Strasbourg, 1 October 1998

Restricted

CM(98)167

(21 – 22 October 1998, A level, item 11.2)

1. At the 636th meeting of the Committee of Ministers, the Ministers' Deputies instructed the Secretary General to:

- prepare the setting up of an alternative social insurance system that could come into force on 1 January 1999;

- give all the Organisation’s staff the opportunity to join this system after a reasonable period of reflection;

- pursue discussions with the French authorities on the ways and means of implementing this decision;

- submit to them the requisite statutory amendments.

2. The Secretary General proposes the following statutory amendments:

Paragraphs 1 and 2 of Article 43 remain unchanged.

Delete paragraph 3 of Article 43.

Replace it with a new paragraph 3 as follows:

Add a new paragraph 4, as follows:

Add a new paragraph 5, as follows:

3. Draft decisions to be submitted for adoption at the 646th meeting (21-22 October 1998):

"The Deputies

- approved in principle the amendments to Article 43 of the Staff Regulations, and the new Appendix XII to the Staff Regulations, introducing a Medical and Social Insurance Scheme for the Organisation, as set forth in document CM (98)167;

- took note of the fact that the Secretary General had invited permanent members of staff currently affiliated to the French Social Security scheme to choose, within a two-month period ending on 30 November 1998, between joining the Scheme provided for in Appendix XII to the Staff Regulations and remaining affiliated to the French Social Security scheme and to a compulsory complementary insurance scheme;

- agreed to proceed to the formal adoption of the amendments to Article 43 of the Staff Regulations and to the adoption of Appendix XII to the Staff Regulations at their 651st meeting (8-10 December 1998), provided that at least one-third of the permanent staff affiliated to the French Social Security scheme on 30 November 1998 will have opted for the Scheme provided for in Appendix XII to the Staff Regulations."

APPENDIX I

Subject to the provisions of Article 43, paragraph 4 of the Staff Regulations, the staff members referred to in Article 1, paragraph 1 of the Staff Regulations shall be affiliated to the Organisation’s Medical and Social Insurance scheme.

1. Entitlement to the medical benefits and accident insurance cover provided by the Organisation’s Medical and Social Insurance Scheme shall start on the date on which the staff member’s journey to take up his/her duties begins.

Entitlement to the other benefits provided by the Scheme shall start on the date on which the staff member takes up his/her duties, and shall be conditional on his/her having undergone the medical examination for new recruits.

2. Except in cases where maintenance of rights is provided for in these Regulations, entitlement to the benefits provided for in Section I of these Regulations shall cease on the date on which the staff member’s contract with the Organisation terminates (Article 23 of the Staff Regulations).

However, staff members in receipt of the expatriation or residence allowance shall remain affiliated to the Organisation’s Medical and Social Insurance Scheme for two weeks after termination of their contract.

Benefits shall cease after that date, subject, in the case of previously occurring contingencies, to rights acquired on the conditions applying to each contingency.

1. Unless otherwise provided for in the special rules governing the maintenance of rights, entitlement to the benefits provided by the Organisation’s Medical and Social Insurance Scheme shall be suspended throughout periods of leave for personal reasons (Appendix VII to the Staff Regulations).

2.    The Secretary General shall determine by rule the conditions for voluntary affiliation to the Organisation’s Medical and Social Insurance Scheme during periods of leave for personal reasons.

The Secretary General shall determine by rule the nature of the expenses covered by the Organisation’s Medical and Social Insurance Scheme, and also the rates of cover, exceptions and limits which apply, depending on the nature or cause of the benefits.

If doubts or disputes arise concerning the application of the provisions of the Organisation’s Medical and Social Insurance Scheme, reference shall be made to the provisions of French Social Security legislation in force at the time when the event giving rise to a claim for benefits occurs.

The text of insurance policies taken out by the Organisation relating to cover for health expenses or provident cover shall be made available to staff members.

1. When their contract with the Organisation terminates for one of the reasons specified in Article 23, paragraphs 2 and 3 a) and b) of the Staff Regulations, staff members affiliated to the Organisation’s Medical and Social Insurance Scheme shall continue to be covered in respect of health care expenses for a period of one year if, having taken up a new professional activity they are not covered for such expenses by another scheme, either because illness or pregnancy pre-dates their joining that scheme or because entitlement thereunder is subject to a qualifying period, or if they have not taken up new professional activity.

In such cases, cover shall be limited to the amounts refundable by the French Social Security scheme.

2. In the cases provided for in paragraph 1, health care expenses shall be covered on the same conditions for persons entitled through staff members, as defined in French Social Security legislation.

3. Provided that their health expenses cannot be covered by a compulsory Social Security scheme, former spouses of staff members affiliated to the Organisation’s Medical and Social Insurance Scheme shall continue to be covered in respect of health care expenses under the latter scheme for a period of one year following divorce. In such cases, cover shall be limited to the amounts refundable by the French Social Security Scheme.

4. Persons entitled through staff members who die while serving, who are not covered by a social protection scheme either in respect of a professional activity, or by virtue of a pension scheme, shall continue to be covered in respect of health expenses for a period of one year. In such cases, cover shall be limited to the amounts refundable by the French Social Security Scheme.

5. During periods of leave for personal reasons, entitlement in respect of health expenses shall be maintained during the period provided for in the French Social Security Scheme. The cover shall be limited to the amounts refundable by the French Social Security Scheme.

6. The provisions of this Article shall not apply to the persons in receipt of pensions under the Organisation’s Pension Scheme, referred to in Article 16, paragraph 1 of these Regulations.

1. Life insurance benefits shall be guaranteed for all deaths, even those resulting from an industrial disease covered by French Social Security legislation.

However, the following risks shall be covered with certain reservations:

if a staff member deliberately commits suicide in full awareness of what he/she is doing, cover shall apply only if he/she has been affiliated to the Organisation’s Medical and Social Insurance Scheme for at least two years.

If, however, the beneficiaries can show that the staff member in question was unaware of what he/she was doing when he/she committed suicide, cover shall apply with no qualifying period.

- In wartime, life insurance cover shall be subject to the conditions applying to – life insurance in wartime specified in the law of the country where the staff member is serving.

Permanent, total and absolute disability resulting from injuries sustained in a generalised war shall never be covered.

The following shall also not be covered:

a) illnesses or accidents deliberately induced or caused by beneficiaries or persons entitled through them;

b) war injuries sustained while beneficiaries are serving in the armed forces, either as conscripts or volunteers;

c) injuries or lesions sustained in the course of speed trials, competitions or wagers, other than ordinary sports competitions;

d) injuries sustained in insurrections or riots in which beneficiaries have unlawfully taken part, or in fights, unless engaging in lawful self-defence;

e) illnesses or accidents affecting beneficiaries resident in countries which obstruct the Organisation in effecting the lawful verifications which it is entitled to carry out;

f) air accidents, unless the beneficiary is on board an aircraft officially certified as airworthy and flown by a pilot in possession of a current pilot’s licence. The pilot may be the beneficiary himself/herself, provided that he/she has complied with current regulations. Competitions, wagers, races, aerobatics, record attempts or preparatory tests, acceptance flights, gliding, and parachute jumps other than those rendered necessary by an aircraft’s critical condition, shall not be covered;

g) the consequences of any attempt at self-mutilation.

The right of affiliated persons to bring proceedings shall lapse two years from the date on which the event giving rise to a claim for the benefits occurs.

Affiliated persons shown to have defrauded the Scheme shall be required to repay the sums wrongfully received and shall also, if they are serving staff members, be liable to disciplinary sanctions.

1. The Organisation shall be entitled to take over affiliated persons’ legal claims against potentially liable third parties, up to the level of the benefits provided. This shall not apply to capital benefits, which may be added to similar compensation paid by third parties.

2. Affiliated persons must inform the Head of Human Resources Division of any accident of which they or other beneficiaries have been the victim, whether or not that accident was caused by a third party. They must furnish any information concerning the identity of the persons involved and their insurers, and also the circumstances of the accident, which the Organisation may require to pursue claims against potentially liable third parties.

1. The cost of medical treatment prescribed or provided by a qualified medical practitioner in cases of accident, illness or maternity shall be covered in accordance with the rules laid down by the Secretary General.

2.    Entitlement to benefits for medical treatment shall apply to staff members and persons entitled through them, viz.:

a)     dependent children under the age of 20;

However, cover for medical treatment costs on a complementary basis may be extended, on payment of an additional contribution, to dependent children aged more than 20 and less than 9 who are covered by Social Security schemes in their own right (students, job-seekers, etc.).

b) the dependent spouses of staff members or persons cohabiting with staff members (as unmarried partners) and totally dependent on them (a certificat de concubinage is required for staff members living in France).

On payment of an additional contribution, cover on a complementary basis may be extended to spouses or unmarried partners who are professionally active or in receipt of unemployment benefits or retirement pensions;

c) a parent or other close relation who lives in the staff member’s home and looks after the house and at least two of his/her dependent children under the age of 14;

d) any person, but only one, who has lived with a staff member for at least one year and is wholly dependent on him/her (proof is required).

3. For the concept of persons entitled through staff members, reference shall be made to the French Social Security legislation in force when these Regulations are adopted and to any subsequent changes in such legislation.

4. Staff members must inform the Organisation of any other compulsory scheme which provides health cover for them or persons entitled through them.

5. Persons entitled to benefits provided for in this chapter, who are entitled in their own personal right to social protection under one or more other compulsory social insurance schemes, must always obtain the benefits due under these schemes before applying for benefits under the Organisation's Medical and social insurance scheme, from which the former benefits shall be deducted.

In the specific case of parents who are each insured under a sickness and maternity scheme, the parents shall designate, by joint agreement, which of them shall be considered as primarily responsible for their children as regards claims for sickness and maternity benefits.

The said designation can be made at anytime. Once it has been made it can only be changed by joint agreement of the parents, after an interval of one year.

However, when one of the insured parents ceases to be entitled to sickness and maternity insurance benefits, entitlement to such benefits shall be transferred to the other parent.

6. In cases where specific sickness benefits which are not covered by the Organisation's Scheme could have been provided by French Social Security, the Secretary General shall decide in each instance whether a reimbursement should be made to the staff member in question.

1. Under the Organisation’s Medical and Social Insurance Scheme, and subject to the special rules applying to accidents at work and to illness, staff members shall be entitled to continued payment of their salaries and allowances for the periods specified in the rules applied under the French Social Security scheme.

2. Continued payment of salary and allowances shall be conditional on the production of a medical certificate. Payment of salary and allowances may be suspended if the doctor appointed by the Organisation finds that the staff member is not following the treatment ordered or the instructions issued by his/her own doctor, or that he/she is fit to return to work.

Serving staff members granted maternity or adoption leave shall be entitled, during such leave, to continued payment of their full salaries and allowances.

Staff members shall also receive a lump-sum allowance on birth or adoption of a child.

When both parents of the child are staff members, the allowance shall be paid once, to the parent designated by them both.

1. In cases of total, permanent disability, recognised as such in terms of the Pension Scheme Regulations applying to the Organisation’s staff members, and if it is confirmed that this condition renders a staff member unfit for all work, professional or otherwise, he/she shall be entitled to payment of a capital sum equivalent to two years’ salary¹ if he/she is not in receipt of the household allowance, and to four years’ salary if he/she is in receipt of the household allowance. However, the sum paid decreases progressively after age 56, unless permanent, total and absolute disability makes the beneficiary permanently dependent on the assistance of another person to perform the normal activities of everyday life.

2. A staff member who, either at the time of making a declaration of disability or subsequently, due to a worsening of his/her condition, is obliged to rely on the assistance of another person to perform the normal activities of everyday life, shall also receive a disability pension, payable for life, the amount of which shall be determined by rule by the Secretary General.

3. In the event of accident-caused permanent partial incapacity of at least 33.33%, a staff member shall be entitled to a capital sum or annual pension, the amount of which shall be determined by rule by the Secretary General. The extent of permanent partial incapacity shall be determined in accordance with the provisions of French Social Security legislation on permanent incapacity following an accident at work or an industrial disease.

The staff member shall also be entitled to a pension equal to that which would have been paid by French Social Security.

A capital sum may be substituted for this pension on the same conditions as those applied by French Social Security.

^{1 The salary referred to here comprises basic salary and, where applicable, the household allowance, the expatriation or residence allowance and the language allowance.}

If a staff member dies, a capital sum equivalent to two years’ salary² if he/she was not in receipt of the household allowance and to four years’ salary if he/she was in receipt of the said household allowance, shall be paid to the persons entitled through him/her, in accordance with Rule No. 883, unless this sum has already been paid under Article 12, paragraph 1.

^{2 The salary referred to here comprises basic salary and, where applicable, the household allowance, the expatriation or residence allowance and the language allowance.}

1.    Definitions

a) An accident at work is any accident which is caused by, or occurs in the course of, functions undertaken in the Organisation, and which damages the physical or mental integrity of a serving staff member.

In particular, any physical injury due to a sudden and usually violent external cause is regarded as accidental.

b) Specifically, any accident occurring while a staff member is on an official journey shall be regarded as an accident at work unless he/she has interrupted that journey for personal reasons unconnected with his/her duties.

c) Accidents at work shall also include accidents occurring:

i.    on a staff member’s normal journey to and from work;

ii.    when a staff member is travelling to or from an official destination or performing duties connected with an official journey;

iii.    on the journey which precedes a staff member’s taking up his/her duties, or which follows his/her ceasing those duties, if that journey follows the route and respects the time-limits laid down in the Organisation’s regulations.

d) Industrial diseases caused by functions performed on behalf of the Organisation shall be assimilated to accidents at work.

e) Accidents at work or industrial diseases shall include the further effects of an accident occurring, or an industrial disease contracted, while a staff member was performing his/her duties, even if those further effects manifest themselves when he/she has left the Organisation.

f) If problems arise with interpretation of the principles laid down in paragraphs a) to e) above, French legislation on accidents at work and industrial diseases, and the relevant French case-law, shall apply by analogy.

2.    Declaration

Any accident covered by paragraphs a), b) and c) of this Article must be notified by written declaration to the Head of Human Resources Division within 48 hours, unless prevented by "force majeure".

3.    Decision

The Secretary General shall inform the staff member, when an enquiry and any necessary medical examinations have been carried out, of the decision to recognise the accident as an accident at work, and of the reasons for any decision not to do so.

4. Effect

The medical costs of treating the consequences of the accident at work or industrial disease, and of functional rehabilitation, shall be covered at 100 % of the costs covered by the French Social Security scheme.

Staff members obliged to interrupt their functions by an accident at work shall be entitled to continued payment of their full salaries and allowances, and shall, if employed on a fixed-term contract, be entitled to extension of that contract until either their health is officially restored or they are declared disabled or, at latest, to age 65.

Staff members affiliated to the Organisation’s Medical and Social Insurance Scheme under Article 1 of these Regulations shall contribute one-third of the cost of cover for the benefits provided by the Scheme, with the exception of benefits for accidents at work or industrial diseases.

1.    The following persons shall be affiliated, at their request, to the Organisation’s Medical and Social Insurance Scheme:

- former staff in receipt of retirement pensions under the Organisation’s Pension Scheme and aged at least 60;

-      former staff in receipt of early retirement pensions under the Organisation’s Pension Scheme, regardless of age;

- former staff in receipt of disability pensions under the Organisation’s Pension Scheme, regardless of age;

-      surviving spouses in receipt of survivors’ pensions within the meaning of, and subject to the conditions and limitations provided for in, the Organisation’s Pension Scheme as well as surviving spouses of deceased staff and former staff who have not been married long enough to qualify for survivors’ pensions;

-      orphans or other dependents of staff members who die while serving or after qualifying for a disability pension or an immediate or deferred retirement pension, who are in receipt of orphans’ or other dependents’ pensions on the conditions specified in the Organisation’s Pension Scheme and in Article 5 of Appendix IV to the Staff Regulations;

2. Apart from the cases expressly listed in paragraph 1, a former staff member of any age may be affiliated to the Organisation’s Medical and Social Insurance Scheme, if he/she has so requested prior to expiry of his/her contract with the Organisation, on the special conditions laid down by the Secretary General.

3. Affiliation shall cease when the persons concerned cease to fulfil the conditions for affiliation.

1. In the cases listed in Article 16, paragraph 1 of this section, entitlement to the benefits provided for in this section shall begin on the date on which the beneficiary becomes entitled to the benefits provided by the Organisation’s Pension Scheme.

2. Entitlement to the benefits provided for in this section shall cease, for any person in receipt of a pension, on the date on which he/she ceases to receive pension benefits.

3. In the case specified in Article 16, paragraph 2 of this section, cover shall begin on the day following that on which the staff member’s contract terminates, and shall cease on the date on which he/she withdraws from the Scheme.

Cover for medical treatment, on the conditions applying to the affiliated persons referred to in Article 16, paragraph 1, shall be suspended for former staff members in receipt of pension benefits under the Pension Scheme Regulations who engage in a remunerated professional activity (this shall not apply to temporary contracts with the Organisation).

The Secretary General shall determine by rule the nature of the expenses covered by the Organisation’s Medical and Social Insurance Scheme, and also the rates of cover, exceptions and limits which apply, depending on the nature or cause of the benefits.

If doubts or disputes arise concerning the application of the provisions of the Organisation’s Medical and Social Insurance Scheme, reference shall be made to the provisions of the French Social Security legislation in force at the time when the event giving rise to a claim for benefits occurs.

The text of insurance policies taken out by the Organisation relating to cover for health expenses or provident cover shall be made available to affiliated persons.

Articles 6, 7 and 8 shall apply, mutatis mutandis, to Section II (pensioned and former staff).

1. The cost of medical treatment prescribed or provided by a qualified medical practitioner in cases of accident, illness or maternity shall be covered by the Organisation in accordance with the rules laid down by the Secretary General.

Entitlement to benefits for medical treatment shall apply to affiliated persons and persons entitled through them, viz.:

a) dependent children under the age of 20.

However, cover for medical treatment costs on a complementary basis may be extended, on payment of an additional contribution, to dependent children aged more than 20 and less than 29 who are covered by Social Security schemes in their own right (students, job-seekers, etc.);

b) the dependent spouses of affiliated persons or persons cohabiting with affiliated persons (as unmarried partners) and totally dependent on them (a certificat de concubinage is required for affiliated persons living in France).

On payment of an additional contribution, cover on a complementary basis may be extended to spouses or unmarried partners who are professionally active or in receipt of unemployment benefits or retirement pensions;

c) a parent or other close relation who lives in the affiliated person’s home and looks after the house and at least two of his/her dependent children below the age of 14;

d) any person, but only one, who has lived with an affiliated person for at least one year and is wholly dependent on him/her (proof is required).

2. For the concept of persons entitled through affiliated persons, reference shall be made to the French Social Security legislation in force when these Regulations are adopted and to any subsequent changes in such legislation.

3. Persons entitled to benefits provided for in this chapter, who are entitled in their own personal right to social protection under one or more other compulsory social insurance schemes, must always obtain the benefits due under these schemes before applying for benefits under the Organisation's Medical and social insurance scheme, from which the former benefits shall be deducted.

In the specific case of parents who are each insured under a sickness and maternity scheme, the parents shall designate, by joint agreement, which of them shall be considered as primarily responsible for their children as regards claims for sickness and maternity benefits.

The said designation can be made at anytime. Once it has been made it can only be changed by joint agreement of the parents, after an interval of one year.

However, when one of the insured parents ceases to be entitled to sickness and maternity insurance benefits, entitlement to such benefits shall be transferred to the other parent.

Affiliated persons shall receive a lump-sum allowance on birth or adoption of a child.

When both parents of the child are affiliated to the Organisation’s Medical and Social Insurance Scheme, the allowance shall be paid once, to the parent designated by them both.

Former permanent staff in receipt of retirement pensions under the Organisation’s Pension Scheme, who retire before the age of 65, may request maintenance of cover for death and for permanent, total and absolute disability.

The capital sum paid in the event of death or permanent and total disability shall be that to which the former staff member would have been entitled on the date on which his/her duties ceased, in accordance with the rules applying to serving staff.

The capital sum, based on the staff member’s last salary prior to retirement, shall remain unchanged during the period of maintained entitlement.

The death grant shall be paid to the persons entitled, in accordance with Rule No. 883.

This cover shall terminate at age 65 in all cases.

Disability and death insurance cover shall not be open to the former staff referred to in Article 16, paragraph 2.

Persons affiliated to the Organisation’s Medical and Social Insurance Scheme under Article 16, paragraph 1 of these Regulations shall contribute one-third of the cost of cover for the benefits provided by the Scheme.

The Secretary General shall determine to what extent, part of the cost of cover for the affiliated persons referred to in Article 16, paragraph 1 is to be borne through the compulsory insurance scheme for serving staff.

Persons affiliated to the Organisation’s Medical and Social Insurance scheme under Article 16, paragraph 2 of these Regulations shall pay the full cost of their insurance.

Article 43 -Social security³

1.    Staff members shall be properly covered against the risks of accident, illness, old age, disability and death and for maternity expenses.

2. The Pension Scheme applicable to staff members is set out in Appendix V to these Regulations.

3. For cover in the event of sickness, maternity, accident at work, disability or death, the Medical and Social Insurance Scheme applicable to staff from 1 February 1999 is set out in Appendix XII to the Staff Regulations.

4. However, for staff members in service on 30 November 1998 and affiliated at that date to the French Social Security scheme, the Scheme set out in Appendix XII to the Staff Regulations shall apply only to those members of staff who have opted for the said Scheme, the others remaining affiliated to the French Social Security scheme and a compulsory complementary insurance scheme. In the latter case staff members shall pay the employee's contribution to the French Social Security scheme as applicable under the Agreement between the Council of Europe and France and one-third of the cost of their affiliation to the compulsory complementary insurance scheme.

5. Regardless of which health insurance scheme covers the staff member, contributions in respect of accidents at work and industrial disease risks shall be borne by the Council of Europe in full.

^{3 As amended by Resolution (98)...of... December 1998.}