Frequently asked questions
After a call for tenders, AFILIATYS has concluded a contract with ALLIANZ CARE for a period of 10 years (starting 01/01/ 2020), This contract covers complementary insurance to the Joint Accident and Disability Health Insurance Scheme of the European Institutions (JSIS). It allows the 100% reimbursement of hospitalization costs related to illness or accident (except in non-EEA countries where reimbursements are limited to €25,000 per person and per year).
The premiums are fixed for the entire duration of the contract (thus until 31/12/2029) excluding appropriate Eurostat indexation, change of age bracket (limited to the age of 61) and, possibly, a technical revision during the fifth year of the contract (but submitted to AFILIATYS agreement). It is possible to join HOSPI SAFE until the day of retirement, but a medical questionnaire is required if affiliation takes place within 6 months from retirement. A 24-month moratorium is provided for illness predating cover.
This insurance, which currently benefits some 25,000 of our Members, is managed by ALLIANZ CARE in close association with AFILIATYS volunteers.
Why additional insurance to JSIS?
The Joint Health and Accident and Invalidity Insurance Scheme of the European Institutions (JSIS) only covers part of the costs related to illness or accident (80 to 85%) except in the event of serious illness (recognized by the JSIS) or accident if you are still active (Article 73 of the Statutes).
The JSIS applies a reimbursement ceiling on 51 medical treatments; the JSIS applies an excessiveness limit on several medical treatments (decided on a case-by-case basis by the medical advisor). The JSIS applies reimbursement reduction coefficients for care in non-EU countries with expensive medicine (e.g. in Switzerland)
HOSPI SAFE is a complementary insurance to the JSIS concluded with ALLIANZ CARE after a call for tenders
HOSPI SAFE makes it possible to supplement up to 100% of hospitalization costs related to an illness or accident covered by the JSIS.
Who can subscribe to HOSPI SAFE?
The pre-conditions :
• Be a member of AFILIATYS, in possession of a membership number
• Be covered by JSIS or by an equivalent primary insurance
• Be the spouse or child of an affiliate to HOSPI SAFE with primary health insurance cover (JSIS or any other primary insurance)
To become a member of AFILATYS you need to be
• An official or other agent of one of the European Union Institutions, agencies or other entities who are in active service or who have occupied an official function within one of these organisations
• An active staff member of the EIB, Eurocontrol, the European University Institute of Florence, the European schools or of any other community entity created by an act of an institution of the European Union
• A member of staff of diplomatic or consular services of the EU Member States
• A pensioner of any of the European Institutions or entities mentioned above.
It is possible to subscribe to HOSPI SAFE up to the day of retirement. A medical questionnaire will be required if such subscription takes place less than 6 months from the date of retirement.
Once retired, subscription is no longer possible. The alternative insurance is: AIACE-CIGNA ‘Hospitalisation’ (insurance BCVR 8673) to which it is possible to subscribe until the age of 67.
BEWARE: there is no insurance which offers coverage after the age of 70; hence the importance of subscribing to a complementary health insurance before retirement or even from the moment of taking up service.
It is possible to subscribe to HOSPI SAFE even when on invalidity, on leave for personal grounds, on ‘disponibilité’, as long as one is covered by JSIS. There is however a moratorium on any existing illness for a period of 24 months after subscription.
Which are The Policies Offered?
HOSPI SAFE ACCIDENTAND SICKNESS: covers health care costs relating to hospitalisation linked to an accident or an illness, including the costs relating to day care (visits to the doctor, subscription medication) if they are directly linked to the cause of hospitalisation and are incurred within the two months preceding hospitalisation or six months after.
HOSPI SAFE SICKNESS – covers the same items as above but applies to illness alone.
HOSPI SAFE PLUS: covers not only the same health care costs as HOSPI SAFE ACCIDENT AND SICKNESS but also offers a wider range of complementary services: day care, dental care, eye care, hearing loss, protheses, …
Discover our 3 covers
What does hospi-safe cover?
Given that this is a complementary health insurance to JSIS, the costs reimbursed are those which JSIS covers, even if the primary insurance of the affiliate to HOSPI SAFE is a national insurance.
As far as HOSPI SAFE PLUS is concerned, when the medical expenses are not reimbursed by JSIS, ALLIANZ CARE could partially reimburses reasonable and customary charges in accordance with standard and customary medical practice.
Is coverage world wide?
However, coverage is limited to a maximum of €25,000 per person, per year for health care obtained outside of the European Economic Space (EEE). This is now also the case for the United Kingdom, except if subscription occurred prior to 1 January 2020 and if the insured is still covered by JSIS.
IMPORTANT FOR COUNTRIES WITH EXPENSIVE MEDICINE: In the USA, for example, a JSIS refund could be as low as 30% of the bill (often very large). HOSPI SAFE will reimburse up to 70% (with this maximum of €25,000) while some additional insurance will only do so at 30%.
AFILIATYS strongly recommends taking out a travel insurance when travelling abroad (where JSIS is unknown).
VERY IMPORTANT: JSIS and the complementary insurances do not cover repatriation.
The JSIS does not reimburse the cost of repatriating its members who fall ill when abroad and, since most supplementary insurance companies follow JSIS rules, they do not take repatriation into account either.
Anyone who requires cover when travelling outside the European Union or even just outside his country of residence should take out an “Assistance” insurance, which provides cover for repatriation and for emergency treatment on the spot, in all countries visited, up to the sum of €1,000,000 or even with no limit.
What about the coverage?
Coverage comes into effect from the date of subscription to the chosen option of HOSPI SAFE.
This complementary health insurance is valid for life. It remains in force at the time of retirement and beyond, bar termination by the insured.
a) ALLIANZ CARE needs to have your latest address (e-mail and other)
b) If the insured subscribes to the insurance HOSPI SAFE SICKNESS alone, it is advisable to move to HOSPI SAFE ACCIDENT & SICKNESS, as pensioners lose their 100% reimbursement of health care resulting from an accident (reimbursement at 85% as for illness). They also lose coverage for invalidity and death.
Coverage ends at the date on which the insured may decide to cancel his/her membership of AFILIATYS, or the date of termination of the insurance contract at the request of the insured or in the case of non-payment of insurance premiums due to ALLIANZ CARE.
The guarantees in favour of the family members cease at the same time as those of the insured, except for the beneficiaries of a survivor’s pension, instated following the death of the person who subscribed to the contract as the principal insured.
The reimbursement of medical expenses ceases at the expiration of the insurance policy.
The expenses covered during the period of insurance will be reimbursed during a maximum period of 6 months after the date of the JSIS reimbursement slip. Any on-going treatment or complementary health care required after the expiry date will no longer be covered.
What of the guarantees?
For HOSPI SAFE there are no ceilings to coverage offered within the confines of the EEE (see above for the countries outside the EEE). Whatever is excluded by JSIS is, in general, also excluded by HOSPI SAFE.
For HOSPI SAFE PLUS the guarantees other than hospitalisation are subject to ceilings or limitations.
• For hospitalisation, no prior authorisation is required by JSIS and thus by HOSPI SAFE,
• For physio-therapy sessions the rules of JSIS apply: It is obligatory to obtain a medical prescription. A maximum of 60 sessions per year are authorised without prior authorisation.
JSIS reimburses the medical costs resulting from illness or an accident (also during retirement). The scheme provides for the reimbursement of up to 80 % of the expenses incurred. The rate of reimbursement rises to 85 % in the case of several usual medical acts.
Post operative rehabilitation is covered at 80%. In the case of a recognised serious illness medical expenses are reimbursed at ±100%. However in several cases the ceilings applied by JSIS need to be taken into account (doctors, dental care, physiotherapy,...)
The complementary insurances provide the 15% or 20% which are not reimbursed by JSIS or more in the case of ceilings or correction coefficients applied by JSIS. In the event of hospitalisation complementary reimbursement is 100%.
The amount of the reimbursement cannot exceed the cost of the expenses incurred by an illness, by a maternity or by an accident after receipt of a reimbursement of any kind.
If health care results from the actions of one or more third parties, it is necessary to inform ALLIANZ CARE of this as soon as possible (example: treatments linked to a wound resulting from a car accident where you are the victim) providing details of the insurance of the third party in order to permit ALLIANZ CARE to take action against his/her insurance company. Any costs of the care paid for and possibly received from this third party’s insurance will need to be reimbursed.
IMPORTANT: Only active staff (Not pensioners or colleagues on invalidity) can benefit from Article 73 of the Staff Regulations for the reimbursement of 100% of the costs relating to an accident and the payment of a capital amount in the event of invalidity or death.
What about the annual primes?
The contract was concluded on January 1, 2020 with ALLIANZ CARE for a period of 10 years. Contractually the premiums will remain fixed until its expiry, namely December 31, 2029 except:
- annual indexation based on the appropriate EUROSTAT index
- change of age group (blocked at 61)
- possible technical revision at the end of the fifth year
On January 1, 2023 the premiums were:
HOSPI SAFE SICKNESS AND ACCIDENT
HOSPI SAFE SICKNESS
HOSPI SAFE PLUS
How to proceed for the payment of premiums?
The premium is payable in advance by the principal insured person, who alone is responsible for payment, in keeping with the following schedule
• Annually for the options HOSPI SAFE ACCIDENT AND SICKNESS and HOSPI SAFE SICKNESS
• Annually or quarterly for HOSPI SAFE PLUS, at the choice of the person insured by HospiSafe Plus
Payment of the premium can be undertaken in three ways:
• Automatic debit from a bank account (direct debit – SEPA)
• Debit by ALLIANZ CARE from a credit card
• Transfer to the account of ALLIANZ CARE on specific request
How to claim for a reimbursement?
The complementary reimbursement is established on the basis of the reimbursement slip made out by JSIS. Contact with Allianz Care should therefore not be undertaken before reception of this slip.
There are four possible ways of requesting reimbursement
1. Using the on-line system MyHealth
Description of reimbursement on the MyHealth system, being aware that you must accept a declaration (this is in the process of being revised).
2. Using the request for reimbursement form to be sent to IGOclaims@allianzworldwidecare.com by email, together with the reimbursement slip from JSIS with a request to reply by e-mail (and not through the on-line MyHealthsystem).
3. A simplification of the procedure under point 2: send the slips by e-mail together with the necessary information for reimbursement: account number and policy number of the insurance in the heading of the e-mail.
4. Using the form and sending it together with the JSIS slips by post to Allianz Care – Claims, 32, Boulevard Roi Albert II, 1000 Brussels with a request to reply by post to the address of the affiliate and not by e-mail and certainly not through the MyHealth on-line system.
THE PRINCIPLE: HOSPI SAFE WILL ONLY REIMBURSE ONCE JSIS HAS INTERVENED
If JSIS reimburses a part of the costs, the insurance reimburses a complementary amount.
REMINDER:If you are insured under HOSPI SAFE ACCIDENT & SICKNESS (formerly CIGNA BCVR 8672) HOSPI-SAFE will reimburse the costs related to hospitalisation. The costs for out-patient care are not covered.
Costs relating to maternity are covered up to 100% by HOSPI SAFE. There is no moratorium.
If JSIS reimburses nothing, except in exceptional circumstances, HOSPI SAFE will not reimburse anything, except in the case of HOSPI SAFE PLUS (cf here above).
IMPORTANT: Even if you are no longer covered by JSIS, HOSPI SAFE will remain in effect as a complementary insurance to another primary health insurance other than JSIS. Reimbursements from HOSPI SAFE will be based on the rates applied by JSIS and not on those of the alternate primary health insurance.
What of the 24-month moratorium?
This concerns only illnesses in existence at the time of subscribing to the insurance. This moratorium concerns only new affiliates to HOSPI SAFE from 1 January 2020 onwards.
For a variety of reasons, among which a change of e-mail address, especially on taking up retirement, certain HOSPI SAFE affiliates could not be informed of the change in management of the insurance from 1 January 2020, given the automatic transfer of their policy with CIGNA to ALLIANZ CARE. As a result, they have involuntarily lost the benefit of their coverage, in particular their seniority of affiliation.
ALLIANZ CARE agrees to reactivate their coverage, up to 31 December 2023, with retroactive effect from 1 January 2020, thus permitting the retention of seniority and avoiding the moratorium, to the extent that the premiums for 2020, 2021 and 2022 have been duly paid.
What of the coverage of dependent children after 26 years of age?
The regulations of JSIS allow, on specific request, for the extension of coverage of dependent children beyond the age of 26 for a period of maximum one year. If this request is accepted by JSIS, this coverage is also extended to HOSPI SAFE on condition that ALLIANZ CARE is duly informed of this.
Adaptations to the contract
Adding another beneficiary
ALLIANZ CARE must be informed in writing (ALLIANZ CARE, 32, Boulevard Roi Albert II, 1000 Bruxelles). The procedure can also be undertaken on-line.
For a newborn the request must be accompanied by a copy of the birth certificate, within four weeks from birth.
This is possible at any time after at least one year of affiliation. It will become effective on the date of the next renewal, except if the accident option is introduced on the date of taking up retirement. To benefit of the upgrade tothe HOSPI SAFE PLUS option a medical questionnaire will be required. This condition only applies to people affiliated since January 1, 2020. A moratorium will apply if the period of cover by HOSPI SAFE SICKNESS or HOSPI SAFE SICKNESS & ACCIDENT is less than 24 months, up to the amount of the difference.
Idem. The change will become effective on the date of the following renewal. Reduced coverage must be maintained for at least two years.
Termination of the contract
This is possible during the 30 days preceding the entry into force of the policy.
The request must be addressed either:
• by e-mail to email@example.com
• by letter to ALLIANZ CARE, 32, Boulevard Roi Albert II, 1000 Bruxelles