims registered 6 June
o Brussels: the average reimbursement time is 15 days, we are dealing with claims registered 7 June
o Luxembourg: the average reimbursement time is 21 days, we are dealing with claims registered 1 June
o Ispra: the average reimbursement time is 15 days, we are dealing with claims registered 7 June
*The average reimbursement time concerns the most standard requests. It may be that some older reimbursement requests are pending for various reasons (complexity of the request, awaiting missing documents, opinion of the medical officer, etc.)
PMO NEWSLETTER - JSIS - Agreements with hospitals
Agreements with hospitals in the Brussels Region: attention to excessive costs
At its meeting held on 20 and 21st May, the JSIS' Joint Management Committee (composed of representatives from the administration and staff of the Commission and all Institutions) has adopted a resolution concerning the agreements signed between the PMO and several hospitals of the Brussels area.
PMO would like to take this opportunity to advise its members to pay careful attention to the estimates which they are asked to attach to their requests for direct billing for hospitals in the Brussels region that have not signed any agreement with PMO. In some cases the amount which remains at the charge of the member, taking into account the reimbursement ceilings and the potential application of a factor for excessive costs, can be substantial.
PMO NEWSLETTER - We check hospital bills with your interests in mind
We check hospital bills with your interests in mind
When the JSIS agrees to direct billing of hospital expenses, the hospital sends its invoice direct to the PMO.
Verification of the invoice
The Direct billing and invoice settlement department which receives the invoice checks various things before paying: whether the amounts invoiced correspond to national scales (for example, INAMI scales in Belgium); that there is no duplication of invoicing; whether the supplies being charged for are compatible with the illness; if, where appropriate, the agreements between the JSIS and the hospital have been observed, etc.
These checks may lead to a correction which the PMO will then claim from the hospital. In this case, the amounts you have been charged will be reduced. This is therefore in both your interest and that of the JSIS.
Calculation of the rate of reimbursement
The bill is then examined by the appropriate department which draws up a statement of charges. This statement shows the total amounts paid, broken down into those to be paid by the JSIS and any for which you are responsible.
In the case of direct billing, the part of the bill for which you are responsible constitutes an advance, as the JSIS has paid the full amount of the invoice to the hospital. This advance will be deducted from the reimbursement of your future medical expenses.
NB: If the hospital stay for which the JSIS has granted you direct billing is at an establishment where the costs exceed the ceilings laid down in the rules, the amounts you must pay will be higher. The JSIS takes these ceilings into account when determining the amount to be reimbursed and the amount you will be charged.
The principle of freedom of choice
As you know, our joint sickness insurance scheme (JSIS) is based, inter alia, on the principle of free choice of hospital, doctor, etc. by the member.
Under this same principle of free choice, you, the Member, must where appropriate address and settle any conflicts, disagreements or disputes with the hospitals, clinics and doctors by whom you have chosen to be treated.
Our services cannot intervene in this regard.