Taking out supplementary insurance: why it might be a good idea?
The U4U offer
The JSIS provides effective protection for civil servants/agents and dependants, both on a primary or complementary basis. However, the existence of several ceilings of reimbursements or exclusions means that you may need supplementary insurance covering, in particular, hospitalisation costs and/or the costs of current medicine, dental and optical care.
Moreover, did you know that while the official/agent is well covered for accidents by the JSIS, this is not the case for pensioners or beneficiaries, even on a primary basis? In the event of an accident for either of them (pensioners or dependants), the costs remain covered at 80-85% but no additional reimbursement for accidents will be paid. Your child or your spouse insured with JSIS on a primary basis is injured while skiing: if there is no other alternative, the transport from the slopes by helicopter to the nearest hospital (real case scenario), emergency transport, will be covered at 85% by the JSIS. Yours will be covered at 100% (85% + 15% for the Accident supplement). Repatriation to your country of origin is not covered in any case.
Or are you aware that in Belgium, in case of a hospitalisation, the JSIS covers 85% of the costs of the stay on the basis of the cheapest single room in the hospital? Yet at the moment many surgeons/doctors ask to work in a single room only in order to charge a supplement… At the moment this supplement can be up to 300% of the RIZIV price (i.e. 4 times the price). Even if this supplement is limited to a maximum of 200% in hospitals with which the JSIS has signed an agreement, the amounts left to be paid by the insured can quickly become very high.
It is also important to remember that, in virtue of Article 20 of the JSIS Common Regulations and in accordance with the General Implementing Provisions (GIP), “where no ceiling for reimbursement is set, including in the case of serious illness, the part of the costs which significantly exceeds the average prices charged in the country where the services were provided may be excluded from reimbursement”. Here again, the amounts can quickly become significant if one wishes to benefit, given the prices charged sometimes.
When it comes to medical reimbursements, however, as in the case of health, to prevent is often better than to cure.
As staff representatives, U4U considers that its role is also to alert colleagues to this situation.
Consequently, we have developed an agreement with Allianz, which through our joint partner Afiliatys offers supplementary health insurance.
How it works: the main principles?
Three options are available with Allianz Care:
- “Hospi Safe Plus”, which covers hospitalisation, routine medical and dental care and optical care under certain conditions
- “Hospi Safe Sickness & Accident, which is the new name of the former Hospi Safe, and covers the costs of hospitalisation due to illness or accident (and childbirth)
- “Hospi Safe Sickness”, which offers the same coverage as “Hospi Safe Sickness & Accident”, except for accident benefits. This plan is suitable for working people (100% accident cover under JSIS) Note that it is possible to choose a different formula for each member of your family.
Example: In the case of a European civil servant married to a woman who does not work in the Institutions and who has a 6 year old child who needs orthodontic treatment, we would advise him to subscribe to Hospi Safe Maladie for himself, to Hospi Safe Sickness & Accident for his wife and to Hospi Safe Plus for his child.
Hospi Safe Illness and Accident
Insurer: Allianz Care / Afiliatys
Master Policy Signatory: U4U
Features
Please note that this is a summary, only the contract is binding.
- Group insurance. Must be taken out before retirement. Lifetime insurance.
- No medical questionnaire unless 6 months before retirement.
- Moratorium of two years for diseases diagnosed before the subscription.
- Hospitalization, surgery and related ambulatory care 2 months before / 6 months after. (including day hospitalization).
- Reimbursement of 100% of the difference between the costs incurred and the RCAM reimbursement. Valid for day hospitalization.
- No ceiling – but 20% for revalidations.
- Beware of RCAM exclusions.
- Covers hospital care in case of accident (for pensioners, spouses, …).
- Fully covers any problem during pregnancy.
- Can continue for contractual employees after their contract.
- Worldwide coverage but limited outside EEA.
- Premium depending on age (€, taxes included). 10 year framework contract.
- Stable premium except Eurostat index (€, including taxes).
Annual premium 2022 in EUR
- 0-1 year (gratuit)
- 2-18 year (73,93€)
- 19-35 year (88,69€)
- 36-50 year (133,01€)
- 51-60 year (177,38€)
- 61+ year (248,34€)
Hospi Safe Plus
Please note that this is a summary, only the contract is binding.
Group insurance. Apply before retirement. Lifetime insurance
No medical questionnaire (unless 6 months before retirement)
Two-year moratorium for illnesses diagnosed prior to purchase
Same as Hospi Safe (100% for hospitalization) but more:
- Reimbursement of 80% of the difference between the expenses and the RCAM reimbursement
- For medical consultations (general practitioner and specialists) and for medicines (annual deductible and ceiling) – Laboratory tests, medical imaging, …
- For outpatient treatment Article 8.2 and others (max. 20%)
- For optical and dental care (700 € 1st year to 3.200€ after 4 years)
- Additional reimbursement of care in case of accident
- Contribution to diet cures, fitness subscriptions (20%)
- Worldwide coverage but limited outside the EEA
- Premiums (€, including taxes) paid per quarter
- 10 year framework contract. Stable premiums except Eurostat index
Annual premium 2022 in EUR :
- 0-1 year (free)
- 2-18 years (536,63€)
- 19-35 years (656,20€)
- 36-50 years (982,67€)
- 51-60 years (1311,43€)
- 61+ (1823,39€)
How do I sign up for this contract?
You must be a member of U4U in good standing.
The subscriber will become a member of Afiliatys for free.
Fill in this form (at this stage, you are not yet making any commitment):
You will then be contacted directly by Afiliatys / the insurer for the contractual formalities.