• WHO IS COVERED?
• WHEN AND WHERE?
• INTERRUPTION OF SERVICE
• CONTRIBUTIONS
• IF YOU ARE INSURED ELSEWHERE:
• BENEFITS
• CLAIMS FOR REIMBURSEMENT
• REIMBURSEMENT
• ROUTINE ENQUIRIES
• IF YOU ARE NOT SATISFIED

INTRODUCTION:

This guide is intended to explain the functioning of the Staff Health Insurance Fund (SHIF) at both the ILO and the ITU.  This guide also provides answers to questions that arise frequently.  However, this guide should not be regarded as an authoritative interpretation of the Regulations of the Fund. 
Back to Top

WHO IS COVERED ?

a) People considered as “compulsorily insured:”

 i) all staff members employed at the headquarters of the ILO  or the ITU, holding a contract and bringing their continuous*  service to at least six months, other than part-time cleaning  staff;

 ii) professionals and general service officials, local and non- local, serving at external offices of the ILO or the ITU;       and bringing their continuous service to a least six months.*

 iii) all officials appointed to field projects, holding a   contract and bringing their continuous service to at least six  months;*

 iv) officials of the International Training Centre of the ILO  in Turin, holding a contract and bringing their continuous   service to at least six months.*

*: An interruption of less than 60 days does not break the continuity.

 N.B: Short-Term officials are not affiliated to the SHIF and they contribute to the Illness/Accident Insurance available to Short-Term Officials at the rate of 0.73% of their salaries.  These officials are entitled to the reimbursement of certain medical expenses up to a specified maximum. 

Note: There are a few exceptions to a compulsory insurance - see Article 1.2 of the Regulations.

b) People considered as “automatically insured;”

 The spouse and children of a person insured are covered automatically in the following cases:
-   if the family allowance is paid in their respect under   the Staff Regulations of the ILO or ITU;
-   if the staff assessment is applied to the salary of the   insured person, at the family rate, by reason of the    spouse or children in question.

N.B: (For more information, please refer to Article 1.5 of the Regulations and Article 1.5.1 of the Administrative Rules).

c) People considered as “voluntarily insured:”

 i) officials on leave without pay (or with partial salary -   eg. study leave);

 ii) officials on secondment to other international                   organizations.

 iii) officials whose service has ceased, for a maximum   period of six months;

 iv) former officials:
-   who have reached the age of 55 upon cessation of  service and have had at least 10 years of service  with the United Nations system (the last  five years have to be spent in the ILO or the ITU);
-   who are receiving a disability pension from the       United Nations Joint Staff Pension Fund (UNJSPF)   or other ILO/ITU pension scheme;

 v) surviving dependants of an official who has deceased   during his/her service or retirement;

 vi) the insured person’s (who do not qualify as            automatically-covered dependants): 
-   spouse; 
-   children who are under 30 years of age, unmarried   and not in regular full- time employment;
-   parents and parents-in-law.

 N.B: To apply for voluntary insurance contact the Secretariat after having consulted Article 1.3 and 1.6 of the Regulations.

Back to Top

WHEN AND WHERE?

A protected person is covered at all times and in all countries:
-  when at duty station;
-  when on official mission;
-  when on leave.

The only exception to this relates to periods of military service when the coverage is suspended (Article 2.4 of the Regulations). Back to Top

INTERRUPTION OF SERVICE

When an insured person is readmitted to the Fund, after any interruption of the period of protection, s/he will be treated as a first admission. 
S/He may opt for voluntary insurance  to cover expenditure during the first six months of any break.  S/He should state the period for which such voluntary insurance is required. 
If the person takes a break of less than 60 days, in the period of protection by the Fund, s/he should not be regarded as interrupting their service.

N.B: For exceptions see Article 5.1 of the Regulations.
Back to Top

CONTRIBUTIONS

Premiums are calculated on the basis of your net salary and regular monthly allowances.

What do I pay?

a) If you are a “compulsorily insured” official, you will be assessed on the basis of your remuneration (refer to Article 3.2 of the Regulations for specifications of this term).

b) Officials on leave without a salary who are voluntary insured will have their contributions assessed on the basis of their last remuneration.

c) Former officials who are “voluntarily insured” should be assessed on whichever is the highest amount between:

 i)  The pension (refer to Article 3.3 of the Regulations for       specifications of this term).

 ii) The pension which the official would have received if s/he  had contributed during 25 years to the applicable pension  scheme (for exceptions see Article 3.3 ).

d) “Voluntarily protected” dependants will be assessed at a flat rate (which is determined by the Management Committee).

For the exact rates of contributions under each separate categories; refer to Article 3.3 of the Regulations.

How do I pay?

a) If you are receiving remuneration from the ILO or the ITU your contributions will be deducted automatically from your salary.

b) Contributions in respect of the six month period after cessation of service (if you have chosen to stay insured) are due in advance, for the whole period of protection chosen.

c) Contributions from all other voluntarily insured persons are due quarterly and in advance.

d) If you receive a pension from the UNCCPP your contributions will automatically be deducted from your pension.
  Back to Top

IF YOU ARE INSURED ELSEWHERE:

You should:

a)  inform the Fund of the name of the scheme or service concerned;

b) supply details of benefits already received, or expected, to determine the expenditure of the claim from the Fund. 
In no case can the reimbursements exceed the expenses incurred by the insured person.
(Refer to Article 2.7 of the Regulations).
Back to Top

BENEFITS:

A free choice
You can choose your medical practitioner (refer to the Regulations for specifications on this term) and pharmacist, as well as your hospital, clinic or other medical establishment.
SHIF has agreements with health care providers. For more information, please refer to SHIF Secretariat.

Ordinary benefits
Ordinary benefits are generally at the rate of 80% of the expenditure (refer to the conditions set out in the Schedule of Benefits, in Annex I of the Regulations).

They are payable on submission of evidence that your medical expenses have been paid (eg. receipted bills). 
Advances may be acquired in exceptional cases. This is provided for hospitalisation outside of Switzerland, by presenting a “pro-forma invoice.”
When are my expenses not reimbursed?
Expenses excluded are those for, or due to:

 i)  self-inflicted injury or illness;

 ii) medical care arising from military service;

 iii) medical care incidental to surgery for aesthetic purposes;

 iv) medical care considered by the Medical Adviser to be useless, unnecessary or medically unsuitable;

 v) when the protected person fails to comply with the  medical practitioner’s advices;

 vi) medical reports issued to administrative bodies.

N.B:  The Management Committee can reduce expenses which the reimbursement is claimed to be excessive, and which otherwise should be payable under these Regulations.  (Article 2.4.2)

Supplementary benefits

 i) where the total approved expenses of an insured person and  his dependants are in excess of $10,000  ($3,000 for the personnel working, locally in the “Field”) in any calendar year, supplementary benefit should be paid at the rate of 15% of the  exceeded amount of this ceiling.

 ii) no supplementary benefit shall be paid in respect of  expenses for stays in an institution which are reimbursed at 100%.

Maximum liability
The fund is not responsible for paying benefits in respect of approved expenses exceeding the amount specified by SHIF, in any calendar year, for an insured person and his dependants protected by the Fund.  (Article 2.6) 
This amount is actually fixed to US$ 150,000.

Third party liability
In any case of illness or accident of a protected person, SHIF should be informed immediately.
In addition, the protected person has to approach the insurance of the third party.
If the protected person gets her/his compensation from the third party in respect of illness or accident, s/he should reimburse the Fund all or part of any benefits that have been paid if the Fund gave an advance for the reimbursement of the expenses.  (Article 2.8)

Employment injury
In the event of illness or accident attributable  to the performance of the official duties, medical expenses are payable by the Organization. 

Forfeiture and suspension of benefits
The Management Committee can decide whether your benefits are forfeited or suspended in whole or in part. This might occur if:
-  you do not comply with the provisions of the Regulations of the Fund and/or the Administrative  Rules;
-   you attempt to gain benefits by fraud;
-   you refuse to undergo a medical examination;
-   you fail to pay the contributions due.

Schedule of Benefits
The full Schedule of Benefits is laid out in Appendix I of the SHIF Regulations, as well as at the end of this guide.  Certain elements of this Schedule are subject to modification from time to time, in the light of changes in exchange rates, evolution of medical treatments, in addition to the general financial situation of the Fund.  The section which concludes this Guide indicates the benefits currently in force for each category of medical care since January 2001.  You should consult the amended Schedule of Benefits in the Regulations, as well as on Intranet or Internet (at http://www...), to ensure that you have the latest information at any given point in the future.
Back to Top

CLAIMS FOR REIMBURSEMENT:

 i) Benefits are normally paid to the insured person;

 ii) Benefits become payable when you have submitted   evidence that the expenses given rise to reimbursement  have been paid;

 iii) Time limit
You will not be entitled to receive benefits, if one of  following three conditions is not respected:
-   21 months after the date the bill was made out (*),   or;
-   27 months after completion of the related treatment   (*), or; 
-   9 months after you have left the Fund (*).

 iv) How to submit a claim?
You should complete the “Claim for Reimbursement” form (ILO 937) and return the yellow and the original copy to the Staff Health Insurance Fund (the third white copy is for your records), together with the original bills, prescriptions and receipts.  Please translate bills which are in languages other than English, French or Spanish.

(*) - The allotted time foreseen in the Regulations (Article 2.10) have been extended by the Management Committee.
Back to Top

REIMBURSEMENT:

When? As soon as possible after submission of your claim.

How?  You will receive a Reimbursement Advice, giving details of the benefit paid.
All the amounts, are given in US Dollars. 

Where? Payments will be made to your chosen bank account. 
If you are on the staff of an external office, you will   be paid through that office.

Currency? Benefits are generally paid in the currency of your duty station. 
Back to Top

ROUTINE ENQUIRIES:

The Staff Health Insurance Fund, the Pensions and Insurance Section at the ITU will be pleased to help you with any enquiry on health insurance matters which is not covered in this Guide.  It would be appreciated if members would confine such enquiries to the afternoon, between 2:00 and 4:00p.m (at the reception desk of the ILO).  Any official at the Headquarters, in the field, or from the Turin centre may request advice in writing, e-mail or fax.
Back to Top

IF YOU ARE NOT SATISFIED:

If you wish to clarify a reimbursement made, please do not hesitate to ask.  If you think your case deserves the attention of the Management Committee, you should ask SHIF secretary to submit it under the so-called “special case procedure.” (Article 4.12.3)
If there is a disagreement, you may appeal in accordance with Article 5.3 of the Regulations.

 Back to Top