CHIS - Long-term care benefits

Long-term care benefits provide financial support to people in need of assistance over an extended period of time resulting from chronic illnesses or disabilities, entailing impairment of their ability to function independently in their daily lives.

People of all ages may need long-term care, however, it is expected that elderly persons will be the primary beneficiaries of the long-term care benefits.

Any member insured with the CERN Normal Health Insurance Cover may claim long-term care benefits subject to the recognition of a state of dependence by the Medico-Social Panel as described in section 2 below.

For coordination with other benefits paid by CERN for handicapped children, please refer to the reference documents below.

1. Benefit details

A state of dependence arises the needs for specific services which can be divided into three areas:

  • medical services
  • paramedical services (physiotherapist, ergonomist, etc.), and
  • home care (includes non-medical services provided at home or in a residential or nursing home)

The CERN Health Insurance Scheme (CHIS) provides cover for these three ares, based on the level of dependence, through:

  • its provisions for the reimbursement of medical expenses
  • higher ceilings on the reimbursement of paramedical expenses
  • a home-care allowance (the LTC allowance) independent of where the Member concerned resides.

 

Low level of dependence

Moderate level of dependence

High level of dependence

Reimbursement of medical expenses

according to the CHIS Normal Health Insurance

according to the CHIS Normal Health Insurance

according to the CHIS Normal Health Insurance

Paramedical ceiling 

1100 CHF / month

1650 CHF / month

2750 CHF / month

Long-term care allowance*

48 CHF / day

 72 CHF / day

120 CHF / day

* The LTC allowance is not paid during periods when the Member concerned is hospitalised.

2.  Procedure for the recognition of a state of dependence

The recognition of a state of dependence is based upon the assessment by a Medico-Social Panel comprising a representative of the Scheme's third-party administrator (UNIQA), a medical practitioner and a representative of the CERN Social Affairs Service.

The Panel's assessment of whether a state of dependence exists shall be based upon two questionnaires:

  • a medical questionnaire completed by the Member's attending physician, and
  • a medico-social questionnaire completed by the Member concerned and/or his family members or another close relation.

The Panel shall distinguish between three levels of dependence (low, moderate or high) according to the Member's degree of ability to perform the following functions of everyday life unaided:

  • getting up, sitting down, getting into bed;
  • mobility;
  • washing and grooming;
  • dressing and undressing;
  • taking food and drink;
  • going to the lavatory;
  • coherence and ability to communicate;
  • orientation in space and time.

The Panel shall also determine the date on which the state of dependence began and the date of effect of related benefits.  

3. Application for long-term care benefits

The Member himself or any person expressly empowered to represent him can formulate the application for the long-term care benefits.

The application shall be addressed to the Scheme's third-party administrator, UNIQA, in writing. It shall specify whether the Member concerned resides at home or in a specialised institution as well as the name and address of the attending physician. An application template (in French only) is available in under reference documents below to help with the formulation a valid request.

Following receipt of the application, UNIQA will send the questionnaires mentioned in section 2 above to the Member concerned together with instructions on how to complete them. 

The completed questionnaires shall be returned to UNIQA, who summons the Medico-Social Panel for the assessment of whether a state of dependence exists according to the procedure described in section 2 above. The Member concerned will be informed of the Panel's recognition of a state of dependence and of the effective date of the related long-term care benefits in writing by UNIQA.

4. Change in the state of dependence

The Member concerned or any person expressly empowered to represent him must inform the Scheme's third-party administrator (UNIQA), in writing ,of any lasting change (detoriation or improvement) that may affect the state of dependence.

Following receipt of such a notification, UNIQA will send the questionnaires mentioned in section 2 above to the Member concerned together with instructions on how to complete them. 

The completed questionnaires shall be returned to UNIQA, who summons the Medico-Social Panel for the (re)assessment of the state of dependence according to the procedure described in section 2 above. The Member concerned will be informed of the Panel's assessment and the effective date of the correspondingly adjusted long-term care benefits in writing by UNIQA.

5. Agreements with care provides

CHIS members can benefit from the following agreements that CERN has concluded with care providers in the nearby area:

  • The agreement with ORSAC for the admission of CHIS members to the care centre for dependent elderly persons Le Clos Chevalier (Etablissement pour l'Herbergement de Personnes Agées Dépendantes - EHPAD) in Ornex, France. More information is available here.
  • The tarif agreement with Presti-Service for services provided by auxiliary nurses. More information is available here.   

For more information

Annex V of the Rules of the CERN Health Insurance Scheme defines the long-term care benefits, as well as conditions of award and procedural aspects. You can also contact UNIQA's Geneva Office for more information on the long-term care benefits.

Please contact CERN's Social Affairs Service for information concerning your personal situation.

Updated on: 04/02/2016