Hospitalization in approved medical establishment (subject to Rules VIII.4 and VIII.8 of the Intrnal Rules) is extended to include care provided by the staff of the establishment and other services normally provided by the establishment.
We strongly recommend all members to consider using medical establishments with whom the UNSMIS has concluded an agreement. In doing so you can reduce YOUR portion of expenses, ensure cost savings to the plan and thus to your monthly contributions and in some cases make use of our Direct Payment facility, i.e. you need not advance any money. Learn More...
In the event of Hospitalization please always remember that:
- it must be in an approved establishment,
- it is subject to Rule VIII.4 of the Internal Rules
- it may also require Prior Authorization(e.g. hospitalization exceeding 30 days)
- the supplementary benefits plan may not always be activated
- Any supplement for private rooms is not covered
Comprehensive flat-rate charge for hospitalization including doctors' fees under annex III, items 1 and 2, and charges for treatment and stay (minimum 2-bed ward)
Reimbursed at 90% and the Supplementary Plan can be applied. The supplement for a private room is however not covered and Supplementary Plan cannnot be applied in respect of said supplement.
Hospitalization in a semi-private room in an establishment approved by the competent health authorities of the country concerned.
Reimbursed at 90% and the Supplementary Plan can be applied.
Hospitalization in a private room in an establishment approved by the competent health authorities of the country concerned
In this case reimbursement is limited to the maximum amount reimbursed for a semi-private room. The same limitation will be applied when calculating the Supplementary Plan.
Hospitalization in an establishment not providing semi-private care, approved by the competent health authorities of the country concerned
In this case reimbursement is limited to 75% and there is no application of the Supplementary Plan
Day hospital at a rate inclusive of all accommodation expenses
Reimbursement at 90% with application of the Supplementary Plan
Please remember that:
- Reimbursement is normally limited to 30 days per hospitalization. Any extension of the length of stay is subject to Prior Authorization by the Society's Medical Adviser, who will determine whether the treatment is curative.
- Supplemental costs for private rooms are NOT reimbursed by the plan