The supplementary plan is a provision within the Benefits provided by the Society which seeks to minimize a member’s share of large medical bills which can have a severe impact on their financial means. The Supplementary Plan is applied only in certain cases relating to certain types of reimbursement. When reading through My Benefits pages, the Supplementary Plan is applied only if explicitly stated.
Example 1: a hospital bill in a semi-private room of CHF 30,000 is accepted for reimbursement at 90%, hence CHF 27,000 is reimbursed. The Society’s member would remain liable for the balance of CHF 3,000.
However, beyond an accumulated amount of CHF 2,800 per member or CHF 4,600 per family, the supplementary plan becomes operational and the Society pays 100% of the costs above the mentioned amounts, i.e. in this example the Society would reimburse in total CHF 27,000 plus 100% of the portion the member is liable for in excess of the CHF 2,800 threshold, in this case CHF 200.
Total amount reimbursed CHF 27,200
Example 2: Hospitalization bill in a private room for CHF 50,000. The same hospitalization a hospital bill in a semi-private room would have cost CHF 45,000.
CHF 45,000 is thus accepted for reimbursement at 90%, hence CHF 40,500.
In this example the Society would reimburse in total CHF 40,500 plus 100% of the portion the member is liable for in excess of the CHF 2,800 threshold, in this case CHF 1,700.
Total amount reimbursed CHF 42,200.
The member remains fully liable for the difference in cost for having a private room
Please note that the Supplementary Plan has lifetime maximum ceiling of CHF 35,000. This ceiling can be re-established by the Executive Committee more than once; in practice UNSMIS coverage is unlimited.