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Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
1.	PROFESSIONAL CARE 1
1.1	DOCTOR'S SERVICES 2	80%	Yes
	CONSULTATIONS with a physician (general practitioner or specialist).			Treatment specified in Code 1.7.	Treatment for weight loss will be reimbursed if prescribed by a physician and provided in a recognised institution only for cases of severe obesity (BMI>30) and for severe metabolical disorders. Payment of benefit shall be subject to verification by the Medical Adviser of compliance with the foregoing conditions.
	TREATMENT given by a physician.			Treatment for aesthetic purposes
	VISITS to home or institutions by a physician
1.2	SURGICAL OPERATIONS Including surgeon's and anaesthetic services.	80%	Yes	Plastic surgery undertaken for aesthetic purposes, except for cases resulting from major injury, neoplasm or infection. If surgery is undertaken partially for aesthetic purposes, a corresponding proportion of expenses is excluded from reimbursement; such cases require the prior approval of the Medical Adviser who determines the proportion to be excluded. Surgery for aesthetic purposes is defined as surgery undertaken to improve a bodily disfigurement, which in itself does not cause any danger to life or health or any disability of bodily function.

 
 
 
 

Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
1.3	MEDICAL IMAGERY (X-rays, MRI, CT-scan, mammograms, etc.) Made or prescribed by a physician (or X-rays made or prescribed by a dentist).	80%	Yes
1.4	LABORATORY SERVICES AND OTHER TESTS Made or prescribed by a physician.	80%	Yes
1.5	FUNCTIONAL REHABILITATION TREATMENT Prescribed by a physician and provided by a person authorised in the country concerned to do so.	80%	Yes	Treatment performed by unqualified personnel.	Subject to a maximum and other conditions as prescribed in the Administrative Rules.
1.6	OUT-PATIENT MEDICAL NURSING SERVICES FOR AN ACUTE CONDITION (other than treatment specified in Code 2.6) Prescribed by a physician.	80%	Yes	Non-medical care, such as cleaning, cooking, shopping, family help etc. Care provided by unqualified personnel, except where provided under regular medical supervision.	Subject to a maximum and other conditions as prescribed in the Administrative Rules.
1.7	PSYCHIATRY, PSYCHOANALYSIS OR PSYCHOTHERAPY Consultations with a psychiatrist, and sessions of psychoanalysis or psychotherapy given or prescribed by a physician.	80%	Yes		Subject to a maximum and other conditions as prescribed in the Administrative Rules.

 
 
 
 

Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also  Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
2.	IN-PATIENT AND LONG-TERM CARE			Plastic surgery or other treatment for aesthetic purposes - same conditions as for Code 1.2. Anti-tobacco treatment. Weight-loss treatment, except with prior approval by the Medical Adviser
2.1	STAYS IN A PUBLIC INSTITUTION MAKING A GLOBAL CHARGE FOR ACCOMMODATION AND CARE Stays in a common (public) ward in a public hospital for examination, diagnosis or curative treatment.	100%	No		(i) Common (public) ward means accommodation in rooms with five beds or more, except as provided in the Administrative Rules. (ii) Subject to the condition that the hospital makes a global charge covering all items (accommodation, doctors', surgeons' and anaesthetists' fees, operating theatre charges, medical care, medicines, laboratory etc.). Benefit is limited to 45 days per protected person per calendar year, unless the Medical Adviser certifies that accommodation is still for curative treatment and fixes the number of additional days.

 
 
 
 

Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also  Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
2.2	ACCOMMODATION IN HOSPITAL OR CLINIC (other than in cases falling under Codes 2.1, 2.3 and 2.5) Accommodation in a recognised hospital or clinic for examination, diagnosis or curative treatment.	80%	Yes		Subject to a maximum per day and conditions prescribed in the Administrative Rules.     Benefit is limited to 45 days per protected person per calendar year, unless the Medical Adviser certifies that accommodation is still for curative treatment and fixes the number of additional days.     Distinct conditions, including conditions relating to maximum daily benefit and duration, may be prescribed for accommodation in a hospital or clinic for purposes of psychotherapy.
2.3	CONVALESCENCE/ FOLLOW-UP TREATMENT Accommodation in a hospital or clinic for follow-up care, including cardiovascular re-education, or convalescence after hospitalization under Code 2.1 or 2.2.	80%	Yes	Stays in hotels.	Subject to a maximum per day, as prescribed in the Administrative Rules.  Benefit is limited to 45 days per protected person per calendar year, unless the Medical Adviser certifies the continuing need for convalescence of follow-up treatment and fixes the number of additional days.
Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also  Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
2.4	CURES Stays prescribed by a physician in a nursing home, rest home, thermal or climatic centre, etc., for other convalescence or for cures.	80%	No		Subject to a maximum per day and conditions prescribed in the Administrative Rules.
2.5                                             2.6	LONG-TERM NURSING SERVICES IN AN INSTITUTION Stays in a hospital, nursing or rest home prescribed by a physician (other than for purposes of treatment, examination or diagnosis or for cure or convalescence) primarily for the provision of long term care which cannot be provided at home. LONG-TERM NURSING SERVICES AT HOME     Codes 2.5 and 2.6 are in respect of the provision of care for chronic or non-curative conditions, prescribed by a physician.	80%                                             80%	Yes                                             Yes	Non-medical care, such as cleaning, cooking, shopping, family help etc. Care provided by unqualified personnel, except where provided under regular medical supervision.	Subject to a maximum per day and other conditions, as prescribed in the Administrative Rules.                             Subject to a maximum per month and conditions prescribed in the Administrative Rules.
2.7	MEDICAL CARE IN INSTITUTIONS COVERED BY CODES 2.2, 2.3 and2.4 Subject to all conditions applicable to the item of care under the corresponding code of this Schedule.	80%	Yes
Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also  Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
3.	PRESCRIBED MEDICAMENTS	80%	Yes	(i) Products excluded by the Administrative Rules. (ii) Current home pharmacy and household supplies.	Subject to prescription PRIOR to purchase
	Pharmaceutical supplies, including drugs and dressings prescribed by a physician or dentist.
4.	DENTAL CARE2	80%	Yes		Subject to a maximum and other conditions as prescribed in the Administrative Rules.
	(i) Odonto-stomatological treatment and laboratory charges for dentures (other than X-rays - Code 1.3). (ii) Orthodontic treatment, including apparatus. Benefit in respect of the following treatments shall be paid not under code 4 but under the codes indicated: (a) Maxilo-facial surgery in the event of hospitalization shall be reimbursed under Code 2.2 and 2.7. (b) Maxilo-facial treatments specified in the Administrative Rules shall be reimbursed under Code 1.2.				For  (a) and (b), subject to approval by the Management Committee PRIOR to treatment
5.	MEDICAL APPLIANCES AND PROSTHESES
	(Acquisition, rental and repair)
5.1	OPTICAL APPLIANCES (including contact lenses)	80%	Yes	Sunglasses without correction	Subject to a maximum and other conditions as prescribed in the Administrative Rules.
5.2	HEARING AIDS	80%	Yes		Subject to a maximum as prescribed in the Administrative Rules.
Code	Items of expenditure	Benefits		Expenditure excluded from reimbursement (see also Articles 2.1 and 2.4)	Qualifying conditions
		Ordinary (Art 2.2)	Supplementary (Art. 2.5)
5.3	PROSTHETIC APPLIANCES (except dentures) Prescribed by a physician.	80%	Yes		In case of purchase, subject to approval by the Management Committee following advice from the Medical Adviser.
5.4	WHEELCHAIRS AND SIMILAR EQUIPMENT Prescribed by a physician.	80%	Yes		In case of purchase, subject to approval by the Management Committee following advice from the Medical Adviser.
5.5	OTHER APPLIANCES Prescribed by a physician.	80%	Yes	Cost of acquisition, rental and repair of minor or auxiliary medical appliances (lamps, alarm systems, etc.).	In case of purchase, subject to approval by the Management Committee following advice from the Medical Adviser.
6.	TRANSPORT COSTS
6.1	IN CASE OF EMERGENCY One-way transportation from the place of emergency to nearest place of treatment.	80%	Yes		An "emergency" is defined as a sudden, generally unexpected occurrence or set of circumstances demanding immediate action.
6.2	WHEN HOSPITALIZED Transport from one institution to another when the protected person is hospitalized, including transfer to another institution for convalescence or follow-up treatment.	80%	Yes
6.3	OTHER MEDICAL TRAVEL Travel for the purpose of medical care covered by Codes 1.2, 2.1, 2.2 and 4 of this Schedule, where adequate medical care cannot be obtained in the duty station/area of residence.	80%	Yes	Transport within the area of the duty station/area of residence, as defined in the Administrative Rules.	Subject to prior approval by the Medical Adviser and other conditions, as prescribed in the Administrative Rules.
7.	FUNERAL COSTS (including cremation)	100%	No		Subject to a maximum as prescribed in the Administrative Rules.
Notes: 1 General: All prescriptions for care or medicines must be made prior to the date of the service or the purchase. 2 According to article 2.1.3 of the Regulations, "Medical practitioner shall refer to physicians or dentists who are qualified and licensed to provide the various types of medical services referred to in the Schedule of Benefits in the country in which their professional services are used by a protected person".