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Medical or paramedical benefits related to a long-stay in a medicalized establishment (including nursing and geriatric care and other services normally provided by the establishment)
100% up to a maximum of CHF 120 per day.
Short Term Nursing Care
Daily nursing care for a period of time inferior to 30 days is defined as Short-Term Nursing Care and is reimbursed at 80% without application of the Supplementary Plan.
Long Term Nursing Care
Daily nursing care for a period exceeding 30 days is considered as Long-Term Nursing Care. In this case the Prior Authorization of the Medical Adviser is needed.
Reimbursement is at 80% with a maximum monetary limit of CHF 80 per day under the condition the nursing care is provided at home or in a medical establishment by persons who are not staff of the establishment.
As is the case with Short Term Nursing Care the Supplementary Plan is not applicable.
Nursing or Home Help Services after Illness or Operation Where Convalescence does not entail Hospitalization
Such a form of Home Help and/or Nursing will be considered for reimbursement exclusively when prescribed by the attending doctor, specifying the person's health state of dependency. Following this it will then need to be granted Prior Authorization by the Medical Adviser.
Reimbursement will be at 80% for a maximum time limit of 30 days and a monetary limit of CHF 45 per day. The Supplementary Plan is not applciable in this case.
Long Term Home Help Services, are reimburseable at 80% with a monetary limit of CHF 250 per month. Also in this case consideration for reimbursement will be done exclusively when such services are prescribed by the attending doctor, specifying the person's health state of dependency. Following this it will then need to be granted Prior Authorization by the Medical Adviser.
Benefits for Care in the Home
Such benefits are defined as nursing or home health services for assistance with hygiene and mobility
For such coverage to be considered for reimbursement the Medical Adviser must first review a questionnaire, to be obtained from UNSMIS, filled by the attending doctor indicating the degree of dependency of the person as regards basic activities of daily life (e.g. eating, getting in/ out of bed, continence, washing/bathing, dressing, mobility indoors) Following said Prior Authorization an individual may be entitled to one of two forms of reimbursement depending on the severity of their dependency;
Total dependency, reimbursed at 100% with a maximum monetary ceiling of CHF 120 per day.
Partial dependency, reimbursed at 50% with a maximum monetary ceiling of CHF 120 per day.
Home Help services will be considered for reimbursement if and only if delivered by institutions or practitioners qualified to perform such services and issue adequate bills as per local legal requirements.