Understanding my Claim Form

The box in the upper right corner is to be left blank as it is for internal UNSMIS purposes.

All instructions are to be found on page two of the Medical Insurance Claim Form.

Always remember that the Staff Member's Name and Surname are to be inserted at question 2, on the right hand side. The Staff Member's dependents will instead need to fill out question 1, on the left hand side of the page.

The patient's insured number requested in question 3 can be found on the insurance card issued to the Staff Member and their dependents.

 

Question 4 is one of the most important questions in the claim form. If you have reason to believe that the accident/illness for which the claim form is being submitted is related to employment (i.e. directly attributable to the performance of official duties on behalf of the Organization) then please ensure you answer question 4.b) correctly. This is important because we will then transmit your claim to our colleagues who deal with service incurred accidents/illnesses. They will then evaluate your claim and advise accordingly. There are some key points to note here:

  • Service Incurred accidents and illnesses are reimbursed at 100% when recognized as such by the competent body vs 80% reimbursement by the UNSMIS.
  • UNSMIS works in partnership with our UN colleagues to advance the reimbursement of said expenses (in accordance with our rules and regulations) to the Staff Member and then recover them from the concerned department if and when the accident or illness is recognized as service incurred.

  • Should your accident or illness not be recognized as service incurred this will not affect the reimbursement received under the UNSMIS rules and regulations.

 

Question 4.c)  is often misunderstood. In the event of a member having another medical insurance or any other form of reimbursement from a National Health System, UNSMIS will automatically work as a complementary plan reimbursing 100% of the out of pocket expenses not reimbursed by the National Health System or other Medical Insurance. For example, a member of UNSMIS presents expenses worth CHF 2,000. These have been reimbursed at 70% by a National Health Scheme or another Medical Insurance Plan. UNSMIS will proceed to pay the outstanding out of pocket (30% of CHF 2,000 equals CHF 600) at 100%, thus leaving the insured with NO out of pocket.

 

 

It is imperative that all claims presented are broken down according to type of treatment and currency. This enables UNSMIS to process the claims faster. The claim form is already built to accomodate this. Staff Members merely need to add totals under each treatment category and specify the currency. Failure to do so will result in your claim being returned. Also do not forget that any claim presented in a language other than the 6 UN languages must be presented with translations of all invoices, prescriptions and supporting documentation. Please refer to Language of Documentation page for more details.

 

 

 

Last but not least please do not forget to sign and date the page. Please remember that the signature is ALWAYS that of the Staff Member.