Selection criteria for a complementary health scheme

In the first article about our health insurance system, we introduced the limitations of JSIS cover and the difference between complementary health schemes which usually cover either “hospitalisation only” or “hospitalisation and other medical expenses”.

In the second article of the series we will address the criteria to take into account when choosing such a complementary health scheme.

Whichever type you choose, you should be aware that most complementary schemes follow the JSIS rules on repatriation, which means that they will not reimburse the costs of a potential repatriation. If you need this cover, you should pay attention that either your complementary insurance covers the costs or that your credit card contract includes it (many do). In any case, be careful to check the precise conditions.

Apart from a possible repatriation, there are many more criteria to consider when choosing a health insurance. First, do you need one at all? Article 72(3) of the staff regulations limits the financial risk of non-reimbursed expenditure to half of one month’s basic salary or pension in any given twelve months period. A special reimbursement would then be possible, depending on the family composition. However, this does not tackle the issue of reimbursement ceilings and possible exclusions. Therefore, the financial risk could be greater than just one half of your monthly basic salary or pension.

There are more points to consider:

  • Collective or individual insurance

A “collective insurance” (or framework contract) is negotiated by an association for its members. In our case, AFILIATYS and AIACE should be named. As the association has more negotiation power vis-à-vis the insurance company, they might get better conditions. On the other hand, an individual contract is between you and the insurance company. While in theory this should allow you to get a contract tailored to your needs, practice has shown that the insurance company makes only a limited number of concessions. Individual contracts are usually annual contracts with a tacit renewal, whereas collective insurances tend to have updated contract terms after longer periods of time, e.g. five years.

  • “Hospitalisation only” or “Hospitalisation and other medical expenses”

As already mentioned in our first article, the difference in cost here is significant. A policy that covers only hospitalisation or major risks has an annual premium in the order of 70-300 EUR/year, depending on age. On the other hand, an insurance that in addition covers also normal medical visits, dental costs, eye treatment etc. can cost between 1400-2200 EUR/year, depending on the covered treatments and the age).

  • Financial type of cover: fixed percentage or the rest

Again, there are mainly two types of insurance policies: one type simply covers 15% or 20% of the total cost and expects that JSIS covers 80% or 85% of the medical bill. Together, the beneficiary has a 100% cover. However, if JSIS limits its reimbursement to a lower level (say 70% due to ceilings), than the insurance would still pay only 20% and the beneficiary would need to pay the remaining share of 10%.

The other type of insurance reimburses everything that JSIS does not cover, to reach a 100% reimbursement. In the above case, the insurance would pay 30% of the medical bill.

  • Insurance for life or shorter

It is essential to have a cover for life! Most medical expenses occur late in life. An insurance that ends at (say) the age of 80 will force you to search for a new cover when you need it most and when the new policy will be extremely expensive due to your age. In addition, you should check that you could maintain the insurance when you leave the Institutions for any reasons.

In the next article, we will present some of the available options for complementary health insurance by outside providers. Of course, if you have any questions, please contact us!

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