Psychiatric and Medico-Psychological Evaluations are covered at 80% and limited to once per annum.
The Prior Authorization of the Medical Adviser is necessary for the above to be considered for reimbursement and the supplementary plan is applicable.
Psychotherapy is reimbursed according to the following criteria:
i) Inpatient Treatments
Hospital Charges are reimbursed in accordance with the reimbursement rules governing Hospitalization. In this case Prior Authorization is necessary and the Supplementary Plan is applicable.
Treatment by staff (a specialist who is not hospital staff) of the hospital is reimbursed at 90%. In this case the Supplementary Plan is applicable.
ii) Outpatient Treatments or Day Hospital Consultations
Outpatient treatment prescribed and given by a psychiatric doctor or prescribed and provided by an approved psychotherapist (registered with FSP or ASP in Switzerland, for example) is covered as follows;
Consultations by a Psychiatrist are reimbursed at 80% up to a maximum of 12 per annum without the need of Prior Authorization and the application of the Supplementary Plan.
Psychotherapy is reimbursed at 80% with a monetary limit of CHF 120 per session and will be limited to an annual maximum of 50 sessions. The Supplementary Plan is not applicable.
Consultations by a psychiatrist beyond 12 visits per year require the Prior Authorization from our Medical adviser. If it is medically justified and approved in advance by our Medical adviser, it will be reimbursed at 80% for the number of supplementary sessions approved. In case of refusal or without Prior Approval, the refund will be 80% up to a maximum of CHF 120.- per session within the available limit of psychotherapy sessions.
A prescription from a medical doctor is required for treatment done by an approved psychotherapist.
For insured persons below the age of 18 there is no limit on the number of treatment sessions.
iii) Sleeping Cures in an establishment with the agreement of UNSMIS may be reimbursed at 80% subject to Prior Authorization and to the time limits. The Supplementary Plan is not applicable.
iv) Day Hospital accommodation charges are not reimbursed
Please note that unless otherwise approved by the Medical Advisor a maximum of one session per day will be considered for reimbursement irrespective of ailments, sessions, time duration or cost in any 24 hour period.