Psychiatric Treatments

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 of the hospital is reimbursed at 80%. In this case Prior Authorization is necessary and the Supplementary Plan is applicable.
  • Treatment by a specialist who is not hospital staff is covered at 80% with a monetary limit of CHF 110 per session. In this case the first 15 sessions do not require Prior Authorization. From the 16th session onwards Prior Authorization is however required. If you envisage a protracted treatment beyond 15 sessions please request Prior Authorization as soon as possible, rather than waiting up to the last session. The Supplementary Plan is not 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 6 per annum without the need of Prior Authorization and no application of the Supplementary Plan.
  • Psychotherapy is reimbursed at 80% with a monetary limit of CHF 110 per session. In this case the first 15 sessions do not require Prior Authorization. From the 16th session onwards Prior Authorization is however required and will be limited to an annual maximum of 50 sessions. If you envisage a protracted treatment beyond 15 sessions please request Prior Authorization as soon as possible, rather than waiting up to the last session. The Supplementary Plan is not applicable.
  • Consultations by a psychiatrist beyond 6 visits per year will be reimbursed at 80% up to a maximum of CHF 110.- 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, but the prior authorization beyond 15 sessions is still valid. In the case the insured person is over the age of 18, the annual maximum number of sessions may be waived, upon recommendation of the Medical Adviser, if the seriousness of the condition warrants such a decision.

 

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.