CHIS Bull' 45

BULLETIN OF THE CERN HEALTH INSURANCE SCHEME No. 45 – APRIL 2020

AS OF 1 AVRIL 2020 CHIS NEW RULES

GOOD TO KNOW ALTERNATIVE THERAPIES

CHANGE www.cern.ch/chis NEW WEBSITE APPROVED HEALTH CARE PROVIDERS 2 | No. 45 – APRIL 2020 | CHIS BULL’ | EDITORIAL

CERN Health Insurance Scheme EDITORIAL Régime d'assurance maladie du CERN s we close this issue 45 of CHIS Bull’, news related to COVID-19 is constantly evolving. As a result, you will not find in this issue the information that this topic deserves. However, we CHIS BOARD Ahave decided not to delay the publication of this issue and to provide MEMBERS 2020 you with other information. Concerning COVID-19, we would like to remind you that CERN The CERN Health Insurance Scheme continues to monitor the evolution of the novel coronavirus COVID-19. Board (CHIS Board) is a sub-group of For up-to-date information, please see: https://hse.cern/news-article/ the Standing Concertation Committee coronavirus-recommendations. (SCC) responsible for the preparatory Furthermore, a helpline has been set up to answer your questions. Call work preceding concertation at the +41 22 766 77 77, from 8 a.m. – 5 p.m. SCC on proposals for adjustments to the CERN Health Insurance Scheme Since the last CHIS Bull’, a number of changes have taken place. Let’s (CHIS) submitted to the Board by the start with the new, spruced-up CHIS Rules, which will come into force Strategic Advisor. The Board is also in April 2020. The major change? You will now be able to submit your kept regularly informed about the reimbursement claims to UNIQA electronically. This was one of your Scheme’s operations. most pressing – and entirely justified! – requests. But don’t worry, you’ll still be able to submit them on paper, as you do today; both submission Some of the members of the CHIS methods will be possible. Changes have also been made to clarify and Board are appointed by the correct a number of articles and make them consistent with one another, Management and others by the Staff as well as to improve the readability of the document. Association and the CERN Pensioners’ A further change at the beginning of this year was the launch of the new Association (GAC). CHIS website, which provides more comprehensive information and makes it easier to find what you need. Please have a browse! As you have STRATEGIC ADVISOR AND CHAIR probably noticed at the top of this page, a new visual identity has also been Carmelo Saitta (FAP) created for the CHIS, including a logo. It will be used in all our communications and documents, as well as on the membership cards MEMBERS APPOINTED BY THE MANAGEMENT supplied by UNIQA, which will also be laminated. Sandrine Baudat (HR – CHIS Manager), On the subject of UNIQA, we have confirmed our (nearly fifty-year-old!) Clara Gaspar (EP), Peter Jurcso (BE), trust in them by renewing their contract for a further five years. Daniela Macina (EN) UNIQA, should you need reminding, is not your insurer but is responsible for processing and paying your reimbursement claims on MEMBERS APPOINTED BY THE STAFF behalf of the CHIS. ASSOCIATION AND THE CERN PENSIONERS’ But that’s not all! We’ve also had some personnel changes. As we ASSOCIATION announced in the last CHIS Bull’, following a flawlessly executed Sébastien Evrard (EN), handover, Jean-Pol Matheys has passed on his pens and pencils and David Jacobs (GAC), Joël Lahaye (EN), address book to our Scheme’s new Administrator, Sandrine Baudat, who Morna Robillard (GAC) is the first woman to take on this role. We thank Jean-Pol warmly for his hard work and dedication over the last STANDING INVITATIONS TO ATTEND nine years in the service of the CHIS, and wish Sandrine good luck and Roberto Buquicchio (Legal Adviser), much success in her new role, which is essential to the smooth running John Wijnberg (Medical Adviser) of our Scheme! In the pages that follow, you will find more information. SECRETARY Happy reading and take care of yourself and your loved ones. Sophie Wanert-Calaga (HR)

Carmelo Saitta Strategic Adviser to the Director-General on health insurance matters, Chair of the CHIS Board NEW RULES | CHIS BULL’ | No. 45 – APRIL 2020 | 3

NEW CHIS RULES

The CHIS Rules have undergone numerous modifi- – In order to be recognised as adequate, spouses’ cations since they were first published, including an health insurance schemes must cover them for the in-depth revision in 2017. This constantly evolving duration of their residence in the relevant country. document has now been revised once again in order This was already standard practice. to align the Rules with actual practice in several – Supplementary contributions are due even if spouses areas, clarify a number of points and introduce the do not use the CHIS as their primary insurance electronic submission of reimbursement claims. scheme. This was already standard practice.

The work to tidy up the document and make it consis- CHANGE IN FAMILY DECLARATIONS tent has been carried out with the cooperation of all In the event of a late declaration of a change in family the members of the CHIS Board, representing the composition, payment of the contributions that Management, the Staff Association and the CERN would have been due may not be required if circum- Pensioners Association. The final text has been stances beyond the control of the main member approved by the Director-General and will enter into concerned are recognised. force on 1 April 2020. CHANGES CONCERNING REIMBURSEMENT CLAIMS The structure of the document, which was revised – The deadline for submitting a reimbursement in 2017, remains the same. The changes affecting claim in the event of the main member’s death has members are as follows: been extended by 180 calendar days. – The authenticity of documents submitted CHANGE AFFECTING THE MEMBERSHIP OF (including the amounts) and the settlement of the POST-COMPULSORY MEMBERS corresponding payments will now be attested to Individuals applying for post-compulsory member- simply by the signature of the paper reimburse- ship must ensure that this membership is compatible ment claim or its electronic submission by the with their legal obligations in the country in which member concerned. In addition, members must they live or work. keep the original documents for two years. This is in line with the practice of other insurance schemes CHANGE AFFECTING THE CONTINUATION OF THE that have introduced the possibility of submitting MEMBERSHIP OF VOLUNTARY MEMBERS electronic documents. Members will be able to continue their voluntary – Invoices will now be required to include the level of membership provided that they hold a valid contract of detail concerning treatments that is usually association with CERN (as well as a carte de légitimation required in the country where the treatment was – current requirement). dispensed. However, the third-party administrator will still be able to request additional information CHANGES AFFECTING SUBSIDIARY MEMBERS from the healthcare provider. – Subsidiary members who no longer meet the conditions to be recognised as family members of the We hope that these changes to the CHIS Rules meet main member concerned will now remain members your expectations. Of course, if anything is not clear, until the final day of the month following that you can always send an e-mail to [email protected]. during which the Organization takes the corresponding decision. For example, if the Organization decides retroactively on 13 November 2020 that a child has not been dependent since 28 June 2020, the child will remain a subsidiary member of the CHIS until 31 December 2020.. 4 | No. 45 – APRIL 2020 | CHIS BULL’ | APPROVED HEALTH CARE PROVIDERS

APPROVED HEALTH CARE PROVIDERS 2020

The list below is not exhaustive and includes only establishments in the local area. Please contact UNIQA to know the status of any establishment not included in this list: [email protected] or +41 (0)22 718 63 00.

IN SWITZERLAND

Name of the Healthcare Type Website Location Medical fields Provider

HUG – Hôpitaux Public hug-ge.ch Geneva, GE All Universitaires de Genève

Clinique de Joli-Mont Convalescence | Medical or surgical Public hug-ge.ch/joli-mont Geneva, GE (HUG) treatment follow-up

Lausanne, Prangins, CHUV – Centre Hospitalier Public chuv.ch Prilly, Yverdon-Les- All Universitaire Vaudois Bains VD

Hôpital ophtalmique All ophthalmological care, including Public ophtalmique.ch Lausanne, VD Jules-Gonin (CHUV) emergencies | Refractive surgery

Clinique Genevoise de Convalescence | Medical or surgical Public cgm.ch Crans-Montana, VS Montana (HUG) treatment follow-up | Rehabilitation

Clinique Générale- General medicine | Surgery | Private beaulieu.ch Champel, GE Beaulieu Maternity

General medicine | Surgery | Private Clinique des Grangettes grangettes.ch Chêne-Bougeries, GE Maternity

Private Clinique de Maisonneuve clinique-maisonneuve.ch Châtelaine, GE Rehabilitation | Treatment follow-up

Psychiatry | Rehabilitation and Private Clinique du Grand Salève grand-saleve.ch Veyrier, GE oncology

Functional rehabilitation | Private Clinique BOIS-BOUGY bois-bougy.ch Nyon, VD Convalescence | Geriatrics

Cardiovascular rehabilitation | Private Clinique LA LIGNIÈRE la-ligniere.ch Gland, VD Functional rehabilitation | Psychiatry | Internal medicine

Psychiatry | Psychotherapy | Private Clinique LA MÉTAIRIE lametairie.ch Nyon, VD Addictions

1. La Tour Réseau de Soins : Hôpital de La Tour, Clinique de Carouge, Centre Médical de Meyrin (outpatient treatment) APPROVED HEALTH CARE PROVIDERS | CHIS BULL’ | No. 45 – APRIL 2020 | 5

IN SWITZERLAND

Name of the Healthcare Type Website Location Medical fields Provider

Genolier, Fribourg, GENOLIER Swiss Medical Various, depending on the clinic or Private genolier.net Neuchâtel, Sion and Network (GSMN) 2 hospital concerned Others 2

Clinique de l'Œil – Several Cantons Ophtalmology, including outpatient N/A Ophtalmology Network ono.world France surgery Organisation – ONO 3

Policlinique Médicale Consultations and emergency N/A pmu-lausanne.ch Lausanne, VD Universitaire (PMU) treatments in various fields

Permanence Médico- Outpatient surgery | Consultations N/A Chirurgicale de gmed.ch Geneva, GE and emergency treatments in Chantepoulet various fields

Geneva, Vaud, N/A UNILABS unilabs.ch Medical Analysis Laboratory elsewhere

Fondation Vaudoise pour Lausanne, VD Breast Cancer Screening | Colorectal N/A swisscancerscreening.ch le Dépistage du Cancer Geneva, GE Cancer Screening

Plan-Les-Ouates, GE Nursing services at home | N/A SITEX sitexsa.ch Lausanne, VD Hospitalisation at home

N/A PRESTISERVICES presti-services.ch Vessy, GE Home care

IN FRANCE

General medicine | Surgery | Centre Hospitalier Contamines s/Arve, Public ch-alpes-leman.fr Intensive Care | Maternity and Alpes-Léman (CHAL) Haute-Savoie (74) pediatrics

Saint-Julien-en- General medicine | Surgery | CH Annecy Genevois, Public ch-annecygenevois.fr Genevois, Maternity and pediatrics | site de Saint-Julien Haute-Savoie (74) Hospitalisation at home

Centre hospitalier Hauteville-Lompnes, Rehabilitation | Convalescence | Public chph.org d’Hauteville Haute-Savoie (74) Geriatrics | Addictions

Centre hospitalier Oyonnax, General medicine | Surgery | Public ch-hautbugey.fr du Haut Bugey Haute-Savoie (74) Maternity

Residential care for the dependent, Ornex, N/A Le Clos Chevalier lecloschevalier.com with an Alzheimer unit and short- Ain (01) stay unit

pharmaciedelapoterie. Ferney-Voltaire, N/A Pharmacie de la Poterie Pharmacy epharmacie.pro/ Ain (01)

2. List of Clinics within GSMN: https://www.swissmedical.net/cliniques/ 3. List of ONO establishments: https://www.ono.world/ 6 | No. 45 – APRIL 2020 | CHIS BULL’ | SOME DEFINITIONS

REMINDER SOME DEFINITIONS

The financial relationship between a patient and a service provider is a client- supplier relationship. The supplier (dentist, doctor, pharmacist, medical auxiliary, TARIFFS clinic, etc.) provides healthcare services to the patient on a remunerative basis. The price may be fixed by general laws or regulations or by bilateral agreements (tariff agreements); it may also be completely unregulated.

In the financial relationship between the patient and the healthcare provider, the insurer acts as a third party within the limits defined by its insurance regulations. In THIRD PARTY our case, although the CHIS is the insurer, it is the third-party administrator, UNIQA, that is responsible for all contact with the healthcare providers.

The healthcare provider sends the invoice to the patient’s third-party insurer (in our case to the third-party administrator UNIQA), not to the patient. After carrying out a check, the third party settles the entire invoice and then forwards an invoice to the THIRD-PARTY PAYER insured member for an amount corresponding to the services not covered under the insurer’s regulations (e.g. personal contribution, personal expenses, services not covered or for which there is limited cover, etc.). Third-party payment is available only in certain cases: see the CHIS Rules.

The insurer confirms to the healthcare provider that the patient is insured and is THIRD-PARTY therefore eligible for reimbursement for the proposed treatment. Under the third- GUARANTOR party guarantor arrangement, the patient settles the whole invoice and then submits a reimbursement claim to UNIQA.

An establishment recognised by the health authorities of the country in which it is located and that dispenses medical and surgical healthcare services. It may have HOSPITAL, CLINIC an integrated emergency service operating 24 hours a day. It may be publicly or privately financed.

Any public hospital. Any private hospital that meets the following conditions: in Switzerland, any hospital with which CERN has concluded a tariff agreement; outside APPROVED HOSPITAL Switzerland, any hospital that has concluded a tariff agreement with the relevant national social security scheme and that applies to CHIS members similar tariffs to those stipulated in the aforementioned agreement.

OUTPATIENT Healthcare dispensed by a doctor or a medical auxiliary either at a surgery or a TREATMENT hospital, but not requiring the patient to spend a night in hospital.

COSTS BORNE BY FCAs are the part of the medical expenses not reimbursed by the CHIS, up THE INSURED to the applicable ceiling if relevant, for the benefits covered by the General MEMBER (FCA) Reimbursement Rule.

The FMH is the association of Swiss medical professionals. To obtain the necessary recognition to practise medicine in Switzerland, doctors must be members FMH DOCTOR of the FMH, which requires them to have a federal degree in medicine or an equivalent qualification.

Medical auxiliaries are healthcare professionals licensed by the competent national authority of the State in which they operate to practise their profession on the basis MEDICAL AUXILIARY of a medical prescription. Medical auxiliaries may be speech therapists, nurses, physiotherapists, psychologists, etc. PRACTICAL INFORMATION | CHIS BULL’ | No. 45 – APRIL 2020 | 7

Insurance card Here is your new insurance card, which is now laminated! Its design has changed to incorporate the CHIS’s new colours and visual identity, but it still features your personal information and some useful telephone numbers. Keep it with you and present it whenever you visit a doctor or a hospital.

GOOD TO KNOW ALTERNATIVE THERAPIES All CHIS members have the right to be reimbursed for certain alternative therapies under specific conditions. These alternative NEW WEBSITE therapies are acupuncture, Chinese medicine, chiropractic medicine, CHIS.CERN osteopathy and etiopathy. 2020 marks a turning point for CHIS communication with the creation of a new You may consult acupuncturists, doctors practising Chinese medicine and visual identity, new colours and a new chiropractors, provided that they are recognised, qualifieddoctors website in order to improve communication licensed to practise medicine by the competent national authority of the with the members of the Scheme. country in which they operate. The new CHIS website was launched on 13 January 2020 and provides members and To find out whether your practitioner is recognised in Switzerland, you can beneficiaries with all the information they consult the register of Swiss doctors on the FMH website: doctorfmh.ch, need about the Scheme, as well as the details which is the only official such register. of contact persons and assistance services. It explains the benefits in more detail For France, the official register is the one maintained by the Ministry for and how to inform the CHIS if your family Solidarity and Health: annuaire.sante.fr, which lists both doctors and situation changes. medical auxiliaries. The website’s structure has also been simplified so that you can find the information Osteopathy and etiopathy are also recognised as alternative therapies, but you need easily and navigate to it in a variety there are two possible scenarios: of ways. You can quickly find the Rules of the – Your osteopath or etiopath is a recognised, qualifieddoctor licensed to CERN Health Insurance Scheme, many forms, practise medicine by the competent national authority of the country including the reimbursement claim form, the in which he or she operates: you may attend a consultation without a list of approved healthcare providers, and so medical prescription. on. Further information is also available on the FAQ page. - Your osteopath or etiopath is not a doctor, but holds a diploma as a

recognised, qualified osteopath or etiopath licensed to practise the Welcome to our site and happy browsing! discipline: you may attend a maximum of five sessions per calendar year without a medical prescription. However, from the 6th session onwards, a medical prescription is necessary to be reimbursed.

If in doubt, we recommend that you contact UNIQA before undergoing any treatment to obtain information on the conditions of coverage. A MESSAGE FROM YOUR TEAM CERN has renewed UNIQA’s contract as the third-party adminis- CONTACTS trator of the CHIS for the coming years. UNIQA would like to take this opportunity to express its gratitude and pride at being selected to & USEFUL LINKS continue to serve CERN and all CHIS members, and to thank you for your trust. We will make every effort to continue to offer you the best of our services in protecting the most precious asset you have: your health! COVID-19 A helpline has been set up to answer your questions. NEW ONLINE SERVICES Call +41(0) 22 766 77 77, from 8 a.m. to 5 p.m. UNIQA is continuing its efforts to improve the services it provides to CHIS members by launching new online services in 2020. These services have CHIS.CERN been requested by many members, but modifications to the CHIS Rules, General information, procedures, which will take effect in April 2020, were required to allow the digital forms, CHIS Rules and other submission of reimbursement claims. official documents.

UNIQA is currently implementing its new web portal myUNIQA.ch, MYUNIQA.CH which will be followed by a mobile application myUNIQA.ch App. Your reimbursements, periodic In the portal, you will find the area dedicated to your family and all of statements, cards and insurance the services that already feature in the current portal, such as details of certificates. your insurance cover, various documents and certificates and the history of your reimbursements. UNIQA IS AT YOUR SERVICE IF YOU REQUIRE ANY MORE The new features include an easy online tool for submitting your usual bills INFORMATION and documents (prescriptions, proofs of payment, etc.) to claim reimburse- Tel. : +41 (0)22 718 63 00 ment. Various digital formats can be sent to us in just a few clicks using a or 72730 from a CERN telephone simple and intuitive procedure, which includes the possibility of taking [email protected] photographs of your documents via the myUNIQA.ch App. You will then be able to see the documents submitted and monitor the status Office hours – UNIQA of your claims in real time. CERN, Main Building (63/R-001) Open from Monday to Friday from As specified in the CHIS Rules, you will be required to keep the origi- 9 a.m. to 1 p.m., and also from nals of the documents submitted online for a period of two years. UNIQA 2 p.m. to 4 p.m. on Tuesdays and will carry out random checks by requesting original documents. We Thursdays. recommend that you pay due care and attention to the filing and storage of these documents. Geneva, Rue des Eaux-Vives 94, Other functions will be available in the myUNIQA.ch App, such as a CH-1207 Geneva virtual insurance card, a location search of the UNIQA medical network, Open Monday to Friday from the option to call the various UNIQA phone numbers and the medical assis- 8 a.m. to 12.30 p.m. and from tance service directly from your smartphone, and much more besides. You 1.30 p.m. to 5 p.m. can even make the environmentally friendly choice of deactivating the option of receiving paper reimbursement statements by post, safe in the SHIPID SERVICE knowledge that this option can be reactivated at any time. Please address all questions concerning the Spouse Health A demonstration video will be available on the uniqa.ch and cern.ch/chis Insurance and Professional websites. Income Declaration (SHIPID) or Of course, UNIQA will continue to accept paper reimbursement claims your supplementary contributions by post from those who wish to continue with that approach. to: [email protected] We remain at your disposal to answer any questions and provide any additional information.

Your UNIQA team

Imprint Editor : Carmelo Saitta, Chair of the CHIS Board CERN, 1211 Genève 23 chis.cern