ABOUT THIS EDITION
Dear Insured Member,
We are delighted to present the May edition of the bimonthly UNSMIS newsletter!
In this issue we will discuss the following:
- Annual enrollment campaign 2025 (1-30 June)
- Reimbursement of mental health care
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
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ANNUAL ENROLLMENT CAMPAIGN 2025 (1-30 JUNE)
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As we approach our annual enrollment period, we extend a warm invitation to active staff members enrolled in our insurance plan to include eligible dependents under their health insurance coverage.
The campaign, taking place between 1-30 June 2025, is the yearly opportunity for insured members to add or remove eligible dependents, with changes taking effect on 1 July 2025.
Enrollment will be possible through your online HR portal (e.g. UMOJA or Workday), or directly through your HR focal point.
Please be aware that this campaign is not available to insured members in ASHI, during extension periods under SLWOP, or after separation.
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REIMBURSEMENT OF MENTAL HEALTH CARE
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In this article we would like to give a thorough overview of reimbursement rules related to mental health medical expenses.
Psychotherapy
The therapist must be a recognized psychotherapist and have the necessary authorizations to exercise their work in the country where they practice.
Additionally, a prescription from a medical doctor is necessary unless the therapist is a psychiatrist (a psychiatrist is a medical doctor). In case of online consultations, the therapist must be licensed in the country where they practice.
Psychotherapy is reimbursed according to the following criteria:
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Outpatient treatment prescribed by a medical doctor and provided by an approved psychotherapist (registered with FSP or ASP in Switzerland, for example), or alternatively prescribed and given by a psychiatric doctor, is covered as follows:
- Psychotherapy is reimbursed at 80% with a monetary limit of CHF 120.- per session and will be limited to an annual maximum of 50 sessions. The Supplementary Plan is not applicable. For secondary dependents, only 35 sessions per annum are reimbursable.
- One session per day is reimbursable.
- A prescription by a medical doctor is imperative for psychotherapy sessions to be considered for reimbursement. (N.B.: Prescriptions are valid for 6 months, or up to 12 months if explicitly stated by the doctor on the prescription.) Please attach your prescription to each claim.
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- The maximum number of sessions mentioned could be waived on the recommendation of the Medical Adviser if there is a valid medical justification.
- Consultations by a psychiatrist (including remote/telehealth) are reimbursed at 80% up to a maximum of 12 sessions per annum without the need of prior authorization, and with the application of the Supplementary Plan.
- Consultations by a psychiatrist (including remote/telehealth care) beyond 12 visits per year require a prior authorization from our Medical Adviser. If prior authorization is not requested or is denied, the sessions beyond the first 12 will be reimbursed at a rate of 80%, up to a maximum of CHF 120 per session, within the available limit of psychotherapy sessions. Prior authorization must be sought and approved before any additional care, based on a medical report detailing the necessity for continued psychiatric treatment. If medically justified and approved in advance, the supplementary psychiatric sessions will be reimbursed at 80% for the number of sessions authorized.
- However, if a psychiatrist performs a psychotherapy consultation, it will be reimbursed according to the limits set for psychotherapy sessions.
- For insured persons below the age of 18, there is no limit to the number of treatment sessions. However, Rule VIII 4 c, d, e on usual, reasonable, and customary charges (URC) will be applied.
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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 or by a specialist who is not hospital staff is reimbursed at 90%. The Supplementary Plan is applicable.
Psychiatric and medico-psychological evaluations are covered at 80% and limited to once per annum.
The prior authorization of the Medical Adviser is not necessary for the above to be considered for reimbursement, and the Supplementary Plan is applicable.
For further information about this topic, please see item 18.a and 18.b in Annex III of our Internal Rules.
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