Van Breda Insurance Scheme

Medical and Accident Insurance Scheme for Researchers and Postdoctoral Fellows (POLICY No. 10.002.761. Code 909187 - VANBREDA International, Antwerp, B-2140 Belgium) (as of 1 September 2009)

Researchers and fellows and their accompanying dependants must have medical insurance for the duration of their stay at the Institute. The EUI offers an insurance scheme for this purpose, the main details below.

• The insurance cover is worldwide
• The monthly premium is €41,81 per adult (*), €20,91 per child (*)

(*) The premium may be covered by a grant-awarding authority: see notes at the end of this document. 

The following will be reimbursed subject to presentation of ORIGINAL RECEIPTED bills. N.B. there are ceiling limits in many cases, please read the clauses carefully.

 

Rules on the Rebimursement of Medical Expenses

The following reimbursements will take effect as of 1 September 2008 and are not retroactive.

Medical expenses incurred by the insured for himself and those insured under him are reimbursed subject to the limits and conditions hereinafter specified, on the understanding that these limits are absolute maxima.

 

I Surgery Visits and Home Calls

Fees for surgery visits and home calls are reimbursed at the rate of 80%, subject to the following maximum limits.

 

General practitioners:

• Surgery visit €45.00
• Home call €45.00
• Calls at night, Sundays, public holidays, emergency calls, as defined by local custom, and where justified €60.00

Specialists

• Surgery visit €65.00
• Home call (where justified) €65.00
• Calls at night, Sundays, public holidays, emergency calls, as defined by local custom, and where justified €85.00

Remarks

Where doctors are authorized to make charges, in addition to their fees, for the distance they have to travel to patients' homes, or where a person covered by this scheme is obliged to call on a doctor living outside his place of employment or residence or the place where he is staying, the travelling expenses shall be reimbursed up to 80% of the expenses incurred, the limit being 20 km for the return journey.

Medical certificates are reimbursed at a rate of 80%.

 

II Surgical Operations

These expenses are reimbursed at the rate of 100%, the maximum reimbursement for each operation, after the opinion of the company's medical advisor has been secured, being:

• Category AA €297,50
• Category AB €594,95
• Category B €2.082,35
• Category C €3.183,00
• Category D €4.239,35

Annex 2 (in the Insurance Handbook) contains a classified list of surgical operations, by category.

Any surgical operation not mentioned in this list shall be treated in the same way as operations listed which, in the opinion of the medical officer of the company, are of a comparable nature.

Surgical expenses shall include only the surgeon's fees. It is immaterial whether the surgical operation is carried out at the doctor's consulting room or requires a stay in hospital of at least one night.

Eighty percent of the expenses incurred for anaesthesia, the use of the operating theatre or plaster room, dressings and other expenses in respect of any general care pertaining to surgical operations listed in Categories AA, AB, B, C, and D shall be reimbursed up to the limit specified for each item.

The expenses for anaesthesia are, however, included in the maximum reimbursement for Categories AA and AB.

 

III Hospitalization

The costs of a stay in clinic or hospital shall, in the case of a surgical operation or medical treatment, be reimbursed at the rate of 100%, subject to a maximum limit of €163.60 per day.

The costs of a stay covers the costs of board, service and care. The surgical operation expenses, as specified in Section 2, the expenses incurred for the use of the operating theatre, plaster room, dressings and other expenses in respect of any general care pertaining to the surgical operation, medical fees for visits and calls, laboratory analyses and tests, X-rays, medicines and other diagnostic or therapeutic services shall be reimbursed separately, in conformity with the provisions for the reimbursement of each of these categories of expenses.

If at a hospital centre the all-in charge for a day in hospital comprises the cost of the stay as defined in the first sentence and all or part of the expenses listed above, reimbursement is 100%.

 

IV Special Cases

Special cases relating to a very serious surgical operation or hospitalization for the treatment of a serious or protracted illness may be the object of a special decision by the company on the basis of an opinion drawn up by their medical officer.

In this case, the actual costs incurred shall be reimbursed at the rate of 100% without taking into account the maximum reimbursable sum.

 

V Pharmeceutical Products Prescribed by a Doctor

The cost of pharmaceutical products prescribed by a doctora is reimbursed at the rate of 80%. Where products are prescribed on a 'repeat' basis and obtained within six months of the date of issue of the prescription, reimbursement is 80%.

Mineral water, tonic wine and beverages, infant food, hair care products, cosmetics, dietetics, irrigators, syringes, thermometers and similar instruments are excluded.

 

VI Dental Treatment

The cost of dental treatment is covered at 70% up to a ceiling of €1,000.00 per person insured. Orthodontic treatment is not covered.

 

VII Radiology, analyses, laboratory tests and other forms of diagnosis

Expenses are reimbursed at the rate of 80%

 

VIII Confinements for Childbirth

In the case of normal confinements, the fees for the doctor and midwife and for anaesthesia shall be reimbursed at the rate of 80% subject to a maximum limit of €654.45.

Fees for a labour room and a physiotherapist and all other expenses relating to services directly connected with the confinement are reimbursed separately at the rate of 80%.

For a twin birth, the maximum reimbursement is €1047.15.

For a difficult confinement requiring special obstetrical treatment or surgical operation or prolonged stay in hospital for postpartum ailments, the costs referred to above are reimbursed after the insurers' medical officer has been consulted, where necessary, at up to 80% in accordance with the scales for surgical operations, hospital medical treatment and special treatment.

The term 'difficult confinement requiring special obstetrical treatment' covers all confinements which are not in the medical sense normal confinements, including Caesarian birth.

For all confinements, the cost of the stay in a hospital establishment is reimbursed separately at the rate of 80%, subject to a maximum limit of €130.90 per day. (For normal birth, the maximum stay shall be 10 days, except where complications arise).

For home confinements, this scheme reimburses nursing fees for 10 days at the rate of 80%; where complications arise, the period for which reimbursement is made shall be extended.

 

IX Physiotherapy, Kinesitherapy and Similar Treatments; Medical Appliances

1) The costs for the types of treatment mentioned below, prescribed by the practitioner and, for the treatment mentioned under d), by a psychiatrist, neuropsychiatrist or neurologist, are reimbursed at the rate of 80% on condition they are carried out by a professionally-qualified person.

• radio and radium therapy, treatment by X-rays and ultra-violet rays, infra-red rays, ultrasonics, pre-and post-natal gymnastics;
• electro-therapy, hydrotherapy, physiotherapy, medical massage, medical gymnastics (except pre- and post-natal), mechanotherapy, logopaedics, kinesitherapy and similar treatment, on condition they have been authorized beforehand, after the company's medical officer has been consulted;
• acupuncture, chiropractic, osteopathy and medical pedicure, on condition the treatments have been recognized as necessary by the consulting doctor and authorized beforehand by the company;
• psychotherapy and psychoanalysis, carried out under medical supervision.

The costs of this treatment shall be reimbursed at the rate of 80% with a ceiling of €38.65 per session, and with a maximum of 60 sessions per period of 12 months.

2) The cost of appliances for medical treatment shall be reimbursed at the rate of 80% after prior authorization.

 

Remark:

The authorization for treatments under par. IX must be secured before treatment is begun.

If these provisions are not complied with because the person concerned is away from the Institution's headquarters or for duly established reasons outside his control, costs for treatments coming under par.

IX shall be reimbursed only if the treatment is recognized by the company's medical officer as justified by the nature of the disease.

 

X Treatment by Medical Auxiliaries

These services are reimbursed at the rate of 80% on condition they have been prescribed by the practitioner and provided by a person legally authorized to exercise the profession.

 

XI Cures

The subsistence expenses relating to a cure prescribed by the practitioner, recognized as strictly necessary by the company's medical officer and carried out under medical supervision, shall be reimbursed at the rate of 80%, subject to the limits set out below and after prior authorization:

• Convalescence, or post-operation cure, for a maximum of 21 days per annum; the authorization may however be renewed in the case of a relapse or a new illness at €32.70 per day
• Cure at a spa for a maximum period of 21 days per annum at €22.90 per day; the lodging expenses pertaining to such a cure may under no circumstances be regarded as hospitalization fees
• Cure for mentally-retarded children up to the age of 16 and for a maximum of 6 weeks per annum, except in exceptional cases at €32.70 per day

Costs of treatment and medical supervision during the cures shall be reimbursed at the rate of 80% subject to the limits established for each service.

 

Remarks:

Applications for prior authorization for a cure at a watering place must be submitted to the company at least six weeks before the anticipated date of the commencement of the cure.

Applications must be accompanied by a detailed medical report to the medical officer showing the strict necessity for the cure.

Applications for reimbursement of the costs of residence, treatment and medical supervision incurred on a cure must be supported by a medical report, giving details of the treatments followed and the results observed, drawn up at the end of the cure for the medical officer.

 

XII Tuberculosis, Poliomyelitis, Cancer, Mental Illness, Aids

For tubercolosis, poliomyelitis, cancer, mental illnesses, and other illnesses recognized by the company's medical officer as of comparable seriousness, the expenses incurred are reimbursed at the rate of 100%.

Applications recognition should be made to the company, through Van Breda & Co International, accompanied by a report from the practitioner treating the person concerned.

Decisions are taken by the company's medical officer.

 

XIII Prostheses on Medical Prescription

Spectacles:

1. The cost of corrective lenses and of non-corrective tint A (12% coloration) lenses, excluding lenses solely for protection against the sun, shall be reimbursed at the rate of 80% up to a maximum of €178,50.

In the case of renewal, reimbursement at the rate of 80% is allowed only after a period of 12 months from the date of the last purchase, except where a variation in eyesight is medically attested.

2. The frames delivered with lenses coming under point 1. It 1) shall be reimbursed at the rate of 80% up to a maximum of €65,45 per frame.

The cost of repairing frames is reimbursed on the same conditions as apply to the renewal of frames.

The amount reimbursed for repairs is deducted from the maximum reimbursement applicable if a new frame is obtained during the same period.

 

Contact lenses:

Contact lenses are reimbursed at the rate of 80% to a ceiling of €65,45 per pair of contact lenses, where they are justified by defects of vision recognized by the company's medical officer and authorized beforehand on the basis of a detailed report from an ophthalmologist.

In the case of renewal, reimbursement at the rate of 80% is allowed only after a period of 24 months from the date of the last purchase, except where a variation in eyesight is medically attested.

 

Remarks:

Details of renewal are as follows:

• spectacle lenses : 1 year
• spectacle frames : 2 years (1 year for children up to the age of 16)
• contact lenses : 2 years

Artificial Eyes: not reimbursed

Hearing-aids: not reimbursed

Orthopedic appliances, bandages and other prostheses

The cost of acquiring articles listed below which have been prescribed by a doctor, and the cost of repairing articles listed in 3 and 4, are reimbursed at the rate of 80%, after prior authorization granted after possible consultation of the insurers' medical adviser.

• Orthopaedic footwear and soles (2 pairs every 12 months)
• Elastic bandages: elastic stockings for varicose veins (3 pairs every 12 months), others : e.g. maternity belts, knee bandages, ankle supports, lumbar girdles
• Artificial limbs and segments thereof
• Crutches, walking sticks, wheel chairs and similar auxiliary appliances, provided that an estimate has been submitted

XIV Transport Costs and Travelling Expenses

Ambulance costs, for transporting the insured from the place where he fell ill or had an accident to the first hospital where treatment has been given is reimbursed at the rate of 80%

 

XV Funeral Expenses

The allowance for funeral expenses is fixed at €1,636.15

 

XVI Costs of Nursing Home Care by Medical Auxiliaries

Expenditure on post-operative or other indispensable nursing attendance, in addition to the normal hospital service, likewise for a nurse at home engaged on the practitioner's prescription, shall be reimbursed at the rate of 80% upon prior authorization granted after consideration of each special case by the company's medical officer.

However, reimbursements under a) above may not exceed €52,35 for each day or night or €89,00 for each 24-hour period of nursing service, on condition that the person concerned is legally authorized to exercise the profession.

No reimbursement is made for board and lodging for a nurse or other person nursing.

 

XVII Final Observations

Expenses for services not mentioned above may be reimbursed at the rate of 80% after the company's medical officer has been consulted. Maximum limits may, however, be set in each case after the company's medical officer has been consulted.

Expenses for non-functional treatments or those considered to be superfluous or unnecessary by the company's medical officer are reimbursed.

Fees for visits to leading specialists considered necessary by the company's medical officer are reimbursed at the rate of 80% subject to a maximum limit three times the limit set for visits to specialists.

The fee for the first emergency home call made by a leading specialist is reimbursed at the rate of 80%.

Upon prior authorization granted after the company's medical officer has been consulted, fees for subsequent calls are reimbursed at the rate of 80% subject to a maximum limit three times the limit set for home calls by specialists.

Where reimbursement is subject to prior authorization, the insured must send the Company's medical adviser, in a closed envelope, the certificates issued by the practitioner in support of the request.  

To subscribe to the EUI-Van Breda Health Insurance scheme, one of the following forms (to be sent to you by email or available from Academic Service (Francoise Thauvin| - must be signed and handed in to the Academic Service at registration.

 

FORM I

Belgian, British, Irish, Polish, Portuguese, Swedish researchers

Researchers whose health insurance premium is either part of their grant or paid for by the national authority; the premium will be paid by the respective national grant authority through the Institute

 

FORM II

Researchers and postdoc fellows who wish to join the Institute's insurance scheme at their own expense.

The premium is paid half-yearly in advance to the Institute via bank transfer or by cheque.

Subscription to the insurance scheme is from 1 September for one year or from the 1st of each month, for a minimum period of 3 months.

 

FORM III

Researchers and  postdoc fellows who have an alternative form of medical insurance, e.g. Italian national health insurance (A.S.L.), or insurance cover through the European Health Insurance Card (EHIC), one of the following forms: E111, E109, E106 or E128, or through a private health usurance policy.

Those in this category must complete this form. This declaration absolves the Institute of all responsibility for any costs arising from sickness during their stay. The alternative insurance scheme must be mentioned.

Queries about the health insurance policies should be sent to Françoise Thauvin|, Academic Service