Modifications to the Rules of the CERN Health Insurance Scheme (CHIS) on 1 January 2012

Following the 2010 five-yearly review of the financial and social conditions of the members of the personnel, the Council decided to make a number of changes to the contributions to the CERN Health Insurance Scheme and to authorise the Director-General to take timely measures to limit the increase of CHIS expenses by encouraging the use of health care providers and treatments which provide the best quality-to-cost ratio. These decisions are intended to allow the general level of cover to be maintained in the future.

The CERN Health Insurance Supervisory Board subsequently gave careful consideration to measures which would not only allow costs to be contained but would also ensure a fairer distribution of benefits while simultaneously providing greater protection for those suffering from serious health problems and hence having to face substantial expenses.

On the proposal of the CHIS Board, and following examination by the Standing Concertation Committee at its meetings on 27 April and 1 September 2011, the Director-General has approved new rules, which will enter into force on 1 January 2012.

The following changes will affect all insured members:

1. The 200 CHF annual deductible will no longer be applied, so that all insured members will henceforth be entitled to reimbursement without having to exceed a given level of expenditure.

2. New General Reimbursement Rule: the reimbursement rate will be progressive and depend on the total Costs Borne by the Insured Member (known by the French acronym "FCA") during a given calendar year, as shown in the table below:

3. Changes in the tariff systems of public hospitals, which have included the introduction of authorised extra billing in their private and semi-private sectors, have made hospitalisation in these sectors as expensive as in private clinics. Hospitalisation in the private and semi-private sectors of public hospitals will therefore be reimbursed in the same way as hospitalisation in approved private hospitals in future, i.e. in accordance with the General Rule referred to in paragraph 2 above. However, hospitalisation in the public sector of public hospitals will continue to be reimbursed at the rate of 100%.

Hospitalisation in non-approved private hospitals will be reimbursed at the rate of 80% and the costs borne by the insured member will not be taken into account to qualify for one of the higher reimbursement rates set out in the table above.

In all cases, any supplements for a private one-bed ward will continue to be fully borne by the insured member as before.

4. The introduction of the General Rule means that henceforth ceilings will have to be expressed in terms of expenditure rather than in terms of reimbursement. By dividing the existing ceilings by 0.9, the same level of benefits will be maintained. In addition, in certain cases, it will be possible for the unused part of the ceiling to be carried over to future years.

o   Benefits under the optics heading (spectacles and contact lenses) have been simplified: the reimbursement rates of the General Reimbursement Rule will apply, up to an annual ceiling of 500/CHF which can be cumulated over 3 years.

o   Refractive surgery will be reimbursed in accordance with the General Reimbursement Rule, up to a ceiling of 2000 CHF per eye for the entire duration of membership of the CHIS. This benefit will be available only after at least one year of membership and will require prior authorisation by the Scheme's administrator (UNIQA).

o   Expenditure on dental treatment will be reimbursed in accordance with the General Reimbursement Rule, up to an annual ceiling of 3300 CHF which can be cumulated over 3 years.

5. A bonus of 5 percentage points will be added to the reimbursement rate for outpatient expenditure (doctors' fees, pharmaceutical expenses, analyses and medical imaging, etc.) incurred in those CERN Member States where health care costs are the lowest. The list of these countries is given in Annex I of the CHIS Rules and will be updated every year, based on the health care costs published by the OECD.

The new CHIS Rules, which will enter into force on 1 January 2012, are available on the CERN website: www.cern.ch/chis

General questions or comments about these changes may be submitted to chis.info@cern.ch

Additional information is available:

· in the next issue of the CHIS Bull', which will be published before the end of the year, and which will explain the new measures through concrete examples.

· from the Scheme's administrator, UNIQA, for questions related to the application of the new rules to your personal situation (uniqa@cern.ch, tel. 72730).

by HR Department