Judgment No. 1880
The complaint is dismissed.
"According to precedent [...] (see Judgments 1094 [...] and 1095 [...]), coverage at the rate of 100 per cent does not mean that in all circumstances an insured person is entitled to full repayment of expenses incurred. [T]o allow the [sickness] fund not to reimburse the part of the expenses deemed to be excessive is in keeping with the purpose of sickness insurance and it is a means of ensuring sound financing and comparable coverage for the beneficiaries, and as such falls within the authority delegated to the Director General. The reimbursement of expenses can be restricted by setting maximum limits or ceilings for certain types of expenditure or by reckoning limits for each case on the basis of costs incurred."
Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
ILOAT Judgment(s): 1094, 1095
case law; insurance; illness; maximum limit; limits; purpose; medical expenses; health insurance