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.

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.

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:

*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.

Did you know that certain outpatient treatments received in one of the Member States (all, except Denmark, Norway and Switzerland) 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, Romania, Serbia, Slovak Republic, Spain, Sweden, and 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!

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.

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. 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.

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.

No. Not all benefits are reimbursed in accordance with the general rule described under the previous question. To check whether the rule applies, please consult the list of benefits that you will find on the site. There you will see that, if you opt for a private hospital that is not approved by the CHIS, your reimbursement will be limited to 80% of your expenditure and the amount at your expense will be unlimited since the general rule does not apply. You may therefore be required to pay large sums of money out of your own pocket.
The table below summarizes the rates that apply, according to whether or not the hospital is subject to the general rule. The same mechanism applies to all benefits that are not subject to the general rule.

In Switzerland, the difference lies in the accommodation and the doctors who will take care of you.

On a general ward, you will stay in a room with several beds (between two and eight), depending on availability. You cannot choose your medical practitioners (surgeon, obstetrician, etc.). In the case of public hospitals, the CHIS reimburses 100% of the costs associated with a stay on a general ward.

On a semi-private ward, you will stay in a room with two beds. You can choose your medical practitioners (surgeon, obstetrician, etc.), provided that they are recognised by the hospital or clinic. In the case of a public hospital or an approved private clinic, the costs of hospitalisation on a semi-private ward are reimbursed by the CHIS according to the General Rule.

The same conditions apply to hospitalisation on a private ward as to hospitalisation on a semi-private ward, but you will stay in a room with one bed and the room supplement will be entirely at your own expense.

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

This depends on when you joined the CHIS, as the annual ceilings are reduced prorata temporis according to your length of membership. The table below explains the ceilings that apply to dental treatment if you joined the CHIS on 1 September of a given year and have a three-year contract ending on 31 August:

* I.e. Year 4 (n)=2200 + Year 3 (n-1)=3300 + Year 2 (n-2)=3300. The unused ceiling from Year 1 (n-3) is lost.

If you are unsure of the amount of your ceilings (dental and optical), you can find them in your personal account at myUNIQA.ch under “More services”.

Am I entitled to the 9 900 CHF ceiling for dental treatment in my first year of CHIS membership?

No. The carry-forward principle is based on an annual expenditure ceiling of 3 300 CHF. Any unused portion of this ceiling can be carried forward to the following year(s) until a maximum cumulated ceiling is reached after three calendar years. This means that the CHF 9 900 expenditure ceiling will apply only in the third year and only if you have not claimed for dental treatment in the previous two years.

I sent you an invoice for dental treatment amounting to 5 000 CHF but was reimbursed only 2720 CHF, even though the annual ceiling shown in the list of benefits is 3300 CHF. Is this a mistake?

No. The ceilings for dental treatment and other items, as shown in the list of CHIS benefits, are ceilings for expenditure and not for reimbursement. This means that 3300 CHF is the maximum amount of expenditure that can be used as the basis for calculating the reimbursement. The table below explains how the amount of reimbursement is calculated, assuming that no other invoice for dental treatment has been submitted in the year concerned (initial cumulated FCA = 0 CHF, invoice = 5000 CHF).

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. 

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.

Yes. Acts performed by medical auxiliaries: nurses, physiotherapists, psychologists, speech therapists, etc., must be performed in accordance with a medical prescription.

However, acts performed by osteopaths, etiopathy therapists and chiropractors may be reimbursed without a medical prescription, up to a maximum of five sessions per calendar year.

To find out more about treatment covered by medical auxiliaries, kindly read the article available on the box "good to know" on the main page of the CHIS website.

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: chis.shipid@cern.ch.

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.

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.

You will find all the information on the page of the CHIS website: Your Obligations.

Income : any form of remuneration, salary, bonuses or other special emolument, holiday pay, 13th- or 14th-month salary payments, fee or emolument deriving from a professional activity, including any replacement salary received during periods of leave.

The following are not considered as income :

• unemployment benefits;
• disability pensions;
• dependent child allowances;
• maternity benefits if they are not a replacement salary;
• adoption benefits; and
• reimbursement of professional expenses incurred.

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.

In Switzerland, the difference lies in the accommodation and the doctors who will take care of you.

On a general ward, you will stay in a room with several beds (between two and eight), depending on availability. You cannot choose your medical practitioners (surgeon, obstetrician, etc.). In the case of public hospitals, the CHIS reimburses 100% of the costs associated with a stay on a general ward.

On a semi-private ward, you will stay in a room with two beds. You can choose your medical practitioners (surgeon, obstetrician, etc.), provided that they are recognised by the hospital or clinic. In the case of a public hospital or an approved private clinic, the costs of hospitalisation on a semi-private ward are reimbursed by the CHIS according to the General Rule.

The same conditions apply to hospitalisation on a private ward as to hospitalisation on a semi-private ward, but you will stay in a room with one bed and the room supplement will be entirely at your own expense.

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

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.

If the information needed cannot be found on these pages, please contact:

• The Third-Party Administrator uniqa@cern.ch, if you have questions concerning the application of the CHIS Rules,
• The CHIS manager at chis.manager@cern.ch, if you have remarks or suggestions on general CHIS policy.

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.