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Laying Down the Procedure for Implementing Regulation (EC) No 8832004 Coordination of Social Security Systems (Text with Relevance for the EEA and for Switzerland) Regulation
Article 1: Definitions
Article 2: Scope and rules for exchanges between institutions
Article 3: Scope and rules for exchanges between the persons concerned and institutions
The relevant institution shall notify the claimant residing or staying in another Member State of its decision directly or through the liaison body of the Member State of residence or stay. When refusing the benefits it shall also indicate the reasons for refusal, the remedies and periods allowed for appeals. A copy of this decision shall be sent to other involved institutions.
Article 4: Format and method of exchanging data
Article 5: Legal value of documents and supporting evidence issued in another Member State
Article 6: Provisional application of legislation and provisional granting of benefits
Benefits in kind granted provisionally by an institution in accordance with paragraph 2 shall be reimbursed by the competent institution in accordance with Title IV of the implementing Regulation.
Article 7: Provisional calculation of benefits and contributions
Article 8: Administrative arrangements between two or more Member States
Article 9: Other procedures between authorities and institutions
Article 10: Prevention of overlapping of benefits
Article 11: Elements for determining residence
Article 12: Aggregation of periods
Article 13: Rules for conversion of periods
If the periods to be converted correspond to the maximum annual amount of periods under the legislation of the Member State in which they have been completed, the application of paragraph 1 shall not result within one calendar year in periods that are shorter than the possible maximum annual amount of periods provided under the legislation concerned.
Article 14: Details relating to Articles 12 and 13 of the basic Regulation
To determine whether a substantial part of the activities is pursued in a Member State, the following indicative criteria shall be taken into account:
Article 15: Procedures for the application of Article 11(3)(b) and (d), Article 11(4) and Article 12 of the basic Regulation (on the provision of information to the institutions concerned)
Article 16: Procedure for the application of Article 13 of the basic Regulation
Where there is a difference of views between the institutions or competent authorities concerned, those bodies shall seek agreement in accordance with the conditions set out above and Article 6 of the implementing Regulation shall apply.
Article 17: Procedure for the application of Article 15 of the basic Regulation
Article 18: Procedure for the application of Article 16 of the basic Regulation
Article 19: Provision of information to persons concerned and employers
Article 20: Cooperation between institutions
Article 21: Obligations of the employer
Article 22: General implementing provisions
Article 23: Regime applicable in the event of the existence of more than one regime in the Member State of residence or stay
Article 24: Residence in a Member State other than the competent Member State
The institution of the place of residence shall inform the competent institution of any registration under paragraph 1 and of any change or cancellation of that registration.
Article 25: Stay in a Member State other than the competent Member State
B. Procedure and arrangements for meeting the costs and providing reimbursement of benefits in kind
C. Family Members
The institution of the place of stay shall provide the competent institution, upon request, with all necessary information about these rates or amounts.
Article 26: Scheduled treatment
B. Meeting the cost of benefits in kind incurred by the insured person
C. Meeting the costs of travel and stay as part of scheduled treatment
D. Family members
In that event, the institution of the place of residence shall certify in a statement whether the conditions set out in the second sentence of Article 20(2) of the basic Regulation are met in the Member State of residence.
The competent institution may refuse to grant the requested authorisation only if, in accordance with the assessment of the institution of the place of residence, the conditions set out in the second sentence of Article 20(2) of the basic Regulation are not met in the Member State of residence of the insured person, or if the same treatment can be provided in the competent Member State itself, within a time-limit which is medically justifiable, taking into account the current state of health and the probable course of illness of the person concerned.
The competent institution shall inform the institution of the place of residence of its decision.
In the absence of a reply within the deadlines set by its national legislation, the authorisation shall be considered to have been granted by the competent institution.
The competent institution shall accept the findings and the treatment options of the doctors approved by the institution of the place of residence that issues the authorisation, concerning the need for urgent vitally necessary treatment.
Article 27: Cash benefits relating to incapacity for work in the event of stay or residence in a Member State other than the competent Member State
B. Procedure to be followed by the institution of the Member State of residence
C. Procedure to be followed by the competent institution
D. Procedure in the event of a stay in a Member State other than the competent Member State
Article 28: Long-term care benefits in cash in the event of stay or residence in a Member State other than the competent Member State
B. Procedure to be followed by the institution of the place of residence
C. Procedure to be followed by the competent institution
D. Procedure in the event of a stay in a Member State other than the competent Member State
E. Family members
Article 29: Application of Article 28 of the basic Regulation
Article 30: Contributions by pensioners
Article 31: Application of Article 34 of the basic Regulation
B. Procedure to be followed by the institution of the place of residence or stay
Article 32: Special implementing measures
The institution of another Member State shall not, on those grounds alone, become responsible for bearing the costs of benefits in kind or in cash provided to those persons or to members of their family.
Article 33: Right to benefits in kind and in cash in the event of residence or stay in a Member State other than the competent Member State
Article 34: Procedure in the event of an accident at work or occupational disease which occurs in a Member State other than the competent Member State
Article 35: Disputes concerning the occupational nature of the accident or disease
Where an accident at work or occupational disease is not established, benefits in kind shall continue to be provided as sickness benefits if the person concerned is entitled to them.
Where an accident at work or occupational disease is established, sickness benefits in kind provided to the person concerned shall be considered as accident at work or occupational disease benefits from the date on which the accident at work occurred or the occupational disease was first medically diagnosed.
Article 36: Procedure in the event of exposure to the risk of an occupational disease in more than one Member State
When the institution to which the declaration or notification was sent establishes that an activity likely to cause the occupational disease in question was last pursued under the legislation of another Member State, it shall send the declaration or notification and all accompanying certificates to the equivalent institution in that Member State.
Article 37: Exchange of information between institutions and advance payments in the event of an appeal against rejection
Article 38: Aggravation of an occupational disease
Article 39: Assessment of the degree of incapacity in the event of occupational accidents or diseases which occurred previously or subsequently
Article 40: Submission and investigation of claims for pensions or supplementary allowances
The claim shall contain the information required under the legislation applied by the competent institution.
Article 41: Special implementing measures
Article 42: Claim for death grants
The claim shall contain the information required under the legislation applied by the competent institution.
Article 43: Additional provisions for the calculation of benefit
Where the legislation applied by the competent institution does not allow it to determine this amount directly, on the grounds that that legislation allocates different values to insurance periods, a notional amount may be established. The Administrative Commission shall lay down the detailed arrangements for the determination of that notional amount.
Article 44: Taking into account of child raising-periods
Article 45: Claim for benefits
B. Submission of other claims for benefits
Article 46: Certificates and information to be submitted with the claim by the claimant
Article 47: Investigation of claims by the institutions concerned
B. Investigation of claims for benefits under type A legislation under Article 44 of the basic Regulation
C. Investigation of other claims for benefits
In addition to investigating the claim for benefits under the legislation which it applies, this institution shall, in its capacity as contact institution, promote the exchange of data, the communication of decisions and the operations necessary for the investigation of the claim by the institutions concerned, and supply the claimant, upon request, with any information relevant to the Community aspects of the investigation and keep him/her informed of its progress.
Article 48: Notification of decisions to the claimant
Article 49: Determination of the degree of invalidity
Where the eligibility criteria, other than those relating to the degree of invalidity, laid down in the applicable legislation are not met, taking into account Articles 6 and 51 of the basic Regulation, the contact institution shall without delay inform the competent institution of the last Member State to whose legislation the claimant was subject. The latter institution shall be authorised to take the decision concerning the degree of invalidity of the claimant if the conditions for eligibility laid down in the applicable legislation are met. It shall without delay notify the other institutions concerned of that decision.
When determining eligibility, the matter may, if necessary have to be referred back, under the same conditions, to the competent institution in respect of invalidity of the Member State to whose legislation the claimant was first subject.
Article 50: Provisional instalments and advance payment of benefit
Article 51: New calculation of benefits
Article 52: Measures intended to accelerate the pension calculation process
Article 53: Coordination measures in Member States
Article 54: Aggregation of periods and calculation of benefits
Article 55: Conditions and restrictions on the retention of the entitlement to benefits for unemployed persons going to another Member State
That institution shall inform the person concerned of his obligations and shall provide the abovementioned document which shall include the following information:
If, in the period during which the unemployed person retains entitlement to benefits, any circumstance likely to affect the entitlement to benefits arises, the institution in the Member State to which the unemployed person has gone shall send immediately to the competent institution and to the person concerned a document containing the relevant information.
At the request of the competent institution, the institution in the Member State to which the unemployed person has gone shall provide relevant information on a monthly basis concerning the follow-up of the unemployed person’s situation, in particular whether the latter is still registered with the employment services and is complying with organised checking procedures.
Article 56: Unemployed persons who resided in a Member State other than the competent Member State
At the request of the employment services of the Member State in which the person concerned pursued his last activity as an employed or self-employed person, the employment services in the place of residence shall send the relevant information concerning the unemployed person’s registration and search for employment.
The non-fulfilment by the unemployed person of all the obligations and/or job-seeking activities in the Member State in which he pursued his last activity shall not affect the benefits awarded in the Member State of residence.
Article 57: Provisions for the application of Articles 61, 62, 64 and 65 of the basic Regulation regarding persons covered by a special scheme for civil servants
Article 58: Priority rules in the event of overlapping
Article 59: Rules applicable where the applicable legislation and/or the competence to grant family benefits changes
Article 60: Procedure for applying Articles 67 and 68 of the basic Regulation
If that institution concludes that its legislation is applicable by priority right in accordance with Article 68(1) and (2) of the basic Regulation, it shall provide the family benefits according to the legislation it applies.
If it appears to that institution that there may be an entitlement to a differential supplement by virtue of the legislation of another Member State in accordance with Article 68(2) of the basic Regulation, that institution shall forward the application, without delay, to the competent institution of the other Member State and inform the person concerned; moreover, it shall inform the institution of the other Member State of its decision on the application and the amount of family benefits paid.
If the institution to which the application was forwarded does not take a position within two months of the receipt of the application, the provisional decision referred to above shall apply and the institution shall pay the benefits provided for under its legislation and inform the institution to which the application was made of the amount of benefits paid.
Article 61: Procedure for applying Article 69 of the basic Regulation
Article 62: Principles
Article 63: Identification of the Member States concerned
Article 64: Calculation method of the monthly fixed amounts and the total fixed amount
F i = Y i *1/12*(1-X) i i
Where:
The number of months completed by the persons concerned in the creditor Member State shall be the sum of the calendar months in a calendar year during which the persons concerned were, because of their residence in the territory of the creditor Member State, eligible to receive benefits in kind in that territory at the expense of the debtor Member State. Those months shall be determined from an inventory kept for that purpose by the institution of the place of residence, based on documentary evidence of the entitlement of the beneficiaries supplied by the competent institution.
Article 65: Notification of annual average costs
Article 66: Procedure for reimbursement between institutions
Article 67: Deadlines for the introduction and settlement of claims
Article 68: Interest on late payments and down payments
Article 69: Statement of annual accounts
Article 70: Reimbursement of unemployment benefits
There is no requirement to consider requests introduced after the time-limit referred to in the first paragraph.
Articles 66(1) and 67(5) to (7) of the implementing Regulation shall apply mutatis mutandis . mutatis mutandis
From the end of the 18-month period referred to in Article 67(5) of the implementing Regulation, interest may be charged by the creditor institution on outstanding claims. The interest shall be calculated in accordance with Article 68(2) of the implementing Regulation.
The maximum amount of the reimbursement referred to in the third sentence of Article 65(6) of the basic Regulation is in each individual case the amount of the benefit to which a person concerned would be entitled according to the legislation of the Member State to which he was last subject if registered with the employment services of that Member State. However, in relations between the Member States listed in Annex 5 to the implementing Regulation, the competent institutions of one of those Member States to whose legislation the person concerned was last subject shall determine the maximum amount in each individual case on the basis of the average amount of unemployment benefits provided under the legislation of that Member State in the preceding calendar year.
Article 71: Common provisions
Article 72: Benefits received unduly
This provision shall apply mutatis mutandis to any family member of a person concerned who has received assistance in the territory of a Member State during a period in which the insured person was entitled to benefits under the legislation of another Member State in respect of that family member. mutatis mutandis
The institution of a Member State which has paid an undue amount of assistance shall send a statement of the amount due to the institution of the other Member State, which shall then deduct the amount, subject to the conditions and limits laid down for this kind of offsetting procedure in accordance with the legislation it applies, and transfer the amount without delay to the institution that has paid the undue amount.
Article 73: Provisionally paid benefits in cash or contributions
The institution identified as being competent for paying the benefits shall deduct the amount due in respect of the provisional payment from the arrears of the corresponding benefits it owes to the person concerned and shall without delay transfer the amount deducted to the institution which provisionally paid the cash benefits.
If the amount of provisionally paid benefits exceeds the amount of arrears, or if arrears do not exist, the institution identified as being competent shall deduct this amount from ongoing payments subject to the conditions and limits applying to this kind of offsetting procedure under the legislation it applies, and without delay transfer the amount deducted to the institution which provisionally paid the cash benefits.
Upon request of the institution identified as being competent, which shall be made at the latest three months after the applicable legislation has been determined, the institution that has provisionally received contributions shall transfer them to the institution identified as being competent for that period for the purpose of settling the situation concerning the contributions owed by the legal and/or natural person to it. The contributions transferred shall be retroactively deemed as having been paid to the institution identified as being competent.
If the amount of provisionally paid contributions exceeds the amount the legal and/or natural person owes to the institution identified as being competent, the institution which provisionally received contributions shall reimburse the amount in excess to the legal and/or natural person concerned.
Article 74: Costs related to offsetting
Article 75: Definitions and common provisions
Article 76: Requests for information
In order to obtain that information, the requested party shall make use of the powers provided for under the laws, regulations or administrative provisions applying to the recovery of similar claims arising in its own Member State.
Article 77: Notification
Article 78: Request for recovery
Article 79: Instrument permitting enforcement of the recovery
Within three months of the date of receipt of the request for recovery, Member States shall endeavour to complete the acceptance, recognition, supplementing or replacement, except in cases where the third subparagraph of this paragraph applies. Member States may not refuse to complete these actions where the instrument permitting enforcement is properly drawn up. The requested party shall inform the applicant party of the grounds for exceeding the three-month period.
If any of these actions should give rise to a dispute in connection with the claim and/or the instrument permitting enforcement issued by the applicant party, Article 81 of the implementing Regulation shall apply.
Article 80: Payment arrangements and deadlines
From the date on which the instrument permitting enforcement of the recovery of the claim has been directly recognised in accordance with Article 79(1) of the implementing Regulation, or accepted, recognised, supplemented or replaced in accordance with Article 79(2) of the implementing Regulation, interest shall be charged for late payment under the laws, regulations and administrative provisions in force in the Member State of the requested party and shall also be remitted to the applicant party.
Article 81: Contestation concerning the claim or the instrument permitting enforcement of its recovery and contestation concerning enforcement measures
Notwithstanding the first subparagraph, the applicant party may, in accordance with the laws, regulations and administrative practices in force in its own Member State, request the requested party to recover a contested claim, in so far as the relevant laws, regulations and administrative practices in force in the requested party’s Member State allow such action. If the result of the contestation is subsequently favourable to the debtor, the applicant party shall be liable for the reimbursement of any sums recovered, together with any compensation due, in accordance with the legislation in force in the requested party’s Member State.
Article 82: Limits applying to assistance
Article 83: Periods of limitation
Article 84: Precautionary measures
For the purposes of implementing the first paragraph, the provisions and procedures laid down in Articles 78, 79, 81 and 82 of the implementing Regulation shall apply mutatis mutandis . mutatis mutandis
Article 85: Costs related to recovery
Article 86: Review clause
On the basis of this report, the European Commission may, as appropriate, submit proposals to review these time limits with the aim of reducing them in a significant way.
In the light of this report, the European Commission may, if necessary, submit appropriate proposals to make these procedures more efficient and balanced.
Article 87: Medical examination and administrative checks
The debtor institution shall inform the institution of the place of stay or residence of any special requirements, if necessary, to be followed and points to be covered by the medical examination.
The debtor institution shall reserve the right to have the beneficiary examined by a doctor of its choice. However, the beneficiary may be asked to return to the Member State of the debtor institution only if he or she is able to make the journey without prejudice to his health and the cost of travel and accommodation is paid for by the debtor institution.
Paragraph 2 shall also apply in this case.
Article 88: Notifications
Article 89: Information
Article 90: Currency conversion
Article 91: Statistics
Article 92: Amendment of the Annexes
Article 93: Transitional provisions
Article 94: Transitional provisions relating to pensions
Article 95: Transitional period for electronic data exchanges
These transitional periods shall not exceed 24 months from the date of entry into force of the implementing Regulation.
However, if the delivery of the necessary Community infrastructure (Electronic Exchange of Social Security information — EESSI) is significantly delayed with regard to the entry into force of the implementing Regulation, the Administrative Commission may agree on any appropriate extension of these periods.
Article 96: Repeal
However, Regulation (EEC) No 574/72 shall remain in force and continue to have legal effect for the purposes of:
Article 97: Publication and entry into force
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Footnote p0: This Regulation shall be binding in its entirety and directly applicable in all Member States.
Done at Strasbourg, 16 September 2009.