Unique benefits for your employees affiliated to the CMU

Transcription

1 Fronta + Modular health insurance solutions for your cross-border employees Unique benefits for your employees affiliated to the CMU Reimbursement for medical care in France and option for everyday treatment and hospitalisation in Switzerland No medical questionnaire No upfront costs with the Tiers Payant card Dental, optical and alternative medicine cover for the whole family Benefits for medical care not reimbursed by French Social Security system Contract in accordance with French regulations (decree of 1st April 2015 & 2016 ANI reform) Many advantages with healthcare partners (optical network, dental specialist, etc.) Online monitoring of contracts and reimbursements Swiss Risk & Care specialists can also provide your cross-border employees who are affiliated to the LAMal with tailored and suitable insurance packages.

2 Understanding the French reimbursement system Total cost of benefit CMU-LAMal What are your rights for medical care cover? As of 1 June 2014, new cross-border employees have the right to choose their medical care cover. They have 90 days to choose either the French CMU system or the Swiss LAMal system. Beyond this period, the LAMal system prevails. Basic rate Reimbursement rate for the French Social Security system Charges over the basic rate CMU reimbursement Fixed contribution Charge over the basic rate Amount included in basic rate not reimbursed by CMU Costs reimbursed by the French Security system Remaining costs to be paid by insured Possible reimbursement by supplemental cover Only a change in legal circumstances, constituted by retirement or a period of unemployment (without benefits received in France) followed by re-employment in Switzerland, provides a new right to choose. What are the options for new cross-border employees? The CMU is a state system based on solidarity and pooling of premiums. The premium is calculated as a percentage of the family income tax, regardless of the number of dependents or age differences. Cross-border employees, who now have a right to choose, can decide the legal system they wish to join (CMU or LAMal) and also receive the best possible rate for a benefit tailored to their needs. Here is the example of a consultation with a general practitioner: I see a general practitioner whose consultation costs me 30, while the basic rate is 23 My fixed contribution for this benefit is 1 The CMU reimburses me (calculated from the basic rate and CMU cover) The co-payment for this benefit is 6.90 ( ) My supplemental health insurance could reimburse up to 6.90 of the co-payment and 7 of charges over the basic rate Whatever their decision, Swiss Risk & Care offers them modular insurance solutions suitable for their personal situation.

3 SWISS OPTION In order to provide medical care cover to your cross-border employees that is equivalent in terms of benefits to the ones used by your employees residing in Switzerland receive, our product Fronta+ offers reimbursement for medical care in France and the option to also receive reimbursement in Switzerland. In addition to medical care cover in France, the modularity of options allows you to choose a swiss cover for your employees needs, with reimbursement of everyday treatment and/or hospitalisation in Switzerland. Fronta+, a modular solution to build together, allowing you to offer the best-suited packages to your employees affiliated to the CMU. Medical care & Hospitalisation in France Single Couple Family with young children Family with adolescent children Couple > 50 years with no children Proximité Option Everyday treatment 1 Proxi 85 Proxi 100 Fronta + Essentielle Flexibilité Option Hospitalisation 2 Flexi 85 Flexi 100 Fronta + Optimale Fronta + Intégrale 1 In % of actual costs only for benefits registered at Swiss obligatory regime. 2 Hospitalisation in medicine, surgery and maternity. Other costs are not covered. : Budget Choice : Safe Choice Our Swiss Risk & Care teams will assist you in choosing the best package.

4 FORMULE ESSENTIELLE Reimbursement example with formule Essentielle From 36 per month per person Total cost Cost for insured* Our Essentielle package meets the needs of young professionals, who are single or couples, and offers the following benefits: Consultation with a specialist (with private fees) % reimbursement for visits to a general practitioner or specialist Rates compatible with smaller budgets Moderate contribution for alternative medicine healthcare Light corrective lenses and frames Fitting of dentures (crowns) Orthodontic treatment over a 2-year period 4,000 2,452 A startup active in the new technologies field presents approximately 30 employees including 10 cross-border employees with an average age of 27. This company wish to offer its employees a quality cover not too expensive. It has consequently adopted the Fronta+ Essentielle package. *After reimbursement from the CMU and supplemental health insurance.

5 Table of benefits BC: French social security basic cover CS: Compulsory scheme : Actual costs Hospitalisation Accommodation costs Fees: surgery, anaesthetics, obstetrics and other specific elements of hospitalisation Daily inpatient charges Private room with overnight stay Private room for day case surgery Costs incurred by persons accompanying the patient Transport costs Total cover 60 per day 15 per day 30 per day Optical care Frames for adults Weak- and medium-prescription monofocal lenses for adults Strong monofocal and varifocal lenses for adults Frames for children Lenses for children Prescription contact lenses (covered or otherwise by the CS) and lens care products Vision correction treatment Everyday medical treatment Consultations, visits to GPs and specialists Medical procedures or surgery and anaesthesia carried out at a doctor s surgery Imaging (radiography, scans, MRI, etc.), ultrasonography (including Doppler) Imaging not covered by social security Medical tests Paramedic, nurse, midwife, physiotherapist, speech therapist, orthopaedic surgeon, chiropodist/podiatrist Spa therapy: treatment, transport and accommodation costs Medicines Medicines for which 65% of the cost is covered by social security Medicines for which 30% of the cost is covered by social security Medicines for which 15% of the cost is covered by social security Dental care Consultations, treatment, x-rays Dental prosthesis Orthodontic treatment 50% of Prosthesis, hearing aids, small medical devices Orthopaedic equipment Hearing aids Wigs (following chemotherapy), breast implants (following a mastectomy or breast cancer) Other treatments Consultations not covered by social security (invoice from the specialist in question required) Qualified practitioners: osteopath, acupuncturist, homeopath, nutritionist, dietician, psychologist, chiropodist, podiatrist, chiropractor, aetiologist, naturopath, auriculotherapist, mesotherapist, shiatsu practitioner, phytotherapist, cryotherapist Prescription not (excluding contraceptives) Medicines to help quit smoking (prescription and receipt required) Sensitive treatments Prescribed contraceptives, amniocentesis not covered by social security, in vitro fertilisation, pregnancy tests (up to 3 per year), prescribed menopause treatment, prescribed treatment for erectile dysfunction Maternity and adoption costs (receipts required) Maternity: private room, TV costs, childminding costs, father s transport costs, etc. Adoption: adoption fees, travel costs, administrative expenses, etc. Allergy prevention (prescription required) Equipment used to treat asthma and allergies, respiratory aids Spa therapy Treatments, transport, accommoda#on. Receipts required for transport and accommodation costs not up to 120 per year up to 120 per year up to 50 per year up to 100 per year up to 100 per year Nota : This table is a summary of benefits, policy terms and conditions in French prevail (4 sessions per year) =

6 FORMULE OPTIMALE Reimbursement example with the formule Optimale From 45 per month per person Total cost Cost for insured* Our Optimale package meets the needs of families with both small and older children, and offers the following benefits: Consultation with a specialist (with private fees) % reimbursement for visits to a general practitioner or specialist Complete cover tailored to the needs of all the family Optimal dental and optical benefits for children and adults Light corrective lenses and frames Fitting of dentures (crowns) Orthodontic treatment over a 2-year period 4, A large company in the Geneva region, working in the luxury sector, presents various types of employees. It wants to offer appropriate and wide cover for all of its cross-border employees aged between 30 and 40 years old, and for their families. It has consequently adopted the Fronta+ Optimale package. *After reimbursement from the CMU and supplemental health insurance.

7 Table of benefits BC: French social security basic cover CS: Compulsory scheme : Actual costs Hospitalisation Accommodation costs Fees: surgery, anaesthetics, obstetrics and other specific elements of hospitalisation Daily inpatient charges Private room with overnight stay Private room for day case surgery Costs incurred by persons accompanying the patient Transport costs Total cover 70 per day 15 per day 40 per day Optical care Frames for adults Weak- and medium-prescription monofocal lenses for adults Strong monofocal and varifocal lenses for adults Frames for children Lenses for children Prescription contact lenses (covered or otherwise by the CS) and lens care products Vision correction treatment Everyday medical treatment Consultations, visits to GPs and specialists Medical procedures or surgery and anaesthesia carried out at a doctor s surgery Imaging (radiography, scans, MRI, etc.), ultrasonography (including Doppler) Imaging not covered by social security Medical tests Paramedic, nurse, midwife, physiotherapist, speech therapist, orthopaedic surgeon, chiropodist/podiatrist Spa therapy: treatment, transport and accommodation costs Medicines Medicines for which 65% of the cost is covered by social security Medicines for which 30% of the cost is covered by social security Medicines for which 15% of the cost is covered by social security Dental care Consultations, treatment, x-rays Dental prosthesis Orthodontic treatment Procedures not 70% of 250% of BC 500 Prosthesis, hearing aids, small medical devices Orthopaedic equipment Hearing aids Wigs (following chemotherapy), breast implants (following a mastectomy or breast cancer) Other treatments Consultations not covered by social security (invoice from the specialist in question required) Qualified practitioners: osteopath, acupuncturist, homeopath, nutritionist, dietician, psychologist, chiropodist, podiatrist, chiropractor, aetiologist, naturopath, auriculotherapist, mesotherapist, shiatsu practitioner, phytotherapist, cryotherapist Prescription not (excluding contraceptives) Medicines to help quit smoking (prescription and receipt required) Sensitive treatments Prescribed contraceptives, amniocentesis not covered by social security, in vitro fertilisation, pregnancy tests (up to 3 per year), prescribed menopause treatment, prescribed treatment for erectile dysfunction Maternity and adoption costs (receipts required) Maternity: private room, TV costs, childminding costs, father s transport costs, etc. Adoption: adoption fees, travel costs, administrative expenses, etc. Allergy prevention (prescription required) Equipment used to treat asthma and allergies, respiratory aids Spa therapy Treatments, transport, accommoda#on. Receipts required for transport and accommodation costs not 250% of BC % of BC up to 240 per year 40 (6 sessions per up to 240 per year year) = 240 up to 50 per year up to 150 per year up to 150 per year - 65 % of BC Nota : This table is a summary of benefits, policy terms and conditions in French prevail

8 FORMULE INTEGRALE Reimbursement example with the formule Intégrale From 53 per month per person Total cost Cost for insured* Our Intégrale package meets the needs of families and the over 50s and offers the following benefits: Consultation with a specialist (with private fees) % reimbursement for visits to a general practitioner or specialist Particularly high reimbursement rates for optical and hearing medical care Additional reimbursement of up to 1,000 for dental care not reimbursed by the compulsory scheme Light corrective lenses and frames Fitting of dentures (crowns) Orthodontic treatment over a 2-year period 4, The majority of employees at a company in commodities trading sector presents various types. They want to receive the maximum benefits for their health and that of their family. Their employer has therefore adopted the Fronta+ Intégrale package. *After reimbursement from the CMU and supplemental health insurance.

9 Table of benefits BC: French social security basic cover CS: Compulsory scheme : Actual costs Hospitalisation Accommodation costs Fees: surgery, anaesthetics, obstetrics and other specific elements of hospitalisation Daily inpatient charges Private room with overnight stay Private room for day case surgery Costs incurred by persons accompanying the patient Transport costs Total cover 100 per day 15 per day 60 per day Optical care Frames for adults Weak- and medium-prescription monofocal lenses for adults Strong monofocal and varifocal lenses for adults Frames for children Lenses for children Prescription contact lenses (covered or otherwise by the CS) and lens care products Vision correction treatment Everyday medical treatment Consultations, visits to GPs and specialists Medical procedures or surgery and anaesthesia carried out at a doctor s surgery Imaging (radiography, scans, MRI, etc.), ultrasonography (including Doppler) Imaging not covered by social security Medical tests Paramedic, nurse, midwife, physiotherapist, speech therapist, orthopaedic surgeon, chiropodist/podiatrist Spa therapy: treatment, transport and accommodation costs Medicines Medicines for which 65% of the cost is covered by social security Medicines for which 30% of the cost is covered by social security Medicines for which 15% of the cost is covered by social security Dental care Consultations, treatment, x-rays Dental prosthesis Orthodontic treatment Procedures not % of BC 500% of BC 500% of BC 1,000 Prosthesis, hearing aids, small medical devices Orthopaedic equipment Hearing aids Wigs (following chemotherapy), breast implants (following a mastectomy or breast cancer) Other treatments Consultations not covered by social security (invoice from the specialist in question required) Qualified practitioners: osteopath, acupuncturist, homeopath, nutritionist, dietician, psychologist, chiropodist, podiatrist, chiropractor, aetiologist, naturopath, auriculotherapist, mesotherapist, shiatsu practitioner, phytotherapist, cryotherapist Prescription not (excluding contraceptives) Medicines to help quit smoking (prescription and receipt required) Sensitive treatments Prescribed contraceptives, amniocentesis not covered by social security, in vitro fertilisation, pregnancy tests (up to 3 per year), prescribed menopause treatment, prescribed treatment for erectile dysfunction Maternity and adoption costs (receipts required) Maternity: private room, TV costs, childminding costs, father s transport costs, etc. Adoption: adoption fees, travel costs, administrative expenses, etc. Allergy prevention (prescription required) Equipment used to treat asthma and allergies, respiratory aids Spa therapy Treatments, transport, accommoda#on. Receipts required for transport and accommodation costs not Nota : This table is a summary of benefits, policy terms and conditions in French prevail. 300% of BC % of BC up to 360 per year 60 (6 sessions per up to 360 per year year) = 360 up to 50 per year up to 200 per year up to 200 per year - 65 % of BC

10 Table of benefits FORMULES PROXI ET FLEXI SWISS OPTION Everyday treatment Proxi 85 Proxi 100 Consultations, specialist treatment X-rays, medical analysis Medical support staff, chiropractor Pharmacy, auxiliary items, orthopedics 85% 2 100% 2 Hospitalisation Flexi 85 Flexi 100 Swiss Risk & Care offers four additional options so that your employees can benefit from the geographic freedom of choice for their benefits: Our Proxi options allow your cross-border employees to see a practitioner in Switzerland Our Flexi options give them the option to be hospitalised in Switzerland Stay in public hospital in common ward (Swiss DRG tariff) 1 Private clinics or public hospital without SwissDRG Transports 85% 2 CHF 600 per day 85% 3 Nota : this table is a summary of benefits, policy terms and conditions in French prevail. 100% 2 CHF per day 100% 3 Examples of reimboursement with Proxi 100 Total cost As of 23 / month / person Cost for the insured* Specialist consultation CHF 130 CHF 0 A company has two very different types of cross-border employees. The first one is not used to medical care in Switzerland, except for emergencies, and has a moderate average income. The second one tends to be hospitalised in Switzerland. The company therefore proposes the Fronta+ Optimale package with the Proxi 100 option and Fronta+ Intégrale with the Flexi 100 option. MRI scan CHF Examples of reimboursement with Flexi 100 Total cost Delivery in a public hospital in common ward (Swiss DRG tariff) 1 CHF 0 As of 47 / month / person Cost for the insured* CHF CHF 0 Delivery in a private clinic 3 days of hospitalisation CHF CHF (3 x CHF 1 400) *After reimbursement from obligatory regime and supplemental health insurance 1 SwissDRG (Swiss Diagnosis Related Groups) 2 3 Actual costs only for benefits registered at Swiss obligatory regime In % of actual costs

11 Swiss Risk & Care in figures employees 600 N 1 2 member companies million premiums under management by the broker of the Lemanic Arc and Lloyd s in Switzerland international networks Swiss Risk & Care is an alliance of hpr, Unirisc, UniCare, GenCare, Gest-Union and A & A Prévoyance, six entities specialized in insurance brokerage, provident funds, risk and human resources management. Leading broker for the Lemanic Arc and Lloyd s in Switzerland, Swiss Risk & Care benefits from the international network of its two partners: Siaci Saint-Honoré (MSH International) and Jardine Lloyd Thompson (JLT). Please contact your Broker advisor for more information about this product. UNIRISC/SWISS RISK & CARE, an insurance broker registered with ORIAS. Product designed by UNIRISC/SWISS RISK & CARE, managed and insured by ADREA Mutuelle.