UNOV/UNIDO GROUP MEDICAL INSURANCE
Information Note
INTRODUCTION
This information note contains a brief description of the UNOV/UNIDO Group Medical Insurance
with the Insurer J. Van Breda & Co. International.
UNIDO is the Policyholder and the United Nations Office at Vienna (UNOV) is a participating
organization in this plan. None of the provisions of this note, nor any omission therefrom, can be
taken to replace or alter the terms of the plan itself or of the governing administrative issuances.
The plan provides world-wide coverage for reimbursement of 80 per cent of the costs for medical,
hospital and dental consultations/examination and prescribed treatment including medicines and
medical devices prescribed by qualified doctors as far as no other limitations or maxima apply. Full
coverage for benefits is provided as of the first day of enrolment, no waiting period applies.
A detailed summary of benefits is attached to Information Circular AGroup Medical Insurance Changes in premiums and benefits@, updated whenever changes occur and distributed desk-to-desk.
Although the staff of the Social Security office of the Human Resources Management Section is
available to assist staff members in administrative matters concerning participation in the group
medical insurance and to provide information in general, questions concerning medical claims,
reimbursements and specific medical treatments should be addressed directly to the Insurer. Van
Breda operates a call centre to provide prompt replies to requests for information from participants in
the group medical insurance plans. Contact details are as below:
The toll-free Van Breda hotline
for telephone calls made within (0800) 20 8596
Austria:
The hotline operates on weekdays from
8 a.m. to 6 p.m. It also operates outside
regular office hours and at weekends
(24 hours) for limited service (such as
confirmation of coverage and issuance of
cost guarantees to hospitals).
The telephone number for calls
+(32) (3) 217 57 17
made outside Austria:
The fax number:
+(32) (3) 235 01 24
The e-mail address:
mcw@int.vanbreda.be
Van Breda & Co. International website: http://www.int.vanbreda.com
The Website contains a general section about Van Breda and a personalized section
under the menue option "Personal access" which is limited to participants in the
UNOV/UNIDO Group Medical Insurance Plan. In order to access the detailed
information about the Medical Insurance Plan, please proceed as follows:
Under the Index number please enter the PREFIX 013 immediately followed by
your 6-digit PERSONNEL/INSURANCE NUMBER (printed on the insurance card,
settlement notes, correspondence on claims etc.)
for example: 013712345
Under the Date of birth please enter your birth dates in the dd/mm/yyyy format:
for example: 01/01/1950
Information is provided under the headings Coverage, Direct Billing, Claims,
Forms, Contacts and Provider List.
Under Forms you will find the claim for reimbursement forms and estimate forms.
The Adobe "Acrobat Reader" software is required to read and print these files.
Please note that the Provider List is yet a preliminary list and will be supplemented
in due course. At the moment you will find information and addresses of Viennese
hospitals as well as of laboratories giving discounts to Van Breda participants. The
laboratories are also listed under Coverage - Cost containment.
The Group Medical Insurance plan is based on experience, i.e. premium adjustments upon
renewal of the policy are determined by comparing the premiums paid with the reimbursements
received during the review period. If the reimbursements received during that period outweigh the
premiums paid less administrative expenses, then, according to the terms of the contract, the
premiums are increased.
The choice of medical providers and products made by the insured participant have an impact on
the Group Medical Insurance plan and are reflected in the performance. The active cooperation of
participants in being cost-conscious when incurring medical expenses is the most effective
measure to contain the participant=s own uncovered share and premium increases. Cost estimate
forms are available from the Social Security office for in-patient hospitalizations or day surgery
and dental treatments to assist participants to obtain information regarding costs in advance of
treatment.
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This information note covers the following subjects:
Section
Title
Page
A
Scope and eligibility ........................................................................................... 4
B
Enrolment and late application ........................................................................... 5
C
Coverage of family members .............................................................................. 6
D
Hospitalization .................................................................................................... 7
E
Claims procedure (time limits, currency of payments) ....................................... 8
F
Reimbursement provisions ............................................................................. 10
G
AOther insured persons@................................................................................... 12
H
Special leave without pay ................................................................................. 14
I
Temporary Disability Insurance Plan/TDIP ...................................................... 15
J
Premiums and subsidies .................................................................................... 16
K
Forfeiture and suspension of benefits ............................................................... 17
L
Insurance coverage after separation .................................................................. 18
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SECTION A - SCOPE and ELIGIBILITY
A.l.
SCOPE
A.l.l.
Medical insurance coverage in the Full Medical Insurance plan (FMIP) of the
UNOV/UNIDO Group Medical Insurance is mandatory for UNOV administered staff
members in Vienna who do not have other adequate medical insurance coverage. Staff
members or retirees enrolled in the Group Medical Insurance are referred to as
Aparticipants@ hereafter.
A.l.2. Medical coverage in the Austrian sickness insurance (Wiener Gebietskrankenkasse GKK) registered through UNOV will be considered adequate medical insurance
coverage. A combination of coverage in GKK with the Group Medical Insurance is
possible and is referred to as Supplementary Medical Insurance plan (SMIP).
A.1.3. Geographical coverage: Reimbursement for medical expenses may be claimed regardless
of where they were incurred.
A.1.4. When the participant and/or his co-insured family members are entitled to reimbursement
by another source, the applicable reimbursement percentages or ceilings are applied to the
difference between the costs actually incurred and the reimbursement obtained from other
sources.
A.2.
ELIGIBILITY
A.2.l. a)
All staff members on fixed term or permanent appointments;
b)
Spouses of participants;
c)
Unmarried children up to the end of the calendar year of attaining age 25, who
reside with or are financially dependent on the participant. The age limit does not
apply in the case of disabled children;
d)
Recognized secondary dependants for whom a dependency allowance is paid;
e)
Under certain conditions, participants who separate for retirement or disability as
well as their eligible spouses and children or eligible survivors of participants who
die in service, may continue coverage in the after-service health insurance (ASHI).
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SECTION B - ENROLMENT and LATE APPLICATION
B.1. ENROLMENT
B.1.1. Unless GKK coverage is elected as of the first day of the appointment or written proof of
adequate outside medical insurance coverage is provided, new staff members will have to
enrol in FMIP from the day of their appointment.
B.1.2. A combination of coverage in GKK, if registered through UNOV, with SMIP is possible
as of the first day of the appointment. Participants who are insured with GKK are entitled
to reimbursement under this plan only after submission of the medical expenses to the
GKK. The applicable reimbursement percentages and ceilings are applied to the
difference between the cost actually incurred and the reimbursement obtained from GKK.
For retired participants and their eligible dependants it is possible to combine SMIP with
coverage in another Austrian social security scheme as primary insurance.
B.1.3. As coverage for eligible dependants is optional, participants have to complete and sign an
enrolment form listing the names and birth dates of their eligible dependants whom they
wish to be covered, otherwise there is no coverage. Please see Section C for more
information.
B.1.4. Application for coverage of family members may be made at the time of enrolment of the
new staff member or within 30 days of marriage or birth/adoption.
B.1.5. Secondary dependants may be enrolled within 30 days following the date on which their
status as secondary dependants is recognized for the first time by UNOV.
B.1.6. It is the responsibility of the participant to ensure that family members whom he or she
covers under SMIP are actually covered under the GKK or another primary insurance.
B.1.7. Coverage for eligible dependants can be canceled at any time upon request by the
participant. The Social Security office should be notified immediately in writing of
changes which affect the eligibility of co-insured dependants, i.e. marital status, marriage
of children, children ceasing to be financially dependent. The responsibility for initiating
the corresponding change in coverage rests with the participant.
B.2. LATE APPLICATION
B.2.1 Coverage of eligible staff members and/or dependants (except secondary dependants)
may be obtained at a date later than stated above. In this case the application must be
supported by a medical questionnaire completed by the applicant and by a medical
certificate from the treating physician. Persons not meeting the medical standards of the
Insurer may be refused coverage. Coverage will start on the first day of the month
indicated by the Insurer.
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SECTION C - COVERAGE OF FAMILY MEMBERS
See also Sections A (Eligibility) and B (Enrolment and late application) above.
C.1. COVERAGE FOR SPOUSES
C.1.1. If a participant marries, the spouse may be covered in the Group Medical Insurance as of
the date of marriage, if enrolled within 30 days of that date. For enrolment at a later date,
the provisions outlined in B.2 apply.
C.1.2. If both spouses are employed by UNIDO or UNOV, insurance coverage may be in each
individual name or, in case of co-insurance, coverage has to be carried by the higher
salaried participant.
C.1.3. If a participant divorces his or her spouse, coverage for the spouse ceases upon divorce.
Continued medical coverage may be arranged under an individual contract (IHIP) with
the Insurer. (See Section L below).
C.2. COVERAGE FOR CHILDREN
C.2.1. If a child is born to a participant, the child may be covered as of the day of birth, or within
30 days of that date. For enrolment at a later date, the provisions outlined in B.2. apply.
C.2.2. Children, who are insured in the Group Medical Insurance and reach age 25 during
service of the participant and are still unmarried and financially dependent may continue
their coverage under certain circumstances as "other insured person" of the participant=s
household. See Section G below for more details.
C.2.3. In case where both parents are employed by Vienna-based Organizations and individually
insured in a group medical insurance plan provided by Van Breda & Co. International, a
child has to be co-insured with the higher salaried staff member/staff member receiving
the dependency allowance for the child.
C.3. SECONDARY DEPENDANTS
C.3.1. Secondary dependants may be enrolled within 30 days following the date on which their
status as secondary dependants is recognized for the first time by UNOV.
C.3.2. If a secondary dependant ceases to be recognized by UNOV, he/she may continue
coverage as Aother insured person@ of the participant=s=s household (see Section G
below).
C.3.3. Secondary dependants are not eligible to co-insurance in the ASHI plan. Continued
medical coverage may be arranged under an individual contract (IHIP) with the Insurer.
(See Section L below).
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SECTION D - HOSPITALIZATION
D.1.
The group insurance contract requires that the Insurer be notified of any injury or illness
requiring hospitalization. Participants should notify the Social Security office whenever
the participant him/herself or any person included in his or her coverage is hospitalized
within Austria. If hospitalization takes place outside Austria, the participant or co-insured
person should contact the Insurer directly.
D.2.
Direct billing arrangements exist between the hospitals in Vienna and the Insurer upon
receipt of a certificate of coverage (Kostenuebernahmebestaetigung). In this case the
hospital will send the original invoice to the Insurer, who pays the hospital the cost
covered by the Group Medical Insurance. This arrangement eliminates the claim
procedure between the patient and the Insurer for medical expenses relating to
hospitalization.
D.3.
Kostenuebernahmebestaetigungen are issued by the Social Security office or the Insurer
for hospitalizations (involving an overnight stay in a hospital) and for day surgery
(requiring the use of a conventional operating theatre and being performed in a hospital
on an in-and-out-same-day basis).
D.4.
Normally, the patient receives a copy of the invoice sent to the Insurer and the payment
advice of the Insurer indicating the payment made. The difference between the total
amount invoiced and the reimbursement by the Insurer is the uncovered share payable by
the participant. It is the responsibility of the participant to settle the uncovered share
promptly.
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SECTION E - CLAIM PROCEDURES
E.1.1. The claim consists of a completed and signed form, either CLAIM FOR
REIMBURSEMENT for FMIP coverage or form ANTRAG AUF RUECKERSTATTUNG
for SMIP coverage together with the receipts as evidence of the medical expenses.
E.1.2. Participants at Vienna Headquarters may submit their claims directly to the Insurer
through the Mail Operations in special pre-addressed envelopes. Mail Operations will
not open these envelopes, thus ensuring the confidentiality of the contents. The envelopes
are forwarded once a week (presently on Tuesday) in bulk to the Insurer.
Forms and envelopes may be obtained from the Supply Office or the Social Security
office. Participants away from Headquarters should forward their claims to the Insurer=s
address directly by mail.
E.1.3. If an entitlement to reimbursement by another Insurer exists, the applicable
reimbursement percentages or ceilings are applied to the difference between the cost
actually incurred and the reimbursement obtained from other sources. Evidence of the
reimbursement obtained from the other insurer should be attached to the claim.
E.1.4. In case of questions concerning medical claims, participants should address the Insurer
directly by calling the Insurer=s Call Centre, by mail using the pre-addressed envelopes,
or via e-mail. In any contact with the Insurer participants should refer to the coverage by
the UNIDO/UNOV group medical insurance, his/her Personnel Number which serves as
insurance number, and his/her full name.
E.2. TIME LIMITS
E.2.1. A claim for reimbursement shall be paid by the Insurer only if it is submitted within two
years of the date of treatment. It is the responsibility of the participant to see that claims
are submitted in due time. A participant who cannot submit a claim for refund within this
time-limit, shall notify the Insurer accordingly within that period, stating the reasons. The
Insurer may, in cases of proven force majeure and as an exceptional measure, extend this
time-limit.
E.3. CURRENCY OF PAYMENTS
E.3.1. Claims will be reimbursed by the Insurer in Austrian Schillings (as of 01.01.2002 in
Euros) to the account of the participant. A reimbursement advice indicating the amount of
reimbursement and/or other comments by the Insurer will be sent to the participant after
processing of the claim.
E.3.2. Any conversion of expenses incurred in another currency will be made on the basis of the
UN operational rate of exchange in force on the date the claim is received by the Insurer.
Differences resulting from exchange rate fluctuations are the responsibility of the
participant.
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E.4.
HOW TO SUBMIT CLAIMS
E.4.1. On the claim for reimbursement form, the costs incurred should be grouped according to
the nature of the services provided and the total cost inserted in the appropriate column
of the claim form. A separate claim form should be used for each person and each
currency in which the expenses were incurred and the currency should be indicated in the
space foreseen for this purpose. Participants stationed at Vienna Headquarters should
insert their room number. The mailing address should only be stated by retirees, staff on
special leave without pay and staff stationed outside Austria. Unless otherwise specified,
the Personnel Number serves as insurance number and should be indicated by active as
well as retired participants.
E.4.2. Participants should keep copy 2 (white) of the claim for reimbursement form and may
wish to keep copies of their submissions for their own records.
E.4.3. Participants covered under FMIP have to provide original bills and prescriptions,
accompanied by receipts of payment (or, in Austria, with the remark "Betrag erhalten").
With SMIP coverage, photocopies are accepted only if the originals have been kept by
GKK (see also paragraph 4.9 below).
E.4.4. A diagnosis must be stated on doctor=s bills, prescriptions and hospital invoices.
E.4.5. Bills for X-rays or laboratory tests must be accompanied by the referral note from the
attending physician.
E.4.6. Claims for reimbursement of the cost of spectacles or contact lenses must be
accompanied by the optician's invoice, listing separately the diopters and cost of each
lens (frames are excluded from reimbursement). The ceiling for lenses applies to two
calendar years.
E.4.7. The original prescriptions from the medical practitioner must be submitted with claims
for reimbursement for medicines or drugs purchased from a pharmacy. Pharmacy
receipts are not accepted in lieu of prescriptions unless local law requires the pharmacy
to retain the original prescription, in which case an explanatory note or a photocopy of
the prescription should accompany the claim.
E.4.8. Bills for dental treatment must be itemized and show the date of treatment(s) in view of
the carry-over of any unused balance from the previous year.
E.4.9. Participants enrolled in GKK and SMIP are reminded that the Insurer requires all bills to
be submitted to GKK and the amount reimbursed by GKK documented and stated on the
claim form. In the event that GKK refuses to reimburse the amount, a written statement
from either GKK or the participant explaining the reason for the refusal is required.
GKK normally retains the original, therefore, photocopies should be made before
submission of the original bills. The Insurer accepts a photocopy as support for a claim
for the difference between the total cost of the treatment and the reimbursement from
GKK.
E.4.10. Claims will be reimbursed by the Insurer in Austrian Schillings (as of 01.01.2002 in
Euros) to the account of the participant. The name of the bank and the full 11-digit
account number should be indicated on the claim form.
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SECTION F - REIMBURSEMENT PROVISIONS
The summary of benefits is attached to the Administrative Circular AGroup Medical Insurance Changes in premiums and benefits@. No reimbursement is foreseen for the following items. The
listing is not exhaustive:

Claims submitted more than two years after the date of treatment;

Frames;

Physiotherapeutic appliances or appliances such as Blutdruckmessgeraete;

Provisional tooth replacements (provisoria);

Psychoanalysis;






The costs of the stay of accompanying persons and of the use of telephone, television and
other non-medical expenses during hospitalization;
Taxi fares;
Drugs that are not provided for by the policy, such as Viagra, Xenical and similar
products;
Pharmaceutical products not deemed to be reimbursable medicines such as skin, hair and
dental care products, vitamin and mineral supplements, herbal teas, toiletries, dietetic
foods and products etc.;
Paramedical treatment not considered as indispensable such as dietetic or energy
assessments, fitness and similar programs;
Certain alternative treatments, such as acupressure, anthroposophical medicine,
autogenic training, biofeedback therapy, bioresonance treatment, treatment within the
framework of traditional Chinese medicine, colon-hydro therapy, hypnosis therapy,
Fussreflexzonen massage, music therapy, nutrition counselling, shiatsu and
Kneipptherapie (the latter may be reimbursed, subject to prior approval, in connection
with a prescribed spa cure). This listing is not exhaustive.
The policy states the following exclusions from coverage:

The consequences of sicknesses or accidents resulting from willful and intentional action
on the part of the insured, such as attempted suicide or intentional mutilation;
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







Medical expenses of persons who, in time of war, are mobilized or voluntarily enter
military service;
The consequences of injuries resulting from motor-vehicle racing and dangerous
competitions on which betting is allowed (injuries resulting from normal sports
competitions are covered);
The consequences of brawls, except in cases of self-defense;
Rejuvenation cures and cosmetic treatment. Cosmetic surgery is covered, however, when
it is necessary as the result of an accident for which medical coverage is provided;
Accidents resulting directly from alcoholic intoxication or the use of drugs that had not
been medically prescribed;
Direct or indirect results of nuclear explosions and related heat release or irradiation;
Injuries resulting from aircraft accidents if the insured is on board a non-commercial
aircraft without a valid certificate of air-worthiness or one piloted by a person not in
possession of a valid license for that type of aircraft;
Treatment necessitated by an injury or illness attributable to the performance of official
duties on behalf of the United Nations (such medical expenses are covered under
Appendix D to the Staff Rules). Until compensation for such treatment has been
approved by the United Nations, the regular reimbursement procedure will apply and the
corresponding amount of the compensation will be refunded to the Insurer.
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SECTION G - AOTHER INSURED PERSONS@
G.1.
ELIGIBILITY
G.1.1. "Other insured persons" are persons insured with a staff member participating in the
group medical insurance on virtue of the fact that they are living in the same household
and are financially dependent on the staff member. "Other insured persons" may comprise
the following persons:
a) unmarried children over 25 years of age (a child away for educational purposes shall
be regarded as living in the staff member=s household);
b) persons financially dependent on the staff member but not recognized as dependants
within the meaning of the staff rules for the purpose of payment of a dependency
allowance (i.e. a parent, brother, sister, life’s companion);
c) non-Austrian live-in household helps or domestic servants.
G.2. CONDITIONS OF COVERAGE
G.2.1. Application by the staff member on basis of a medical questionnaire completed by the
applicant and a medical certificate of good health from the treating physician. Persons not
meeting the medical standards of the Insurer may be refused coverage. Coverage will start
as of the month indicated by the Insurer.
G.2.2. In case of continuous coverage, persons insured as eligible dependants may convert to
coverage as "other insured persons" with uninterrupted entitlement to benefits (e.g.
coverage as eligible dependant may end on 31 December of the calendar year in which a
child reaches age 25 and coverage as "other insured person" would commence on
1 January thereafter). No medical certificate is required for continuous coverage.
G.2.3. Persons whose stay in the staff member=s household will be of long duration (at least one
year) shall be entitled to benefits immediately after enrolment.
G.2.4. Persons whose stay in the staff member=s household will be temporary (less than one
year but at least 6 months) shall be entitled to benefits only three months after enrolment,
except for treatment resulting from an accident sustained after the date of enrolment.
G.2.5. Minimum length of coverage:
in case of G.2.2. and G.2.3. above:
in case of G.2.4 above:
one year
six months
G.2.6. Coverage ceases when the eligibility criteria for the Aother insured person@ are no longer
applicable, upon request by the staff member after the minimum length of coverage, or
separation from service of the staff member, whichever is earlier.
G.2.7. The Social Security office should be notified immediately of changes which affect the
eligibility of Aother insured persons@. The responsibility for initiating the corresponding
change in coverage rests with the staff member.
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G.2.8. Fixed premiums according to age and sex are payable as of the date of enrolment.
Premiums are not subsidized by UNOV and are payable in full by the staff member
through payroll deduction.
G.2.9. The coverage shall comprise the benefits as described in the Group Medical Insurance
plan except that the uncovered expenses in respect of the "other insured person" will not
be considered in the calculation of major (catastrophic) medical expenses.
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SECTION H - SPECIAL LEAVE WITHOUT PAY
H.l.
In case of Special Leave without Pay (SLWOP) not extending over a complete calendar
month, insurance coverage continues as in full pay status.
H.2.
In case of SLWOP for one calendar month or more, continued coverage may be
maintained on a voluntary basis. The participant must pay the total premium, i.e. UNOV
pays no subsidy. A delay of payment for more than two months will result in automatic
cancellation of the health insurance coverage. Participants who continue in the
supplementary medical insurance plan (SMIP) must remain covered by the Austrian
sickness insurance to be eligible for reimbursements.
H.3.
Participants who apply for SLWOP should advise the Social Security office in writing of
the requested coverage prior to the start of the SLWOP period.
H.4.
If the participant does not wish to continue in the group medical insurance, coverage is
suspended for the period of SLWOP and will be reinstated the day he or she returns to
pay status.
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SECTION I - TEMPORARY DISABILITY INSURANCE PLAN (TDIP)
I.l.
ELIGIBILITY
I.l.1.
Staff members who have an appointment of one year or more and who are enrolled in the
Group Medical Insurance are eligible to enrol in the Temporary Disability Insurance Plan
(TDIP). Coverage is voluntary, however, enrolment in TDIP can be made only at the
time of the initial enrolment, or within one month of becoming eligible if the initial
appointment was for less than one year.
I.2.
BENEFITS
I.2.1.
In the event of temporary disability due to an accident or illness that continues after the
exhaustion of sick leave on full pay, a daily indemnity is paid by the Insurer. An
indemnity of 25 per cent of the emoluments1 is payable for the duration of sick leave on
half pay. From the date of exhaustion of sick leave on half pay, the indemnity is 50 per
cent of the emoluments for the balance of the period of temporary disability up to a
maximum of l2 months. The indemnity is credited day-by-day and is payable at the end
of each calendar month.
I.2.2.
Payment of the indemnity is continued up to the date on which the insured person is
regarded as being capable of resuming his or her duties or until a disability benefit is
awarded by the United Nations Joint Staff Pension Fund. For each single case of
disability, the above benefits will not be payable for any period, continuous or not,
exceeding l5 months for participants entitled to sick leave of 3 months on full pay and 3
months on half pay in any 12 consecutive months not to exceed a total of 9 months of full
salary and 9 months of half salary in any 4 consecutive years (Category A); and 2l
months for participants who are entitled to sick leave for a period of 9 months of full
salary and 9 months of half salary in any 4 consecutive years (Category B).
I.3.
PREMIUMS
I.3.1.
The premium for TDIP for Category A (staff members with fixed-term appointments of
one year or longer but less than 3 years) is 0.10 per cent of emoluments1 and for Category
B (staff members with appointments of 3 years or longer or who have completed 3 years
of continuous service) is 0.08 per cent of emoluments1. There is no subsidy payable by
UNOV.
1Emoluments
include net base salary plus post adjustment, language allowance and dependency allowance.
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SECTION J - PREMIUMS AND SUBSIDIES
J.l.
As part of their social security policy the organizations pay half the total cost of
premiums of participants and eligible dependants in the Group Medical Insurance
scheme. The United Nations do not contribute to the costs of medical insurance arranged
privately by a staff member, nor are there any other provisions for other payments
towards medical expenses.
J.2.
No subsidy is paid for Aother insured persons@, voluntary coverage during periods of
leave without pay, and TDIP.
J.3.
The staff members' shares of premium are expressed as a percentage of emoluments. For
medical insurance purposes, emoluments include net base salary plus post adjustment,
language allowance and dependency allowance. Premiums are to be paid per month and
cannot be pro-rated per working days. There are three categories of coverage depending
on the number of insured persons. The monthly contributions structure for the coverages
in FMIP and SMIP of the Group Medical Insurance respectively are shown in the
Administrative Circular AGroup Medical Insurance - Changes in premiums and
benefits@, issued whenever changes occur.
J.4.
There are three categories of medical insurance coverage.
Category
I
II
III
Staff member only
Staff member with one dependant
Staff member with two or more dependants
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SECTION K - FORFEITURE AND SUSPENSION OF BENEFITS
K.1.
Entitlements may be wholly or partially suspended:
a)
If an insured person fails to comply with the provisions and rules of the Group
Medical Insurance Plan;
b)
If it is established that the person concerned has attempted fraudulently to obtain
benefits to which he or she was not entitled;
c)
If the participant is late in paying the premiums due during voluntary coverage
during periods of leave without pay, or after separation from service. Non-payment
of contributions for a period of 12 months will end participation in the after-service
health insurance with no possibility of readmission.
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SECTION L - INSURANCE COVERAGE AFTER SEPARATION
L.l.1. Insurance coverage ceases at the end of the calendar month in which the date of
separation occurs.
L.1.2. Participants with FMIP coverage may request continued coverage for up to two months
after the month in which separation occurs. The request must be made to the Social
Security office before separation. The period of retention of coverage will be stated on
the Personnel Payroll Clearance Action form, and the unsubsidized premiums for that
period of coverage will be deducted from final pay. Unless the coverage for a specific
period is stated on the Personnel Payroll Clearance Action form and premiums are paid in
advance, coverage will cease at the end of the month in which the date of separation
occurs.
L.1.3. Participants who continue their insurance coverage after separation are required to retain
their accounts with the VIC branch of the Creditanstalt-Bankverein or Bank Austria until
such time as all outstanding claims have been reimbursed. No change in coverage is
permitted during the last month of service.
L.2. INDIVIDUAL HEALTH INSURANCE PLAN (IHIP)
L.2.1. Participants with FMIP coverage as well as their co-insured dependants, may apply to the
Insurer for continued medical coverage in the Individual Health Insurance Plan (IHIP)
provided by the Insurer on an individual contract. The participant can apply for this
scheme prior to separation by sending a completed application form and by paying the
initial premium for three months before his/her current coverage expires. No medical
exam or submission of medical questionnaire is required.
L.2.2. A co-insured spouse of a participant whose eligibility for coverage ceases as a result of
divorce may apply for IHIP, as long as the application is made within 30 days of divorce.
L.2.3. The IHIP scheme provides for reimbursement of reasonable and customary expenses for
medical and hospital services, necessitated through sickness, accident or maternity as well
as for the payment of a capital sum in case of accidental death. Premiums are based on
age and sex and shall be paid by means of a banker=s draft. Premiums and
reimbursements are made in US Dollars.
L.2.4. Information on general conditions, premiums and application forms is available from the
Social Security office.
L.3. AFTER-SERVICE HEALTH INSURANCE (ASHI)
L.3.1. Under certain conditions, participants who separate for retirement or disability and their
eligible spouses and children or eligible survivors of participants who die in service may
continue coverage in the after-service health insurance (ASHI).
L.3.2. Secondary dependants and Aother insured persons@ are not eligible to continue coinsurance with a participant in ASHI.
L.3.3. ASHI is only available as a continuation of previous coverage in one of the health
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insurance schemes provided by the United Nations. ASHI is not automatic but requires
an application. The Circular AAfter-service health insurance coverage@ provides the
details on eligibility, contributions and related conditions.
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