A distinction shall been made between occupational and non-occupational accidents. Accidents and illnesses recognised as occupational by the Organization in accordance with the provisions of Administrative Circular No. 14 give entitlement to specific cover for the expenses for medical treatment directly associated with them. Only Compulsory Main Members are entitled to this cover.
Accidents resulting in bodily injuries of a Member of personnel and presumed to be of an occupational nature shall, under normal circumstances, be declared within 10 working days via EDH. For more info, please consult the admin e-guide.
CERN will notify both you and the Third-party Administrator UNIQA about its decision to qualify (or not) the accident as an occupational accident.
Whichever the qualification is, when you claim reimbursement for costs related to an accident declared via EDH, please tick box "Occupational illness" on the CHIS/F01-Claim for the reimbursement of medical expenses and indicate the CERN-EDH number of the declaration. It is not necessary to print the declaration and to attach it to the claim form.
UNIQA reimburses those invoices which have previously been paid by you. It is therefore required to provide proof of payment for each invoice for which you claim reimbursement. You may claim reimbursement up to 12 months after the date of issue of the invoice.
Contribution and Benefits
The Organization pays 100% of the contribution for this cover. Subject to obtaining the applicable prior opinion or approval, medical expenses and treatments directly linked to an occupational illness or accident are reimbursed at a level of 100%, without any limit or ceiling. Medical treatment for the condition concerned will cease to be reimbursed under the occupational scheme in the event of recovery or consolidation. The right to such reimbursement may resume in the event of a relapse.
End of coverage
This cover ends when the Member ceases to be a Compulsory Main Member. However, benefits arising from an occupational accident recognised by CERN as having occurred during the membership period, or an occupational illness recognised by CERN as having been contracted during the membership period are payable until recovery from or consolidation of the condition.