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CERN Health Insurance Scheme (CHIS): new Rules as of 1 April 2020

The new Rules of the CERN Health Insurance Scheme (CHIS) will come into force on 1 April 2020.

The main changes are as follows (the corresponding articles of the Rules are indicated in square brackets):

Change affecting the membership of post-compulsory members:

Individuals applying for post-compulsory membership must check that this membership is compatible with their legal obligations in the country in which they live or work [III 2.02 al. 2].

Change affecting the continuation of the membership of voluntary members:

As of 1 April, members will be able to continue their voluntary membership provided that they hold a valid contract of association with CERN (as well as a carte de légitimation – current requirement) [III 3.02].

Changes affecting subsidiary members:

  • Subsidiary members who no longer meet the conditions to be recognised as family members of the main member concerned will now remain members until the final day of the month following that during which the Organization takes the corresponding decision [IV 1.01 bis]. For example, if the Organization decides retroactively on 13 November 2020 that a child has not been dependent since 28 June 2020 (the precise nature of their education having been established only at the beginning of November 2020), the child will remain a subsidiary member of the CHIS until 31 December 2020.
  • In order to be recognised as adequate, spouses’ health insurance must cover them for the duration of their residence in the relevant country [IV 1.03]. This was already standard practice.
  • Supplementary contributions are due even if spouses do not use the CHIS as their primary insurance scheme [IV 1.05]. This was already standard practice.

Change in family declarations:

  • In the event of a late declaration of a change in family composition, payment of contributions in arrears may not be required if circumstances beyond the control of the main member concerned are recognised [IV 2.01 bis].

Changes concerning reimbursement claims:

  • The deadline for submitting a reimbursement claim in the event of the main member’s death has been extended by 180 calendar days [VI 1.01].
  • The authenticity of documents submitted (including the amounts) and the settlement of the corresponding payments will now be attested to simply by the signature of the paper reimbursement claim or its electronic submission by the member concerned. In addition, members must keep the original documents for two years. This is in line with the practice of other insurance schemes that have introduced the possibility of submitting electronic documents [VI 1.01 bis and VI 1.02].
  • Invoices will now be required to include the same level of detail concerning treatments as is usually required in the country where the treatment was dispensed [VI 1.03]. However, the third-party administrator will still be able to request additional information from the healthcare provider (see Article VI 2.01).

CERN Health Insurance Scheme