Reimbursement

Reimbursement

1

What is the reimbursement rule for hospitalisation?

On a general ward in a public hospital, 100% of the costs will be reimbursed.

The costs of hospitalisation on a semi-private ward in an approved clinic or a public hospital will be covered in accordance with the General Rule.

In a non-approved clinic, 80% of the costs will be reimbursed, with no limit on the costs borne by the member (no FCA accumulation).

In all cases, the supplement for a private ward is borne by the member.

I have the choice between a private (single-bed) ward and a semi-private (two-bed) ward. If I choose a private ward, will the CHIS reimburse the price difference? 

The CHIS covers hospitalisation costs on a semi-private ward (room with two beds). The supplement for hospitalisation in a private ward is borne by the member.

If you choose a private ward, the hospital/clinic will be able to tell you the amount of the supplement.

Is there a time limit for submitting claims for reimbursement of medical expenses?

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.