Direct Pay Agreements

Following Annex II, Para 1(d) of the internal rules and in an effort to facilitate matters for our insured population, the Society avails itself of the right of paying the medical provider directly.  The advantage for insured members is clear, as they do not need to advance large sums of money and then wait for these to be reimbursed.

In practice, UNSMIS has established as a rule that, in the event of hospitalizations exceeding CHF 20,000 of costs, the Society will intervene and issue a direct payment to the service provider (the CHF 20,000 amount is increased to CHF 30,000 for retirees)

Upon receipt of such bills, UNSMIS will systematically establish a direct pay agreement with the medical provider and, when applicable, a second bill for the insured's out of pocket (co-share) amount. The latter is in turn deducted directly from the staff member's salary.

In the event of direct pay for retirees, UNSMIS will often ask that retirees pay their out of pocket (co-share) costs upfront and UNSMIS will then proceed to settle the bill. This, and the higher CHF 30,000 limit, stem from the fact that the UNJSPF is a separate legal entity and UNSMIS has no authority to deduct advances from the pension.

UNSMIS will in all cases establish contact with the insured member in order to ensuring the timely and accurate processing of such claims.