ABOUT THIS EDITION
Dear Insured Member,
We are delighted to present the September edition of the bimonthly UNSMIS newsletter!
In this issue we will discuss the following:
- Contact information, bank account, and status updates
- Orthodontic treatments
- Direct billing – “Find a provider” in eClaims
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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CONTACT INFORMATION, BANK ACCOUNT, AND STATUS UPDATES
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UNSMIS is often not informed of changes that may occur in your life or that of your dependents—changes that can directly impact your health insurance affiliation and reimbursement eligibility. As an insured member, it is your responsibility to notify UNSMIS of any updates that may affect your coverage.
This article outlines the most important changes you must report and explains how to do so effectively:
- Change of banking details: Please submit your updated banking information using the form below. UNSMIS does not receive banking updates from your employing organization, so reimbursements will be sent to the most recent account details you provided. If your banking information changes, reimbursements may be sent to an incorrect account. Therefore, it is essential to keep your banking details up to date.
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- Change of address: If you are an active staff member, please ensure that your residential address and telephone number are shared with your HR colleagues—or updated via the HR self-service portal, if applicable—so that our records reflect your most current contact details.
If you are a retiree or have an extension of coverage, kindly inform us directly of any changes to your residential address or telephone number.
To report updated contact details, please complete the form below and return it by email to unsmis@un.org.
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- Changes in the status of your children (marriage, employment): If your insured child gets married or begins regular employment, please notify us by email and attach supporting documentation (e.g., marriage certificate or employment contract). This allows us to terminate their coverage promptly.
Note: UNHCR employees do not need to report these changes, as they are automatically updated via Workday.
- New employment: New employment may affect the dependency status of your family members. Please ensure that both your HR colleagues and UNSMIS are informed of any employment changes.
- Retirement: During retirement, UNSMIS relies solely on the information you provide. Please keep us informed of any changes to your residential address, banking details, or family status (e.g., marriage or employment of children, or divorce of a spouse).
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- Death: In the event of a death, a family member or representative must send a death certificate to UNSMIS to update the insurance records accordingly.
To ensure uninterrupted coverage and timely reimbursements, please keep UNSMIS informed of any changes. We appreciate your proactive communication.
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Orthodontic treatment is a specialized field within dentistry that concentrates on the diagnosis, prevention, and correction of dental and jaw misalignments (malocclusions). Eligible treatments include braces, clear aligners (such as Invisalign), retainers, and more advanced procedures like jaw surgery.
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Orthodontic treatments do not require prior authorization. In accordance with Article 23 of Annex III of our Internal Rules, these treatments are reimbursed at a rate of 80%, subject to the dental credits available at the time of treatment. The cost of orthodontic appliances is also eligible for reimbursement.
Please be aware that invoices are only accepted once the treatment has been completed. However, orthodontic procedures are typically prolonged and may involve advance payments. We suggest you request the clinic/orthodontist to issue invoices for treatment phases occurring over defined intervals (for example, every three to six months). Additionally, obtaining a treatment plan will allow you to submit claims periodically.
When submitting a claim, it is essential to attach all relevant documentation to each individual claim.
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The Claims Team can only access the supporting documents attached to the specific claim being processed. Documents attached to previous claim reimbursement submissions should be resubmitted if necessary for the reimbursement of other claim submissions.
Dental credits:
Each member is entitled to CHF 2,500 in dental credits per calendar year, which may be accumulated over two years, resulting in a maximum of CHF 5,000. New members accrue credits on a pro-rata basis during their first year of affiliation, calculated monthly. Credits of upcoming months may not be used in advance.
Dental treatments are reimbursed at 80%, up to the available dental credits at the time of treatment. Credit balances are updated at the beginning of each year.
It is imperative to note that expenses will always erode the credit of the ongoing year first (the year when the expenses were incurred). Should this be insufficient, any carryover credits from the previous year will be further eroded.
You may check your up-to-date dental credit balance on the eClaims portal and in the UNSMIS mobile app.
Further details regarding the calculation of dental credits are available on our website.
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DIRECT BILLING – “FIND A PROVIDER” IN eCLAIMS
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UNSMIS maintains agreements with a broad network of medical providers and assistance companies worldwide. These partnerships facilitate seamless access to care and often allow for direct payment arrangements between UNSMIS and the medical provider.
To view the full list of participating providers or to request direct payment, please visit the eClaims portal and click on “Find a Provider.” You may filter providers by geographic location, type of service, and other criteria.
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Hospitalizations Requiring an Overnight Stay Outside of Europe and North America
For non-emergency hospitalizations that involve an overnight stay, insured members are not required to pay any costs up front at facilities listed under the “Find a Provider” section. UNSMIS will cover the full cost of the hospitalization (100%) and subsequently recover any applicable out-of-pocket expenses.
To initiate direct billing, submit a formal request through the eClaims Portal:
- Select the hospital from the “Find a Provider” list.
- Click on the “Request Direct Payment” icon next to the hospital’s name.
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3. Choose the family member concerned, enter the planned admission dates, and provide a brief explanation of the hospitalization. Please note:
- If authorization is not requested and obtained in advance, you will be responsible for paying the hospital directly.
- Upon receiving your request, UNSMIS will coordinate with its assistance company to arrange direct payment. The assistance company will pay the full bill, and UNSMIS will reimburse them while recovering any out-of-pocket expenses from you:
- Active staff members will receive a reimbursement notice in advance, detailing the amount to be recovered via payroll.
- Retired members will receive a bill with payment instructions.
- As these hospitalizations are non-urgent, insured members are strongly encouraged to submit the direct payment request at least 30 days in advance. This allows sufficient time to gather any additional information if needed.
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Outpatient Treatment
If the medical facility you intend to visit appears in the list, the process for outpatient care is as follows:
- Identify the provider.
- Schedule an appointment through their contact details.
- Present your UNSMIS insurance card at admission (your virtual insurance card available in the UNSMIS mobile app will suffice).
- Pay the costs up front (in certain cases, discounted rates may also apply).
After the treatment, you may submit the settled invoice for reimbursement via the eClaims portal or the UNSMIS mobile application.
Facilities Not Listed under “Find a Provider”
If the medical facility you plan to visit is not included in the provider list, direct billing may not be available.
In such cases, you will typically be required to settle the invoice directly with the provider and submit a claim for reimbursement after the treatment.
Before proceeding with hospitalization, we recommend verifying whether the fees are consistent with usual, reasonable and customary pricing in the region. You may send a quote in advance to unsmis@un.org, allowing our team to review it.
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Hospitalizations Requiring an Overnight Stay in North America
UNSMIS relies on the services of a North American third-party administrator to arrange direct billing and re-pricing with significant discounts for inpatient care.
If you require elective surgery in the USA, for further information, please send the details of your upcoming hospitalization to UNSMIS at unsmis@un.org.
For insured members whose duty station (for staff members) or legal place of residence (for retirees) is not within the United States of America, it is obligatory to obtain prior authorization from the UNSMIS Medical Adviser. 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 pre-operative medical report.
Reimbursement for elective surgeries for non-residents 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.
This limitation does not apply to medical emergency treatments, and accidents.
Hospitalizations Requiring an Overnight Stay in Europe
For access to healthcare in the Bonn region, please click here to request a direct payment for hospitalizations.
For access to healthcare in the Geneva region please click on this link to be redirected to our dedicated website page.
If you would like UNSMIS to consider direct payment for an overnight hospitalization to a hospital not in Bonn or the Geneva region, please contact us well in advance so we can reach out to the concerned hospital and try and make the necessary arrangements.
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