ABOUT THIS EDITION
Dear Insured Member,
We are delighted to present the July edition of the bi-monthly UNSMIS newsletter!
In this issue we will discuss the following:
- How to plan a surgery
- Digital insurance card and attestations
- Difference between eClaims and mobile app
The newsletter will be sent to insured members via email, will be published on the website and will appear as a pop-up window on the eClaims Portal.
We hope you find this newsletter helpful.
Kind regards,
The UNSMIS Team
|
|
|
MEDICAL ADVISER - TIPS & TRICKS
|
|
|
How to plan a surgery
Not all surgeries are urgent. Most procedures — such as a knee or hip replacement and even certain cardiac interventions — can be planned weeks or months in advance.
Planning your surgery, your post operative rehabilitation or even seeking a second medical opinion can help provide alternatives and maybe minimize your risk of complications and improve recovery times.
Once the diagnosis is confirmed, please liaise with UNSMIS before you move forward with your surgery.
|
|
|
A - If the surgery requires a prior authorization: Send a detailed medical report and a quotation of the surgery to the UNSMIS medical adviser team (medrepunsmis@un.org) before you confirm the date to the surgeon. UNSMIS will review your request. Additional documents or a second opinion may be requested before UNSMIS provides you with a prior authorization based on the type of surgery. Please refer to our communication on the types of treatment (be they surgeries or not) where a prior authorization is needed (view list). You may also refer to the dedicated webpage on UNSMIS’s website (view page) and the FAQ section (view section).
Additionally, Annex III of the internal rules clearly identifies what type of treatment requires a Prior Authorization.
It is imperative to note that failure to obtain a prior authorization, or proceeding with a surgery without the approval of the medical adviser can result in the claim being reimbursed partially or not at all, leaving a large part or all of the invoiced fees at your charge.
|
|
|
|
B - If the surgery DOES NOT require a prior authorization: kindly contact UNSMIS with a quotation for confirmation of the amount to be reimbursed. Note that as per our Usual, Reasonable and Customary charges (URC rule VIII.4.c), UNSMIS can limit the reimbursement if the amount is deemed to exceed the URCs in the country concerned.
|
|
General information on direct payments and quotes
Public hospitals with whom UNSMIS has a tariff agreement: the hospitalization, the surgeon fees, the assistant fees, and the anesthetist fees are often grouped in one single invoice. A letter of guarantee is issued to secure the payment. UNSMIS settles the invoice directly and recovers out of pocket amounts directly from the insured.
Private clinics with whom UNSMIS has a tariff agreement: the hospitalization will be secured by a letter of guarantee. You will not need to obtain a quote for this.
However, if the surgeon and the anesthetists are not employees of the clinic/hospital, often the case with private clinics/hospitals, then they will issue their separate invoices directly to your attention. In such cases, we strongly encourage you to obtain a quote from the surgeon and the anesthetist prior to the surgery taking place and to bring it to the attention of UNSMIS colleagues.
PLEASE NOTE: Refer to the following communication for a list of entities with which UNSMIS has tariff and direct pay agreements in the Geneva area and in Bonn: Communication March 2021. We take this opportunity to encourage you to read once again the communication as it touches also on Cost Containment and Preventive Care. An updated version will be issued after the summer.
For surgery in the USA, you must always contact UNSMIS in advance.
For direct payment hospitalizations in Africa, Asia, and Central and South America please refer to our eClaims portal and follow the procedures (see instructions here) to raise a request for a direct payment.
Hospitals or clinics with whom UNSMIS does not have agreements: you will receive the bill, settle the invoice and then submit your claim to UNSMIS for reimbursement. You can contact us for payment assistance in case of large amounts.
In the event of any doubt, we strongly urge you to contact UNSMIS in advance prior to scheduling any surgery.
|
|
Digital insurance card and attestations
Carrying a physical insurance card, which can easily become lost, damaged, or worn out, is no longer necessary. Our Mobile App empowers our members to access their up-to-date digital insurance card directly from their smartphones, ensuring it is readily available whenever required. This digital transformation eliminates the inconvenience of managing a physical card and thus simplifies the process of accessing healthcare.
|
|
|
Our mobile app is accessible for download on both Google Play and the App Store by simply searching for “UNSMIS”.
In addition, members have 24/7 access to official attestations of their health insurance coverage and that of their dependents through the mobile app or our eClaims Portal.
|
|
|
Difference between eClaims and mobile app
This article provides a short presentation of our two digital platforms – the eClaims Portal and our mobile app – highlighting the differences and benefits of each.
Both platforms enable members to submit claims easily online, view their credit balance, access attestations of coverage, and view past reimbursement advices and claims.
To log in to any of our digital platforms, members should use their insurance number and username. If you have forgotten any of your credentials, please click on “Issues logging in?” and follow the provided instructions.
While our two digital channels offer similar functionalities, we have outlined the key differences and our tips for the most user-friendly experience below.
|
|
UNSMIS mobile app
Our Mobile App is available on both Google Play and the App Store, by simply searching for “UNSMIS”.
Use the mobile app to:
- Access your digital insurance card 24/7
- Submit smaller claims containing maximum 1 invoice (e.g. pharmacy bills). Supporting documents, including the prescription and the invoice, can be uploaded by taking clear photos with your camera. A maximum of 5 photos can be attached to each submission.
- Access your up-to-date attestation of coverage
- View your credits, past claims and reimbursement advices on-the-go
|
|
|
eClaims Portal
We invite you to access our portal via the following link: https://eclaims.unog.ch/. Although it is compatible with all browsers, for the optimal experience, we recommend using Google Chrome.
|
|
Use the eClaims Portal to:
- Submit claims with up to 10 attachments
- Update, correct or withdraw claims submitted (N.B.: you may withdraw only claims that have not been assigned to our claim agents yet)
- Initiate direct billing requests for hospitals within our network
- Book individual consultations via Teams meetings with our client services team
- Access your tax attestations
|
|
|
|
|
|
