Group Medical Scheme for UN/DESA Fellows & Study Tour Participants

A group insurance contract has been signed with J. VAN BREDA and CO. INTERNATIONAL, Plantin and Meratuslei 295, B - 2200 Antwerp, Belgium, for this purpose. The general conditions are indicated below and the medical coverage is indicated in the Annex.

Commencement and Termination of Coverage

The coverage will start on the day of commencement of the award. Coverage is for the entire period of the award up to and including the last day for which stipend or DSA is payable.

Insured Persons

Fellowship holders and study tour participants will be covered by the above medical scheme; dependents are not included in this coverage. To be eligible for this coverage, fellowship holder/study tour participant is required to send to the Training and Fellowships Section, UN/DDSMS, New York, 1) a statement of good health attested to by a duly-qualified physician if his/her tenure is up to one month, 2) an updated medical report and chest X-ray if his/her tenure is more than one month but less than six months, or 3) Medical Form MS22 Entry Medical Examination for Fellowship Candidate (complete exam & chest X-ray) if his/her tenure is over six months.

Submission of Claims

Claims for reimbursement of medical expenses must be submitted on the attached claim form, preferably within three months from the date on which the expenses are first incurred. This form can also be obtained from the Training & Fellowships Section, DESA, New York.

This form is in triplicate: the fellowship holder or participant retains the pink copy, and sends the yellow copy and the top copy to J. VAN BREDA and CO. INTERNATIONAL, Antwerp, Belgium.

Please make sure that your name is clearly written in the same way with each and every claim. The name should be as indicated on the travel/payment instructions.

The claims for reimbursement should be submitted to J. VAN BREDA and CO. INTERNATIONAL directly together with a copy of your travel/payment instructions. Claims will not be reimbursable if submitted more than two years after the date on which the expenses were incurred for the first time during the insurance period.

If fellowship holders or participants are entitled to reimbursement by another Insurer, reimbursement by J. VAN BREDA and CO. INTERNATIONAL will be made as appropriate on the basis of the costs actually incurred and the reimbursement obtained from other sources.

Claims for reimbursement must be accompanied by a statement of the diagnosis and the medical, surgical, pharmaceutical and hospital bills, etc., as well as by any payment slips made out by other Insurers (with details of the amounts reimbursed).

Confidential information may be sent under seal to the Medical Adviser of J. VAN BREDA and CO. INTERNATIONAL, who will provide the claims department only with that information which is essential to the processing of the claim.

In Case of an Accident

The fellowship holder or participant should mention the date, place and circumstances of its occurrence and, if possible, the names and addresses of any witnesses or legal authorities involved.

Settlement of Claims

Claims will normally be settled within two weeks, following the receipt of the written evidence by J. VAN BREDA and CO. INTERNATIONAL, by cheque in US Dollars.

The conversion of medical expenses incurred in currency other than US Dollars will normally be made at the UN?operational rate of exchange in force on the date the claim form is signed.

The United Nations will under no circumstances consider claims rejected by J. VAN BREDA and CO. INTERNATIONAL. Costs related to processing of claims, (e.g., postal charges) are to be borne by the fellowship holder or participant.

Medical Reservations

Neither the United Nations nor VAN BREDA will assume responsibility for medical expenses incurred by a fellow as participant in respect to medical conditions for which the Medical Service of the United Nations has made a medical reservation. The fellow or participant as well as VAN BREDA will be informed of the nature of the medical reservation by the Medical Service of the United Nations.

Death and Disability Insurance Coverage

As part of the Fellowships Global Insurance Policy for United Nations Fellows and Study Tour Participants which has been negotiated by IAPSU/UNDP with J. VAN BREDA and CO. INTERNATIONAL, Belgium, death and disability has also been included in the coverage.

The death benefit amounts to a maximum of US$25,000; the maximum for disability is US$40,000. However, in the event of death by natural causes of an insured person over age 60, only 50% of the benefit will be paid.

Medical Coverage

The medical insurance scheme provides for reimbursement of medical, hospital and dental treatment up to a maximum of US$50,000 per fellowship holder or participant in any individual period of coverage, subject to the following limitations:

A. The Insurers undertake to reimburse 100% of the expenses involved in respect of medical treatment prescribed by doctors qualified to treat patients.

At the rate of 100% are also reimbursed the costs of hospital services such as:

  • bed and board (maximum rate: the rate of the hospital concerned for a room for two or more patients)
  • general nursing service
  • use of operating rooms and equipment
  • use of recovery rooms and equipment
  • laboratory examinations
  • X-ray examinations
  • drugs and medicine for use in the hospital

B. The following types of treatment alone are subject to certain limitations:

1. Dental treatment

The costs of dental care, of periodontic treatment, of false teeth crowns, bridges, other similar appliances, and of dentofacial orthopaedics is reimbursed only to a maximum sum of US$500 per individual period of coverage.

2.Special examinations and treatments

  • The costs of psychiatric treatment including psychoanalysis are reimbursable only if the patient is treated by a psychiatrist. The costs of psychiatric treatment are reimbursable only at the rate of 50% and to a maximum reimbursement of US$500, for not more than 50 visits per insured person in any consecutive six?month period.
  • The costs of radiological treatment are reimbursable only if the patient has been referred to the specialist by the doctor in attendance.

3. Expenses for or in connection with travel or transportation whether by ambulance or otherwise are covered if a professional ambulance service is used to transport the insured person between the place where he is injured by an accident or stricken by a disease and the first hospital where treatment is given. In case of emergency or major disability, special transport of insured person, including cost of accompanying person or attendant will be allowed, up to a maximum of US$7,500. In addition, preparation on repatriation to the home country will be covered up to a maximum of US$ 7,500.

C. Exclusions:

1.Excluded costs:

  • Hearing aids, spectacles, fees for examination of the eye for glasses and costs of spa?cures
  • periodic, preventive health examinations
  • rejuvenation cures and cosmetic treatment. Cosmetic surgery is covered, however, when it is necessary as a result of an accident occurred during the insurance period.

2. Excluded risks:

Following risks are not covered:

  • the consequences of sicknesses or accidents resulting from voluntary and intentional action on the part of the insured person;
  • the results of wounds or injuries resulting from motor vehicle racing and dangerous competitions in respect of which betting is allowed; normal sports competitions are covered;
  • the consequences of insurrections or riots, if by taking part the insured person has broken the applicable laws; the consequences of brawls, except in cases of self-defense;
  • the direct or indirect results of explosions, heat release or irradiation produced by transmutation of the atomic nucleus or by radioactivity or resulting from radiations produced by the artificial acceleration of nuclear particles;
  • aircraft accidents are only covered if the insured person is a passenger on board of an aircraft with a valid certificate of air?worthiness, piloted by a person in possession of a valid license for the type of aircraft in question.

IMPORTANT REMARK: Medical expense of the first US$10 per individual period of coverage are not reimbursable.