Working abroad with full health insurance. gruppenversicherung

Transcription

1 Working abroad with full health insurance The central.world and central.world50 tariffs: the new international group insurance policies from Central gruppenversicherung

2 The task Many German companies temporarily post personnel abroad. A number of factors have to be taken into consideration in this context. In particular, health insurance cover should be taken out before the start of the stay abroad for the event of illness, ideally in the form of central.world or central.world50. For employers, Article 17 of Volume V of the German Social Code (SGB V) is crucially important. Normally, members of the statutory health insurance system receive benefits from their health insurance fund in the event of illness. However, in the case of employment abroad, the following applies: Article 17 Benefits in the case of employment abroad (1) Members who are employed abroad and become ill during their employment receive their due benefits from their employer. Sentence 1 applies accordingly for those family members insured pursuant to Article 10, for the period that they accompany or visit the member during the time of this employment. (2) The health insurance fund is obliged to reimburse the employer the costs incurred in accordance with Section 1 to the extent that they would have been incurred in Germany. (3) 2

3 In the event that Article 17 of Volume V of the German Social Code (SGB V) applies, the employer is fully liable vis-à-vis the employee for all costs incurred in the event of illness. Although the employer then has a right to reimbursement vis-à-vis the health insurance fund of his employee, substantial costs may nevertheless be incurred abroad that are not always covered to the full extent (indeed, occasionally not at all!) by the statutory health insurance system. For instance, the health insurance system is not allowed to reimburse the costs for repatriation at all. Furthermore, the employer is also subject to a general obligation to protect the life and health of his employees in accordance with Art. 618 of the German Civil Code (BGB), regardless of whether these are insured under the statutory health insurance system or privately. This duty of care is inalienable (Art. 619 German Civil Code). By means of an efficient private health insurance plan for his employees working abroad, an employer is comprehensively covered for the event of employee illness. Of course, an employee is also extremely interested in having the right cover for the event of illness abroad. It is also extremely important for an employee that he receives the proper care in the period after repatriation. Numerous statutory provisions also have an influence on the possible insurance cover in the event of illness during a temporary stay abroad, especially as regards the proper cover after returning from abroad. The following paragraphs provide some important information on this topic. Unfortunately, many aspects have not been unequivocally regulated by the legislature. We therefore recommend that unequivocal agreements be made with the statutory or private health insurance fund concerning health insurance after returning from abroad before travelling abroad in all cases. 3

4 The solution The company concludes a group insurance contract with Central for its employees abroad. The employees are insured under this contract for the duration of their stay abroad pursuant to the central.world tariff or the central.world50 tariff. The central.world tariff provides Cover for outpatient medical treatment 100% reimbursement of the expenses for medical services, midwife services, medicines and surgical dressings Extensive benefits for the use of remedies, aids and adjuvants 100% reimbursement of the costs of travelling to the nearest physician Psychotherapy (up to 30 sessions per insurance year) 100% reimbursement of expenses for vaccinations in accordance with a comprehensive catalogue and for other vaccinations that are necessary or prescribed for a planned trip 100% reimbursement of the expenses for medically necessary transportation in direct connection with outpatient surgery, as well as medically necessary accommodation outside the physician's clinic for one day or one night directly after outpatient surgery 4

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6 Cover for inpatient medical treatment 100% reimbursement of the expenses for medical services, bed and board and medical care in a hospital In the case of treatment in the Federal Republic of Germany the expenses for general hospital services, treatment by consulting physicians and the services of a consulting midwife are reimbursed. Expenses for inpatient psychotherapy are not reimbursable. The expenses for bed and board in hospital for an accompanying person will also be reimbursed for the duration of inpatient treatment of a child under fourteen years of age (rooming-in). 100% reimbursement of the expenses for medically necessary transportation to/from a hospital up to a distance of 100 km. In the event that no hospital can be reached within this distance that can provide the medically necessary treatment, the expenses for transportation to/from the nearest suitable hospital are reimbursable. In the case of inpatient medical treatment, reimbursement of the expenses for home medical treatment with a ceiling of EUR 2,000 may be chosen instead of the reimbursement of expenses for bed, board and treatment in a hospital, provided that said home treatment takes place directly after inpatient medical treatment in place of otherwise medically necessary further hospitalisation, is ordered by a physician and is carried out by qualified care professionals, i.e. nurses (home nursing). 6

7 Cover for dental treatment 100% reimbursement of the expenses for dental treatment (excluding all types of dental crowns and inlays), as well as prophylactic services 80% reimbursement of the expenses for dental prostheses, all types of dental crowns and inlays, as well as dental and jaw regulation, including the dental fees for these measures up to the maximum amounts in accordance with the reimbursement scale* * 2,500 for an insurance case caused by accident, in all other insurance case: 500 in the first year of insurance 1,000 in the second year of insurance, less any insurance benefits in the first year of insurance 1,500 in the third year of insurance, less any insurance benefits in the first two years of insurance 2,000 in the fourth year of insurance, less any insurance benefits in the first three years of insurance 2,500 in the fifth year of insurance, less any insurance benefits in the first four years of insurance 2,500 per year of insurance as of the sixth year of insurance. 7

8 Additional benefits Reimbursement of the following 100% of the additional expenses of medically necessary repatriation ordered by a physician (reimbursement of these additional expenses also if, as a result of the nature and severity of the illness or injuries, medically necessary inpatient medical treatment would exceed a period of two weeks, or if the anticipated costs of the medical treatment would exceed the costs of repatriation) 100% of the necessary costs for repatriation of an insured child under the age of 16, insofar as all adults on the trip likewise insured under this tariff have been or will be repatriated, or have died, up to a maximum amount of EUR 5, % of the costs of transporting blood abroad when the blood is medically necessary for surgery and it must be expected that local blood supplies would give rise to infections 100% of the necessary costs for repatriation of a deceased person to their home, their home town or to the country of the deceased, up to a maximum amount of EUR 10, % of the costs of a funeral abroad, up to a maximum amount of EUR 10,000 8

9 The tariff for employees abroad who are members of the statutory health insurance system is... Note: The overall content and scope of the insurance cover are specified in the provisions of the selected tariff, the general terms and conditions of insurance, the insurance certificate and additional written agreements. central.world50 This tariff provides the same benefits as central.world, but reimbursement takes place as a matter of principle taking into account the initial benefits of the statutory health insurance system, which must be taken avail of first. However, the costs for transport and for the repatriation and funeral of a deceased person are reimbursed to the same extent as under the central.world tariff. 9

10 Constellations: consequences and requirements 1. The employee is subject to mandatory insurance cover in Germany and is posted in the context of Art. 4 of Volume IV of the German Social Code (SGB IV). Consequence: the existing insurance cover remains valid. Requirement: central.world50 tariff 2. The employee is in Germany and is subject to mandatory insurance cover and is posted abroad, but Art. 4 of Volume IV of the German Social Code does not apply. Consequence: the existing insurance cover ends. Requirement: central.world tariff 4. The employee is voluntarily covered by statutory health insurance in Germany, is posted in the context of Art. 4 of Volume IV of the German Social Code and terminates his membership in the statutory health insurance system. Consequence: the existing insurance cover ends. Requirement: central.world tariff 5. The employee is voluntarily covered by statutory health insurance in Germany, is posted abroad, but Art. 4 of Volume IV of the German Social Code does not apply. Consequence: the existing insurance cover ends. Requirement: central.world tariff 3. The employee is voluntarily covered by statutory health insurance in Germany, is posted in the context of Art. 4 of Volume IV of the German Social Code and remains in the statutory health insurance system. Consequence: the existing insurance cover remains valid. Requirement: central.world50 tariff 10

11 6. The employee is covered by a private medical expenses comprehensive insurance scheme. Consequence: in principle, the existing insurance cover continues to apply. Requirement: Insofar as it has been clarified with the insurer that the insurance cover also permanently applies abroad (including an entitlement to repatriation for medical reasons), there is, in principle, no further requirement. However, it is advisable in most cases to temporarily suspend the private insurance cover and to take out cover for the duration of the stay abroad with the central.world tariff. Speaking of "suspension": It should be clarified prior to the commencement of the stay abroad that it is possible to rejoin the suspended system. In the case of statutory health insurance, it can be ensured by means of a suspension agreement that the insurance cover becomes active again upon return. In private health insurance this is already ensured by way of the aforementioned suspension insurance. What qualifies as a posting abroad in accordance with Art. 4 of Volume IV of the German Social Code? The employee must travel abroad in order to work on behalf of his employer for a previously determined period of time within the framework of a domestic employment relationship and in line with the instructions of his employer 11

12 A special partnership in the interests of our customers: Central and Vanbreda International Central offers more than just highly efficient tariffs. The new international group insurance also provides a very special service. Via our partner Vanbreda International in Antwerp, we provide services that are tailored specifically to international companies and which take international particulars into consideration to an extensive degree. This primarily has an influence on the effectiveness of claims processing and registering for insurance cover is also extremely simple. We also ensure that the flow of information is in no way impeded. 12

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14 Vanbreda at a glance 40 years of experience in providing consulting and management services in the field of employee benefits in cooperation with international organisations and enterprises for 40 years Business activities in more than 192 countries Services for more than 375,000 people living abroad Processing of more than 4.0 million invoices for medical services per year Reimbursement of medical costs totalling EUR 490 million per year Online access for the partner to the respective portfolio (in accordance with the provisions of data protection law) Online contract management (new contracts, changes, cancellations) Claims processing certified in accordance with ISO 9001:2000, i.e.: - 75% of all claims are processed within 5 business days - Cost reimbursement assurances within 48 hours - Agreement to assume costs in the event of an emergency within 2 hours - Response to s within 3 days - Max. 1% error rate in the payment of benefits - 24/7/365 service provided by in-house multilingual staff Translation service for uncommon languages via conference line Internet pages in multiple languages for insured persons (protected area) Online invoices with reimbursement forms (in accordance with the provisions of data protection law) Insurance card valid worldwide Direct payment agreements with hospitals in the event of inpatient treatment Preferential agreements with more than 10,000 medical facilities and physicians in 192 countries Online access to this network with detailed information In the USA, partnerships with so-called Preferred Provider Organisations (PPOs) Cooperation with all major assistance companies Intermeshed coordination in the event of hospitalisation Competitive advantages through effective claims processing and cost management 14

15 Absolutely simple and convenient contract management Insurance of employees and their family members abroad in accordance with the tariffs central.world or central.world50 is based on a group insurance contract between Central and a company. In this contract it is also agreed that the registration, management and administration of the individual employee insurance policies are realised by Vanbreda International. The employer (with the approval of the employee!) registers the persons to be insured with Vanbreda International via a dedicated and specially protected Internet access. Cancellations and contract changes can also be applied for via the same channel. There is no need for time-consuming written processing. Via the uncomplicated online management of the group contract, the employer can see at any time which employees are currently insured. In this context, it is ensured that the provisions of data protection law are complied with in every respect. Collection of the insurance contributions is also handled by Vanbreda, either via direct debit or invoicing. The staff of our group insurance contract partner receive their insurance confirmations from Vanbreda International. Benefits claims are also submitted to Vanbreda International. Vanbreda International is also the partner in every respect for the clarification of any questions pertaining to your insurance and provides a multilingual customer service to this end. However, the individual employees can also access their data at any time via a protected Internet access. This allows an employee, for example, to check the status of the processing of a claim that he has submitted. International customer service Vanbreda International also provides access to an extensive database of medical service providers all over the world and assists the insured person in all questions regarding their insurance cover. Specialists with profound knowledge of local particulars and billing and reimbursement practices are available to provide information at all times. The long-term international experience of our partner Vanbreda International guarantees the best possible support support that would simply not be possible at this level of quality in the case of contract management focussed on insurance claims in Germany. 15

16 Your contact partner: Central Krankenversicherung AG Hansaring Köln Germany Phone: +49 (0) Fax: +49 (0) GR