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CHIS benefits changes as of 1 st January 2012 Jean-Pol MATHEYS Presentation based on Ph. CHARPENTIER’s CHIS benefits as of January 2012 1
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CHIS benefits as of January 2012 1
CHIS benefits changesas of 1st January 2012
Jean-Pol MATHEYS
Presentation based on Ph. CHARPENTIER’s
CHIS benefits as of January 2012 2
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 3
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 4
Why change the CHIS benefits ? 2010 5YR outcome:
Increase contribution rates (2011-2015)
Keep level of benefits (they are comparable to comparators’)
Allow Director-General to “take measures to limit the increase of CHIS expenses, by encouraging use of health care providers/treatments with best quality-to-cost ratio.” <<< This is main reason why
Simplify some rules, adapt to new techniques (provided they do not increase CHIS costs) <<< This is also why
CHIS benefits as of January 2012 5
Principles for the changes Keep current level of benefits (our system is
comparable in terms of benefits with that in other IOs) Give benefits to all members (even if spending
little) Better protect members with high expenses
Review some benefits in order to make their understanding (by members) and handling (by
contractor) easier
Adapt to new health care conditions (costs varied in recent years)
CHIS benefits as of January 2012 6
New CHIS Rules: 1st January 2012 Available on the web at cern.ch/chis
Note: Reimbursement of 2011 expenses will still follow the 2011 rules (throughout 2012)
Note: Your feedback on web site is most welcome
Members received a personal information letter, a CHIS Bull’ with detailed article
CHIS benefits as of January 2012 7
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 8
New Reimbursement Rate Reasoning Reimburse from the first CHF spent onwards Above given amount reimburse fully Maintain overall cost to CHIS and individuals
>>> New General rule of reimbursement:
80% up to a certain threshold, then 90% up to a second threshold, then 100%
threshold expressed in Frais à la Charge de l’Assuré (500 CHF & 3000 CHF – yearly & individual thresholds)
CHIS benefits as of January 2012 9
Frais à la Charge de l’Assuré ???
Not zero
Maximum amount paid by person
Curve adjusted so overall costs are kept the same
CHIS benefits as of January 2012 10
Reimbursement Rate vs. FCA
CHIS benefits as of January 2012 11
Reimbursement Rate vs.
ExpenditureInstantaneous (CHF by CHF) Total Previous
CHIS benefits as of January 2012 12
Reimbursement Rate vs. ExpenditureOverall Total
CHIS benefits as of January 2012 13
Reimbursement Rate - Examples
CHIS benefits as of January 2012 14
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 15
Hospitalisation changes: reasons(Semi-)private sections of public hospitals cost more !
Evolution of Swiss public hospitals: Include more (semi-)private sections Attracts more practitioners
Free choice of practitioner for the patient … but this has a cost
Example: HUG costs now similar to private hospitals’
In France: “dépassement d’honoraires”
CHIS benefits as of January 2012 16
Hospitalisation: new rules Public sections of public hospitals:
100% as before (Semi-)private sections of public hospitals or
approved private hospitals:Reimbursed following the General Rule (80-90-100%)No longer limited to 2000 CHF borne to the member
Replaced by the 100% rate for FCA above 3000 CHF Non-approved hospitals:
80% reimbursement rate, whatever the amount (!) and not used for cumulating FCAs
Direct payment by UNIQA (“tiers-payant”)Only for public or approved private hospitals (as now)
CHIS benefits as of January 2012 17
Hospitalisation new rules
CHIS benefits as of January 2012 18
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 19
Ceilings Ceilings used to be expressed in reimbursed
amounts No longer possible with the variable rate … Ceilings now expressed in maximum expenses
Previous ceilings have been divided by 0.9 … and rounded up!
Ceilings expressed per calendar yearPro-rata the duration of the contract
Some “unused” parts of the ceilings may be carried over to subsequent year(s)Moving 3-year window
CHIS benefits as of January 2012 20
Other modified rules Optical care:
Single ceiling: 500 CHF per annum with 3 year carry-over (i.e. 1500 CHF in 3 years) Suppress change of diopters and ceiling for
frames Suppress special ceiling for contact lenses
Refractive surgery (ceiling 2000 CHF per eye, once in a lifetime)
Dental care: Ceiling with 3 year carry-over : 3000 CHF
per annum Prevention: 100% reimbursed
Mammography, hemoculture (colon cancer screening), papilloma-virus vaccination
CHIS benefits as of January 2012 21
Incentive measures Many calls to use less expensive health care providers
Quite a few of you changed your habits, thank you! However: 69% of members live in France and 64% of outpatient
expenses are in Switzerland ! This means many residents in France still go to doctors, buy their
drugs or make blood tests, X-rays etc, in Switzerland 5% extra reimbursement rate (i.e. 85%/95%) for out-patient
expenses in selected Member States Concerns: doctors, drugs, lab tests, imagery, and more
generally most out-patient expenses (see details in the rules) Countries selection based on the OECD report on health costs All member states but Switzerland, Norway and Denmark
The list will be reviewed every year In the future similar incentive measures could be granted to
other health care providers, if it helps keeping costs under control
CHIS benefits as of January 2012 22
On our plate today Context of changes (why, principles, when)
New reimbursement rates and FCAs
New reimbursement policy for hospitalizations
Other changes (ceilings, incentives …)
Conclusion
CHIS benefits as of January 2012 23
Conclusions Maintain same overall benefits Continue protecting (even more) members
with high expenses “Fix” hospitalisation in view of new situation Simplify some rules and adapt to new practice
(e.g. optical care and prevention) Encourage strongly usingless expensive
health care providers … and, last but not least:
Continue to negotiate best tariffs with health care providers (all renewed except “Les Grangettes”)
CHIS benefits as of January 2012 24
Thanks !
CHIS benefits as of January 2012 26
Today’s reimbursement rate Deductible
First 200 CHF per year not reimbursed This means: up to 222 CHF expenses,
reimbursement rate is zero, raises to 80% for 2000 CHF expenses
Reimbursement rateGeneral rule: 90% – deductible Cost borne by the member in an approved
hospital limited to 2000 CHFSome benefits have ceilings (e.g. dental care)100% for a given case if outpatient expenses
(cumulated for the given case) > ~ 80,000 CH
CHIS benefits as of January 2012 27
Hospitalisation today Public hospital
100% in all classes (public, semi-private, private)
Extra cost for single room not reimbursed Approved hospital
90% (-deductible) with a limit of 2,000 CHF borne to the member
Direct payment by the contractor (UNIQA) Non-Approved hospital
90% (-deductible) but no limit The member must advance the payments
Still possibility to obtain an advanced reimbursement…[email protected]
CHIS benefits as of January 2012 29
Special (selected) health care cases today Dental care:
Normal rate but reimbursement ceiling 2,928 CHF per year No carry over
Optical care:Subject to change of dioptres (0.25)
Almost imperceptible change…Glasses: 90% without ceilingFrames: 76 CHF per year, carry-over over 3
yearsDisposable lenses: 500 CHF/year, no carry-over
