Hospi Safe

FAQ > Questions & Information

WHO CAN SUBSCRIBE TO HOSPI-SAFE?

The pre-conditions :
  • Be a member of AFILIATYS, in possession of a membership number
  • Be or have been covered by JSIS or by an equivalent primary insurance
  • Be the spouse or child of an affiliate to HOSPI SAFE with primary health insurance cove (JSISI 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 Europea n 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.


HOW CAN ONE SUBSCRIBE TO HOSPI-SAFE?
  1. Subscribe on-line:  for the relevant information go to www.hospi-safe.eu or the website of ALLIANZ https://allianzcare.com/en/group-hub/afiliatys.html

  2. Subscribe at one of the three insurance brokers recommended by Allianz Care:

    Wilink Insurance
    Avenue d`Auderghem 40
    1040 Etterbeek

    Stefano Ristuccia  | Team Manager
    (m) +32 (0)475 50 01 18 | (t) +32 (0)2 210 59 53
    (e)  stefano.ristuccia@wilink.be   | wilink.be

    Vanbreda Risk and Benefits, "Bureau Eurinsurances"
    Rue Stévin 144 (Behind the Berlaymont)
    1000 Brussels
    Tel: 02 230 16 60
    www.eurinsurances.be

    OCA - Luxemburg
    23 Rue Aldringen
    L-1118 Luxemburg
    Tel: +352 671 177 077
    jnguyen@oca.lu
    www.oca.lu


WHICH ARE THE POLICIES OFFERED?

HOSPI-SAFE ACCIDENT AND ILLNESS:  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 MALADIE – 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 ILLNESS but also offers a wider range of complementary services:  day care, dental care, eye care, hearing loss, prostheses, ... (for further details visit www.hospi-safe.eu ).


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 reimburse the costs.


IS COVERAGE WORLD WIDE?

Yes.
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.

The only restriction is that the complement paid out by HOSPI-SAFE cannot exceed the reimbursement made by JSIS.  Such could be the case in countries outside the EU where JSIS applies reduction factors such that the reimbursement could represent less than 50% of the costs incurred.  This might occur relative to three countries:  United States, Switzerland and Norway.

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.

VERY MPORTANT:
  1. ALLIANZ CARE needs to have your latest address (e-mail and other)

  2. If the insured subscribes to the insurance HOSPI-SAFE ILLNESS alone, it is advisable to move to HOSPI-SAFE ACCIDENT & ILLNESS, 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 (cf www.hospi-safe.eu) .

IMPORTANT:
  • 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.S  (cf www.hospi-safe.eu ).  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.


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 ILLNESS and HOSPI-SAFE ILLNESS
  • Annually or quarterly at the choice of the insured for HOSPI-SAFE PLUS
Payment of the premium can be undertaken in three ways:
  • Debit by ALLIANZ CARE from a credit card
  • Automatic debit from a bank account (direct debit – SEPA)
  • Transfer to the account of ALLIANZ CARE

HOW TO CLAIM FOR A REIMBURSEMENTS

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 this slip as been received.

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 MyHealth system).

  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, 1 place du Samedi, 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 & ILLNESS (formerly CIGNA BCVR 8672) HOSPI-SAFE will reimburse the costs related to hospitalisation.  The costs for day care  (out-patien 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 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, 1 Place du Samedi, 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.

INCREASING COVERAGE
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 to the HOSPI-SAFE PLUS option a medical questionnaire will be required. 

REDUCING COVERAGE
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:
OTHER INSURANCES

For officials and other agents of the European institutions the partial or total reimbursement of health care is ideally based on 4 'pillars':
  • The Joint Sickness Insurance System – JSIS  (statutory membership)
  • Accident insurance (either statutory membership or to be subscribed to)
  • Complementary insurances to JSIS (to be subscribed to)
  • Assistance Insurances for trips abroad (to be subscribed to)
  1. JSIS (statutory coverage)
    JSIS ensures the reimbursement of medical costs at 80 – 85% for illness, hospitalisation, analyses, treatment, medication, ... whether the affiliate is in active service or retired.  JSIS reimburses medical costs for serious illness, it has formally recognised, at 100%.  JSIS has put in place ceilings for a good number of treatments; exclusions are also possible as are rules on excessiveness.

  2. Accident insurance (statutory coverage for active staff, or to be subscribed)
    The Staff Regulations (Art 73) provide for high complementary cover for officials in active employment who are involved in occupational accidents and those occurring in private life: reimbursement of medical care costs is at 100% and may also provide a lump sum if the accident results in permanent disability (partial or total) or death.
    Retired staff or those on permanent or temporary disability allowances  and those on leave on personal grounds (LPG/CCP), the partners of active staff and children are not covered by this statutory supplementary accident insurance.  But JSIS always reimburses medical care given as a result of an accident as if it were for an illness (i.e. 80% or 85% with ceilings, exclusions and possible reductions for excessive costs). JSIS would however not provide any compensation in case of disability or death after an accident.
    A specific supplementary accident insurance is offered by Cigna (negotiated by AIACE - framework contract) to pensioners, to the colleagues in disability and to spouses of retired staff (and hopefully to children in the future). It includes: a capital in case of death, a capital in case of permanent total or partial disability, it supplements at 100% (no limitation) the medical care expenses reimbursed by JSIS as if it were an illness.
    A death and permanent total disability (as a result of accident or illness) insurance policy is also offered by Afiliatys for officials (up to 65), for partners and for children

  3. The complementary health insurances (to be subscribed)
    Every affiliate of JSIS can subscribe for him/herself and for members of his/her family, a complementary health insurance to JSIS which permits a complementary reimbursement of health costs to reach a total of more or less 100%, as a function of the health care and the general conditions of the pertinent insurances.  These complementary insurances, collective or individual, are offered by known insurance companies such as Allianz BE; Cigna; LALUX (DKV valid only in Luxemburg); Allianz Worldwide Care; Foyer Global Health (Luxemburg); Expat & Co.  These insurers have all thoroughly studied the rules of JSIS.
    In general, they cover, with certain limitations, the part of the health care bills that are not covered by JSIS.  Some insurers offer to reimburse up to 100% in complement to JSIS for hospitalisation; others limit this complementary reimbursement to 15 or 20% of the total bill.

  4. Assistance insurances (to be subscribed)
    As indicated above, JSIS and the complementary assurers to JSIS are limited, at times very severely, as to health care treatments that are undertaken in non-EU countries, in particular in countries where health costs are very high such as the USA and Switzerland,...  Care must also be taken where the costs of private health care are very high such as in the United Kingdom, Italy, ... Several complementary insurances limit their reimbursement to €25,000 per year for treatment outside the EEE.
    JSIS does not reimburse the costs of repatriation of affiliates who have fallen ill overseas (except on mission).  Several complementary insurances to JSIS follow the rules of JSIS and do not offer repatriation either.
    It also needs to be recognised that JSIS is not known very much beyond Brussels, Luxemburg, Ispra, ... and that the health care institutions can demand very high guarantees.  Whoever wants to be well covered whilst on vacation outside the EU or even outside his/her country of residence should take out an assistance insurance, which ensures repatriation in case of need and which covers immediate medical costs, on the spot, in any country visited, up to €1,000,000 or without limit.  
    Several credit cards offer assistance insurance, but it is imperative to know their general conditions, limitations and exclusions before needing to call on it.

CONTACTS

As indicated in the introduction AFILIATYS is not in a position to personally reply to the questions you may not have found an answer to in these pages and we would be grateful for you to submit these questions in writing (www.afiliatys).  You can rest assured you will receive a reply.

The 'Insurance' duty stations of Thursdays held by ALLIANZ CARE should resume during September, from 10:00 to 16:00, at 105 avenue des Nerviens, 1040 Brussels (near the Cinquantenaire park).  Confirmation will be sent out soon.  In the meanwhile, please contact Mr Jeremy VEDEL, Sales manager (IGO, NGO and Governmental) Allianz Partners. Place du Samedi 1000 Brussels Belgium. Direct + 32 2 210 65 32. Mobile : + 32 4 75 05 26 23 ·  jeremy.vedel@allianz.com

Other possibilities:

By e-mail:
Brokers for ALLIANZ CARE:
  • Wilink Insurance
    Avenue d`Auderghem 40
    1040 Etterbeek

  • Stefano Ristuccia  | Team Manager
    (m) +32 (0)475 50 01 18 | (t) +32 (0)2 210 59 53
    (e)  stefano.ristuccia@wilink.be   | wilink.be

  • Vanbreda Risk and Benefits, "Bureau Eurinsurances"
    Rue Stévin 144 (Behind the Berlaymont)
    1000 Brussels
    Tel: 02 230 16 60
    www.eurinsurances.be

  • OCA - Luxemburg
    23 Rue Aldringen
    L-1118 Luxemburg
    Tel: +352 671 177 077
    jnguyen@oca.lu
    www.oca.lu
At the offices of ALLIANZ-CARE in Brussels (by appointment only)
  • 1 place du Samedi
    1000 Brussels