Yes. Here the non-exhaustive list of expenses for the following items are not reimbursed by CHIS :
- Missed appointments
- Products bought on-line
- Expenses requiring prior approval or opinion, for which no prior approval or opinion was obtained
- Expenses incurred without medical prescription, except treatment by doctors, including specialists, and emergency transport
- Expenses for which no proof of payment is provided
- In case another basic health insurance reimburses the same expenses or provide a similar benefit: any annual deductible and the part already reimbursed by the other insurance.
- Cosmetic treatments and surgery (except reconstructive surgery following an accident which is reimbursable under certain conditions and subject to prior agreement by UNIQA)
- The costs for treatment for the after-effects of a treatment not covered by the CHIS (e.g. cosmetic or rejuvenating treatment or surgery and alternative medicine)
- Items (e.g. treatments, pharmaceuticals, alternative medicine) not recognised as medical treatment in the country where they were prescribed
- Treatment provided or prescribed by care providers (hospitals, clinics, doctors and other medical professionals) not recognised as medical professionals and licensed to provide health care services in the country where they operate.
For further information, please contact UNIQA.
Did you know that certain outpatient treatments received in one of the Member States where health costs are the least onerous benefit from the reimbursement bonus?
Indeed, the reimbursement rate for certain outpatient services (see Annex I of the CHIS Rules) is increased by 5% if they are dispensed in one of the following Member States: Austria, Belgium, Bulgaria, Czech Republic, Finland, France, Germany, Greece, Hungary, Israel, Italy, Netherlands, Poland, Portugal, Slovak Republic, Romania, Spain, Sweden, United Kingdom.
So do not hesitate to go to these countries to do your medical examinations because not only will you be better reimbursed for good quality medical care, but you will also contribute to the CHIS costs containment!
General Reimbursement Rule defines the reimbursement rates according to the costs borne by the insured member* (referred to hereinafter by the French acronym FCA) cumulated by the Member over a calendar year.
Reimbursement rates are the following:
|Cumulated Costs Borne by the Member (FCA)||Reimbursement rate|
|up to 500 CHF inclusive||80%|
|over 500 CHF up to 3 000 CHF inclusive||90%|
|3 000 CHF||100%|
*FCA represents the part of the expenses not reimbursed by the CHIS, up to the applicable ceiling if relevant, for the benefits covered by the General Reimbursement Rule.
Yes, the time limit is twelve (12) months .
Indeed, claim for reimbursement of medical expenses must be submitted within 12 months from the date of emission on the invoice.
However, we advise you to submit your claims for reimbursement of high medical expenses without delay in order to facilitate the checks carried out (correct invoicing, approved rate) by the Third-Party Administrator.
Yes. CHIS serves as supplementary insurance for those who are members of another adequate primary health insurance scheme. (e.g. Swiss LAMal insurance, French social security, etc.).
If the reimbursement under another primary insurance scheme is subject to an annual deductible, the deductible is not reimbursed by the CHIS. Where medical expenses have been partly paid or reimbursed, for example by another insurance scheme, the Member may submit a reimbursement claim to the CHIS only for the amount remaining at his or her expense.
If you have any doubts, please contact UNIQA.
If your physician issues a prescription for a long period (e.g. a few months), you should only send this prescription to UNIQA after having used it for the last time.
There is no need to wait for the completion of the treatment to introduce a claim. Hence, for example, in the case of a drug prescription renewable for six months:
- keep the original prescription so you can show it each time you go to buy the drugs;
- attach a copy of the prescription to each intermediate reimbursement claim you make, underlining the "à renouveler" mention;
- finally, when you last request reimbursement, send the original prescription to UNIQA.
Yes. Acts performed by medical auxiliaries: nurses, physiotherapists, psychologists, speech therapists, etc., must be performed in accordance with a medical prescription.
You need a prior approval by the Third-Party Administrator for:
- transport (except emergency transport);
- refractive surgery;
- thermal spa therapy, convalescence stays, rehabilitation stays, stays in a respite care home or in a unit for those waiting for space to become available in a suitable establishment;
- home nurses;
- hire or purchase of auxiliary appliances;
- cost of accommodation in a hospital for a family member, other than one of the two parents, whose presence is required by the hospitalisation of a child of less than ten years of age.
For all these benefits, it is necessary to submit a written request for prior approval to the Third-Party Administrator, UNIQA, at least 14 calendar days before the medical expenses are incurred, except in the case of cures and convalescence cures where the notice period is at least 30 calendar days before the expenses are incurred.
You need prior opinion from the Third Party Administrator for:
- dental treatment, prostheses and orthodontics,
if the total cost for the treatment exceeds 25% of the annual ceiling (i.e. CHF 800.00), except in case of emergency. The request for a prior opinion must be made by submitting to UNIQA, at least 14 calendar days before the start of the treatment, the CHIS/F03- Estimate for dental and orthodontic treatment and prostheses completed by the attending dentist.
Expenses incurred without the required prior approval or opinion will not be reimbursed by the CHIS.
Acupuncture is part of the alternative therapies recognised by the CHIS as well as Chinese medicine, chiropractic medicine, osteopathy and etiopathy; provided that it is dispensed by healthcare provider recognised for this specific treatment.
In order to be recognised by the CHIS, the healthcare provider used by the Members must be recognised, qualified and licensed to practice medicine and/or to provide the healthcare or medical treatment concerned by the competent national authorities of the country where they operate.
Help on SHIPID declaration
For spouses who are associated members of the personnel, it is therefore necessary to declare the income received from the home institute, as well as any subsistence allowance paid during the period of association with CERN. The various incomes must be declared in a single document.
You must declare the income or pension in the original currency. You can declare several amounts in different currencies by adding an income source (e.g. an income and a subsistence allowance). The official exchange rate in force at CERN on the effective date of your declaration will be used to produce the conversion into Swiss francs, and this is displayed immediately in the EDH form.
Do not convert the amount into Swiss francs yourself.
Any person performing a salaried activity for more than 8 hours a week in Switzerland is covered by an accident insurance (LAA) scheme, which covers damage sustained in the event of an illness or accident of an occupational or private nature.
LAA insurance provides more comprehensive coverage of occupational and private accidents than the CHIS. Any request for the reimbursement of associated costs must be submitted in the first instance to this insurance scheme because the amount reimbursed will be greater.
Please provide us with a certificate showing the name of your insurance provider, as this will make it easy for UNIQA to liaise with them, if necessary.
A primary health insurance Scheme is any Health Insurance provided by the national system of a Member State of the Organisation (e.g. Swiss LAMal insurance, French social security, etc.). It can also be the health insurance provided by an international organisation based in Switzerland. These primary health insurances are considered adequate if it cover the spouse in his or her place of residence.
If you have any doubts, please contact the SHIPID service: email@example.com.
No. The effective date cannot be a future date. You will therefore have to wait for the change to occur before declaring it within 30 calendar days.
Initially, ask for an explanation from UNIQA or from the CERN Administration, depending on who made the challenged decision.
If you are not satisfied by the explanation, try to reach an amicable settlement of the dispute in accordance with the provisions of Chapter XIV section 2 of the CHIS Rules.
Only if the procedure of amicable settlement has failed, can an appeal procedure be opened.
The procedure for settlement of dispute is detailed in Chapter XIV of the CHIS Rules.
Your insurance number is printed on the front of your insurance card. This number also corresponds to your CERNid and consists of 5 or 6 characters, plus an extension:
CERNid followed by .0 = Principal Member (xxxxxx.0)
CERNid followed by .20 = Spouse (xxxxxx.20)
CERNid followed by .1 = 1st child (xxxxxx.1)
CERNid followed by .2 = 2nd child (xxxxxx.2)
CERNid followed by .3 = 3rd child (xxxxxx.3) ...
You can also find your CERNid on your CERN access card above the expiration date.
Membership of the CERN health insurance scheme (CHIS) is compulsory* for technical, doctoral or administrative student. CHIS provides for reimbursement of a major portion of reasonable and customary expenses resulting from medical treatment within the conditions specified in its Rules, incurred by its Members.
*Unless the students are subject to compulsory health insurance in Switzerland (LAMal), in which case CERN shall nevertheless insure them against occupational illnesses and accidents. The students concerned should submit a LAMal insurance certificate to the HR programme coordinator.
You may remain a Main Member of the CHIS for an indefinite period if you submit your application to the Third-Party Administrator UNIQA Office at CERN within 30 calendar days of the end of your contract. UNIQA will inform you about the monthly contribution.
However, if you choose not to remain a Main Member of the CHIS at the end of your contract with CERN, you will not be able to re-join the CHIS once you become a beneficiary of the Pension Fund.