Specially Protected Persons (Dependent Parents)

Specially Protected Persons (SPPs) are defined in Rule IV of the Internal Rules and include various categories such as dependent parents or siblings or a spouse or children not recognized as dependents. Please refer to Rule IV of the Internal rules for a complete definition. 

Benefits payable in respect of a dependent father, mother, brother or sister, insured in accordance with rule IV of the Internal Rules of the Society, shall be subject to the following, as stated in Annex IV of the Internal Rules

 

BENEFITS

The benefits payable shall include only basic benefits. The supplementary plan shall NOT be applicable. Benefits shall be paid in accordance with the procedure laid down by the Internal Rules of the Society and shall be calculated in the manner specified in annex III of these Rules, except for those benefits which are subject to an exclusion, limitation or waiting period as described below:

Exclusions: No benefit shall be paid for the following:

  • Medical or paramedical benefits related to a long-term stay in a medicalized establishment or at home (item 6)
  • Long-term nursing care (item 8)
  • Nursing and home-help charges (item 9)
  • Benefits for care in the home (nursing or home health services): assistance with hygiene and mobility (item 10)
  • Cures (items 11 and 12)
  • Sessions with a dietician (item 13)
  • Maxillo-facial operations (item 25).

 

Waiting period (for new affiliates): Expenses incurred for the following items during the first year of coverage shall not be reimbursed:

  • Functional rehabilitation treatment (item 17)
  • Psychiatric and psychoanalytical treatment (item 18)
  • Prosthetic appliances (item 20 (a))
  • Hearing aids (item 21)
  • Eyeglasses (item 22)
  • Dental treatment (item 23 and 24).

 

Limitation: The cost of the following items shall be reimbursed up to the limits shown:

  • Psychiatric and psychoanalytical treatment (item 18)
  • In-patients: 50 sessions per year
  • Out-patients: 35 sessions per year
  • Dental treatment (item 23 and 24): CHF 1,000 per annum, non-cumulative.

 

Overall ceiling for reimbursements: During the first year of coverage, the overall amount of benefits paid by the Society shall be subject to a ceiling of CHF 10,000.

For persons enrolled during the annual enrolment campaign (i.e not immediately upon recognition of dependency status), the overall amount of benefits paid by the Society shall be subject to a ceiling of CHF 10,000 per year for three calendar years.