Reimbursement
Reimbursement will be according to a ceiling on reimbursement by calendar year which may be reduced in proportion to the duration of the membership of the Scheme.
Example :
A Fellow has dental treatment. A Fellow is automatically a Member of the Scheme for a duration of one year (which corresponds to the length of an initial Fellowship contract). Should his contract start on 1 January, the full amount of the annual ceiling may be claimed (2 808 CHF for dental expenses, as of 1.1.2007).
However, should his contract start during the course of the year, the reimbursement may be split by calendar years. If the fellow starts on 1 May and has dental expenses: the applicable ceiling will be 1 872 CHF (according to the ceiling 2007) for the period from 1 May to 31 December. Any expense above this amount will be at his charge. For the period running from 1 January to 30 April of the following year, the applicable ceiling will be reduced pro rata temporis to the remaining length of his contract, i.e. 936 CHF in our example (according to the ceiling 2007).
If physician issues a prescription for a long period (e.g. a few months), you should only send it to UNIQA after having used it for the last time. Hence, for example, in the case of a drug precription valid (renewable) for six months : keep the original prescription so you can show it each time you go to buy the drugs (drugs are often only provided if you have an original prescription); attach a copy of the prescription to each intermediate reimbursement claim you make, underlining the "à renouveller" mention (there is no need to wait for the completion of the treatment to introduce a claim); and attach the original prescription to the last claim you make.
Yes. Claim for reimbursement of medical expenses must be submitted within 12 months from the date of emission on the invoice.
Claims for high medical expenses should be submitted without delay as this facilitates the controls carried out (correct invoicing, approved tariffs) by the Third-Party Administrator, UNIQA, on behalf of the Scheme.
By going to France or one of the 17 other Member States (any apart from Denmark, Norway and Switzerland) to see a doctor, buy medication, have tests, scans or other outpatient treatments for which the bonus applies (see Annex I or Annex III of the CHIS Rules), you will be reimbursed 85% of the costs instead of 80% or 95% instead of 90%. What’s more, the treatments themselves are less expensive!