Long-Term Care (LTC) benefits provide financial support to people in need of assistance over an extended period of time resulting from chronic illnesses or disabilities, entailing impairment of their ability to function independently in their daily lives.
Everyone may need Long-Term Care, regardless of age. Any person who is a Compulsory or Post-compulsory Main Member or Subsidiary Member is eligible for the Long-Term Care Benefit, subject to the recognition of a state of dependence by the Medico-Social Panel.
For coordination with other benefits in respect of children whose disability is / special educational needs are recognized by CERN, please refer to this document.
Application for long-term care benefits
The Member themselves or any person expressly empowered to represent them can formulate the application for the Long-Term Care Benefit.
The request is made by completing form F05 - Claim for LTC benefits and shall be addressed to UNIQA. It shall specify whether the Member concerned resides at home or in a specialised institution as well as the name and address of the medical practitioner.
Following receipt of the application, UNIQA will send questionnaires to the Member concerned together with instructions on how to complete them.
The completed questionnaires shall be returned to UNIQA, who summons the Medico-Social Panel for the assessment of whether a state of dependence exists. The Member concerned will be informed of the Panel's recognition of a state of dependence and of the effective date of the related long-term care benefits in writing by UNIQA.
Procedure for the recognition of a state of dependence
The recognition of a state of dependence is based upon the assessment by a Medico-Social Panel comprising a representative of the Scheme's third-party administrator (UNIQA), a medical practitioner and a representative of the CERN Social Affairs Service.
The Panel's assessment of whether a state of dependence exists shall be based upon two questionnaires:
- a medical questionnaire completed by the Member's attending physician, and
- a medico-social questionnaire completed by the Member concerned and/or their family members or another close relation.
The Panel shall distinguish between three levels of dependence (low, moderate or high) according to the Member's degree of ability to perform the following functions of everyday life unaided:
- getting up, sitting down, getting into bed ;
- mobility ;
- washing and grooming ;
- dressing and undressing ;
- taking food and drink ;
- going to the lavatory ;
- coherence and ability to communicate ;
- orientation in space and time.
The Panel shall also determine the date on which the state of dependence began and the date of effect of related benefits.
Benefit details
A state of dependence arises the needs for specific services, which can be divided into three areas:
- medical services ;
- paramedical services (physiotherapist, ergonomist, etc.) ;
- home care (includes non-medical services provided at home or in a residential or nursing home).
The CHIS provides cover for these three fields, based on the level of dependence, through:
- its provisions for the reimbursement of medical expenses ;
- higher ceilings on the reimbursement of paramedical expenses ;
- a home-care allowance (the LTC allowance) independent of where the Member concerned resides.
|
Low level of dependence |
Moderate level of dependence |
High level of dependence |
|
|---|---|---|---|
|
Reimbursement of medical expenses |
According to Normal Health Insurance | According to Normal Health Insurance | According to Normal Health Insurance |
|
Plafond paramédical |
1 100 CHF/ month | 1 650 CHF / month | 2 750 CHF / month |
|
Long-term care allowance* |
48 CHF / day | 72 CHF / day | 120 CHF / day |
* The LTC allowance is not paid during periods when the Member concerned is hospitalised.
Change in the state of dependence
The Member concerned or any person expressly empowered to represent them must inform UNIQA, in writing of any lasting change (deterioration or improvement) that may affect the state of dependence.
Following receipt of such a notification, UNIQA will send follow-on questionnaires to the Member concerned together with instructions on how to complete them.
The completed questionnaires shall be returned to UNIQA, who summons the Medico-Social Panel for the (re)assessment of the state of dependence. The Member concerned will be informed of the Panel's assessment and the effective date of the correspondingly adjusted long-term care benefits in writing by UNIQA.
Agreements with care provides
- In March 2008, CHIS signed an agreement with ORSAC for a priority admission for CHIS members to the EHPAD (Établissement d'hébergement pour personnes âgées dépendantes - Care centre for dependent elderly persons) Le Clos Chevalier in Ornex. More information can be found here.
- In October 2009, CHIS also signed an agreement with Presti-Services concerning the services provided by auxiliary nurses. More information can be found here.
For more information
Annex IV of the Rules of the CERN Health Insurance Scheme defines the long-term care benefits, as well as conditions of award and procedural aspects. You can also contact UNIQA's Geneva Office for more information on the long-term care benefits.
Please contact CERN's Social Affairs Service for information concerning your personal situation.