ABOUT THIS EDITION
Dear Insured Member,
We are delighted to present the January edition of the bimonthly UNSMIS newsletter!
In this issue we will discuss the following:
- Changes to our Internal Rules
- Elective care in the USA
- Reproductive Health
- Changes in SPP premium rates
- Affiliation conditions for spouses
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
|
|
|
CHANGES TO OUR INTERNAL RULES
|
|
|
As we have communicated to our members in December, effective 1 February 2025, UNSMIS’s Internal Rules will undergo significant changes. These adjustments are in response to evolving needs and practices, feedback from our insured members, and the necessity to ensure the long-term financial solvency of the insurance scheme. Several rules have been clarified, new ones introduced, and some withdrawn.
You can expect changes in the following topics: SPP premium rates, treatments in the USA, reproductive health, ceiling of the Supplementary Plan, medical check-ups, long-term hospitalization, breast surgeries, nutritional treatment, vaccines, medical appliances, genetic tests and the ceiling of coverage for secondary dependents.
The detailed circular of the amendments can be found on our website, together with a brief summary. The new Internal Rules will be published on our website on 1 February 2025.
In the current newsletter, we will look at a few of the most important changes in more detail.
|
|
|
Current rules allow UNSMIS to limit the reimbursement of the cost of elective care to what would have been payable in Geneva.
We have introduced the need to seek prior authorization from our Medical Adviser, and to make the obligations and limitations explicitly clear and avoid the insured person being caught off guard, a new paragraph has been added explaining in detail the steps to be taken when seeking elective care in the USA for non-residents.
Please see the added paragraph below:
“For insured members whose duty station (for staff members) or legal place of residence (for other insured members) is not within the United States of America, the following rules apply to medical treatments received in the USA:
|
|
|
I. Treatments listed under benefits 2, 3, 5, 13, 16, 24 and 25 of the table in Annex III are subject to prior authorization from the UNSMIS Medical Adviser, unless these are received due to a Medical Emergency and/or an accident as defined under Rule II of the Internal Rules. This is in addition to treatments requiring prior authorization as listed in table in Annex III .
II. Requests for prior authorization must be submitted no later than 30 days before the planned treatment date together with details of the upcoming surgery and a preoperative medical report.
III. Reimbursement for the treatments above shall be limited to the cost of equivalent treatment in the canton of Geneva, an estimated cost ceiling will be specified in the prior authorization. Any expenses exceeding this ceiling will be borne entirely by the insured member unless additional costs are pre-approved by UNSMIS.”
The above limitations do not apply in the event of a medical emergency and/or accident. Furthermore, other benefits under Annex III that do not require prior authorization under the UNSMIS Internal Rules remain reimbursable under standard UNSMIS terms.
|
|
Maternity and infertility benefits have been merged into a single category entitled Reproductive Health, providing better coverage for IVF treatments, prenatal diagnostics, and other related services. The new rules clearly define what is covered and the limitations.
Amongst others, the age limit for IVF has been increased to 45 years (previously the standard practice, though not explicitly stated, was 42 years), and access to assisted reproduction is explicitly extended to individuals in same-sex relationships.
We also clarified the conditions of reimbursement in case of home delivery and genetic tests.
For a complete list of benefits covered under “Reproductive Health”, please see the detailed circular of the amendments on our website.
The new Internal Rules will be published on our website on 1 February 2025.
|
|
|
CHANGES IN SPP PREMIUM RATES
|
|
|
Due to the increased cost of care and subsequent increase in claim reimbursements a premium increase was deemed necessary for the SPP categories.
Based on financial projections and to safeguard the financial solvency of the mutual insurance scheme, the monthly flat premium for Specially Protected Persons (SPPs) has been increased by at least 15%, depending on the category.
The changes are as follows:
|
|
|
Changes in the premium contributions will be reflected in your February payslip.
If you consider the new conditions to be unsuitable, you can choose to opt out of the SPP coverage exceptionally without a notice period. To do this, please submit a request no later than 28 February 2025.
If you have any questions, please reach out to our team via email to unsmisaffiliations@un.org.
|
|
|
AFFILIATION CONDITIONS FOR SPOUSES
|
|
|
In this article, we explain the affiliation conditions for spouses, highlighting the importance of informing us about any changes that affect their dependency status.
Members under the Temporary Plan (on short-term contract / temporary contract of less than 3 months) may not cover their dependent, or non-dependent spouses under UNSMIS.
However, insured members with contracts of over 3 months are eligible to cover their spouses as dependents or as Specially Protected Persons (SPP) as per the below:
- A dependent spouse within the meaning of the Staff Rules can be insured as a dependent family member in the Main Plan.
- A spouse not recognized as dependent by HR can be insured as a Specially Protected Person in the SPP Plan.
It is important to note that the dependency status is reviewed every year by your HR colleagues and a change in the dependency status will affect the coverage eligibility for the whole calendar year.
I.e., if your dependent spouse becomes non-dependent in May, the eligibility for the Main Plan will be lost from 1 January and your spouse will have to be moved to the SPP plan retroactively, from 1 January. This might result in retroactive premium recoveries.
To avoid this, please make sure to inform your HR colleagues whenever there is a change that could affect the dependency status of your spouse (e.g., a new job or salary increase).
|
|
|
Premium contributions
Premium contributions for the Main Plan are a certain percentage of the salary/pension depending on the number of dependents covered, while SPPs are covered through a flat monthly premium without any participation from the organization.
The premiums are payable for the full month for each month of the calendar year.
Hence if an individual becomes affiliated on the 10th day of any given month for example, the premium for the month will be paid in full, with no pro-rata calculation.
This also applies when separating; coverage terminates on the last day of the month in which an insured member and/or family members separated or disaffiliated.
For further information on premiums, please visit our website.
|
|
Enrollment–time periods
- Within 31 days of entry on duty (EOD)
- Within 31 days of arrival of the family member at the staff member's duty station
- Within 31 days of recognition as dependent (or marriage)
- During the UNSMIS annual enrollment campaign held every year during the month of June
If you are employed by an organization that uses Umoja, enrollment is done through Umoja’s Employee Self-Service (ESS) platform. For a step-by-step guide on how to select the right health insurance plan and how to enroll members of your family, please see the relevant job aid (available here).
If you are employed by UNHCR and wish to add your spouse to your coverage, please contact UNHCR HR.
If you are employed by any other UN organization, and you wish to add your spouse to your coverage, please fill out the affiliation form (available here) and send it to your HR focal point.
|
|
Disaffiliation of your spouse
In case you wish to terminate the UNSMIS coverage of your spouse, you may do so during the 'annual enrollment campaign' (in this case, the change will be effective from 1 July in the year of your request) or you may request their disaffiliation at any time but you will be required to give a full 3 month notice.
If you are employed by an organization that uses Umoja, disaffiliation is done through Umoja’s Employee Self-Service (ESS) platform. You may reach out to your HR focal point for assistance, if necessary.
In case you are a staff member of UNHCR, you may submit the opt-out request for your spouse directly within Workday, or notify the relevant HR colleagues in case there is a potential change in your spouse’s dependency status by raising a CASE in Workday.
In all other cases, please reach out to your HR focal point.
|
|
|
|
|
