Chis Rules 2016

ORGANISATION EUROPENNE POUR LA RECHERCHE NUCLAIRE
EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH
Laboratoire Europen pour la Physique des Particules

European Laboratory for Particle Physics
Rules of the
1st June
2014
CERN Health
Edition Insurance
Revised 1st November 2016 Scheme
Rules of the CERN Health Insurance Scheme 1 June 2014
Preamble
The Director-General of the European Organization for Nuclear Research,
Considering the Convention establishing the European Organization for Nuclear Research
(CERN) signed in Paris on 1 July 1953, as amended on 17 January 1971;
Considering Article 21 of the Agreement between the Swiss Federal Council and CERN
establishing the legal status of the Organization in Switzerland, signed on 11 June 1955,
under which the Organization is exempt from all compulsory contributions to general social
protection schemes, on the understanding that the Organization will so far as possible and
under conditions to be agreed upon, insure with Swiss insurance funds those of its agents
who are not assured an equivalent social protection by the Organization itself;
Considering Article 1 of the Agreement between the Government of the French Republic
and CERN, signed on 30 December 1970, under which members of the personnel of the
Organization are exempt from French laws relating to social security and family allowances
and under which the Organization undertakes to protect the members of its personnel
against the financial consequences of illness, maternity, occupational illnesses and
accidents, disability and old age within the provisions of the social protection scheme it has
set up;
Considering the provisions of the CERN Health Insurance Scheme, as previously laid
down in the Health Insurance Agreement 605/ADM between CERN and the Austria
insurance company;
Considering the Council decision of 18 June 1999 to modify the administration of the
CERN Health Insurance Scheme by approving a new contract for the administration of the
said Scheme replacing the Agreement 605/ADM;
Considering the need to set out in a separate document the "Rules of the CERN Health
Insurance Scheme" including the general principles, the contributions and the benefits of
the CERN Health Insurance Scheme, as previously laid down in Agreement 605/ADM,
initially approved by the Council of the Organization on 6 October 1970;
Considering the Council decision of 15 December 2000 to introduce cover against the
risks associated with dependence (long-term care) into the CERN Health Insurance
Scheme;
Considering the provisions of Chapter IV of the CERN Staff Rules and Regulations
entitled "Social insurance cover";
Considering that the Council of the Organization, in accordance with the Staff Rules, fixes
the contributions of the Organization as well as the benefits and contributions of the
members of the personnel relating to social insurance measures taken by the Organization;
Considering the Council decision of 16 December 2010 to make certain modifications to

the contributions payable to the CERN Health Insurance Scheme and to authorize the
Director-General to take timely measures to limit the increase of the CERN Health
Insurance Scheme expenses by encouraging the use of health care providers and treatments
which provide the best quality-to-cost ratio.
Hereby adopts the "Rules of the CERN Health Insurance Scheme", as amended on
1 June 2014.
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Table of contents
PREAMBLE ....................................................................................................................................................... 1
TABLE OF CONTENTS........................................................................................................................................ 2
CHAPTER I GENERAL PROVISIONS ................................................................................................................. 4

Section 1 General Provisions .......................................................................................................................... 4
CHAPTER II DEFINITIONS ............................................................................................................................... 6
Section 1 Definitions ....................................................................................................................................... 6
CHAPTER III NORMAL HEALTH INSURANCE COVER ....................................................................................... 8
Section 1 General Description ........................................................................................................................ 8
Section 2 Membership ..................................................................................................................................... 8
Section 3 Territorial Scope ............................................................................................................................. 9
Section 4 Benefits .......................................................................................................................................... 10
Section 5 Contributions ................................................................................................................................. 10
Section 6 Obligation to Furnish Information ................................................................................................ 12
CHAPTER IV REDUCED HEALTH INSURANCE COVER ..................................................................................... 13
Section 1 General Description ...................................................................................................................... 13
Section 2 Membership ................................................................................................................................... 13
Section 3 Territorial Scope ........................................................................................................................... 13
CHAPTER V SHORT-TERM HEALTH INSURANCE COVER ................................................................................ 14
CHAPTER VI OCCUPATIONAL ILLNESSES AND ACCIDENTS............................................................................ 15
CHAPTER VII COMMON PROVISIONS .......................................................................................................... 16
Section 1 Non-concurrence of Benefits Rule ................................................................................................. 16
Section 2 Cosmetic Treatment and Surgery .................................................................................................. 16
Section 3 Grounds for Refusal, Reduction or Withdrawal of Benefits .......................................................... 17
Section 4 General Insurance Provisions ....................................................................................................... 17
Section 5 Duration of Membership ............................................................................................................... 18
CHAPTER VIII PROCEDURES ......................................................................................................................... 19
Section 1 Medical Expense Reimbursement Claims ...................................................................................... 19
Section 2 Prior Approvals and Opinions....................................................................................................... 20
Section 3 Cures and Convalescence Cures ................................................................................................... 21
Section 4 Settlement of Disputes ................................................................................................................... 22
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CHAPTER IX FINANCIAL PROVISIONS ........................................................................................................... 25

Section 1 Reference Salaries ......................................................................................................................... 25
Section 2 Reserve Fund ................................................................................................................................. 26
CHAPTER X OPERATION OF THE SCHEME .................................................................................................... 26
Section 1 Operation....................................................................................................................................... 26
CHAPTER XI AUDITING ................................................................................................................................ 28
Section 1 Auditing ......................................................................................................................................... 28
CHAPTER XII ANNEXES ................................................................................................................................ 28
Section 1 Annexes .......................................................................................................................................... 28
ANNEX I NORMAL HEALTH INSURANCE COVER ........................................................................................... 29
ANNEX II ALLOWANCE FOR REDUCED EARNING CAPACITY ......................................................................... 35
ANNEX III SHORT-TERM HEALTH INSURANCE .............................................................................................. 37
ANNEX IV CONTRIBUTION RATES ................................................................................................................ 39

Section 1 Contributions and Contribution Rates ........................................................................................... 39
ANNEX V LONG-TERM CARE BENEFITS ........................................................................................................ 40
Section 1 Conditions of Award and Procedural Aspects ............................................................................... 40
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Chapter I General Provisions
Section 1 General Provisions
I 1.01 The Director-General shall be responsible for the management of the Scheme and shall
MANAGEMENT OF THE determine and implement the relevant associated structures.
SCHEME
The benefits and contributions shall be decided by the Council on the proposal of the
Director-General following discussion at the Standing Concertation Committee, pursuant
to Article S IV 2.07 of the Staff Rules. The Director-General is authorised by the Council
to take timely measures to contain the increase of expenditure of the Scheme by
encouraging use of healthcare providers offering the best value for money.
I 1.02 The Rules of the Scheme shall be adopted and amended by the Director-General on the
RULES basis of the decisions concerning contribution levels and benefits taken by the CERN
Council.
I 1.03
OBJECTIVE OF THE The objective of the CERN Health Insurance Scheme, hereafter referred to as "the
SCHEME Scheme", is to safeguard its Members against the financial consequences of illnesses,
accidents and maternity by providing for reimbursement of expenses resulting from
medical treatment, in accordance with the conditions laid down in these Rules.
Under certain circumstances, the Scheme safeguards its Members against the financial
consequences of disability.
I 1.04 The Scheme, to which the Organization and the Members contribute, is based on the
MUTUALITY principle of mutuality.
I 1.05 Both the English and French texts of these Rules shall be authentic.
AUTHENTIC VERSION
I 1.06 Reference to Members in the masculine gender shall apply equally to both sexes, except
GENDER where it is clear from the context that the provisions relate exclusively to either men or
women.
I 1.07 Any document or information containing personal administrative or medical data relating
CONFIDENTIALITY to a Member shall be treated confidentially.
Persons having access to such personal data in the exercise of their functions are bound by
professional secrecy and may not communicate the content of the information to which
they have access to unauthorized persons.
In particular, professional medical secrecy shall be preserved.
I 1.08 The provisions of the present Rules shall be interpreted in accordance with their terms and
INTERPRETATION OF THE purpose.
RULES
In the event of difficulty in applying these Rules, notably in the event of silence of the
texts, reference may be made subsidiarily and by analogy to Swiss and/or French
legislation governing social security and health insurance matters.
I 1.09 The administration of benefits shall beentrusted to a specialist contractor (hereafter the
ADMINISTRATION AND Third-Party Administrator), as defined in Article II 1.20. The Third-Party Administrator
DECISIONS is mandated to apply the present Rules in accordance with the provisions of the contract for
the administration of the Scheme concluded with the Organization.
The administration of the contributions shall be under the overall responsibility of the
CERN department responsible for finance.
All decisions pursuant to these Rules shall be taken on behalf of the Director-General of the
Organization.
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I 1.10 The Scheme provides for three types of insurance cover for non-occupational illnesses and
TYPES OF INSURANCE accidents:
COVER
Normal Health Insurance Cover (see Chapter III).
Reduced Health Insurance Cover (see Chapter IV).
Short-term Health Insurance Cover (see Chapter V).
The Scheme also provides cover for occupational illnesses and accidents in accordance
with the provisions set out in Chapter VI.
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Chapter II Definitions
Section 1 Definitions
II 1.01 Any certified impairment of a Member's health, including his mental health, which affects
ILLNESS him against his will and is not caused by an accident.
II 1.02 Any event due to the action of a sudden and external force, irrespective of its nature and
ACCIDENT origin, affecting a Member against his will, causing certified physical injury.
Any personal physical effort resulting in physical injury to a Member is regarded as an

accident.
Provided that they are not obviously caused by illness or degenerative phenomena, the
following bodily injuries in the list below, which is exhaustive, shall be deemed to be the
result of an accident, even if they are not caused by a sudden, external force:
fractures;
strains;
sprains and pulled muscles;
dislocated limbs;
injuries to ligaments;
eardrum injuries;
injuries resulting from a fall;
back pain and hernia resulting from physical strain;
severe injuries resulting from radiation;
electric shocks, including those caused by lightning;
asphyxia, intoxication caused by gas or fumes, poisoning or burns caused by the
involuntary absorption of poisonous or corrosive substances;
drowning caused by immersion hypothermia;
death caused by a circulatory condition.
The contents of this list, which derives from Article 9 of the Swiss Federal law on Accident
Insurance (OLAA) of 20 December 1982, shall be automatically adapted to reflect any
changes in this article. This Law may be consulted on the internet site of the Swiss
Confederation: http://www.admin.ch
II 1.03 Any illness contracted or any accident suffered by a member of the CERN personnel that
OCCUPATIONAL the Organization deems to be of occupational origin.
ILLNESSES AND
ACCIDENTS
II 1.04 Permanent or long-term inability to perform the ordinary functions of everyday life
DEPENDENCE unaided.
II 1.05 The physical condition of a woman from conception to childbirth and all medically related
MATERNITY occurrences resulting therefrom.
II 1.06 All examinations carried out and all treatment given with a view to restoring or preserving
MEDICAL TREATMENT health and/or physical integrity. Vaccination is also considered to be medical treatment.
The treatment must be recognized as medical treatment by the competent health authorities
of the State in which it is provided.
II 1.07 Any establishment providing medical, surgical or functional rehabilitation treatment

HOSPITAL recognised as a hospital by the competent health authorities of the State concerned.
II 1.08 Any hospital recognised as public by the competent health authorities of the State
PUBLIC HOSPITAL concerned.
II 1.09 Any hospital that does not correspond to the definition in Article II 1.08.
PRIVATE HOSPITAL
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II 1.10 Any public hospital as defined in Article II 1.08, or

APPROVED HOSPITAL
Any private hospital:
in Switzerland, provided that it has concluded a tariff agreement with the
Scheme;
outside Switzerland, provided that it has concluded a tariff agreement with the
national social security scheme and that it applies similar tariffs for medical
treatment and accommodation to the Members of the Scheme.
II 1.11 Any hospital that does not correspond to the definition in Article II 1.10.
UNAPPROVED HOSPITAL
II 1.12 Any establishment, other than a hospital, providing patients with care, medical assistance
SPECIALISED INSTITUTION and rehabilitation measures for long periods (medico-social establishments (MSE) or any
similar type of facility).
II 1.13 Any physician qualified and licensed by the competent national authority to exercise his
MEDICAL PRACTITIONER profession in the State in which the treatment is provided.
II 1.14 Provision of a certificate provided by a medical practitioner attesting to a specific medical

CERTIFICATION condition affecting a Members state of health.
II 1.15 Certification that no further improvement in the patients state of health can be expected
CONSOLIDATION from appropriate medical treatment.
II 1.16 Certified disappearance of the impairment of the patients state of health resulting from an
CURE illness or accident.
II 1.17 Certified worsening of the patient's state of health resulting from an illness or accident, not
RELAPSE attributable to external factors, occurring within 10 years from the date of consolidation and
necessitating medical treatment.
II 1.18 Any person qualified and licensed by the competent national authority in the State in which
MEDICAL AUXILIARY the treatment is provided to dispense treatment on the basis of a medical prescription and
assist the medical profession in treating and caring for the victims of illnesses or accidents.
The acts performed by medical auxiliaries must be consistent with the medical prescription.
II 1.19 Any person qualified to assist dependent persons in performing the ordinary functions of
HOME-NURSE everyday life.
II 1.20 The company with which the Organization has concluded a contract for the administration
THIRD-PARTY of the Scheme.
ADMINISTRATOR
II 1.21 Any Main Member (see Article II 1.22) and the members of his family (see Article II 1.23)
MEMBER as defined in these Rules, unless otherwise specified.
II 1.22 Any member of the CERN personnel for whom membership of the Scheme is compulsory
MAIN MEMBER under the terms of his contract of employment or association with the Organization, and
any person fulfilling the necessary conditions to opt for membership of the Scheme and
having opted for membership under the provisions of these Rules.
II 1.23 Any member of the family of the Main Member as defined by the CERN Staff Rules and
FAMILY MEMBER Regulations. In these Rules, the term spouse shall mean either the spouse in the case of
marriage or the partner in the case of a registered partnership recognized by the Staff Rules
and Regulations. Similarly, the terms marriage and divorce are considered to be
synonymous with "partnership" and "annulment of the partnership".
II 1.24 Obligatory contribution paid by the Main Member of a family or, where both spouses are
MAIN CONTRIBUTION Main Members of the Scheme, by the Main Member who is in receipt of the higher income.
II 1.25 Contribution payable in addition to the main contribution in certain circumstances where
SUPPLEMENTARY both spouses have an income or a retirement pension deriving from a professional activity.
CONTRIBUTION
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II 1.26 Any remuneration, salary, honoraria or fees deriving from a professional activity.
INCOME
Unemployment and maternity benefits are not regarded as income.
II 1.27 Any payment from an old age insurance scheme.

RETIREMENT PENSION Invalidity pensions are not regarded as retirement pensions.
II 1.28 The following are regarded as similar health insurance:

SIMILAR HEALTH subject to the bilateral agreements between Switzerland and the European Union,
INSURANCE
any health insurance provision under a national scheme of a Member State of the
European Union;
any individual or collective private health insurance providing benefits and levels
of reimbursement in the State in which the member resides that are at least
equivalent to those guaranteed by the Swiss Federal Law on Health Insurance
(LAMal).
II 1.29 The non-reimbursed part of the expenses, up to the applicable ceiling, for the items covered
COSTS BORNE BY THE by the General Reimbursement Rule.
INSURED MEMBER
(referred to hereinafter by the
French acronym FCA)
II 1.30 Rule defining the reimbursement rates according to the Costs Borne by the Insured
GENERAL Member (FCA) cumulated by the Member over a calendar year.
REIMBURSEMENT RULE
Details of the reimbursement rates according to the FCA are set out in Articles A I 1.01 and
A III 1.01.
II 1.31 An increase in the reimbursement rate as defined in Articles A I 1.01 and A III 1.01 for
BONUS some benefits covered by the General Reimbursement Rule, provided that the
reimbursement rate does not exceed 100%.
Details of the amount of the bonus and the items to which it applies are provided in the
table of benefits covered by Normal Health Insurance Cover in Annex I and in the table of
benefits covered by the Short-Term Health Insurance Cover in Annex III.
Chapter III Normal Health Insurance Cover
Section 1 General Description
III 1.01 The Normal Health Insurance cover provides for reimbursement of a major portion of the
GENERAL DESCRIPTION reasonable and customary expenses resulting from medical treatment that have been
incurred by Members benefiting from this cover under the conditions specified in these
Rules.
The Normal Health Insurance also provides for a death benefit and long-term care benefits,
as well as an allowance for reduced earning capacity of family members.
Section 2 Membership
III 2.01 Membership of the Normal Health Insurance is compulsory for:

COMPULSORY staff members, fellows and apprentices, except during periods of special
MEMBERSHIP OF MAIN
MEMBERS
unremunerated leave lasting one complete calendar month or more;
students, except during periods of unpaid absence lasting one complete calendar
month or more.
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III 2.02 The following persons may opt for membership of the Normal Health Insurance
VOLUNTARY irrespective of the State in which they reside:
MEMBERSHIP OF MAIN
MEMBERS
associates and users, aged below 65, whose contract of association with the
Organization runs for three months or more;
beneficiaries of the CERN Pension Fund who have opted to remain Members of
the Scheme without interruption since the departure of the Main Member from
CERN;
former CERN staff members who have opted for a deferred pension and to
remain Members of the Scheme without interruption since their departure from
CERN;
staff members and fellows for any period of special unremunerated leave lasting
one complete calendar month or more;
students for any period of unremunerated absence lasting one complete calendar
month or more.
children of a Main Member who are no longer dependent within the meaning of
the CERN Staff Rules and Regulations and who are less than 26 years of age.
Their membership remains dependent on that of the Main Member.
III 2.03 With the exception of apprentices family members and of children who are no longer
FAMILY MEMBERS dependent, family members (as defined by the CERN Staff Rules and Regulations) of a
Main Member are Members benefiting from the Normal Health Insurance cover through
the Main Member.
However, a family member who himself belongs to a category of the CERN personnel and
whose membership of the Normal Health Insurance is compulsory is considered as a Main
Member within the meaning of Article II 1.22
III 2.04 The following categories of Members, in the event that their entitlement to cover under the
CONTINUATION OF Normal Health Insurance ceases for any reason, except in the event of exclusion from the
COVERAGE Scheme under Article VII 4.11, may remain Members of the Scheme for a further
maximum period of 12 months upon request, provided that they are not entitled to opt for
membership under the terms of Article III 2.02:
staff members, fellows, students or apprentices ; the members of their families
are covered in accordance with the conditions in Article III 2.03;
in the event of divorce, the ex-spouse and his dependent children who are
considered as family members of the Main Member on the date the divorce
became final;
in the event of death of the Main Member, the members of his family at the time
of his death.
Notwithstanding the foregoing, former staff members receiving unemployment benefits

from the Organization may remain Members for a further maximum period of 60 weeks.
Section 3 Territorial Scope
III 3.01 The Members are covered for expenses resulting from medical treatment anywhere in the
WORLD-WIDE world. The provisions of Article VII 4.07 shall apply.
COVERAGE
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Section 4 Benefits
III 4.01 The cost of medical treatment and accommodation shall be reimbursed in accordance with
HOSPITALISATION the General Reimbursement Rule enshrined in Article II 1.30, except:
in the case of hospitalisation in a public hospital as defined in
Article II 1.08, in which case these costs are 100% reimbursed, except where
hospitalisation is in the private or semi-private sector of the hospital.
In this latter case, the General Reimbursement Rule shall apply.
in the case of hospitalisation in an unapproved hospital, as defined in
Article II 1.11, in which case these costs are 80% reimbursed.
Doctors fees during hospitalisation shall be reimbursed according to the conditions in

force in the hospital concerned.
In any event, the supplement for accommodation and board in a single-bed ward invoiced
by the hospital shall be exclusively borne by the Member.
III 4.02 All other medical expenses subject to reimbursement as well as the rates and ceilings are
MEDICAL EXPENSES specified in Annex I of these Rules.
III 4.03 The maximum amounts of expenses that can be reimbursed per item (ceilings) are
DETERMINATION OF determined annually by CERN for application as from 1 January of the following year.
CEILINGS
III 4.04 In the event of death of a CERN staff member, or of a member of his family (within the
INDEMNITY IN THE meaning of the CERN Staff Rules and Regulations), an indemnity is paid in accordance
EVENT OF DEATH with Annex I of these Rules.
III 4.05 Any Member suffering permanent or long-term inability to perform the ordinary functions
LONG-TERM CARE of everyday life unaided may apply to receive long-term care benefits under the conditions
BENEFITS specified in Annex V of these Rules.
III 4.06 Payment of an allowance for reduced earning capacity may be claimed under the conditions
ALLOWANCE FOR specified in Annex II of these Rules.
REDUCED EARNING
CAPACITY
Section 5 Contributions
III 5.01 The main and supplementary contributions for Normal Health Insurance cover are
CONTRIBUTIONS expressed as a percentage (Article III 5.09 and Article A IV 1.01) of the Member's
Reference Salary (Chapter IX, Section I).
III 5.02 The rate of contribution and its apportionment between the Organization and the Member
BREAKDOWN OF THE are specified in Annex IV, Section I of these Rules.
CONTRIBUTION
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III 5.03 Unless otherwise specified in Articles III 5.05 and III 5.07, a main contribution is payable
MAIN CONTRIBUTION for each Main Member.
The main contribution is the product of the contribution rate indicated in Article A IV 1.01
and the following reference salaries:
Staff members, fellows, students:

Reference Salary I
Associates, users, former CERN staff members who have opted for a deferred
pension and to remain Members of the Scheme without interruption since their
departure from CERN:
Reference Salary II
Apprentices:
50% of Reference Salary II
Children of a Main Member who are no longer dependent:
40% of Reference Salary II
Beneficiaries of the CERN Pension Fund:
Reference Salary III
III 5.04 The main contribution payable by a staff member, fellow, paid associate, student or
PAYMENT OF THE beneficiary of the CERN Pension Fund is deducted each month from the remuneration or
MAIN CONTRIBUTION payment received from the Organization or from the pension received from the CERN
Pension Fund.
In all other cases, the main contribution is paid by the Member to the designated bank
account of the Scheme each month in advance.
III 5.05 Where both spouses are either staff members or fellows, the main contribution is payable in
MAIN OR respect of the spouse working full-time whereas the supplementary contribution is payable
SUPPLEMENTARY in respect of the spouse working part-time.
CONTRIBUTION
Where both spouses work full-time or both work part-time, the main contribution is
payable in respect of the spouse whose remuneration calculated on the basis of Reference
Salary I gives the higher contribution, whereas the supplementary contribution is payable in
respect of the other spouse.
Where both spouses are beneficiaries of the CERN Pension Fund, the main contribution is
payable in respect of the spouse whose pension calculated on the basis of the Reference
Salary III gives the higher contribution, whereas the supplementary contribution is payable
in respect of the other spouse.
III 5.06 Unless otherwise specified in Articles III 5.03 and III 5.07, no contribution is payable in
NO CONTRIBUTION respect of family members (as defined in the CERN Staff Rules and Regulations) of the
Main Member.
III 5.07 The supplementary contribution, payable in respect of the Members listed below, is the
SUPPLEMENTARY product of the contribution rate(s) indicated in Article A IV 1.02 and the following
CONTRIBUTION reference salaries:
1. Staff members and fellows, married to a staff member or a fellow paying the
main contribution based on Reference Salary I :
Reference Salary IV
2. The spouse:
of a staff member, fellow or beneficiary of the CERN Pension Fund, and
who is not a staff member, fellow, student or apprentice himself, and
who is not covered by another similar basic health insurance as defined in
Article II 1.28, and
who has a monthly gross income or monthly retirement pension (including
the CERN pension) deriving from professional activity of more than
2500 CHF:
Reference Salary V
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III 5.08 The supplementary contribution payable by a staff member or a fellow under
PAYMENT OF THE Article III 5.07, paragraph 1 is deducted each month from the remuneration of the Member
SUPPLEMENTARY concerned.
CONTRIBUTION
The supplementary contribution for spouses under Article III 5.07 paragraph 2 is deducted
from the remuneration, payment or pension of the Main Member.
III 5.09 The contribution rate is a percentage of the Member's Reference Salary (Chapter IX,
CONTRIBUTION RATE Section 1), as specified in Article A IV 1.01.
III 5.10 The contribution rate defined in Article III 5.09 is examined annually for the following
ADJUSTMENT OF THE calendar year, taking into account:
CONTRIBUTION RATE
the past and foreseen evolution of cost factors such as demographic trends, price
changes, new medical treatment, etc.;
the estimated total amount to which the contribution rate of active members of
the personnel and beneficiaries of the CERN Pension Fund is applicable for the
following calendar year;
the forecast level of funds remaining in the CERN Health Insurance Reserve
Fund at the end of the calendar year; and,
any other relevant factor.
If necessary, a proposal to adjust the contribution rate is submitted to the Council of the
Organization.
III 5.11 The monthly contribution required for continuation of Normal Health Insurance is:
CONTRIBUTION FOR for a member of the personnel terminating his active employment, that
CONTINUATION OF THE
INSURANCE COVER
corresponding to the total contribution paid by the Member and the Organization
on his behalf during his last month as a member of the personnel;
for ex-spouses of Main Members, the amount of the monthly contribution based
on Reference Salary II.
Section 6 Obligation to Furnish Information
III 6.01 Any staff member, fellow or beneficiary of the CERN Pension Fund who is a Member of
PERSONS OBLIGED TO the Normal Health Insurance is obliged to notify CERN in writing of any other health
FURNISH INFORMATION insurance cover from which his spouse benefits, as well as, where applicable, any income
or retirement pension deriving from professional activity of which his spouse is in receipt.
III 6.02 When requested to do so, the Member concerned has the obligation to submit supporting
SUPPORTING documentation regarding the information furnished in accordance with Article III 6.01.
DOCUMENTATION
III 6.03 Any change in the income or health insurance cover of the Member's spouse must be
NOTIFICATION notified to CERN in writing within 30 calendar days after occurrence of the change.
OF A CHANGE
III 6.04 The effective date of a change notified by the Member in accordance with Article III 6.03
EFFECTIVE DATE OF A is the first day of the month in which the change occurred.
NOTIFIED CHANGE
III 6.05 Failure by a Member to furnish information in accordance with Article III 6.01 entails the
FAILURE TO NOTIFY deduction from his CERN remuneration or CERN pension of the highest supplementary
contribution based on Reference Salary V, as defined in Article IX 1.05.
III 6.06 In cases of late notification or false declaration, any supplementary contributions due will
LATE NOTIFICATION OR be deducted retroactively. However, no contributions already paid will be reimbursed.
FALSE DECLARATION
III 6.07 Where a Member has declared, in accordance with Article III 6.01, that his spouse benefits
SUBMISSION OF BILLS TO from another similar health insurance as defined in Article II 1.28, his spouse must submit
A SIMILAR HEALTH the bills for reimbursement to that other health insurance first.
INSURANCE
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III 6.08 Any medical expenses not reimbursed by the other similar health insurance, including any
COMPLEMENTARY difference between the amount reimbursed by the other similar health insurance and the
REIMBURSEMENT actual expenses incurred, may be submitted for reimbursement in accordance with the
provisions of the present Rules.
Chapter IV Reduced Health Insurance Cover
IV 1.01 Reduced Health Insurance offers reduced benefits compared to the Normal Health
GENERAL Insurance for some categories of associated members of the CERN personnel during their
DESCRIPTION stay at CERN.
IV 2.01 Associates and users may subscribe to Reduced Health Insurance provided that their
MAIN MEMBERS contract with the Organization runs for three months or more.
IV 2.02 The family members of the Main Member are not covered by this insurance.
FAMILY MEMBERS
IV 3.01 The territorial scope of the Reduced Health Insurance is the same as that specified for
TERRITORIAL SCOPE Normal Health Insurance in Article III 3.01.
Section 4 Benefits
IV 4.01 Members of the Reduced Health Insurance enjoy the same benefits as those listed in
BENEFITS Annex I for the Normal Health Insurance, with the exception of those indicated in Article
IV 4.02.
IV 4.02 The following items are excluded from the Reduced Health Insurance cover:
EXCLUSIONS treatment given by medical auxiliaries;
prostheses, orthopaedic appliances and hearing aids;
dental prostheses;
optics (spectacles, contact lenses and refractive surgery);
the cost of accommodation in a respite care home or in a unit for those waiting
for space to become available in a suitable institution;
long-term care benefits;
indemnity in the event of death.
IV 5.01 The contribution for Reduced Health Insurance is 50% of Reference Salary II (as defined in
CONTRIBUTION Article IX 1.02) multiplied by the contribution rate indicated in Article A IV 1.01.
IV 5.02 The contribution rate is examined annually in accordance with Article III 5.10. If
ADJUSTMENT OF THE necessary, a proposal to adjust the contribution rate is submitted to the Council of the
CONTRIBUTION RATE Organization.
IV 5.03 The contribution is paid by the Member to the designated bank account of the Scheme each
PAYMENT OF THE month in advance.
CONTRIBUTION
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Chapter V Short-term Health Insurance Cover
V 1.01 The Short-term Health Insurance is a limited health insurance cover specially designed for
GENERAL members of the CERN personnel with short-term contracts who do not benefit from health
DESCRIPTION insurance cover against the financial consequences of illnesses and accidents in
Switzerland and/or in France.
V 2.01 Members of the CERN personnel, holding a contract with the Organization of less than
MAIN MEMBERS three months may subscribe to the Short-Term Health Insurance during their stay at CERN.
V 2.02 A family member of a Main Member subscribing to the insurance is only covered if he
FAMILY MEMBERS pays the contribution for this insurance cover.

V 3.01 The Members are covered on the continental and island territory of Europe, and on duty
TERRITORIAL SCOPE travel authorised by the Organization outside Europe under the conditions set out in
OF COVER Article V 3.02.
V 3.02 During duty travel outside Europe authorised by the Organization, the Main Member and
DUTY TRAVEL the members of his family accompanying him are covered for the expenses resulting from
necessary medical treatment within the following ceilings:
for out-patient treatment: the regulated price applicable in the Canton of Geneva
at the time of treatment;
for stays in hospital: reimbursement of cost of accommodation with a ceiling of
500 CHF per day.
Section 4 Benefits
V 4.01 Details of the reimbursement conditions are given in Article III 4.01.
HOSPITALISATION
V 4.02 The other benefits covered by the Short-term Health Insurance are listed in Annex III of
BENEFITS these Rules.
V 4.03 Benefits in respect of medical conditions existing prior to the beginning of the contract with
MEDICAL EXPENSES NOT CERN are not covered by the Short-Term Health Insurance.
COVERED
V 5.01 The contribution for Short-Term Health Insurance is a paid on a daily or monthly basis.
CONTRIBUTION The corresponding amounts are specified in Article A IV 1.03. The contribution must be
paid in advance for the entire period of cover.
Children up to the age of 18 shall be entitled to a 50% reduction.
V 5.02 The contributions shall be examined annually. If necessary, a proposal to adjust the
ADJUSTMENT OF THE contribution rate shall be submitted to the Council of the Organization.
CONTRIBUTION
- 14 -
V 5.03 If the contract of the member of the CERN personnel is extended, the contribution for the
PAYMENT OF THE new contract period must be paid before the previous one expires in order for insurance
CONTRIBUTION cover to be maintained. If the length of the contract is shortened, no contributions paid will
be reimbursed.
The insurance cover shall take effect provided that the contribution is paid by the first
working day after arrival at the Organization at the latest.
Chapter VI Occupational Illnesses and Accidents
VI 1.01 Occupational accidents and illnesses give entitlement to coverage of the expenses for
GENERAL medical treatment directly associated with them.
DESCRIPTION
VI 2.01 Members of the Scheme covered by the Normal, Reduced or Short-Term Health Insurance
MAIN MEMBERS are automatically covered against the financial consequences of occupational illnesses and
accidents.
VI 3.01 The insurance cover for occupational illnesses and accidents is world-wide.
TERRITORIAL SCOPE
Section 4 Benefits
VI 4.01 Subject to the applicable prior opinions or agreements, medical treatments directly linked
BENEFITS to an occupational illness or accident is reimbursed at the rate of 100%, without any limit
or ceiling.
Medical treatment ceases to be reimbursed under the occupational scheme in the event of
cure or consolidation. The entitlement to such reimbursement resumes only in the event of
a relapse.
The reimbursement benefits for occupational accidents and illnesses applicable to members
covered by Normal, Reduced and Short-Term Health Insurance are specified in Annex 1.
VI 4.02 No medical treatment resulting from occupational illnesses contracted or accidents

PERIOD OF sustained before the beginning of the insurance cover provided for in this Chapter is
INSURANCE COVER reimbursed under the occupational scheme.
VI 4.03 The deadline for claiming reimbursement of medical treatment expenses resulting from
TIME LIMIT occupational illnesses or accidents is identical to that specified in Article VIII 1.01. This
period begins on the date on which the illness or accident was recognised to be an
occupational illness or accident by the Organization or on the date on the bill, whichever is
the later.
- 15 -
VI 5.01 The Organization pays 100% of the contribution for the occupational illnesses and
CONTRIBUTION accidents cover.
VI 5.02 The contribution rate, as indicated in Article A IV 1.04, is a percentage of the reference
CONTRIBUTION RATE salaries in Chapter IX Section 1.
VI 5.03 The contribution rate for occupational illness and accident cover is examined annually for
ADJUSTMENT OF THE the following calendar year, taking into account:
CONTRIBUTION RATE the past and foreseen evolution of cost factors such as price changes, new
medical treatments, etc.;
the estimated total amount to which the contribution rate of active Members is
applicable for the following calendar year; and
any other relevant factor.
If necessary, a proposal to adjust the contribution rate is submitted to the Council of the
Organization.
Chapter VII Common Provisions
Section 1 Non-concurrence of Benefits Rule
VII 1.01 Any other benefit received as a result of compulsory membership of a national social-
NON-CONCURRENCE security or equivalent scheme shall be deducted from the benefits provided for by the
OF BENEFITS CERN Health Insurance Scheme. The Member concerned is required to inform the Third-
Party Administrator if he is in receipt of any such benefit. This provision does not apply to
other benefits resulting from membership of a scheme to which the Member has opted to
contribute.
Where medical expenses have been partly reimbursed by another insurance, the Member
must inform the Third-Party Administrator and is entitled to submit a reimbursement claim
to the Scheme only for the balance due.
If the reimbursement under the primary scheme is subject to an annual deductible, the latter
is not reimbursed by the Scheme.
Section 2 Cosmetic Treatment and Surgery
VII 2.01 Courses of rejuvenation treatment and cosmetic treatment and surgery, except in the case of
COSMETIC TREATMENT disfigurement or serious burns to the hands, are not covered by the Scheme. However,
AND SURGERY repair and reconstructive surgery is covered, subject to prior agreement, if it is rendered
necessary as a result of the occurrence of a guaranteed risk or an accident or illness suffered
less than two calendar years before the start of insurance coverage for the Member
concerned.
- 16 -
Section 3 Grounds for Refusal, Reduction or Withdrawal of

Benefits
VII 3.01 The allowance for reduced earning capacity, the long-term care allowance and the
GROUNDS FOR REFUSAL, indemnity in the event of death may be refused, reduced or withdrawn, temporarily or
REDUCTION OR permanently, if the person concerned has caused or worsened his own condition either
WITHDRAWAL OF
intentionally or by serious negligence, or by committing a crime or criminal offence.
BENEFITS
Furthermore, the cost of treatment for the after-effects of a treatment not covered by the
Scheme is not refundable.
Section 4 General Insurance Provisions
VII 4.01 Each Member of the Scheme receives an insurance card which indicates:
INSURANCE CARD the name and first name of the Member;
the insurance number;
the period of insurance cover.
VII 4.02 Each Member is free to choose his own medical practitioner and medical establishment.
FREE CHOICE OF
MEDICAL PRACTITIONER
AND ESTABLISHMENT
VII 4.03 Reimbursements are made on condition that the expenses incurred are covered by a
MEDICAL PRESCRIPTION medical prescription, except in the case of emergency transport.
The acts performed by medical auxiliaries must be consistent with the medical prescription.
VII 4.04 Members receive benefits that are subject to a ceiling exclusively on the basis of a ceiling
CALCULATION OF calculated pro rata temporis of the duration of their membership of the Scheme.
BENEFITS PRO RATA
TEMPORIS
This provision does not apply in the event of death of the Member.
VII 4.05 No benefits are paid in the event of missed appointments.

MISSED APPOINTMENTS
VII 4.06 In exceptional circumstances, a Member may request that a benefit exceeding the
EX GRATIA PAYMENTS reimbursement ceiling or a benefit not listed in these Rules be granted to him.
VII 4.07 Where the Third-Party Administrator observes that the rate applied for a given treatment
EXCESSIVE RATES significantly exceeds the reasonable usual rate for the treatment concerned, he may limit
CHARGED the amount refunded to the usual rate applied in the region in which the treatment is
provided. In order to avoid this measure, the Member must check with the Scheme
beforehand whether the rate proposed is acceptable.
VII 4.08 Any sum paid by the Scheme and unduly accepted by a Member must be paid back without
RECOVERY OF UNDUE delay. In the event of death of the Member, long-term care daily allowances already
PAYMENTS received do not have to be refunded.
VII 4.09 The Third-Party Administrator may decide to suspend all or part of the benefits concerned:
SUSPENSION OR of a Member who fails to comply with the provisions of these Rules;
REFUSAL OF BENEFITS
of a Member who refuses to undergo a medical examination prescribed by the
Medical Advisor of the Third-Party Administrator;
of a voluntary Member of the Scheme who is late in paying the contribution due;
of a Member in case of suspicion of fraud.
The Third-Party Administrator, with CERNs prior consent, may refuse to reimburse the
suspended benefits.
VII 4.10 Any member of the CERN personnel who is a Member of the Scheme and who fails to
DISCIPLINARY comply with the provisions of these Rules shall be liable to disciplinary action in
ACTION accordance with the CERN Staff Rules and Regulations.
- 17 -
VII 4.11 Following a hearing of the Member concerned, the Organization may exclude a Member
EXCLUSION FROM THE who has opted for membership of the Scheme:
SCHEME in the event of failure to pay the contribution within 30 calendar days from the
date on which the contribution is due;
in the event of fraud or proven attempt to defraud.
VII 4.12 In the event of death of a Member, any outstanding reimbursement shall be paid to the
REIMBURSEMENT IN THE heirs.
EVENT OF DEATH OF A
MEMBER
The claim for reimbursement of medical expenses incurred for the deceased must be
submitted within the deadline indicated in Article VIII 1.01.
VII 4.13 Where hospitalisation is in an approved hospital pursuant to Article II 1.10, at the request
HOSPITAL GUARANTEE of the hospital or the patient the Third-Party Administrator will guarantee direct payment of
bills at least three working days before commencement of the hospitalisation, except in
emergencies.
An initial guarantee is given for 14 calendar days of hospitalisation.
Any request for an extension of the guarantee must be submitted by the hospital to the
Third-Party Administrator for approval.
Where hospitalisation is in an unapproved hospital pursuant to Article II 1.11, the Third-

Party Administrator will grant a guarantee as third-party guarantor. The Member must then
settle the hospitalisation bill directly and claim reimbursement in accordance with the
provisions of Chapter VIII, Section 1 of these Rules.
VII 4.14 Up to the amount of the reimbursement made by the Third-Party Administrator, the latter
SUBROGATION shall, on behalf of the Scheme, be subrogated to the rights which a victim of an accident or
illness may have against any third parties who are liable. The Member may forfeit his right
to reimbursement in accordance with Article VII 4.09 if he does not confirm in writing
such subrogation when so requested by the Third-Party Administrator.
Section 5 Duration of Membership
VII 5.01 Compulsory Members are covered by the Normal Health Insurance from the first to the last
DURATION OF day of their contract of employment or association with the Organization, except during
COMPULSORY periods of special unpaid leave of one complete calendar month or more.
MEMBERSHIP
VII 5.02 Applications for voluntary membership of the Normal or Reduced Health Insurances must
APPLICATION FOR be made within 30 calendar days:
VOLUNTARY MEMBERSHIP for members of the personnel: from the first day of the contract of association
with the Organization; or from the first day of their renewed contract of
association where their annual working hours have increased from 50% or less
under the previous contract to over 50% under the new one; or from the first day
of their renewed contract of association under the responsibility of a new
employer who does not provide similar health insurance;
from the first day following the termination of compulsory membership as a
member of the CERN personnel or membership as a family member.
VII 5.03 Provided that the application for voluntary insurance is accepted, the insurance cover
DURATION OF commences on the first day of the month in which the Member becomes entitled to
VOLUNTARY MEMBERSHIP subscribe to it.
Members of personnel must subscribe to voluntary membership for the duration of the
contract with CERN. Any extension of the contract with CERN automatically extends
voluntary membership, except where annual working hours under the renewed contract of
association have decreased from over 50% under the previous contract to 50% or less
under the new one; or where renewal of the contract of association is under the
responsibility of a new employer who is under the obligation to cover the member of the
personnel with a similar health insurance.
- 18 -
VII 5.04 Voluntary Members may terminate the insurance at any time subject to a minimum of 30
TERMINATION OF calendar days notice. The termination of voluntary insurance cover is irrevocable and
VOLUNTARY MEMBERSHIP effective at the end of a calendar month.
VII 5.05 The Short-Term Health Insurance shall be subscribed to for the duration of the Main
SHORT-TERM HEALTH Member's contract with CERN without possibility of early termination and is for a
INSURANCE maximum of three months.
VII 5.06 All medical expenses incurred up to the last day of the insurance cover for non-
TERMINATION OF occupational illnesses and accidents may be submitted for reimbursement according to the
NON-OCCUPATIONAL provisions and time limits indicated in these Rules.
INSURANCE COVER
Where a stay in hospital exceeds the last day of insurance cover, the Member concerned is
entitled to maintain his voluntary membership of the Scheme until he is able to subscribe to
another basic health insurance or until he is discharged from hospital, whichever is earlier.
VII 5.07 An application for a change from reduced cover to normal cover or vice versa will be
APPLICATION FOR A accepted only if it is justified by the change in the family situation of the Main Member,
CHANGE OF COVER notably as a result of marriage, divorce or the birth or adoption of a child.
Chapter VIII Procedures
Section 1 Medical Expense Reimbursement Claims
VIII 1.01 Any claim for reimbursement of expenses resulting from medical treatment must be
TIME LIMIT submitted within 12 months from the date of issue on the bill.
VIII 1.02 The originals of the prescriptions, bills and proofs of payment of the bills must be attached
SUPPORTING to the medical expense claim.
DOCUMENTATION
Members are advised to keep photocopies of these documents and of the associated
reimbursement statements.
When submitting a request to the Scheme for a complementary reimbursement, the

Member concerned must attach the original of the reimbursement statement received from
the primary health insurance stating the amounts already reimbursed by that insurance.
VIII 1.03 Under special circumstances, and upon prior written request by the Member, the Third-
HIGH MEDICAL COSTS Party Administrator may grant reimbursement of a bill containing high medical costs
before the Member has paid the said bill.
The Member must subsequently submit proof of payment of this bill. Failure to settle a bill
for which prior reimbursement has been granted shall constitute an infringement of the
Rules and may lead to application of Articles VII 4.09, VII 4.10 et VII 4.11.
VIII 1.04 The bills submitted for reimbursement must indicate the full name of the patient, a
BREAKDOWN OF breakdown of the treatment undergone, the date or period of the said treatment, the amount
THE BILL payable and the currency of payment of the bill.
The bills shall clearly indicate the name, qualification and address of the attending medical
practitioner or the medical service provider concerned.
VIII 1.05 The Member himself is responsible for ensuring that he receives and pays the bills for
PAYMENT OF BILLS medical expenses in such a way as to be able to submit them for reimbursement within the
deadlines specified in these Rules.
This provision is not applicable where a guarantee of direct payment of the bills has been
given by the Third-Party Administrator.
- 19 -
VIII 1.06 Except in exceptional circumstances, the Main Member shall assume responsibility for the
ACCURACY OF accuracy of claims sent for reimbursement in his name or in the name of a member of his
REIMBURSEMENT family. The Main Member must also, as far as possible, check that the bills correspond to
CLAIMS
the treatment undergone.
VIII 1.07 The Member concerned must provide all the information required by the Third-Party
MEDICAL Administrator on the illness suffered or the treatment followed.
INFORMATION
The Third-Party Administrator may also contact those administering medical treatment
directly. Confidential information may be sent under sealed cover to the Third-Party
Administrator's Medical Adviser. The latter shall forward to the service for the settlement
of claims only such information as is necessary for the reimbursement.
VIII 1.08 Any Member receiving treatment may be required by the Third-Party Administrator to
MEDICAL EXAMINATION undergo a medical examination by a medical practitioner designated by the Third-Party
Administrator. Upon request of the Member concerned, the latter's medical practitioner
may be present during such an examination.
VIII 1.09 Where reimbursement is claimed for medical expenses resulting from an occupational
OCCUPATIONAL illness or accident, a copy of the official declaration made to CERN of the occupational
ILLNESSES AND illness or accident must be attached to the medical expense claim.
ACCIDENTS
No reimbursement under the provisions for occupational illnesses and accidents is granted
unless the illness or accident has been recognized as such by CERN.
VIII 1.10 Reimbursement of medical expense claims shall normally be made within 14 calendar days
REIMBURSEMENT OF following receipt of a duly completed medical expense claim including the requisite
CLAIMS supporting documents.
VIII 1.11 All payments in respect of contributions, reimbursements and allowances shall be made in
APPLICABLE CURRENCY Swiss francs. Any bank charges shall be borne by the Member.
REIMBURSEMENT CLAIMS
Where expenses to be reimbursed are not expressed in Swiss francs, the applicable rate of
exchange with the Swiss franc shall be the official rate in force at CERN on the date of
submission of the reimbursement claim.
In cases where a guarantee of direct payment of bills has been given pursuant to
Article VII, 4.13, bills submitted directly to the Third-Party Administrator by the hospital
concerned shall be paid in the currency of the State where treatment was provided.
Section 2 Prior Approvals and Opinions
VIII 2.01 Prior approval by the Third-Party Administrator is required for reimbursement of the
PRIOR APPROVAL following items:
transport costs (except in the case of emergency transport);
refractive surgery;
cures, convalescence and rehabilitation cures, in a respite care home or in a unit
for those waiting for space to become available in a suitable establishment;
home nurses;
hire or purchase of auxiliary appliances;
cost of accommodation in a hospital for a family member other than one of the
two parents and whose presence is required by the hospitalisation of a child of
less than 7 years of age.
VIII 2.02 Requests for prior approval must be made on the appropriate official form and submitted to
TIME LIMIT FOR the Third-Party Administrator at least 14 calendar days before the medical expenses subject
PRIOR APPROVAL to prior approval are incurred. This deadline is increased to 30 calendar days for expenses
for cures and convalescence cures.
VIII 2.03 Each request for prior approval must be supported by a medical prescription indicating the
SUPPORTING treatment, its justification, its duration and the expected result. An estimate must be
DOCUMENTATION attached to any request for prior approval of the hire or purchase of auxiliary appliances.
- 20 -
VIII 2.04 Expenses incurred without obtaining the requisite prior approval are not reimbursed by the
PRIOR APPROVAL NOT Scheme.
OBTAINED
VIII 2.05 A prior opinion on the medical evaluation and financial estimate must be obtained from the
PRIOR OPINION ON Third-Party Administrator for any planned dental treatment, prostheses and orthodontics
DENTAL TREATMENT scheduled to cost in excess of 800 CHF, except in cases of emergency.
VIII 2.06 The estimate for a prior opinion on dental treatment must be submitted to the Third-Party
SUBMISSION OF ESTIMATE Administrator at least 14 calendar days before the commencement of the treatment.
FOR DENTAL TREATMENT
Section 3 Cures and Convalescence Cures
VIII 3.01 All cures and convalescence cures1, including related treatment costs, are subject to prior
PRIOR APPROVAL approval in accordance with Article VIII 2.01.
VIII 3.02 Convalescence cures are accepted following medical surgery involving a stay in hospital,
CONVALESCENCE CURES or after a stay in hospital of at least 10 calendar days without medical surgery, provided
that the cure commences within 30 calendar days after the end of the hospital stay.
Wherever possible, requests for prior approval must be submitted seven calendar days
before commencement of the convalescence cure.
VIII 3.03 The prescription for a cure, other than convalescence cures, shall be accompanied by a
OTHER CURES medical case history setting out the results obtained by the medical treatment preceding the
cure, the schedule for medical treatment during the cure and the expected result with
respect to curing or consolidating the state of health of the person concerned.
In the event of a cure being repeated with the following cure commencing less than 12
months after the previous cure began, the medical practitioner shall submit a detailed
supporting document to justify the effectiveness of the cure.
In the event of a third or further cure for the same condition, the medical practitioner must
attach to the prescription for the cure a detailed evaluation of the previous cures.
Cures must be undergone in establishments recognized by the competent authorities of the

State in which the establishment is situated.
VIII 3.04 Where a cure is refused, the Third-Party Administrator will inform the Member concerned
REFUSAL OF CURE of his decision and the grounds for it.
VIII 3.05 High-altitude, rejuvenation, rest and change-of-air cures and any other such cures shall not
EXCLUSION OF CURES be considered as cures within the meaning of the present Rules.
______________________________
1
The term cure in Section 3 does not fall within the definition of cure specified in Article II 1.16.
- 21 -
Section 4 Settlement of Disputes
VIII 4.01 Any decision to apply these Rules is taken on behalf of the Director-General of the
GENERAL PROCEDURAL Organization. The general arrangements for challenging such a decision are described in
ASPECTS the procedure set out below.
However, the arrangements for challenging a decision relating to the recognition of a state
of dependence are described in Annex V of these Rules.
During the procedure set out below, personal medical data shall be subject to
confidentiality, as indicated in Article I 1.06.
The Director-General may delegate his authority to any member of the personnel within the
Organization whom he deems competent to settle disputes concerning health insurance
matters.
Application of the challenged decision shall not be suspended pending the outcome of the
procedure set out below.
The Director-General may extend the deadlines provided for in the procedure set out below
whenever the proper administration of justice so requires. He shall immediately inform the
Member concerned accordingly.
VIII 4.02 In order to reach an amicable agreement, a Member of the Scheme may request a review of
REVIEW OF A DECISION a decision taken in accordance with these Rules. Such a request must be made in writing
within 60 calendar days after notification of the challenged decision, to the Third-Party
Administrator if he has taken the challenged decision, otherwise to the Director-General.
The request for a review shall be signed by the Member concerned and sent by registered
mail. It shall include a copy of the challenged decision and a written summary of the
grounds for the request.
VIII 4.03 The Third-Party Administrator, or the Director-General where applicable, shall review the
NEW DECISION AFTER grounds for the challenged decision and consult the competent CERN authority. A
REVIEW substantiated reply, which constitutes a new decision, shall be addressed to the Member
concerned within 60 calendar days after receipt of the request. This new decision, which
cancels and replaces the challenged decision, shall indicate the grounds for the decision and
the possibilities of lodging an appeal in accordance with Article VIII 4.04.
VIII 4.04 An appeal regarding health insurance matters may be lodged only after completion of the
APPEAL AGAINST THE review procedure.
NEW DECISION
The Member concerned shall lodge the appeal in writing to the Director-General within 60
calendar days after notification of the decision taken in accordance with Article VIII 4.03.
The letter of appeal shall be signed by the Member concerned and sent by registered mail.
It shall include a copy of the challenged decision and a summary of the grounds for the
appeal.
VIII 4.05 Upon receipt of the appeal, the Director-General shall first examine the receivability.
RECEIVABILITY OF
THE APPEAL If the appeal is irreceivable, the Member concerned shall be informed of the grounds in
writing within 30 calendar days after receipt of the appeal.
If the appeal is receivable, the Director-General shall determine whether the dispute is of an
administrative or medical nature.
Any dispute concerning the allowance for reduced earning capacity is deemed to be of a
medical nature.
In disputes of an administrative nature, the Director-General shall convene the Health

Insurance Litigation Board in accordance with Article VIII 4.06 within 30 calendar days
after receipt of the appeal.
In disputes of a medical nature, a medical practitioner shall be appointed in accordance

with Article VIII 4.09.
- 22 -
VIII 4.06 The Health Insurance Litigation Board, hereafter referred to as "the Board", is competent to
SETTLEMENT OF DISPUTES hear any appeal against a decision of an administrative nature concerning health insurance
OF AN ADMINISTRATIVE matters taken in accordance with Article VIII 4.03.
NATURE
The Board shall be composed of three members who shall normally be members of the
CHIS Board, as referred to in Article X 1.03.
Two permanent members and their alternates shall be appointed for a renewable period of
two years, as follows:
one member and one alternate, appointed by the CERN Management;
one member and one alternate, appointed by the Staff Association.
Within 10 calendar days after the Board has been convened, the two permanent members
shall choose, by mutual agreement, the Chairman of the Board who shall normally also be a
member of the CHISB.
If no agreement has been reached within the set time limit, the third member of the Board
shall be the Chairman of the CHISB.
When the composition of the Board has been finalized, the Board shall begin to examine
the case within 30 calendar days.
VIII 4.07 The procedure is conducted entirely in writing. However, at its discretion, the Board may
PROCEDURE OF THE hear the member or any person who may give the Board the benefit of his expertise.
BOARD
The Board may initiate any investigation procedures which it deems necessary for
examination of the case.
The Chairman represents the Board for all legal proceedings.
The Board shall:

examine the documents which are presented to it by the parties;
consult the Third-Party Administrator or any expert, if it deems this necessary.
The conclusions of any expert consulted shall be communicated to the parties for
comments.
Where an expert assessment requested by the Board entails expenses, the Chairman of the
Board shall inform the Director-General beforehand and he shall decide whether such
expenses should be borne by the Scheme.
When the Chairman of the Board deems that he has obtained all the relevant information,
he shall close the investigation procedure and inform the parties thereof.
VIII 4.08 The Board shall draw up a report which it shall forward to the Director-General within 30
REPORT BY THE BOARD calendar days after the closure of the investigation procedure.
This report shall include the following elements:

the main arguments of the parties;
a summary of the conclusions by any possible experts consulted;
the considerations of the Board;
the recommendation of the Board, approved by the majority of its members.
- 23 -
VIII 4.09 Where the Director-General has determined that the dispute is of a medical nature, it shall
SETTLEMENT OF DISPUTES be examined, within 30 calendar days after the lodging of the appeal, by a medical
OF A MEDICAL NATURE practitioner jointly appointed by the medical practitioner chosen by the Member concerned
and the one chosen by the Organization.
If the parties fail to agree on a choice of medical practitioner, the appointment shall be
made by any competent medical authority in the Canton of Geneva.
Once the medical practitioner has been appointed, he shall begin to examine the case within
30 calendar days.
The medical practitioner may initiate any investigation procedures that he deems necessary
for examination of the case.
The medical practitioner shall:

examine the documents which are presented to him by the parties;
consult the Third-Party Administrator or any expert, if he deems this necessary.
In the event of a dispute concerning the allowance for reduced earning capacity, the
medical practitioner shall consult a rehabilitation specialist familiar with Swiss Federal
legislation on disability.
Communication of information and documents of a medical nature, including within the

context of Article VIII 4.10, shall be strictly limited to the minimum required for a proper
administration of the dispute.
The fees due to the medical practitioner and to any expert consulted shall be borne by the
Scheme.
VIII 4.10 The medical practitioner shall draw up a report which he shall forward to the Director-
REPORT BY THE General within 30 calendar days after the closure of the investigation procedure.
MEDICAL PRACTITIONER
This report shall include the following elements:
the main arguments of the parties;
a summary of the conclusions by any possible experts consulted;
the considerations of the medical practitioner;
a recommendation.
VIII 4.11 The Director-General shall notify the Member concerned of his decision in writing,
FINAL DECISION BY THE enclosing a copy of the report submitted by the Board or by the medical practitioner, within
DIRECTOR-GENERAL 30 calendar days after receipt of the report. Where applicable, he shall indicate his reasons
for not following the recommendation of the Board or of the medical practitioner.
The decision of the Director-General shall be final.
VIII 4.12 A complaint against the final decision pursuant to Article VIII 4.11 may be filed with the
APPEAL TO THE ILOAT Administrative Tribunal of the International Labour Organization (ILOAT) in accordance
with the latters Statute and Rules.
- 24 -
Chapter IX Financial Provisions
Section 1 Reference Salaries
IX 1.01 Reference Salary I is the basic monthly remuneration specified in the contract of
REFERENCE SALARY I employment or association with the Organization on the basis of a 40-hour working week.
This Reference Salary is used to calculate the main contributions of staff members, fellows
and students.
IX 1.02 Reference Salary II is the weighted average basic monthly remuneration of all staff
REFERENCE SALARY II members and fellows on the last day of the preceding calendar year, using the salary scale
for the current calendar year.
This Reference Salary is used to determine the contribution of associates, users and
beneficiaries of a deferred pension from the CERN Pension Fund. It is also used to
determine the contribution of apprentices (50% of Reference Salary II), and of children no
longer insured as dependants (40% of Reference Salary II).
IX 1.03 Reference Salary III is the monthly basic salary paid to a beneficiary of the CERN Pension
REFERENCE SALARY III Fund at the time of his departure from the Organization. It is adjusted in line with the
pensions.
For beneficiaries of a surviving spouses pension and/ or an orphans pension, the

Reference Salary III is reduced in accordance with the Rules and Regulations of the
Pension Fund.
This Reference Salary is used to determine the amount of the main contribution for
beneficiaries of the CERN Pension Fund opting for membership of the Normal Health
Insurance.
IX 1.04 Reference Salary IV is the basic monthly remuneration specified in the contract of
REFERENCE SALARY IV employment with the Organization on the basis of the actual duration of the working week.
This Reference Salary is used to calculate the amount of the supplementary contribution
when both spouses are staff members or fellows.
IX 1.05 Reference Salary V is the mid value (except for the lowest and highest brackets) of the
REFERENCE SALARY V income bracket corresponding to the monthly gross income or retirement pension
(including the CERN pension) deriving from a professional activity.
Monthly income bracket Reference Salary

up to 2,500 CHF inclusive 0 CHF / month
Above 2,500 CHF up to 4,250 CHF inclusive 3,333 CHF / month
Above 10'000 CHF Reference Salary II x 0.5
x Overall rate (Member +
Organization)/ rate of Member
alone
This Reference Salary is used to determine the contribution of spouses of Main Members
covered under Article III 5.07, paragraph 2, using the CERN Health Insurance Scheme as
their primary health insurance.
- 25 -
Section 2 Reserve Fund
IX 2.01 CERN has set up two funds, one for the capitalisation of its Long-Term Care (LTC) fund
RESERVE FUND reserves and the other for the provisions and reserves of its Health Insurance Scheme
(HIS).
The latter corresponds to the following provisions and reserves:

provision for reimbursements incurred and not yet claimed (20% of all
anticipated reimbursements for the year);
provision for catastrophic risk (30% of all anticipated reimbursements for the
year);
reserve against any future deficit of the Scheme (at least 20% of all anticipated
reimbursements for the year).
The capital of these funds is formally separate from the rest of CERN's assets.
Actuarial studies shall be regularly conducted in order to monitor the evolution of the HIS
and LTC schemes, taking into account the contributions, anticipated expenditure and the
assets of the funds. Any structural imbalance of these schemes shall be remedied as rapidly
as possible.
Chapter X Operation of the Scheme
Section 1 Operation
X 1.01 The Director-General shall appoint a Manager to manage the daily operation of the
MANAGER Scheme. In this framework the Manager shall:
- monitor and supervise the performance of the contract between the Organization
and the Third-Party Administrator;
- negotiate healthcare tariffs with providers;
- in collaboration with the CERN department responsible for finance, monitor the
financial position of the Scheme and its funds and report to the Strategic Advisor
referred to in Article X 1.02;
- check the benefits and contributions data submitted to and received from the
Third-Party Administrator and report to the Strategic Advisor;
- deal with any membership issue;
- in agreement with the Strategic Advisor, decide on the award of ex-gratia
benefits pursuant to Article VII 4.06
- monitor developments in the health insurance systems in the Member States and
other intergovernmental organisations and report on them to the Strategic
Advisor;
- perform any other tasks required for the daily operation of the Scheme.
- 26 -
X 1.02 The Strategic Advisor shall be appointed by the Director-General to assist him in drawing
STRATEGIC ADVISOR up the medium and long-term health insurance strategy. In this framework he shall, in
particular:
- analyse the reports on the financial position of the Scheme and its funds and the
associated long-term projections, as well as the contributions and benefits
statistics submitted to him by the Manager;
- in collaboration with the Manager, analyse developments in the health insurance
systems in the Member States and other intergovernmental organisations;
- in collaboration with the Manager, draw up and submit to the Director-General
proposals for adjustments of the Scheme needed to ensure that it achieves its
objectives and remains in long-term financial balance and that its conditions are
competitive with those of the health insurance schemes of the intergovernmental
organisations used as comparators;
- in agreement with the Director-General, submit these adjustment proposals to the
CHIS Board, as referred to in Article X 1.03, in preparation for subsequent
discussion at the Standing Concertation Committee (SCC).
X 1.03 The CERN Health Insurance Scheme Board (hereafter the CHIS Board) is a sub-group of
CHIS BOARD the SCC responsible for preparing discussion at the SCC of the adjustment proposals
submitted to the Board by the Strategic Advisor pursuant to Article X 1.02.
The CHIS Board shall be chaired by the Strategic Advisor and shall also comprise:
- four members appointed by the Director-General from among the members of the
personnel, including the Manager;
- four members appointed by the Staff Association from among the members of the
personnel and the beneficiaries of the CERN Pension Fund.
The CHIS Board shall establish its own working procedures. To allow it to successfully
complete its work, the CHIS Board shall be regularly informed by its Chairman and by the
Manager of details relating to the operation of the Scheme (including quality of service,
statistics, financial position, tariff negotiations, actuarial analyses). The members of the
CHIS Board shall have access to the documents containing such information.
- 27 -
Chapter XI Auditing
Section 1 Auditing
XI 1.01 CERN's internal and external auditors may on their own initiative examine all or part of the
INTERNAL AND EXTERNAL CERN Health Insurance Scheme.
AUDITORS
In order to be able to carry out this task, the auditors shall have access to all documents,
confidential or otherwise, required to verify the transactions shown in the Third-Party
Administrator's financial records together with the supporting documentation.
On request, the auditors shall also have access to the Third-Party Administrator's internal
written instructions.
The auditors shall not have access to personal medical data concerning the Members.
Chapter XII Annexes
Section 1 Annexes
XII 1.01 The following documents form an integral part of the Rules :
ANNEXES Annex I entitled "Normal Health Insurance Cover";
Annex II entitled "Allowance for Reduced Earning Capacity";
Annex III entitled "Short-Term Health Insurance Cover";
Annex IV entitled "Contribution Rates";
Annex V entitled "Long-Term Care benefits".
- 28 -
Rules of the CERN Health Insurance Scheme 1 June 2014 - Revised 1 November 2016
Annex I Normal Health Insurance Cover
A I 1.01 The reimbursement rates according to the Costs Borne by the Insured Member (FCA) cumulated by the Member over a calendar year are as follows:
REIMBURSEMENT RATES Cumulated Costs Borne by a Member (FCA) Reimbursement rate
UNDER THE GENERAL RULE up to 499.99 CHF 80 %
as from 500 CHF and up to 2999.99 CHF 90 %
3000 CHF 100 %
A I 1.02 Reimbursement of some items is limited to a certain level of expenses (ceiling), which generally applies per calendar year and in certain cases can be
CEILINGS cumulated over several years. Details of these ceilings are given in the table in this Annex.
Under Article VII 4.06, the ceilings below may be exceeded with the prior agreement of the Third-Party Administrator, in particular in the case of
children whose state of health requires prolonged medical treatment.
A I 1.03 In order to promote use of healthcare providers in Member States where health costs are less onerous, the 80% and 90% reimbursement rates are
BONUS FOR OUTPATIENT increased by 5 percentage points for certain outpatient treatments (defined in the table below) if they are dispensed in one of the following Member
TREATMENT States: Austria, Belgium, Bulgaria, Czech Republic, Finland, France, Germany, Greece, Hungary, Israel, Italy, Netherlands, Poland, Portugal, Romania,
Slovak Republic, Spain, Sweden and the United Kingdom.
A I 1.04 Certain preventive examinations and treatments are 100% reimbursed. They are:
PREVENTION - Vaccination against the human papilloma virus: with medical prescription
- Mammography (screening for breast cancer): women from the age of 50, once every two years
- Occult blood test in stool (colon cancer screening): men and women from the age of 50, once every two years
Other preventive examinations and treatments (e.g. vaccinations) are reimbursed in accordance with the General Rule.
A I 1.05 Expenses under items B1 to B5 for a given illness or accident that are incurred after the point where the cumulated expenses for that illness or accident
SERIOUS CASE exceed 80000 CHF are 100% reimbursed.
- 29 -
The following benefits are covered by the Normal Health Insurance cover:
PRIOR
AUTHORISATION
BY THE THIRD-
REIMBURSEMENT OTHER CONDITIONS
BENEFITS RATE
BONUS PARTY CEILING
ADMINISTRATOR
(see Chapter VIII,
Section 2)
A. OCCUPATIONAL ILLNESSES AND 100% NA Without limit or ceiling, but subject to prior agreement
ACCIDENTS or opinion for the items concerned, as in B below.
Any supplements for hospitalisation in a single-bed ward
borne exclusively by the Member.
B. NON-OCCUPATIONAL ILLNESSES
AND ACCIDENTS
1. Doctors' fees General rule According to
A I 1.03
2. Pharmaceutical costs General rule According to Recognised as such in the State where prescribed.
A I 1.03 The cost of non-reimbursed medication is not included in
the calculation of the Costs Borne by the Insured
Member (FCA).
3. Medical imaging General rule According to

A I 1.03
4. Laboratory and analysis work General rule According to
A1.1.03
5. Medical treatment and miscellaneous General rule According to Including outpatient treatment at a hospital
examinations A I 1.03
6. Treatment given by:
a) Speech therapist General rule According to 13300 CHF per
A I 1.03 calendar year
b) Child psychotherapist General rule According to 25000 CHF per

A I 1.03 calendar year
c) Home nurses General rule According to YES 68 CHF per day In the case of recognised long-term dependence, the
A I 1.03 daily limit is replaced by the monthly limit
(see Annex V 2.01)
- 30 -
PRIOR
AUTHORISATION
BY THE THIRD-
BENEFITS RATE
BONUS PARTY CEILING
ADMINISTRATOR
(see Chapter VIII,
Section 2)
d) Medical auxiliaries other than those General rule According to 3300 CHF per
mentioned in points 6 a) to c) A I 1.03 calendar year
7. In-patient hospital treatment
(cost of accommodation and treatment)
a) Hospitalisation in a public hospital, 100%
apart from the private or semi-private
sector
b) Hospitalisation in an unapproved private 80%
hospital
c) Any other hospitalisation General rule
d) Cost of accommodation in a hospital for 70% 132 CHF

one of the two parents whose presence is per day
required by the hospitalisation of their
child of less than 7 years of age
e) Cost of accommodation in a hospital for 70% YES 132 CHF In the absence of prior agreement, the Third-Party
a family member, other than one of the per day Administrator may exceptionally accept reimbursement
two parents, whose presence is required if the attending physician at the hospital considers the
by the hospitalisation of a child of less presence of this family member necessary.
than 7 years of age
8. Cures and accommodation in In accordance with Chapter VIII, Section 3.
convalescence and rehabilitation facilities,
in a respite care home or in a unit for
those waiting for space to become
available in a suitable institution
a) Cost of accommodation and board for a 100% YES 10 CHF
cure per day
b) Cost of accommodation and board for a 100% YES 80 CHF

convalescence cure per day
c) Cost of accommodation and board in a 100% YES 120 CHF Cost of accommodation and board in a specialised social
rehabilitation facility per day rehabilitation facility, e.g. in an alcohol or drug abuse
rehabilitation centre.
- 31 -
PRIOR
AUTHORISATION
BY THE THIRD-
BENEFITS RATE
BONUS PARTY CEILING
ADMINISTRATOR
(see Chapter VIII,
Section 2)
d) Cost of accommodation in a respite care General rule YES Benefit cannot be cumulated with the daily long-term
home or in a unit for those waiting for care allowance.
space to become available in a suitable
institution;
e) Medical and pharmaceutical costs General rule According to
A1.1.03
9. Optical and ophthalmologic expenses

a) Corrective glasses (lenses and frame) General rule 500 CHF per On prescription.
and contact lenses, including disposable calendar year, As a transitory measure for members affiliated before
lenses which can be 1.1.2012, the annual ceiling shall be increased as
cumulated over follows:
3 years - for 2012: by 1000 CHF minus the
expenses incurred in 2010 and 2011;
- for 2013: by 500 CHF minus the
expenses incurred in 2011.
Article VII 4.04, which concerns the calculation of
ceilings pro rata temporis shall be applied to calculate
these increases.
b) Refractive surgery General rule YES 2000 CHF per No reimbursement within the first 12 months of
eye for the membership of the Scheme.
entire period of
cover
10. Hire or purchase of auxiliary appliances: General rule YES 11000 CHF per
orthopaedic appliances, prostheses other than calendar year,
dental prostheses, hearing aids, oxygen which can be
extractors, dialysis machines, etc. cumulated over
2 years
- 32 -
PRIOR
AUTHORISATION
BY THE THIRD-
BENEFITS RATE
BONUS PARTY CEILING
ADMINISTRATOR
(see Chapter VIII,
Section 2)
11. Hire or purchase of auxiliary appliances General rule YES 11000 CHF per This concerns the following appliances:
designed to foster personal autonomy in calendar year, - wheelchairs;
the case of recognised disability, reduced which can be - supplementary automatic sanitary installations
earning capacity or dependence cumulated over where the Member is unable to wash himself
2 years without one;
- chair lifts for use by patients in their home;
- electric beds (with base, but excluding mattress and
other accessories) for use at home;
- adaptation of the Members place of residence:
installation of support rails, elimination of changes
in floor levels, construction of ramps over changes
in floor levels, modification of door embrasures,
installation of luminous signals for the deaf and
those suffering from serious hearing impairment,
emergency call systems for the deaf and blind;
- adjustments to a vehicle to allow the Member to
travel.
12. Dental treatment, prostheses and General rule YES 3300 CHF per * Subject to prior opinion if the costs exceed
orthodontics calendar year, 800 CHF, except in emergencies.
which can be
cumulated over
3 years
13. Transport costs: in an ambulance or
medical vehicle (exceptionally by taxi)
a) from the place of residence or the site of General rule
the accident to the nearest suitable
hospital, or any other means of transport
used in an emergency
b) from one hospital to another General rule YES

f) to a rehabilitation facility General rule YES
d) any other medically essential transport General rule YES
C. PREVENTION 100% NA Exclusively for the examinations and treatments listed in

A I 1.04.
- 33 -
PRIOR
AUTHORISATION
BY THE THIRD-
BENEFITS RATE
BONUS PARTY CEILING
ADMINISTRATOR
(see Chapter VIII,
Section 2)
D. ALLOWANCE FOR REDUCED NA See Annex II

EARNING CAPACITY of a family
member
E. LONG-TERM CARE ALLOWANCE NA See Annex V
F. INDEMNITY IN THE EVENT OF

DEATH
a) of a staff member NA 14000 CHF 3 times the basic salary with a ceiling of
14000 CHF.
b) of a family member NA 1600 CHF
- 34 -
Annex II Allowance for Reduced Earning Capacity
A II 1.01 For the purpose of this Annex, the notion "reduced earning capacity" means a reduction in
DEFINITION earning capacity, assumed to be permanent or of a long duration, resulting from the effects
of physical or mental illness caused by congenital infirmity, illness or accident, preventing
the person concerned from carrying out his normal work.
A II 1.02 A member of the family (as defined in the CERN Staff Rules and Regulations) of a
ELIGIBLE PERSONS member of the personnel in active employment, of a former member of the personnel in
receipt of a pension or of a deceased member of the personnel or as defined in Article III
2.04 may claim payment of an allowance for reduced earning capacity provided the
following conditions are fulfilled cumulatively at the time of the application:
the member of the personnel must be (or have been, in the case of former
members of the personnel) a staff member, a fellow or an apprentice;
the member of the personnel must have, or have had, at least two years of
uninterrupted service within the Organization. This two-year period includes the
total period of uninterrupted contracts as a staff member, a fellow or an
apprentice;
the member of the personnel and the eligible person must be Members of the
Normal Health Insurance, and must have been Members for at least one year;
the eligible person must not be a member of the CERN personnel;
all attempts to restore the earning or working capacity of the person concerned
must have proven either completely or partly ineffective;
the eligible person must have reached the age of 18 but not have reached the
official retirement age laid down in the CERN Staff Rules and Regulations.
A II 1.03 A person is eligible to request the allowance where:

CONDITIONS FOR his earning capacity is permanently reduced by at least 50%;
ENTITLEMENT TO
THE ALLOWANCE or
where his earning capacity has been reduced, with no significant interruption
(i.e. more than 30 consecutive days), by an average of at least 50% over 360
days, and where his earning capacity is still reduced by at least 50%.
A II 1.04 The allowance for reduced earning capacity may be claimed at any time provided the
APPLICATION FOR conditions set out in this Annex are fulfilled.
ALLOWANCE
If a claim is accepted, the effective date is the first day of the month in which the claim is
made. The allowance may be paid retroactively for a maximum period of 12 months if the
person concerned proves that the conditions justifying the payment were fulfilled
continuously.
A II 1.05 Anyone claiming payment of the allowance must provide the Third-Party Administrator, at
SUPPORTING his own expense, with a detailed medical report by the competent national authority setting
DOCUMENTATION out the cause, nature, commencement, history and probable duration of the illness, injuries
or the intellectual and physical deterioration of the person concerned. The report shall also
state the extent of reduced earning capacity determined by a medical practitioner and a
certificate indicating the chances of recovery. The Third-Party Administrator shall be
entitled to request any useful information and proof; he may himself, at the expense of the
Scheme, carry out investigations and have the Member concerned examined by the medical
practitioners of his choice.
A II 1.06 Within six weeks following receipt of the supporting documents set out above, the Third-
RECOGNITION OF Party Administrator shall inform the person concerned, and, where appropriate, CERN, in
ENTITLEMENT writing whether it has been decided to grant an allowance for reduced earning capacity and,
if this is so, giving details of the amount and the date from which it is payable.
The Third-Party Administrator shall be entitled to defer the decision by a maximum of one
year after medical treatment is completed if the medical report leaves doubts concerning
permanent reduced earning capacity and its extent.
- 35 -
A II 1.07 The entitled person shall receive a full allowance if he is diagnosed as having at least a
FULL ALLOWANCE two-thirds reduction in earning capacity.
A II 1.08 The entitled person shall receive a half allowance if he is diagnosed as having at least a
HALF ALLOWANCE 50% reduction in earning capacity.
A II 1.09 The allowance shall be equal to the minimum allowance which would be payable by the AI
AMOUNT OF THE (disability insurance) of the Swiss Confederation in the same circumstances, irrespective of
HALF ALLOWANCE the State of residence of the person concerned.
A II 1.10 Anyone receiving an allowance provided for in the present Annex is required to inform the
OBLIGATION TO Third-Party Administrator without delay of any allowance, pension or sum of money for
FURNISH INFORMATION reduced earning capacity, disability or old-age that is not an allowance from voluntary
private insurance in return for payment.
A II 1.11 Any allowance, pension or sum of money for reduced earning capacity, disability or old
NON-CONCURRENCE OF age received by an entitled person shall be deducted from the allowance granted under the
BENEFITS terms of the present Annex, provided that it is not an allowance from voluntary private
insurance in return for payment. However, the handicapped orphan's pension, as granted
under the Rules of the CERN Pension Fund, may run concurrently with the benefits
covered by this Annex.
A II 1.12 The Third-Party Administrator must immediately be informed of any improvement in

IMPROVEMENT IN earning or working capacity. The allowance shall be cancelled or reduced following
EARNING OR WORKING restoration of or improvement in working capacity. Any allowance to which the person
CAPACITY
concerned was not entitled must be repaid in accordance with Article VII 4.08.
A II 1.13 Where a person in receipt of a half allowance suffers a further deterioration that results in a
DETERIORATION IN reduced earning capacity of at least two thirds, the allowance becomes full.
EARNING OR WORKING
CAPACITY
A II 1.14 The consequences of a change in the extent of the reduction in earning capacity take effect
DATE OF EFFECT from the day on which the change is medically certified.
A II 1.15 The Third-Party Administrator may at any time request any proof he deems necessary and
PROOF AND MEDICAL have the Member concerned examined by any medical practitioner of the choice of the
EXAMINATION Third-Party Administrator and at the expense of the Scheme. Upon request of the Member
concerned, the latter's medical practitioner may be present during such an examination.
A II 1.16 The allowance shall be refused, reduced or withdrawn, temporarily or permanently, if the
GROUNDS FOR REFUSAL, person concerned has caused or worsened his own reduced earning capacity either
REDUCTION OR intentionally or by serious negligence, or by committing a crime or criminal offence.
WITHDRAWAL OF
ALLOWANCE
A II 1.17 The person concerned shall be temporarily or permanently refused an allowance if he

REFUSAL OF evades or objects to rehabilitation measures which he can reasonably be expected to
REHABILITATION undergo and which are likely to bring about a significant improvement in his earning or
MEASURES
working capacity.
A II 1.18 The allowance shall be paid as long as the person concerned remains insured under the
TERMINATION OF Normal Health Insurance and the conditions provided for in Articles A II 1.02 and
ENTITLEMENT A II 1.03 remain valid. Payment shall cease on the last day of the month in which the
entitlement ceases and, whatever the circumstances, as soon as the person concerned has
reached the retirement age as set out in the CERN Staff Rules and Regulations.
A II 1.19 For the implementation and interpretation of the provisions of this Annex, the parties shall
APPLICABLE LAWS refer, in the following order, to:
the provisions of this Annex;
the Rules, without prejudice to the provisions of Article I 1.08 thereof;
Swiss Federal legislation on disability insurance, it being understood that the
notion "reduced earning capacity" used in this Annex corresponds to the notion
"disability" in the LAI (Loi sur l'assurance-invalidit);
the insurance laws and regulations in force in Switzerland.
- 36 -
Annex III Short-Term Health Insurance

A III 1.01 The reimbursement rates according to the Costs Borne by the Insured Member (FCA) cumulated by the Member over a calendar year are as follows:
REIMBURSEMENT RATE
UNDER THE GENERAL RULE Cumulated Costs Borne by a Member (FCA) Reimbursement rate
up to 499.99 CHF 80 %
as from 500 CHF and up to 2999.99 CHF 90 %
3000 CHF 100 %
A III 1.02 In order to promote use of healthcare providers in Member States where health costs are less onerous, the 80% and 90% reimbursement rates are increased
BONUS FOR OUTPATIENT
TREATMENTS
by 5 percentage points for certain outpatient treatments (defined in the table below) if they are dispensed in one of the following Member States: Austria,
Belgium, Bulgaria, Czech Republic, Finland, France, Germany, Greece, Hungary, Israel, Italy, Netherlands, Poland, Portugal, Romania, Slovak Republic,
Spain, Sweden and the United Kingdom.
PRIOR
AUTHORIZATION
BY THE THIRD-
REIMBURSEMENT
BENEFITS RATE
BONUS PARTY CEILING OTHER CONDITIONS
ADMINISTRATOR
(see Chapter VIII,
Section 2)
A. OCCUPATIONAL ILLNESSES AND 100% NA Without limit or ceiling, but subject to prior agreement or
ACCIDENTS opinion for the items concerned, as in B below.
B. NON-OCCUPATIONAL ACCIDENTS
AND ILLNESSES
1. Doctors' fees General rule According to
A III 1.02
2. Pharmaceutical costs General rule According to Recognised as such in the State where prescribed.
A III 1.02 The cost of non-reimbursed medication is not included in the
calculation of the Costs Borne by the Insured Member
(FCA).
- 37 -
PRIOR
AUTHORIZATION
BY THE THIRD-
REIMBURSEMENT
BENEFITS RATE
BONUS PARTY CEILING OTHER CONDITIONS
ADMINISTRATOR
(see Chapter VIII,
Section 2)
3. Medical imaging General rule According to
A III 1.02
4. Laboratory and analysis work General rule According to
A III 1.02
5. In-patient hospital treatment
(cost of accommodation and treatment)
a) Hospitalisation in a public hospital apart 100%
from the private or semi-private sector
b) Hospitalisation in an unapproved private 80% Any supplements for hospitalisation in a single-bed ward
hospital borne exclusively by the Member.
c) Any other hospitalisation General rule
6. Urgent dental treatment General rule 300 CHF

(excluding prostheses and orthodontics)
7. Transport costs: in an ambulance or

medical vehicle (exceptionally by taxi)
a) from the place of residence or the site of General rule
the accident to the nearest suitable
hospital, or any other means of transport
used in an emergency
b) from one hospital to another General rule YES

c) to a rehabilitation facility General rule YES
g) any other medically essential transport General rule YES
- 38 -
Annex IV Contribution Rates
Section 1 Contributions and Contribution Rates
A IV 1.01 In accordance with Articles III 5.09 and IV 5.01, the contribution rate for non-occupational
CONTRIBUTION RATE FOR illnesses and accidents is the following percentage of the Members reference salary
NORMAL AND REDUCED defined in Chapter IX Section 1 for (a) beneficiaries of the CERN Pension Fund and (b) all
HEALTH INSURANCES
other Members:
(a) (b)
for the year 2011 11.66% 10.86%
for the year 2012 12.07% 11.27%
for the year 2013 12.48% 11.68%
for the year 2014 12.91% 12.11%
for the year 2015 13.37% 12.57%
A IV 1.02 For the year 2011,

APPORTIONMENT OF THE (a) the Member pays 4.27% of the reference salaries defined for staff members,
CONTRIBUTION FOR THE fellows, students and for beneficiaries of the CERN Pension Fund;
NORMAL HEALTH
(b) the Organization pays
INSURANCE COVER
1. 6.59% of the reference salaries defined for staff members, fellows and
students, and,
2. 7.39% of the reference salaries defined for beneficiaries of the CERN
Pension Fund.
Thereafter, this apportionment will be increased to the following percentage of the

respective reference salary:
(a) (b)1. (b)2.
for the year 2012 4.41% 6.86% 7.66%
for the year 2013 4.55% 7.13% 7.93%
for the year 2014 4.70% 7.41% 8.21%
for the year 2015 4.86% 7.71% 8.51%
The Organization pays 100% of the contribution payable for apprentices.
When a supplementary contribution is calculated on Reference Salary V, the contribution is

paid by the Member alone at the rate as specified under (a).
During periods of special leave of one complete calendar month or more, the
apportionment of the contributions are determined in each individual case by mutual
agreement between the Organization and the member of the CERN personnel concerned.
In all other cases, unless otherwise specified, the Member concerned pays 100% of the
contribution.
A IV 1.03 The contribution for the Short-Term Health Insurance is 13 CHF per Member per full day
CONTRIBUTION FOR of insurance cover (0.00 to 24.00) or 330 CHF per month (30 consecutive days) per
SHORT-TERM HEALTH Member.
INSURANCE
A IV 1.04 In accordance with Article VI 5.02, the contribution rate for occupational illnesses and
CONTRIBUTION RATE accidents is 0.12% of the reference salaries defined in Chapter IX, Section 1.
FOR OCCUPATIONAL
ILLNESSES AND
ACCIDENTS
- 39 -
Annex V Long-Term Care Benefits
Section 1 Conditions of Award and Procedural Aspects
A V 1.01 Unless otherwise specified, the conditions of the Health Insurance Scheme shall apply to
GENERAL CONDITIONS the provisions of this Annex.
A V 1.02 Any Member of the Normal Health Insurance considering himself to be in a state of
ELIGIBLE PERSONS dependence may apply to receive the long-term care benefits set out in Section 2 of this
Annex.
A V 1.03 Within the meaning of this Annex, "Member concerned" shall signify the Member himself
MEMBER CONCERNED or any person expressly empowered to represent him, except where it is clear from the
context that the provisions in question relate exclusively to the Member himself.
A V 1.04 The application shall be addressed to the Third-Party Administrator in writing. It shall
FORM OF THE specify whether the Member concerned resides at home or in a specialised institution, as
APPLICATION well as the name and address of the attending physician.
A V 1.05 The recognition of a state of dependence is based upon an assessment by a Medico-Social

PROCEDURE FOR THE Panel comprising a representative of the CERN Social Affairs Service, the Third-Party
RECOGNITION OF A STATE Administrator's consulting medical practitioner specialising in geriatrics and dependence,
OF DEPENDENCE
appointed in agreement with CERN and a representative of the Third-Party Administrator.
The Panel's assessment of whether a state of dependence exists shall be based upon two
questionnaires: a medical questionnaire completed by the Member's attending physician
and a medico-social questionnaire completed by the Member concerned and/or his family
members, friends or others close to him. Wherever appropriate, the Panel may request any
additional information it deems necessary.
The Medico-Social Panel shall distinguish between three levels of dependence (low,
moderate or high) according to the Member's degree of ability to perform the following
functions of everyday life unaided:
getting up, sitting down, getting into bed;
mobility;
washing and grooming;
dressing and undressing;
taking food and drink;
going to the lavatory;
coherence and ability to communicate;
orientation in space and time.
The Panel shall also determine the date on which the state of dependence began.
A V 1.06 The Third-Party Administrator's recognition of a level of dependence, on the advice of the
RECOGNITION OF A Medico-Social Panel, shall be the subject of written notification sent to the Member
STATE OF DEPENDENCE concerned and shall give him entitlement to the corresponding long-term care benefits set
out in Section 2 of this Annex.
A V 1.07 The long-term care benefits shall be granted from the date on which the application was
DATE OF EFFECT submitted provided that it is medically recognised that the Member concerned was in the
state of dependence on this date.
Where the date of recognition of the state of dependence falls later than the date of
application, the long-term care benefits shall be paid only from the date of recognition
onwards.
- 40 -
A V 1.08 The Member concerned shall be required to inform the Third-Party Administrator of any
CHANGE IN THE STATE OF lasting change (deterioration or improvement) that may affect the state of dependence. This
DEPENDENCE change shall be substantiated by a medical certificate.
The Medico-Social Panel may, at any time, conduct a new assessment of the Member's
state of dependence.
A V 1.09 The Third-Party Administrator's recognition of a change in the state of dependence shall
DATE OF EFFECT OF A take effect from the day on which this change is medically recognised.
CHANGE IN THE STATE OF
DEPENDENCE
A V 1.10 Any benefit of the same nature for the same purpose received as a result of compulsory
RULE CONCERNING NON- membership of a national social-security scheme shall be deducted from the long-term care
CONCURRENCE OF allowance provided for under Section 2 of this Annex.
BENEFITS
The Member concerned is required to inform the Third-Party Administrator that he is in
receipt of any such benefit.
A V 1.11 Any decision concerning the recognition of a state of dependence shall be taken on behalf
APPEAL AGAINST A of the Director-General of the Organization and may be challenged according to the appeal
DECISION CONCERNING procedure set out below.
THE RECOGNITION OF A
STATE OF DEPENDENCE
During the procedure set out below, personal medical data shall be subject to
confidentiality, as indicated in Article I 1.06.
The Director-General or the person to whom he has delegated his authority may extend the
time limits specified in the procedure set out below whenever circumstances so require. He
shall immediately inform the Member concerned accordingly.
The Member concerned shall lodge the appeal with the Director-General in writing within
60 calendar days following the notification of the challenged decision.
The letter of appeal shall be signed by the Member concerned and sent by registered mail.
It shall include a copy of the challenged decision and a summary of the grounds for the
appeal.
The dispute shall then be examined by a medical practitioner specialising in geriatrics and
dependence, jointly appointed by the Member concerned and the Organization within 15
calendar days following the lodging of the appeal.
If the parties fail to agree on the choice of the specialist medical practitioner, the
appointment shall be made by any competent medical authority in the Canton of Geneva.
When the specialist medical practitioner has been appointed, he shall begin to examine the
case within 15 calendar days.
The specialist medical practitioner may initiate any investigation procedures which he
deems necessary for examination of the case.
The specialist medical practitioner shall:

examine the documents which are presented to him by the parties;
consult the Third-Party Administrator or any expert, if he deems this necessary.
The specialist medical practitioners fees and those of any expert consulted shall be borne
by the Scheme.
The specialist medical practitioner shall draw up a report which he shall forward to the
Director-General within 15 calendar days following the closure of the investigation
procedure. This report shall include the following elements:
main arguments of the parties;
a summary of the conclusions of the experts consulted;
considerations of the specialist medical practitioner;
a recommendation.
- 41 -
The Director-General shall notify the Member concerned of his decision in writing,
enclosing a copy of the report submitted by the specialist medical practitioner, within 15
calendar days of receiving the report.
The decision of the Director-General shall be final.
A complaint against this decision may be filed with the Administrative Tribunal of the
International Labour Organization (ILOAT), in accordance with the latter's Statute and
Rules.
Section 2 Benefits
A V 2.01 In the event of recognition of a state of dependence in accordance with the procedure
BENEFITS described in Section 1 of this Annex, the following benefits shall be granted in addition to
those of the Normal Health Insurance Cover provided for in Annex I of these Rules, with
the exception of points 6 c) [home nurses] and 6 d) [other medical auxiliaries].
PARAMEDICAL BENEFITS
6 c) home nurses
6 d) Medical auxiliaries other than
those mentioned in points 6 a) to c) of
Annex I.
Rate of Ceiling
reimbursement
low level of dependence general rule 1100 CHF per month

moderate level of dependence general rule 1650 CHF per month
high level of dependence general rule 2750 CHF per month
LONG-TERM CARE ALLOWANCE

Amount Conditions
low level of dependence 48 CHF / day the long-term care allowance

moderate level of dependence 72 CHF / day shall not be paid during
high level of dependence 120 CHF / day periods of hospitalisation.
- 42 -
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE
EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH
Laboratoire Europen pour la Physique des Particules

European Laboratory for Particle Physics
Rglement du
Version Rgime
1er juin 2014 dAssurance
Mise jour 1er novembre 2016
maladie du CERN
Rglement du Rgime dAssurance maladie du CERN 1er juin 2014
Prambule
Le Directeur gnral de lOrganisation europenne pour la Recherche nuclaire,
Considrant la Convention tablissant lOrganisation europenne pour la Recherche

nuclaire (CERN) signe Paris le 1er juillet 1953, telle quamende le 17 janvier 1971 ;
Considrant lArticle 21 de lAccord entre le Conseil Fdral suisse et le CERN

tablissant le statut juridique de lOrganisation en Suisse, sign le 11 juin 1955, selon
lequel lOrganisation est exempte de toutes cotisations obligatoires des institutions
gnrales de prvoyance sociale, tant entendu que lOrganisation assure, dans la mesure
du possible et selon des conditions convenir, laffiliation aux systmes suisses
dassurance de ses agents qui ne sont pas assurs dune protection sociale quivalente par
lOrganisation elle-mme ;
Considrant lArticle 1 de lAccord entre le Gouvernement de la Rpublique franaise et

le CERN, sign le 30 dcembre 1970, selon lequel les membres du personnel de
lOrganisation ne sont pas soumis aux lgislations franaises relatives la scurit sociale
et aux prestations familiales et selon lequel lOrganisation protge les membres de son
personnel contre les consquences conomiques rsultant de la maladie et de la maternit,
des accidents du travail et des maladies professionnelles, de linvalidit et de la vieillesse
dans les conditions du rgime de prvoyance quelle a institu ;
Considrant les dispositions du Rgime dAssurance maladie du CERN, telles que

Prcdemment fixes dans la Convention dAssurance maladie 605/ADM conclue entre le
CERN et la compagnie dassurance Austria ;
Considrant la dcision du Conseil du 18 juin 1999 de modifier ladministration du

Rgime dAssurance maladie du CERN par lapprobation dun nouveau contrat pour
lAdministration dudit Rgime remplaant la Convention 605/ADM ;
Considrant la ncessit dnoncer, dans un document distinct, le "Rglement du Rgime

dAssurance maladie du CERN" qui inclut les principes gnraux, les cotisations et les
prestations du Rgime dAssurance maladie du CERN, tels que prcdemment fixs dans la
Convention 605/ADM, initialement approuvs par le Conseil de lOrganisation le 6 octobre
1970 ;
Considrant la dcision du Conseil du 15 dcembre 2000 dintroduire une couverture

contre les risques lis la dpendance au sein du Rgime dAssurance maladie du CERN ;
Considrant les dispositions du Chapitre IV des Statut et Rglement du Personnel du

CERN intitul "Protection sociale" ;
Considrant le fait que le Conseil de lOrganisation, conformment au Statut du

Personnel, fixe les cotisations de lOrganisation ainsi que les prestations et les cotisations
des membres du personnel relatives aux mesures de protection sociale prises par
lOrganisation ;
Considrant la dcision du Conseil, prise le 16 dcembre 2010, dapporter certaines

modifications aux cotisations payables au Rgime dAssurance maladie du CERN et
dautoriser le Directeur gnral prendre en temps opportun des mesures pour contenir les
dpenses dudit rgime en encourageant le recours des prestataires de soins et de
traitements offrant le meilleur rapport qualit-prix ;
Adopte le prsent "Rglement du Rgime dAssurance maladie du CERN" dans

son dition du 1er juin 2014.
1
Table des matires
PREAMBULE .......................................................................................................................................................................... 1
TABLE DES MATIERES ....................................................................................................................................................... 2

CHAPITRE I DISPOSITIONS GENERALES .................................................................................................................. 4
Section 1 - Dispositions gnrales ..................................................................................................................... 4

CHAPITRE II - DEFINITIONS ............................................................................................................................................. 5
Section 1 - Dfinitions ........................................................................................................................................ 5

CHAPITRE III - COUVERTURE DASSURANCE MALADIE NORMALE .................................................................. 8
Section 1 - Description gnrale ........................................................................................................................ 8

Section 2 - Adhsion ........................................................................................................................................... 8
Section 3 - Couverture territoriale ..................................................................................................................... 9
Section 4 - Prestations........................................................................................................................................ 9
Section 5 - Cotisation ....................................................................................................................................... 10
Section 6 - Obligation de renseigner ................................................................................................................ 11
CHAPITRE IV - COUVERTURE DASSURANCE MALADIE REDUITE ................................................................... 12
Section 1 - Description gnrale ...................................................................................................................... 12

Section 2 - Adhsion ......................................................................................................................................... 12
Section 3 - Couverture territoriale ................................................................................................................... 12
Section 4 - Prestations...................................................................................................................................... 12
Section 5 - Cotisations...................................................................................................................................... 13
CHAPITRE V - COUVERTURE DASSURANCE MALADIE A COURT TERME ..................................................... 13

Section 2 - Adhsion ......................................................................................................................................... 13
CHAPITRE VI MALADIES ET ACCIDENTS PROFESSIONNELS........................................................................... 14

Section 2 - Adhsion ......................................................................................................................................... 14
CHAPITRE VII DISPOSITIONS COMMUNES ............................................................................................................ 16
Section 1 - Rgle de non-cumul ........................................................................................................................ 16

Section 2 - Traitement esthtique ..................................................................................................................... 16
Section 3 - Motif de refus, rduction ou suppression de prestations ................................................................ 16
Section 4 - Dispositions gnrales dassurance ............................................................................................... 16
Section 5 - Dure dadhsion ........................................................................................................................... 18
CHAPITRE VIII - PROCEDURES ..................................................................................................................................... 19
Section 1 - Demande de remboursement des frais mdicaux ........................................................................... 19

Section 2 - Accords et avis pralables .............................................................................................................. 20
Section 3 - Cures et sjours de convalescence ................................................................................................. 21
Section 4 - Rglement des litiges ...................................................................................................................... 22
2
CHAPITRE IX - DISPOSITIONS FINANCIERES ........................................................................................................... 25
Section 1 - Salaires de rfrence ...................................................................................................................... 25

Section 2 - Fonds de Couverture ...................................................................................................................... 26
CHAPITRE X FONCTIONNEMENT DU REGIME...................................................................................................... 26
Section 1- Fonctionnement ............................................................................................................................... 26

CHAPITRE XI - AUDIT ....................................................................................................................................................... 27
Section 1 - Audit ............................................................................................................................................... 27

CHAPITRE XII - ANNEXES ............................................................................................................................................... 28
Section 1 - Annexes .......................................................................................................................................... 28

ANNEXE I - COUVERTURE DASSURANCE MALADIE NORMALE ....................................................................... 29
ANNEXE II - ALLOCATION POUR INCAPACITE DE GAIN ...................................................................................... 34
ANNEXE III - COUVERTURE DASSURANCE MALADIE A COURT TERME ....................................................... 36
ANNEXE IV - TAUX DE COTISATION ............................................................................................................................ 38
Section 1 - Cotisations et taux de cotisation .................................................................................................... 38

ANNEXE V - PRESTATIONS DEPENDANCE ................................................................................................................. 39
Section 1 - Conditions d'octroi et aspects procduraux ................................................................................... 39

3
Chapitre I Dispositions Gnrales
Section 1 - Dispositions gnrales

I 1.01 La gestion du Rgime dAssurance maladie du CERN, ci-aprs le "Rgime"relve de la
GESTION DU REGIME responsabilit du Directeur gnral qui dtermine et met en place les structures y relatives.
Les prestations et cotisations sont fixes par le Conseil, sur proposition du Directeur
gnral et aprs concertation au sein du Comit de Concertation permanent, ci-aprs CCP,
conformment lArticle S IV 2.07 du Statut du Personnel. Le Directeur gnral est
autoris par le Conseil prendre en temps opportun des mesures visant limiter
laugmentation des dpenses du Rgime en encourageant le recours des prestataires de
soins et de traitements offrant le meilleur rapport-qualit prix.
I 1.02 Le Rglement du Rgime est adopt et modifi par le Directeur gnral sur la base des
REGLEMENT dcisions du Conseil de lOrganisation concernant les niveaux de cotisations et les
prestations.
I 1.03 Lobjectif du Rgime est de protger ses Membres contre les consquences conomiques
OBJECTIF DU REGIME de la maladie, des accidents et de la maternit en prvoyant le remboursement des frais
rsultant dun traitement mdical, dans les conditions spcifies dans le prsent Rglement.
Dans certaines circonstances, le Rgime protge ses Membres contre les consquences
conomiques de linvalidit.
I 1.04 Le Rgime, auquel contribuent lOrganisation et les Membres, est fond sur le principe de
MUTUALITE mutualit.
I 1.05 Les textes franais et anglais du prsent Rglement font galement foi.
VERSION
AUTHENTIQUE
I 1.06 La rfrence aux Membres au genre masculin s'applique indiffremment aux personnes des
GENRE deux sexes, sauf lorsquil ressort clairement du contexte que les dispositions en question
visent exclusivement soit les hommes soit les femmes.
I 1.07 Tout document ou information contenant des donnes personnelles administratives ou

CONFIDENTIALITE mdicales dun Membre est trait de faon condentielle.
Les personnes ayant accs ces donnes personnelles dans lexercice de leurs fonctions
sont lies par le secret professionnel et ne peuvent communiquer la teneur des informations
auxquelles elles ont accs des personnes non autorises.
En particulier, le secret professionnel mdical doit tre prserv.
I 1.08 Les dispositions du prsent Rglement doivent tre interprtes selon leur contenu et leur
INTERPRETATION DU but.
REGLEMENT
En cas de difficult dapplication du prsent Rglement, notamment en cas de silence des
textes, rfrence peut tre faite subsidiairement et par analogie la lgislation suisse et/ou
franaise en matire de scurit sociale et dassurance maladie.
I 1.09 Ladministration des prestations est confie un contractant spcialis en la matire

ADMINISTRATION ET dnomm le Tiers-Administrateur, dfini lArticle II 1.20. Le Tiers-Administrateur est
DECISIONS mandat pour appliquer le prsent Rglement conformment aux dispositions du contrat
pour lAdministration du Rgime conclu avec lOrganisation.
Ladministration des cotisations est assure par le dpartement responsable des finances de
lOrganisation.
Toutes dcisions prises en application du prsent Rglement sont prises au nom du

Directeur gnral de lOrganisation.
4
I 1.10 Le Rgime prvoit trois types de couverture dassurance pour les accidents et maladies
TYPES DE non-professionnels :
COUVERTURE la couverture dAssurance maladie normale (cf. Chapitre III) ;
la couverture dAssurance maladie rduite (cf. Chapitre IV) ;
la couverture dAssurance maladie court terme (cf. Chapitre V).
Le Rgime prvoit galement une couverture pour les accidents et maladies professionnels
selon les dispositions prvues au Chapitre VI.
Chapitre II - Dfinitions
Section 1 - Dfinitions
II 1.01 Toute altration certifie de la sant dun Membre, y compris les affections mentales, dont
MALADIE il est atteint involontairement et qui ne rsulte pas dun accident.
II 1.02 Tout vnement entranant une lsion corporelle certifie dont le Membre est atteint
ACCIDENT involontairement par laction dune force soudaine et extrieure, quelles quen soient la
nature et lorigine.
Tout effort physique personnel entranant une lsion corporelle est assimil un accident.
Pour autant qu'elles ne soient pas manifestement imputables une maladie ou des
phnomnes dgnratifs, les lsions corporelles suivantes dont la liste est exhaustive sont
considres comme rsultant dun accident, mme si elles ne sont pas causes par une force
soudaine et extrieure :
les fractures ;
les dchirures ;
les distorsions et longations ;
les dbotements d'articulations ;
les lsions de ligaments ;
les lsions du tympan ;
les lsions rsultant de chutes ;
les lumbagos et les hernies rsultant defforts physiques ;
les lsions aigus dues aux radiations ;
les commotions lectriques, y compris celles rsultant de la foudre ;
les asphyxies, les intoxications par leffet de gaz ou de vapeurs, les
empoisonnements ou les brlures involontairement causs par l'absorption de
substances vnneuses ou corrosives ;
les noyades par hydrocution ;
les dcs dus une affection circulatoire.
Les lments de cette liste dcoulant de lArticle 9 de lOrdonnance fdrale suisse, du 20

dcembre 1982, sur lassurance-accidents (OLAA) sont automatiquement adapts en cas de
modification de cet Article. Cette ordonnance peut tre consulte sur le site Internet de la
Confdration helvtique : http://www.admin.ch
II 1.03 Toute maladie contracte et tout accident subi par un membre du personnel de
MALADIES ET lOrganisation et qualifi comme tant dorigine professionnelle par lOrganisation.
ACCIDENTS
PROFESSIONNELS
II 1.04 Lincapacit permanente ou de longue dure accomplir seul les actes ordinaires de la vie
DEPENDANCE courante.
II 1.05 Ltat physique dune femme de la conception de l'enfant laccouchement et tous les
MATERNITE vnements mdicaux qui en rsultent.
5
II 1.06 Tout examen effectu et tout soin apport en vue du rtablissement ou du maintien de ltat
TRAITEMENT MEDICAL de sant et/ou de lintgrit physique. La vaccination est galement considre comme un
traitement mdical. Le traitement mdical doit tre reconnu comme tel par les autorits
sanitaires comptentes de ltat o il est dispens.
II 1.07 Tout tablissement de soins mdicaux, chirurgicaux ou de rducation fonctionnelle dont la

ETABLISSEMENT qualit dtablissement hospitalier a t reconnu par les autorits sanitaires comptentes de
HOSPITALIER ltat concern.
II 1.08 Tout tablissement hospitalier dont la nature publique a t reconnu par les autorits
ETABLISSEMENT sanitaires comptentes de ltat concern.
HOSPITALIER PUBLIC
II 1.09 Tout tablissement hospitalier ne rpondant pas la dfinition de lArticle II 1.08.

ETABLISSEMENT
HOSPITALIER PRIVE
II 1.10 Tout tablissement hospitalier public tel que dfini lArticle II 1.08, ou
ETABLISSEMENT
HOSPITALIER AGRE Tout tablissement hospitalier priv tabli
- en Suisse, pour autant quil ait conclu une convention tarifaire avec le Rgime,
- hors de Suisse, pour autant quil ait conclu une convention tarifaire avec le
rgime national de scurit sociale et quil applique aux Membres du Rgime des
tarifs de traitements mdicaux et de sjour similaires ceux tablis dans ladite
convention.
II 1.11 Tout tablissement hospitalier ne rpondant pas la dfinition de lArticle II 1.10.

ETABLISSEMENT
HOSPITALIER NON
AGREE
II 1.12 Tout tablissement non-hospitalier prodiguant des soins, une assistance mdicale ainsi que
INSTITUTION des mesures de radaptation des patients pour une longue dure (tablissements mdico-
SPECIALISEE sociaux (EMS) ou tout autre tablissement similaire).
II 1.13 Toute personne qualifie et habilite par lautorit nationale comptente pratiquer la
MEDECIN mdecine dans lEtat dans lequel le traitement mdical est dispens.
II 1.14 Acte par lequel un mdecin atteste dune situation se rapportant ltat de sant dun
CERTIFICATION Membre.
II 1.15 Certification quune amlioration de ltat de sant de lintress par un traitement mdical
CONSOLIDATION appropri nest plus envisageable.
II 1.16 Disparition certifie de laltration de ltat de sant cause par la maladie ou laccident.
GUERISON
II 1.17 Aggravation certifie de ltat de sant cause par la maladie ou laccident, survenue, sans
RECHUTE intervention dune cause extrieure, dans les dix ans suivant la date de consolidation et
entranant la ncessit dun traitement mdical.
II 1.18 Toute personne qualifie et habilite par lautorit nationale comptente de lEtat dans
AUXILIAIRE MEDICAL lequel le traitement est dispens pratiquer sa profession, agissant sur ordonnance
mdicale et apportant son concours la profession mdicale dans les soins et traitements
des victimes de maladies ou daccidents.
Les actes effectus par les auxiliaires mdicaux doivent tre conformes la prescription
mdicale.
II 1.19 Toute personne qualifie aider les personnes dpendantes accomplir les actes ordinaires
GARDE-MALADE de la vie courante.
II 1.20 La socit avec laquelle lOrganisation a conclu un contrat pour lAdministration du

TIERS- Rgime.
ADMINISTRATEUR
6
II 1.21 Tout Membre principal (voir Article II 1.22) et les membres de sa famille (voir Article
MEMBRE II 1.23) tels que dfinis par le prsent Rglement, sauf indication contraire.
II 1.22 Tout membre du personnel du CERN pour qui ladhsion au Rgime est obligatoire en
MEMBRE PRINCIPAL vertu de son contrat demploi ou dassociation avec lOrganisation, ainsi que toute
personne remplissant les conditions requises pour une adhsion volontaire et ayant opt
pour cette adhsion selon les termes du prsent Rglement.
II 1.23 Tout membre de la famille du Membre principal tel que dfini par les Statut et Rglement
MEMBRE DE LA du Personnel du CERN. Dans le prsent Rglement, le terme conjoint dsigne soit
FAMILLE lpoux / pouse dans le cas dun mariage, soit le partenaire dans le cas dun partenariat
enregistr et reconnu selon les Statut et Rglement du Personnel. Similairement, les termes
mariage et divorce sont considrs comme synonymes pour partenariat et rupture
de partenariat.
II 1.24 Cotisation obligatoire verse par le Membre principal dune famille ou par celui des deux
COTISATION Membres principaux ayant le revenu le plus lev dans le cas o les deux conjoints sont
PRINCIPALE tous deux Membres principaux du Rgime.
II 1.25 Cotisation verse en sus de la cotisation principale dans certaines circonstances lorsque les
COTISATION deux conjoints peroivent un revenu ou une pension de retraite dcoulant dune activit
COMPLEMENTAIRE professionnelle.
II 1.26 Toute forme de rmunration, salaire, honoraires ou rtribution dcoulant dune activit
REVENU professionnelle.
Les allocations de chmage et de maternit ne sont pas assimiles un revenu.
II 1.27 Tout paiement provenant dun rgime dassurance-vieillesse.

PENSION DE RETRAITE Les pensions dinvalidit ne sont pas assimiles des pensions de retraite.
II 1.28 Est considre comme similaire :

ASSURANCE MALADIE sous rserve des Accords Bilatraux entre la Suisse et lUnion Europenne, toute
SIMILAIRE assurance maladie dun systme national dun Etat de lUnion ;
toute assurance maladie prive individuelle ou collective dont les prestations et
niveaux de remboursement dans lEtat de rsidence du Membre sont au moins
quivalents ceux garantis par la loi fdrale suisse sur lassurance-maladie
(LAMal).
II 1.29 La part des dpenses non rembourses, jusquau plafond applicable le cas chant, pour des
FRAIS A CHARGE prestations couvertes par la Rgle Gnrale de Remboursement.
DE LASSURE (FCA)
II 1.30 Rgle dfinissant les taux de remboursement selon les Frais charge de lAssur (FCA)
REGLE GENERALE cumuls par Membre durant une anne civile.
DE REMBOURSEMENT
Les taux de remboursement selon les FCA sont dtaills aux Articles A I 1.01 et A III 1.01.
II 1.31 Augmentation du taux de remboursement dtaill aux Articles A I 1.01 et A III 1.01 pour
BONUS certaines prestations couvertes par la Rgle Gnrale de Remboursement, pour autant que
ce taux ne dpasse pas 100%.
Le montant du bonus, ainsi que les prestations auxquelles il sapplique, sont dtaills dans
le tableau des prestations prvues par la Couverture dAssurance maladie normale repris
lAnnexe I, et le tableau des prestations prvues par la Couverture dAssurance maladie
court terme repris lAnnexe III.
7
Chapitre III - Couverture dAssurance Maladie Normale
Section 1 - Description gnrale

III 1.01 La couverture dAssurance maladie normale prvoit le remboursement dune part majeure
DESCRIPTION des dpenses courantes et raisonnables rsultant dun traitement mdical encourues par les
GENERALE Membres bnficiant de cette couverture dans les conditions spcifies dans le prsent
Rglement.
La couverture dAssurance maladie normale prvoit galement une indemnit de dcs et

des prestations pour dpendance ainsi quune allocation pour lincapacit de gain des
Membres de la famille.
Section 2 - Adhsion
III 2.01 Ladhsion au titre de la couverture dAssurance maladie normale est obligatoire
ADHESION pour les membres du personnel titulaires, les boursiers et les apprentis, sauf
OBLIGATOIRE DES pendant des priodes de cong spcial non rmunr dun mois calendaire
MEMBRES PRINCIPAUX complet ou plus ;
pour les tudiants, sauf pendant des priodes dabsence autorise non paye dun
mois calendaire complet ou plus.
III 2.02 Les personnes suivantes peuvent adhrer au titre de la couverture dAssurance maladie
ADHESION normale, quel que soit lEtat dans lequel elles rsident :
VOLONTAIRE DES les attachs et utilisateurs, gs de moins de 65 ans, dont le contrat dassociation
MEMBRES PRINCIPAUX avec lOrganisation est dune dure gale ou suprieure trois mois ;
les bnficiaires de la Caisse de Pensions du CERN ayant choisi de rester
Membres du Rgime sans interruption depuis le dpart du CERN du Membre
principal ;
les anciens membres du personnel titulaires du CERN qui ont opt pour une
pension diffre et ayant choisi de rester Membres du Rgime sans interruption
depuis leur dpart du CERN ;
les membres du personnel titulaires et les boursiers, pour toute priode de cong
spcial non rmunr dun mois calendaire complet ou plus ;
les tudiants, pour toute priode dabsence autorise non paye dun mois
calendaire complet ou plus ;
les enfants dun Membre principal ntant plus charge au sens des Statut et
Rglement du Personnel du CERN et gs de moins de 26 ans. Leur adhsion
reste dpendante de celle du Membre principal.
III 2.03 A lexception des membres de la famille des apprentis et des enfants qui ne sont plus
MEMBRES DE LA charge, les membres de la famille (tels que dfinis par les Statut et Rglement du Personnel
FAMILLE du CERN) dun Membre principal sont Membres au bnfice de la couverture dAssurance
maladie normale par le biais du Membre principal.
Toutefois, un membre de la famille appartenant lui-mme une catgorie du personnel du

CERN dont ladhsion est obligatoire au titre de la couverture dAssurance maladie
normale, est considr comme Membre principal au sens de lArticle II 1.22.
8
III 2.04 Les catgories suivantes de Membres dont le droit la couverture dAssurance maladie
CONTINUATION DE normale prend fin pour quelque raison que ce soit, sauf en cas dexclusion du Rgime selon
COUVERTURE lArticle VII 4.11, peuvent rester Membres du Rgime, sur demande, pour une priode
ultrieure maximale de 12 mois, condition quils ne puissent pas adhrer au Rgime selon
les termes de lArticle III 2.02 :
les membres du personnel titulaires, les boursiers, les tudiants ou les apprentis.
Les membres de leur famille sont couverts selon les conditions de lArticle III
2.03 ;
en cas de divorce, lex-conjoint et ses enfants charge qui sont considrs
comme membres de la famille du Membre principal au jour de la date dfinitive
du divorce ;
en cas de dcs du Membre principal, les membres de sa famille au moment du
dcs.
Nonobstant ce qui prcde, les anciens membres du personnel titulaires bnficiant des
prestations de chmage de lOrganisation peuvent rester Membres pendant une priode
ultrieure maximale de soixante semaines.
Section 3 - Couverture territoriale

III 3.01 Les Membres sont couverts pour les frais rsultant dun traitement mdical partout dans le
COUVERTURE monde. Les dispositions de lArticle VII, 4.07, sappliquent.
MONDIALE
Section 4 - Prestations
III 4.01 Les frais de traitements mdicaux et de sjour sont rembourss selon la Rgle Gnrale de
HOSPITALISATION Remboursement, telle que dfinie lArticle II 1.30 except :
en cas dhospitalisation dans un tablissement hospitalier public tel que dfini
lArticle II 1.08, auquel cas ces frais sont rembourss 100%, sauf si
lhospitalisation a lieu dans le secteur priv ou semi-priv de cet tablissement.
Dans ce dernier cas, la Rgle Gnrale de Remboursement sapplique ;
en cas dhospitalisation dans un tablissement hospitalier non agr tel que dfini
lArticle II 1.11, auquel cas ces frais sont rembourss 80%.
Les honoraires des mdecins pendant lhospitalisation sont rembourss selon les conditions
en vigueur pour ltablissement hospitalier concern.
Dans tous les cas, le supplment htelier factur par ltablissement pour une chambre
individuelle est la charge exclusive du Membre.
III 4.02 Tous autres frais mdicaux remboursables ainsi que les taux et plafonds sont indiqus dans
FRAIS MEDICAUX lAnnexe I du prsent Rglement.
III 4.03 Les limitations de remboursement jusqu' une dpense maximale (plafonds) sont fixes
DETERMINATION DES annuellement par le CERN, pour application partir du 1er janvier de lanne suivante.
PLAFONDS
III 4.04 En cas de dcs dun membre du personnel du CERN titulaire, ou dun membre de sa
INDEMNITE EN CAS DE famille (au sens des Statut et Rglement du Personnel du CERN), une indemnit est verse
DECES aux termes de lAnnexe I du prsent Rglement.
III 4.05 Tout Membre dans lincapacit permanente ou de longue dure daccomplir seul les actes
PRESTATIONS ordinaires de la vie courante peut demander le bnfice des prestations dpendance dans les
DEPENDANCE conditions fixes lAnnexe V du prsent Rglement.
III 4.06 Dans les conditions fixes lAnnexe II du prsent Rglement, le paiement dune
ALLOCATION POUR allocation pour incapacit de gain peut tre demand.
INCAPACITE DE GAIN
9
Section 5 - Cotisation
III 5.01 Les cotisations principales et complmentaires pour la couverture dAssurance maladie
COTISATIONS normale sont exprimes en pourcentage (Article III 5.09 et Article A IV 1.01) du salaire de
rfrence du Membre (Chapitre IX Section I).
III 5.02 Le taux de cotisation et la rpartition entre lOrganisation et le Membre sont prciss
REPARTITION DE LA lAnnexe IV Section 1 du prsent Rglement.
COTISATION
III 5.03 Sauf indication contraire aux Articles III 5.05 et III 5.07, une cotisation principale est
COTISATION verse pour chaque Membre principal.
PRINCIPALE
La cotisation principale est le produit du taux de cotisation indiqu lArticle A IV 1.01 et
des salaires de rfrence suivants :
Membres du personnel titulaires, boursiers, tudiants :
Salaire de rfrence I
Attachs, utilisateurs, les anciens membres du personnel titulaires du CERN qui
ont opt pour une pension diffre et ayant choisi de rester Membres du Rgime
sans interruption depuis leur dpart du CERN :
Salaire de rfrence II
Apprentis :
50% du Salaire de rfrence II
Enfants ntant plus charge dun Membre principal :
40% du Salaire de rfrence II
Bnficiaires de la Caisse de Pensions du CERN :
Salaire de rfrence III
III 5.04 La cotisation principale due par un membre du personnel titulaire, boursier, attach pay,
VERSEMENT DE LA tudiant ou bnficiaire de la Caisse de Pensions du CERN est dduite chaque mois de la
COTISATION rmunration ou du paiement quil peroit de lOrganisation ou de la pension quil peroit
PRINCIPALE de la Caisse de Pensions du CERN.
Dans tous les autres cas, le Membre verse, chaque mois et par avance, la cotisation
principale sur le compte bancaire du Rgime.
III 5.05 Lorsque deux conjoints sont soit membres du personnel titulaires soit boursiers, la
COTISATION cotisation principale est verse pour le conjoint travaillant plein temps, tandis que la
PRINCIPALE OU cotisation complmentaire est verse pour le conjoint travaillant temps partiel. Lorsque
COMPLEMENTAIRE tous deux travaillent plein temps ou temps partiel, la cotisation principale est verse
pour le conjoint dont la rmunration calcule sur le Salaire de rfrence I donne lieu au
montant de cotisation le plus lev, tandis que la cotisation complmentaire est verse pour
lautre conjoint.
Lorsque deux conjoints sont bnficiaires de la Caisse de Pensions du CERN, la cotisation

principale est verse pour le conjoint dont la pension calcule sur le Salaire de rfrence III
donne lieu au montant de cotisation le plus lev, tandis que la cotisation complmentaire
est verse pour lautre conjoint.
III 5.06 Sauf indication contraire aux Articles III 5.03 et III 5.07, aucune cotisation nest verse
AUCUNE COTISATION pour les membres de la famille (au sens des Statut et Rglement du Personnel du CERN) du
Membre principal.
10
III 5.07 La cotisation complmentaire verse pour les Membres dsigns ci-dessous est le produit
COTISATION du ou des taux de cotisation indiqus lArticle A IV 1.02 et des salaires de rfrence
COMPLEMENTAIRE suivants :
1. Les membres du personnel titulaires et boursiers, conjoint dun autre membre du
personnel titulaire ou boursier payant la cotisation principale base sur le Salaire
de rfrence I :
Salaire de rfrence IV
2. Le conjoint :
dun membre du personnel titulaire, boursier ou bnficiaire de la Caisse de
Pensions du CERN, et
ntant pas lui-mme membre du personnel titulaire, boursier, tudiant ou
apprenti, et
ntant pas couvert par une assurance maladie de base similaire telle que dfinie
lArticle II 1.28, et
dont le revenu mensuel brut ou la pension de retraite mensuelle (y compris une
pension du CERN) dcoulant dune activit professionnelle est suprieur
2'500 CHF :
Salaire de rfrence V
III 5.08 La cotisation complmentaire due par un membre du personnel titulaire ou par un boursier
VERSEMENT DE LA conformment lArticle III 5.07 paragraphe 1 est dduite chaque mois de la rmunration
COTISATION du Membre concern.
COMPLEMENTAIRE
La cotisation complmentaire des conjoints, telle que prvue lArticle III 5.07
paragraphe 2, est dduite de la rmunration, du paiement ou de la pension du Membre
principal.
III 5.09 Le taux de cotisation est un pourcentage du salaire de rfrence du Membre (Chapitre IX
TAUX DE COTISATION Section 1), tel quindiqu lArticle A IV 1.01.
III 5.10 Le taux de cotisation dfini lArticle III 5.09 est examin annuellement pour lanne
AJUSTEMENT DU TAUX civile suivante, en prenant en compte :
DE COTISATION lvolution passe et venir des facteurs de cots tels que les tendances
dmographiques, les variations de prix, les nouveaux traitements mdicaux, etc. ;
lassiette totale de cotisations des membres du personnel en activit et des
bnficiaires de la Caisse de Pensions du CERN telle questime pour lanne
civile suivante ;
le niveau prvisible du Fonds de Rserve du Rgime la fin de lanne civile ; et,
tout autre facteur pertinent.
Sil y a lieu, un ajustement du taux de cotisation est propos au Conseil de lOrganisation.
III 5.11 La cotisation mensuelle requise pour la continuation de la couverture dAssurance maladie
COTISATION POUR normale est la suivante :
CONTINUATION DE LA pour un membre du personnel dont les fonctions prennent fin, la cotisation
COUVERTURE correspond la cotisation totale verse par le Membre et par lOrganisation au
DASSURANCE cours de son dernier mois de service en tant que membre du personnel ;
pour les ex-conjoints des Membres principaux, le montant de la cotisation
mensuelle est base sur le Salaire de rfrence II.
Section 6 - Obligation de renseigner

III 6.01 Tout membre du personnel titulaire, boursier ou bnficiaire de la Caisse de Pensions du
PERSONNES DANS CERN qui est Membre au bnfice de la couverture dAssurance maladie normale a
LOBLIGATION DE lobligation de dclarer par crit au CERN toute couverture dassurance maladie autre dont
RENSEIGNER bnficie son conjoint, ainsi, le cas chant, que tout revenu ou pension de retraite
dcoulant dune activit professionnelle peru par son conjoint.
III 6.02 Sur demande, le Membre concern a lobligation de fournir des pices justificatives
PIECES JUSTIFICATIVES relatives aux informations fournies conformment lArticle III 6.01.
11
III 6.03 Tout changement de revenu ou de couverture dassurance maladie du conjoint du Membre
NOTIFICATION doit tre notifi par crit au CERN dans un dlai de 30 jours civils compter de la
DUN CHANGEMENT survenance du changement.
III 6.04 La date deffet dun changement notifi par le Membre conformment lArticle III 6.03
DATE DEFFET DU est le premier jour du mois au cours duquel le changement est intervenu.
CHANGEMENT NOTIFIE
III 6.05 Tout dfaut de notification conformment lArticle III 6.01 a pour consquence une
DEFAUT DE dduction, sur la rmunration ou la pension du CERN, de la cotisation complmentaire la
NOTIFICATION plus leve base sur le Salaire de rfrence V, tel que dfini lArticle IX 1.05.
III 6.06 En cas de notification tardive ou de fausse dclaration, les cotisations complmentaires
NOTIFICATION dues sont dduites rtroactivement. Toutefois, aucune cotisation dj paye nest
TARDIVE OU FAUSSE rembourse.
DCLARATION
III 6.07 Lorsquun Membre a dclar, conformment lArticle III 6.01, que son conjoint bnficie
SOUMISSION DES dune autre couverture dassurance maladie similaire telle que dfinie lArticle II 1.28,
FACTURES A UNE celui-ci est tenu de soumettre ses factures pour remboursement cette autre assurance
ASSURANCE MALADIE maladie en premier lieu.
SIMILAIRE
III 6.08 Toute dpense mdicale non rembourse par l'autre assurance maladie similaire, y compris
REMBOURSEMENT toute diffrence entre le montant rembours par cette dernire et les frais rels encourus,
COMPLEMENTAIRE peut tre soumise pour remboursement conformment aux dispositions du prsent
Rglement.
Chapitre IV - Couverture dAssurance Maladie Rduite

IV 1.01 La couverture dAssurance maladie rduite offre certaines catgories de membres du
DESCRIPTION personnel associs du CERN, pendant leur sjour au CERN, des prestations rduites en
GENERALE comparaison de la couverture dAssurance maladie normale.
Section 2 - Adhsion
IV 2.01 Les attachs et les utilisateurs peuvent souscrire la couverture dAssurance maladie
MEMBRES PRINCIPAUX rduite condition quils aient un contrat de trois mois ou plus avec lOrganisation.
IV 2.02 Les membres de la famille dun Membre principal ne sont pas couverts par cette assurance.
MEMBRES DE LA
FAMILLE

IV 3.01 Ltendue territoriale de la couverture dAssurance maladie rduite est la mme que celle
COUVERTURE spcifie pour la couverture dAssurance maladie normale lArticle III 3.01.
TERRITORIALE
IV 4.01 Les Membres au bnfice de la couverture dAssurance maladie rduite bnficient des
PRESTATIONS mmes prestations que celles numres lAnnexe I pour la couverture dAssurance
maladie normale, lexception de celles indiques lArticle IV 4.02.
12
IV 4.02 Les prestations suivantes sont exclues de la couverture dAssurance maladie rduite :
EXCLUSIONS - traitements dispenss par des auxiliaires mdicaux ;
- prothses, appareils orthopdiques et acoustiques ;
- prothses dentaires ;
- optique (lunettes, lentilles de contact, chirurgie rfractive) ;
- frais de sjour en unit daccueil temporaire ou unit dattente de placement ;
- prestations dpendance ;
- indemnit en cas de dcs.
Section 5 - Cotisations
IV 5.01 La cotisation pour la couverture dAssurance maladie rduite quivaut 50% du Salaire de
COTISATION rfrence II (tel que dfini lArticle IX 1.02) multipli par le taux de cotisation indiqu
lArticle A IV 1.01.
IV 5.02 Le taux de cotisation est examin annuellement, conformment lArticle III 5.10. Sil y a
AJUSTEMENT DU TAUX lieu, un ajustement du taux de cotisation est propos au Conseil de lOrganisation.
DE COTISATION
IV 5.03 La cotisation est verse par le Membre chaque mois et par avance sur le compte bancaire
VERSEMENT DE LA du Rgime.
COTISATION
Chapitre V - Couverture dAssurance Maladie Court

Terme

V 1.01 La couverture dAssurance maladie court terme est une couverture dassurance maladie
DESCRIPTION limite, spcialement conue pour les membres du personnel du CERN ayant un contrat
GENERALE court terme et ne bnficiant pas dune couverture dassurance maladie contre les
consquences conomiques des accidents et maladies en Suisse et/ou en France.
Section 2 - Adhsion
V 2.01 Les membres du personnel du CERN, dont la dure de contrat est infrieure trois mois,
MEMBRES PRINCIPAUX peuvent souscrire la couverture dAssurance maladie court terme pendant leur sjour au
CERN.
V 2.02 Un membre de la famille dun Membre principal qui souscrit cette assurance nest
MEMBRES DE LA couvert que sil paie la cotisation pour cette assurance.
FAMILLE

V 3.01 Les Membres sont couverts sur le territoire europen, continental ou insulaire, et hors
COUVERTURE dEurope pendant un voyage officiel autoris par lOrganisation dans les conditions
TERRITORIALE prvues lArticle V 3.02.
13
V 3.02 Pendant les voyages officiels autoriss par lOrganisation hors dEurope, le Membre
VOYAGES OFFICIELS principal et les membres assurs de sa famille qui laccompagnent sont couverts pour les
frais rsultant du traitement mdical ncessaire dans les limites suivantes :
pour les traitements ambulatoires : le tarif dusage en vigueur dans le Canton de
Genve au moment o les soins sont dispenss ;
pour les traitements stationnaires : frais de sjour avec un plafond de 500 CHF
par jour.
V 4.01 Les conditions de remboursement sont dtailles lArticles III 4.01.
HOSPITALISATION
V 4.02 Les autres prestations offertes par la couverture dAssurance maladie court terme sont
PRESTATIONS numres lAnnexe III du prsent Rglement.
V 4.03 Les prestations affrentes aux affections mdicales prexistantes la date de dbut du
FRAIS MEDICAUX NON contrat avec le CERN ne sont pas comprises dans la couverture dAssurance maladie
COMPRIS court terme.
V 5.01 La cotisation pour la couverture dAssurance maladie court terme est une somme
COTISATION journalire ou mensuelle telle qunonce lArticle A IV 1.03. La cotisation doit tre
verse davance pour la priode entire de couverture.
Les enfants jusqu lge de 18 ans bnficient dune rduction de 50%.
V 5.02 Les cotisations sont examines annuellement. Sil y a lieu, un ajustement des cotisations est
AJUSTEMENT DE LA propos au Conseil de lOrganisation.
COTISATION
V 5.03 Si le contrat dun membre du personnel du CERN est prolong, la cotisation pour la
VERSEMENT DE LA nouvelle priode de contrat doit tre paye avant le terme du contrat prcdent, de sorte que
COTISATION la couverture dassurance puisse tre maintenue. Si la dure du contrat est courte, les
cotisations dj verses ne sont pas rembourses.
La couverture dassurance entre en vigueur condition que la cotisation soit paye au plus
tard le premier jour ouvrable suivant larrive au CERN.
Chapitre VI Maladies et Accidents Professionnels

VI 1.01 Les accidents et maladies professionnels ouvrent droit la prise en charge des frais des
DESCRIPTION traitements mdicaux qui leur sont directement lis.
GENERALE
Section 2 - Adhsion
VI 2.01 Les membres ayant adhr au Rgime dassurance maladie au bnfice des couvertures
MEMBRES PRINCIPAUX normale, rduite ou court terme sont couverts contre les consquences conomiques des
maladies et accidents professionnels.
14

VI 3.01 La couverture dassurance pour les accidents et maladies professionnels est valable dans le
COUVERTURE monde entier.
TERRITORIALE
VI 4.01 Sous rserve des avis ou accords pralables applicables, les traitements mdicaux
PRESTATIONS directement lis une maladie ou un accident professionnels sont pris en charge 100%,
sans limitation ni plafond.
La gurison ou la consolidation entranent la fin du remboursement des traitements

mdicaux sous le rgime professionnel. Ce droit ne peut tre rouvert quen cas de rechute.
Les prestations rembourses pour les accidents et maladies professionnels sont indiques
lAnnexe I pour les membres au bnfice de la couverture dAssurance maladie normale,
rduite et court terme.
VI 4.02 Les traitements mdicaux rsultant dun accident professionnel subi ou dune maladie
DUREE DE LA professionnelle contracte avant le dbut de la couverture dassurance prvue dans le
COUVERTURE prsent Chapitre ne sont pas rembourss sous le rgime professionnel.
DASSURANCE
VI 4.03 Le dlai de soumission dune demande de remboursement de frais de traitements mdicaux

DELAI rsultant dun accident ou dune maladie professionnels est identique celui prvu
lArticle VIII 1.01. Ce dlai court compter de la date laquelle laccident ou la maladie a
t qualifi comme professionnel par lOrganisation ou compter de la date de la facture,
laquelle des deux survient le plus tard.
VI 5.01 LOrganisation verse 100% de la cotisation pour la couverture des accidents et maladies
COTISATION professionnels.
VI 5.02 Le taux de cotisation, tel quindiqu lArticle A IV 1.04, est un pourcentage des salaires
TAUX DE COTISATION de rfrence figurant au Chapitre IX Section 1.
VI 5.03 Le taux de cotisation pour la couverture des maladies et accidents professionnels est
AJUSTEMENT DU TAUX examin annuellement pour lanne civile suivante, en prenant en compte :
DE COTISATION lvolution passe et venir des facteurs de cots tels que les variations de prix,
les nouveaux traitements mdicaux, etc. ;
lassiette totale de cotisations des Membres en activit telle questime pour
lanne civile suivante ; et,
tout autre facteur pertinent.
Sil y a lieu, un ajustement du taux de cotisation est propos au Conseil de lOrganisation.
15
Chapitre VII Dispositions Communes
Section 1 - Rgle de non-cumul

VII 1.01 Toute autre prestation rsultant d'une affiliation obligatoire un rgime de protection
NON-CUMUL DES sociale national, public ou assimil vient en dduction des prestations prvues par le
PRESTATIONS prsent Rgime. Dans ce cas le Membre concern est tenu d'en informer le Tiers-
Administrateur. Cette disposition ne s'applique pas aux autres prestations rsultant d'une
affiliation volontaire et payante de la part du Membre.
Lorsque des frais mdicaux ont t partiellement rembourss par une autre assurance, le
Membre doit en aviser le Tiers-Administrateur et ne peut soumettre au Rgime qu'une
demande de remboursement sur le montant restant d.
Si le remboursement au titre de lassurance maladie primaire fait lobjet dune franchise

annuelle, celle-ci nest pas rembourse par le Rgime.
Section 2 - Traitement esthtique

VII 2.01 Les cures de rajeunissement et les traitements esthtiques lexception des dfigurations et
TRAITEMENT des trs graves brlures aux mains ne sont pas pris en charge. La chirurgie rparatrice ou
ESTHETIQUE reconstructive est nanmoins couverte, sous rserve daccord pralable, lorsquelle est
rendue ncessaire la suite de la ralisation dun risque garanti ou dun accident ou dune
maladie survenue moins de deux annes civiles avant la date dadhsion du Membre
concern.
Section 3 - Motif de refus, rduction ou suppression de

prestations
VII 3.01 Lallocation pour incapacit de gain, lallocation dpendance et lindemnit en cas de dcs
MOTIF DE REFUS, peuvent tre refuses, rduites ou retires, temporairement ou dfinitivement, si la personne
REDUCTION OU concerne a caus ou aggrav latteinte son tat de sant, intentionnellement ou par faute
SUPPRESSION DE grave, ou en commettant un crime ou un dlit.
PRESTATIONS
Le traitement des squelles rsultant dun traitement non remboursable par le Rgime nest
pas remboursable non plus.
Section 4 - Dispositions gnrales dassurance

VII 4.01 Tout Membre du Rgime reoit une carte dassur qui indique :
CARTE DASSURE les nom et prnom du Membre ;
le numro dassurance ;
la priode de couverture.
VII 4.02 Tout Membre dispose du libre choix du mdecin et de ltablissement hospitalier.
LIBRE CHOIX DU
MEDECIN ET DE
LETABLISSEMENT
HOSPITALIER
VII 4.03 Les remboursements, lexclusion des frais de transport durgence, ne peuvent tre
ORDONNANCE effectus que pour des frais engags sur ordonnance mdicale.
MEDICALE
Les actes effectus par les auxiliaires mdicaux doivent tre conformes lordonnance
mdicale.
16
VII 4.04 Les Membres ne bnficient des prestations dont le montant est plafonn que sur la base
CALCUL DE dun plafond calcul prorata temporis de la dure de leur adhsion au Rgime.
PRESTATIONS
PRORATA TEMPORIS En cas de dcs du Membre, cette mesure nest pas applicable.
VII 4.05 Aucune prestation nest verse en cas de dfaut de prsentation un rendez-vous.
DEFAUT DE
PRESENTATION A UN
RENDEZ-VOUS
VII 4.06 Dans des circonstances exceptionnelles, un Membre peut demander quune prestation
PRESTATIONS venant en dpassement dun plafond ou quune prestation non numre dans le prsent
BENEVOLES Rglement lui soit accorde.
Loctroi dune prestation bnvole est dcid par lAdministrateur en accord avec le
Conseiller Stratgique, conformment lArticle X 1.01.
VII 4.07 Lorsque le Tiers-Administrateur constate que le tarif appliqu pour une prestation de soins
TARIFS EXCESSIFS dpasse de manire significative le tarif raisonnable et usuel pour ladite prestation, il peut
limiter le remboursement au tarif usuel dans la rgion du prestataire. Afin dviter cette
mesure, il appartient au Membre de vrifier pralablement auprs du Rgime si le tarif
propos est acceptable.
VII 4.08 Toute somme verse par le Rgime et indment perue par un Membre doit tre restitue
RESTITUTION DE sans dlai. En cas de dcs du Membre, les allocations journalires de dpendance dj
LINDU perues nont pas tre restitues.
VII 4.09 Le Tiers-Administrateur peut suspendre tout ou partie des prestations concernes :
SUSPENSION OU REFUS dun Membre ne se conformant pas aux dispositions du prsent Rglement ;
DES PRESTATIONS dun Membre refusant de subir un examen mdical prescrit par le Mdecin
Conseil du Tiers-Administrateur ;
dun Membre affili au Rgime sur une base volontaire, en retard dans le
paiement de sa cotisation ;
dun Membre, en cas de suspicion de fraude.
Le Tiers-Administrateur, avec laccord pralable du CERN, peut refuser de rembourser les

prestations jusqualors suspendues.
VII 4.10 Tout membre du personnel du CERN qui est Membre du Rgime sexpose des sanctions
SANCTIONS disciplinaires, conformment aux Statut et Rglement du Personnel du CERN, en cas
DISCIPLINAIRES dinobservation des dispositions du prsent Rglement.
VII 4.11 Aprs audition du Membre concern, lOrganisation peut exclure un Membre affili sur
EXCLUSION DU REGIME une base volontaire au Rgime, pour les motifs suivants :
en cas de dfaut de paiement de la cotisation dans les 30 jours civils suivant la
date dchance ;
en cas de fraude ou de tentative de fraude avre.
VII 4.12 En cas de dcs dun Membre, toute somme rembourser est verse la succession.
REMBOURSEMENT EN
CAS DE DECES DUN La demande de remboursement des frais mdicaux encourus pour le dfunt doit tre
MEMBRE formule dans le dlai indiqu lArticle VIII 1.01.
17
VII 4.13 Lorsquune hospitalisation a lieu dans un tablissement hospitalier agr selon lArticle II
GARANTIE POUR 1.10, une garantie de paiement direct des factures est accorde par le Tiers-Administrateur
HOSPITALISATION sur demande de ltablissement hospitalier ou du patient au moins trois jours ouvrables
avant le dbut de lhospitalisation, sauf en cas durgence.
Une garantie initiale est accorde pour une dure de 14 jours civils dhospitalisation.
Toute demande de prolongation de la garantie doit tre soumise par ltablissement

hospitalier au Tiers-Administrateur pour accord.
Lorsquune hospitalisation a lieu dans un tablissement hospitalier non agr selon

lArticle II 1.11, le Tiers-Administrateur accorde une garantie en tiers-garant. Le Membre
doit alors rgler directement la facture dhospitalisation et en demander le remboursement,
conformment au Chapitre VIII Section 1 du prsent Rglement.
VII 4.14 Le Tiers-Administrateur est subrog, au nom du Rgime, dans les droits que la victime
SUBROGATION dun accident ou dune maladie dtient envers tout tiers responsable, dans la limite du
remboursement effectu par le Tiers-Administrateur. Le Membre est tenu, sous peine dun
refus de remboursement au sens de lArticle VII 4.09, de confirmer par crit cette
subrogation lorsque le Tiers-Administrateur le demande.
Section 5 - Dure dadhsion

VII 5.01 Les Membres dont ladhsion est obligatoire sont au bnfice de la couverture dAssurance
DUREE DE LADHESION maladie normale du premier au dernier jour de leur contrat demploi ou dassociation avec
OBLIGATOIRE lOrganisation, sauf pendant tout cong spcial non pay dun mois calendaire complet ou
plus.
VII 5.02 Les demandes dadhsion volontaire au titre des couvertures dAssurance maladie normale
DEMANDE DADHESION ou rduite doivent tre effectues dans les 30 jours civils compter :
VOLONTAIRE pour les membres du personnel : du premier jour du contrat dassociation avec
lOrganisation ; ou du premier jour du renouvellement de leur contrat
dassociation comportant un taux de prsence annuel de plus de 50%, alors quil
tait jusque-l infrieur ou gal 50% ; ou du premier jour de renouvellement de
leur contrat dassociation sous la responsabilit dun nouvel employeur qui ne
fournit plus dassurance-maladie similaire ;
du premier jour suivant la cessation de ladhsion obligatoire en tant que membre
du personnel du CERN ou de la couverture en tant que membre de la famille.
VII 5.03 A condition que la demande dadhsion soit accepte, la couverture dassurance dbute le
DUREE DE LADHESION premier jour du mois au cours duquel le Membre remplit les conditions pour souscrire
VOLONTAIRE cette couverture.
Pour les membres du personnel, ladhsion volontaire doit tre souscrite pour la dure du
contrat de lintress avec le CERN.
Toute prolongation du contrat avec le CERN prolonge automatiquement ladhsion

volontaire, sauf si le renouvellement du contrat dassociation comporte un taux de prsence
annuel de 50% ou moins, alors quil tait jusque-l suprieur 50% ; ou si le
renouvellement de leur contrat dassociation a lieu sous la responsabilit dun nouvel
employeur qui couvre le membre du personnel obligatoirement avec une assurance-maladie
similaire.
VII 5.04 Les Membres affilis au Rgime sur une base volontaire peuvent rsilier leur couverture
RESILIATION DE tout moment sous rserve dun pravis de 30 jours calendaires.
LASSURANCE
La rsiliation de la couverture dassurance maladie volontaire est irrvocable et prend effet
la fin dun mois calendaire.
18
VII 5.05 La couverture dAssurance maladie court terme doit tre souscrite pour la dure du
COUVERTURE contrat du Membre principal avec le CERN, avec un maximum de trois mois, sans
DASSURANCE possibilit de rsiliation anticipe.
MALADIE A COURT
TERME
VII 5.06 Tous frais mdicaux encourus jusquau dernier jour de la couverture dassurance pour les
FIN DE LA accidents et maladies non-professionnels peuvent tre soumis pour remboursement selon
COUVERTURE les dispositions et dlais indiqus dans le prsent Rglement.
DASSURANCE NON
PROFESSIONNELLE Lorsquun sjour en hpital se prolonge au-del du dernier jour de la couverture
dassurance, le Membre concern peut rester Membre du Rgime titre volontaire, jusqu
ce quil puisse souscrire une autre assurance maladie de base ou quitter lhpital, lequel
des deux survient le plus tt.
VII 5.07 Une demande de changement dune couverture rduite une couverture normale ou vice-
DEMANDE DE versa ne sera accepte que si elle est justifie par un changement dans la situation de
CHANGEMENT DE famille du Membre principal, notamment le mariage, le divorce ou la naissance ou
COUVERTURE l'adoption d'un enfant.
Chapitre VIII - Procdures
Section 1 - Demande de remboursement des frais mdicaux

VIII 1.01 Toute demande de remboursement des frais rsultant dun traitement mdical doit tre
DELAI soumise dans les douze mois suivant la date dmission de la facture.
VIII 1.02 La demande de remboursement des frais mdicaux doit tre accompagne des originaux
PIECES JUSTIFICATIVES dordonnances, des factures et des preuves de paiement.
Il est conseill aux Membres de conserver des copies des documents prcits ainsi que leurs
relevs de remboursement.
Dans le cas d'une demande de remboursement complmentaire au Rgime, le Membre

concern doit joindre loriginal du relev de remboursement reu de lassurance maladie
primaire indiquant les sommes dj rembourses par cette assurance.
VIII 1.03 Dans des circonstances particulires et aprs demande crite pralable du Membre, le Tiers-
FRAIS MEDICAUX Administrateur peut accorder le remboursement anticip dune facture de frais mdicaux
ELEVES levs.
Le Membre doit prsenter ultrieurement la preuve du paiement de cette facture. Le dfaut

de paiement d'une facture rembourse par anticipation constitue une infraction au
Rglement pouvant conduire lapplication des Articles VII 4.09, VII 4.10 et VII 4.11.
VIII 1.04 Les factures soumises pour remboursement doivent indiquer les nom et prnom du patient,
DETAIL DE LA le dtail du traitement entrepris, la date ou la priode dudit traitement, le montant payer et
FACTURE la monnaie de rglement.
Les factures doivent clairement indiquer le nom, la qualification et ladresse du mdecin

traitant ou du fournisseur de services mdicaux concern.
VIII 1.05 Le Membre doit s'assurer lui-mme qu'il reoit et rgle les factures lies des frais
PAIEMENT DES mdicaux afin de pouvoir les soumettre pour remboursement dans les dlais indiqus dans
FACTURES le prsent Rglement.
Cette disposition n'est pas applicable lorsquune garantie de paiement direct des factures a
t accorde par le Tiers-Administrateur.
19
VIII 1.06 Sauf circonstance exceptionnelle, le Membre principal assume la responsabilit de

EXACTITUDE DES l'exactitude des demandes de remboursement envoyes en son nom ou en celui d'un
DEMANDES DE membre de sa famille. Le Membre principal doit galement, dans la mesure du possible,
REMBOURSEMENT vrifier que les factures correspondent au traitement suivi.
VIII 1.07 Le Membre concern doit fournir toute information requise par le Tiers-Administrateur sur
INFORMATIONS laffection contracte ou le traitement suivi.
MEDICALES
Le Tiers-Administrateur peut galement sadresser directement aux tiers soignants. Les
informations condentielles peuvent tre envoyes sous pli cachet au Mdecin Conseil du
Tiers-Administrateur. Celui-ci ne transmettra aux services de traitement des demandes que
les renseignements ncessaires pour le remboursement.
VIII 1.08 Le Tiers-Administrateur peut faire examiner tout Membre en cours de traitement par un
EXAMEN MEDICAL mdecin choisi par ses soins. Sur demande du Membre concern, son mdecin traitant peut
assister un tel examen.
VIII 1.09 Lorsquune demande de remboursement est soumise pour des frais mdicaux rsultant dun
ACCIDENTS ET accident ou dune maladie professionnels, un exemplaire de la dclaration officielle
MALADIES daccident ou de maladie professionnels faite auprs du CERN doit tre joint la demande
PROFESSIONNELS de remboursement.
Aucun remboursement aux termes des dispositions concernant les accidents et maladies
professionnels nest accord tant que la maladie ou laccident en question na pas t
reconnu comme tel par le CERN.
VIII 1.10 Le rglement des sommes dues titre de remboursement est normalement effectu dans les
REGLEMENT DES 14 jours civils suivant rception de la demande de remboursement dment complte
REMBOURSEMENTS accompagne des pices justificatives ncessaires.
VIII 1.11 Tous paiements concernant les cotisations, les remboursements et les allocations sont
MONNAIE DE effectus en francs suisses. Les ventuels frais bancaires sont la charge du Membre.
REMBOURSEMENT
Dans le cas o les frais rembourser ne sont pas exprims en francs suisses, le taux de
change avec le franc suisse est le taux officiel en vigueur au CERN la date de
prsentation de la demande de remboursement.
Lorsquune garantie de rglement direct des factures a t accorde conformment

lArticle VII 4.13, les factures soumises directement au Tiers-Administrateur par
ltablissement hospitalier concern sont payes dans la monnaie de ltat o le traitement
a t dispens.
Section 2 - Accords et avis pralables

VIII 2.01 Un accord pralable du Tiers-Administrateur est ncessaire pour le remboursement des
ACCORD PREALABLE prestations suivantes :
frais de transport (sauf les transports durgence) ;
chirurgie rfractive ;
cures et sjours de convalescence, de radaptation, en unit daccueil temporaire
ou en attente de placement ;
garde-malades domicile ;
location ou achat de moyens auxiliaires ;
frais de sjour lhpital dun des membres de famille autre que lun des deux
parents dont la prsence est exige par lhospitalisation dun enfant de moins de
sept ans.
VIII 2.02 La demande daccord pralable doit tre soumise au Tiers-Administrateur au moins 14
DELAI POUR ACCORD jours civils avant l'engagement des frais mdicaux soumis accord pralable, au moyen du
PREALABLE formulaire officiel appropri. Ce dlai est tendu 30 jours civils pour les frais de cures.
20
VIII 2.03 Chaque demande daccord pralable doit tre accompagne dune ordonnance mdicale
PIECES JUSTIFICATIVES indiquant le traitement, son motif, sa dure ainsi que le rsultat escompt. Avec toute
demande daccord pralable pour la location ou lachat de moyens auxiliaires, un devis doit
tre joint.
VIII 2.04 Les frais encourus sans avoir obtenu l'accord pralable exig ne sont pas rembourss par le
ACCORD PREALABLE Rgime.
NON OBTENU
VIII 2.05 Un avis pralable doit tre obtenu de la part du Tiers-Administrateur pour une valuation
AVIS PREALABLE EN mdicale et financire de tout traitement dentaire, des prothses et des appareils
CAS DE TRAITEMENT orthodontiques prvus, dun montant suprieur 800 CHF, sauf en cas durgence.
DENTAIRE
VIII 2.06 Le devis pour avis pralable en cas de traitement dentaire doit tre soumis au Tiers-
SOUMISSION DUN Administrateur au moins 14 jours civils avant le dbut du traitement.
DEVIS EN CAS DE
TRAITEMENT
DENTAIRE
Section 3 - Cures et sjours de convalescence

VIII 3.01 Toutes cures ou sjours de convalescence, y compris les frais de traitement lis, sont
ACCORD PREALABLE soumis accord pralable conformment lArticle VIII 2.01.
VIII 3.02 Les sjours de convalescence sont accepts suite une hospitalisation avec opration, ou
SEJOURS DE une hospitalisation sans opration dau moins dix jours civils, condition que le sjour en
CONVALESCENCE question dbute dans les 30 jours civils suivant la n de lhospitalisation.
Dans la mesure du possible, les demandes daccords pralables doivent tre soumises
sept jours civils avant le dbut du sjour de convalescence.
VIII 3.03 Lordonnance pour une cure, autre quun sjour de convalescence, est complter par une
AUTRES CURES anamnse prcisant les rsultats obtenus par le traitement mdical ayant prcd la cure, le
programme des traitements mdicaux de la cure et le rsultat escompt quant la gurison
ou la consolidation de ltat de sant de la personne concerne.
Sil sagit dune cure rpte dont le dbut intervient moins de 12 mois aprs le dbut de la
cure prcdente, le mdecin doit dlivrer une pice justificative dtaille quant lefficacit
de la cure.
A partir de la troisime cure pour la mme affection, le mdecin joint lordonnance de

cure une valuation dtaille des cures prcdentes.
Les cures doivent tre effectues dans des tablissements reconnus par les autorits
comptentes de lEtat o se trouve ltablissement.
VIII 3.04 Lorsque la cure est refuse, le Tiers-Administrateur informe le Membre concern de sa
REFUS DE CURE dcision et des raisons qui la motivent.
VIII 3.05 Les cures daltitude, de rajeunissement, de repos et de changement dair, ainsi que toutes
EXCLUSION DE CURES autres cures similaires ne sont pas considres comme cures au sens du prsent Rglement.
21
Section 4 - Rglement des litiges

VIII 4.01 Toute dcision dapplication du prsent Rglement est prise au nom du Directeur gnral
ASPECTS GENERAUX DE de lOrganisation. Les modalits gnrales de contestation dune telle dcision sont dcrites
PROCEDURE dans la procdure dtaille ci-aprs.
Toutefois, les modalits de contestation d'une dcision concernant la reconnaissance dun

tat de dpendance sont dcrites lAnnexe V du prsent Rglement.
Au cours de la procdure dtaille ci-aprs, les donnes mdicales personnelles sont

soumises la confidentialit, telle quindique lArticle I 1.06.
Le Directeur gnral peut dlguer son autorit tout membre du personnel au sein de
lOrganisation quil estime comptent pour traiter des litiges relatifs lassurance maladie.
Le recours la procdure dtaille ci-aprs na pas deffet suspensif sur la dcision

conteste.
Le Directeur gnral peut proroger les dlais spcifis dans la procdure dtaille ci-aprs,
si la bonne administration de la justice lexige. Il en informe ds lors le Membre concern.
VIII 4.02 Afin daboutir un rglement lamiable, un Membre du Rgime peut demander le
REEXAMEN DUNE rexamen dune dcision prise conformment au prsent Rglement. La demande doit tre
DECISION effectue par crit dans les 60 jours civils suivant la notification de la dcision conteste au
Tiers-Administrateur sil en est lauteur, ou au Directeur gnral dans tous les autres cas.
La demande de rexamen doit tre signe par le Membre concern et envoye par courrier
recommand. Elle doit comprendre une copie de la dcision conteste et un expos crit
des motifs de la demande.
VIII 4.03 Le Tiers-Administrateur, ou le Directeur gnral le cas chant, rexamine les motifs de la
NOUVELLE DECISION dcision conteste et consulte lautorit comptente du CERN. Une rponse motive,
APRES REEXAMEN constituant une nouvelle dcision, est adresse au Membre concern dans les 60 jours civils
suivant la rception de la demande. Cette nouvelle dcision, qui annule et remplace la
dcision conteste, indique les motifs de la dcision et les possibilits dintroduire un
recours conformment lArticle VIII 4.04.
VIII 4.04 Un recours en matire dassurance maladie ne peut tre introduit qu lissue de la
RECOURS CONTRE LA procdure de rexamen.
NOUVELLE DECISION
Le Membre concern saisit le Directeur gnral par crit dans les 60 jours civils suivant la
notification de la dcision prise conformment lArticle VIII 4.03.
La lettre de recours doit tre signe par le Membre concern et envoye par courrier
recommand. Elle doit inclure une copie de la dcision conteste et un expos des motifs de
recours.
22
VIII 4.05 A rception de la demande de recours, le Directeur gnral examine en premier lieu la
RECEVABILITE DU recevabilit.
RECOURS
Lorsque le recours est irrecevable, le Membre concern est inform des motifs de
lirrecevabilit par crit dans les 30 jours civils suivant la rception de la lettre de recours.
Lorsque le recours est recevable, le Directeur gnral dtermine si le litige est de nature
administrative ou mdicale.
Tout litige concernant une allocation pour incapacit de gain est considr comme tant de
nature mdicale.
En cas de litige de nature administrative, le Directeur gnral convoque le Comit des

Litiges en matire dAssurance Maladie, conformment lArticle VIII 4.06, dans les
30 jours civils suivant la rception de la lettre de recours.
En cas de litige de nature mdicale, un mdecin est dsign conformment

lArticle VIII 4.09.
VIII 4.06 Le Comit des Litiges en matire dAssurance Maladie, ci-aprs "le Comit", est comptent
REGLEMENT DES pour connatre tout recours dirig contre une dcision de nature administrative en matire
LITIGES DE NATURE dAssurance maladie prise conformment lArticle VIII 4.03.
ADMINISTRATIVE
Le Comit est compos de trois membres, appartenant en gnral au CHIS Board, tel que
vis lArticle X 1.03.
Deux membres permanents et leurs supplants sont dsigns pour une priode de deux ans
renouvelable, comme suit :
un membre et son supplant nomms par la Direction du CERN ;
un membre et son supplant nomms par lAssociation du Personnel.
Dans les dix jours civils suivant la convocation du Comit, les deux membres permanents
choisissent, dun commun accord, le Prsident du Comit, lui-mme en gnral membre du
CHISB.
Si aucun accord na pu tre obtenu dans le dlai prescrit, le troisime membre du Comit
est le Prsident du CHISB.
Ds que sa composition est devenue dfinitive, le Comit commence lexamen du cas dans
les 30 jours civils.
VIII 4.07 La procdure est crite. Toutefois, sa discrtion, le Comit peut entendre le membre ou
PROCEDURE DU toute personne pouvant faire bnficier le Comit de son expertise.
COMITE
Le Comit peut prendre toutes mesures dinstruction qui lui paraissent ncessaires pour
lexamen du cas.
Le Prsident reprsente le Comit pour tous les actes de procdure.
Le Comit :
examine les documents qui lui sont prsents par les parties ;
consulte le Tiers-Administrateur ou tout expert, si cela lui parait ncessaire.
Les conclusions de tout expert consult sont communiques aux parties pour commentaires.
Au cas o une expertise demande par le Comit devrait entraner des frais, le Prsident du
Comit en informe au pralable le Directeur gnral qui dcide si le Rgime doit les
supporter.
Ds lors que le Prsident du Comit estime disposer de toutes les informations ncessaires,
il clt la procdure dinstruction et en informe les parties.
23
VIII 4.08 Le Comit tablit un rapport quil transmet au Directeur gnral dans les 30 jours civils
RAPPORT DU COMITE suivant la clture de la procdure dinstruction.
Le rapport comprend les lments suivants :

arguments principaux des parties ;
rsum des conclusions des experts ventuellement consults ;
considrations du Comit ;
recommandation du Comit, approuve la majorit de ses membres.
VIII 4.09 Lorsque le Directeur gnral a dtermin le litige comme tant de nature mdicale, ce litige
REGLEMENT DES est examin par un mdecin conjointement dsign par le mdecin choisi par le Membre
LITIGES DE NATURE concern et celui choisi par lOrganisation dans les 30 jours civils suivant lintroduction du
MDICALE recours.
Si les parties nont pu saccorder sur le choix du mdecin, la dsignation sera effectue par
toute autorit mdicale comptente dans le Canton de Genve.
Lorsque le mdecin a t dsign, il commence lexamen du cas dans les 30 jours civils.
Le mdecin peut prendre toutes mesures dinstruction qui lui paraissent ncessaires pour
lexamen du cas.
Le mdecin :
En cas de litige relatif une allocation pour incapacit de gain, le mdecin consulte
obligatoirement un spcialiste de la rducation ayant une bonne connaissance de la
lgislation fdrale suisse sur linvalidit.
La communication dinformations et de documents de nature mdicale, y compris dans le

contexte de lArticle VIII 4.10, est limite au strict minimum exig pour une gestion
approprie du litige.
Les honoraires du mdecin et de tout expert consult sont pris en charge par le Rgime.
VIII 4.10 Le mdecin tablit un rapport quil transmet au Directeur gnral dans les 30 jours civils
RAPPORT DU MEDECIN suivant la clture de la procdure dinstruction.
Le rapport comprend les lments suivants :

rsum des conclusions des experts ventuellement consults ;
considrations du mdecin ;
recommandation.
VIII 4.11 Le Directeur gnral notifie par crit sa dcision au Membre concern, en y joignant une
DECISION FINALE DU copie du rapport soumis par le Comit ou le mdecin, dans les 30 jours civils suivant la
DIRECTEUR GENERAL rception dudit rapport. Il indique, le cas chant, le motif pour lequel il ne suit pas la
recommandation du Comit ou du mdecin.
La dcision du Directeur gnral est dfinitive.
VIII 4.12 Une requte contre la dcision dfinitive prise conformment lArticle VIII 4.11 peut tre
RECOURS DEVANT LE introduite devant le Tribunal Administratif de lOrganisation Internationale du Travail
TAOIT (TAOIT) conformment aux Statut et Rglement dudit Tribunal.
24
Chapitre IX - Dispositions Financires
Section 1 - Salaires de rfrence

IX 1.01 Le Salaire de rfrence I est la rmunration mensuelle de base indique dans le contrat
SALAIRE DE demploi ou dassociation avec le CERN sur la base de 40 heures de travail hebdomadaires.
REFERENCE I
Ce salaire de rfrence est utilis pour le calcul des cotisations principales des membres du
personnel titulaires, des boursiers, et des tudiants.
IX 1.02 Le Salaire de rfrence II est la moyenne pondre de la rmunration mensuelle de base de

SALAIRE DE tous les membres du personnel titulaires et des boursiers au dernier jour de l'anne civile
REFERENCE II prcdente, en utilisant le barme de rmunration pour lanne civile en cours.
Ce salaire de rfrence est utilis pour dterminer la cotisation des attachs, des utilisateurs,
et des bnficiaires dune pension diffre de la Caisse de Pensions du CERN. Il est
galement utilis pour dterminer la cotisation des apprentis (50% du Salaire de rfrence
II), et des enfants qui ne sont plus assurs en tant quenfants charge (40% du Salaire de
rfrence II).
IX 1.03 Le Salaire de rfrence III est le salaire de base mensuel peru au moment du dpart de
SALAIRE DE lOrganisation dun bnficiaire de la Caisse de Pensions du CERN. Il est adapt comme
REFERENCE III les pensions.
Pour les bnficiaires de pensions de conjoint survivant et/ou d'orphelin, le salaire de

rfrence III est rduit selon les Statuts de la Caisse de Pensions.
Ce salaire de rfrence est utilis pour dterminer le montant de la cotisation principale

pour les bnficiaires de la Caisse de Pensions du CERN ayant adhr au titre de la
couverture dAssurance maladie normale.
IX 1.04 Le Salaire de rfrence IV est la rmunration mensuelle de base telle quindique dans le
SALAIRE DE contrat demploi avec lOrganisation sur la base de la dure de travail hebdomadaire
REFERENCE IV effective.
Ce salaire de rfrence est utilis pour calculer le montant de la cotisation complmentaire

lorsque deux conjoints sont membres du personnel titulaires ou boursiers.
IX 1.05 Le Salaire de rfrence V est la valeur moyenne de la tranche de revenus correspondant au

SALAIRE DE revenu mensuel brut ou la pension de retraite (y compris la pension du CERN) dcoulant
REFERENCE V dune activit professionnelle (sauf pour les tranches infrieure et suprieure).
Tranche de revenus mensuels Salaire de rfrence

Jusqu 2500 CHF inclus 0 CHF/mois
Plus de 2'500 CHF et jusqu 4250 CHF inclus 3'333 CHF/mois
Plus de 4'250 CHF et jusqu 7500 CHF inclus 5'833 CHF/mois
Plus de 7'500 CHF et jusqu 10000 CHF inclus 9167 CHF/mois
Plus de 10000 CHF Salaire de rfrence II x 0.5 x
taux global (Membre
+Organisation)/ taux du
Membre seul
Ce salaire de rfrence est utilis pour dterminer la cotisation des conjoints des Membres
principaux couverts selon lArticle III 5.07 paragraphe 2, qui utilisent le Rgime
dAssurance maladie du CERN comme assurance maladie primaire.
25
Section 2 - Fonds de Couverture

IX 2.01 Le CERN a cr deux fonds, l'un pour la capitalisation des rserves du fonds de
FONDS DE dpendance (LTC), l'autre pour les provisions et rserves du rgime d'assurance maladie
COUVERTURE (HIS).
Ce dernier correspond aux provisions et rserves suivantes :

provision pour les remboursements encourus et non encore rclams (20% du
total des remboursements prvus pour l'anne) ;
provision pour risque catastrophique (30% du total des remboursements prvus
pour l'anne) ;
rserve pour faire face un dficit ventuel du Rgime dans le futur (au
minimum 20% du total des remboursements prvus pour l'anne).
Le capital de ces fonds est formellement distinct du reste des actifs du CERN.
Des tudes actuarielles seront ralises rgulirement afin de suivre l'volution des rgimes
HIS et LTC en tenant compte des cotisations, des dpenses prvisibles et des avoirs des
fonds. Il devra tre remdi le plus rapidement possible tout dsquilibre structurel de ces
rgimes.
Chapitre X Fonctionnement du Rgime
Section 1- Fonctionnement
X 1.01 LAdministrateur est nomm par le Directeur gnral afin dassurer le fonctionnement
ADMINISTRATEUR quotidien du Rgime. A cette fin, lAdministrateur:
suit et supervise lexcution du contrat liant lOrganisation au Tiers-

Administrateur ;
ngocie les tarifs des soins auprs des prestataires ;
effectue, en liaison avec le Dpartement responsable des finances de
lOrganisation, le suivi de la situation financire du Rgime et de ses fonds pour
rapport au Conseiller Stratgique vis lArticle X 1.02;
vrifie les donnes transmises et reues du Tiers-administrateur en matire de
prestations et cotisations pour rapport au Conseiller Stratgique;
traite toute question relative laffiliation des Membres;
dcide, en accord avec le Conseiller Stratgique, de loctroi de prestations
bnvoles selon lArticle VII 4.06 ;
suit lvolution des systmes dassurance maladie dans les Etats membres et les
autres organisations intergouvernementales pour rapport au Conseiller
Stratgique;
excute toute autre tche ncessaire pour assurer le fonctionnement quotidien du
Rgime.
26
X 1.02 Le Conseiller Stratgique est nomm par le Directeur gnral afin de lassister dans
CONSEILLER llaboration de la stratgie moyen et long terme en matire dassurance maladie. A cette
STRATEGIQUE fin, notamment, le Conseiller Stratgique :
analyse les rapports sur la situation financire du Rgime et de ses fonds et leurs
projections long terme, ainsi que les statistiques relatives aux cotisations et
prestations qui lui sont transmises par lAdministrateur;
analyse, en collaboration avec lAdministrateur, lvolution des systmes
dassurance maladie dans les Etats membres et les autres organisations
intergouvernementales;
labore, en collaboration avec lAdministrateur, et soumet au Directeur Gnral
les propositions dajustement du Rgime ncessaires pour assurer la ralisation
de ses objectifs, maintenir son quilibre financier long terme, et assurer la
comptitivit de ses conditions par rapport celles des rgimes dassurance
maladie des organisations intergouvernementales qui servent de comparateurs;
en accord avec le Directeur gnral, soumet ces propositions dajustement au
CHIS-Board vis lArticle X 1.03 afin de prparer la concertation ultrieure au
sein du CCP.
X 1.03 Le Comit de lAssurance maladie, ci-aprs dsign par son acronyme anglais CHIS-
CHIS-BOARD Board est un sous-groupe du CCP charg de prparer la concertation au sein du CCP sur
les propositions dajustement qui lui sont soumises par le Conseiller Stratgique
conformment lArticle X 1.02.
Le CHIS-Board est prsid par le Conseiller Stratgique et comprend en outre:

quatre membres nomms par le Directeur gnral parmi les membres du
personnel, dont lAdministrateur;
quatre membres nomms par lAssociation du Personnel parmi les membres du
personnel et les bnficiaires de la Caisse de Pensions du CERN.
Le CHIS-Board labore sa propre procdure de travail. Afin de mener bien ses travaux, le
CHIS-Board est rgulirement inform du fonctionnement du Rgime (notamment qualit
du service, statistiques, situation financire, ngociations tarifaires, analyses actuarielles)
par son Prsident et par lAdministrateur. Les membres du CHIS-Board ont accs aux
documents contenant ces informations.
Chapitre XI - Audit
Section 1 - Audit
XI 1.01 Les commissaires aux comptes internes et externes au CERN peuvent, de leur
COMMISSAIRES AUX propre initiative, examiner tout ou partie du Rgime dAssurance maladie du
COMPTES INTERNES CERN.
ET EXTERNES
Afin de pouvoir effectuer cette tche, les commissaires aux comptes ont accs tous
documents et pices justificatives, confidentiels ou non, ncessaires la vrification
des transactions figurant dans les dossiers financiers du Tiers-administrateur.
Sur demande, les commissaires aux comptes ont galement accs aux instructions
internes crites du Tiers-administrateur.
Les commissaires aux comptes nont pas accs aux donnes personnelles mdicales
des Membres.
27
Chapitre XII - Annexes
Section 1 - Annexes
XII 1.01 Les documents suivants font partie intgrante du prsent Rglement :
ANNEXES Annexe I intitule "Couverture dAssurance maladie normale" ;
Annexe II intitule "Allocation pour incapacit de gain" ;
Annexe III intitule "Couverture dAssurance maladie court terme" ;
Annexe IV intitule "Taux de cotisation" ;
Annexe V intitule "Prestations dpendance".
28
Rglement du Rgime dAssurance maladie du CERN 1er juin 2014 - Mise jour 1er novembre 2016
Annexe I - Couverture dAssurance maladie normale
AI.1.01 Les taux de remboursement selon les Frais charge de lAssur (FCA, tel que dfini l'Article II.1.30) cumuls par Membre durant une anne civile
TAUX DE REMBOURSEMENT sont les suivants :
SELON LA REGLE GENERALE FCA cumuls Taux de remboursement
jusqu 499.99 CHF 80 %
de 500 CHF et jusqu 2999.99 CHF 90 %
3'000 CHF 100 %
AI.1.02 Certaines prestations ne sont rembourses que jusqu' une dpense maximale (plafond), dfinie en gnral par anne civile et dans certains cas
PLAFONDS cumulable sur plusieurs annes. Ces plafonds sont dtaills dans le tableau de la prsente annexe.
Conformment l'Article VII 4.06, les plafonds ci-dessous peuvent tre dpasss sur accord pralable du Tiers-Administrateur, notamment pour les
enfants dont l'tat de sant ncessite des soins mdicaux prolongs.
AI.1.03 Afin de favoriser l'utilisation de prestataires de soins dans les Etats membres o le cot de la sant est le moins lev, le taux de remboursement 80
BONUS POUR PRESTATIONS ou 90% est augment de 5 points pour certaines prestations ambulatoires (dfinies dans la table ci-dessous), si elles ont t dispenses dans un des
AMBULATOIRES Etats membres suivants :
Allemagne, Autriche, Belgique, Bulgarie, Espagne, Finlande, France, Grce, Hongrie, Isral, Italie, Pays-Bas, Pologne, Portugal, Royaume-Uni,
Rpublique slovaque, Rpublique tchque, Roumanie, Sude.
AI.1.04 Certains examens et traitements qui ont pour but de prvenir des maladies sont rembourss 100%. Il s'agit de :
PREVENTION - vaccin papillomavirus : sur prescription mdicale ;
- mammographie (dpistage cancer du sein) : femmes partir de 50 ans, une fois tous les 2 ans ;
- recherche de sang occulte dans les selles (dpistage cancer du colon) : hommes et femmes partir de 50 ans, une fois tous les 2 ans.
Les autres examens et traitements prventifs (par exemple vaccins) sont rembourss selon la rgle gnrale.
AI.1.05 Les prestations B1 B5 sont rembourses 100% pour un cas donn (maladie/accident) ds que les dpenses cumules pour ce cas, dpassent
CAS GRAVE 80000 CHF.
29
Les prestations prvues par la Couverture dAssurance maladie normale sont les suivantes :
AUTORISATION
PREALABLE DU
TAUX DE
TIERS-
PRESTATIONS REMBOURSE BONUS PLAFOND AUTRES CONDITIONS
ADMINISTRATEUR
-MENT
(voir chapitre VIII,
section 2)
A. MALADIES ET ACCIDENTS 100% pas applicable Sans limitation ni plafond, mais avec accord ou avis
PROFESSIONNELS pralable pour les prestations concernes, comme en B ci-
dessous.
Supplment pour chambre individuelle la charge
exclusive du membre.
B. ACCIDENTS ET MALADIES NON
PROFESSIONNELS
1. Honoraires de mdecins rgle gnrale selon A1.1.03
2. Frais pharmaceutiques rgle gnrale selon A1.1.03 Reconnus comme tels dans lEtat dans lequel ils ont t
prescrits.
Les cots des mdicaments non rembourss n'entrent pas
dans le calcul des Frais charge de lAssur (FCA).
3. Imagerie mdicale rgle gnrale selon A1.1.03
4. Analyses et travaux de laboratoire rgle gnrale selon A1.1.03
5. Soins mdicaux et examens divers rgle gnrale selon A1.1.03 Y compris les traitements ambulatoires l'hpital.
6. Traitements dispenss par des :
a) Logopdistes rgle gnrale selon A1.1.03 13300 CHF par
anne civile
b) Psychothrapeutes pour enfants rgle gnrale selon A1.1.03 25000 CHF par
jusqu18 ans anne civile
c) Gardes malades domicile rgle gnrale selon A1.1.03 OUI 68 CHF par jour En cas de dpendance de longue dure reconnue, limite
journalire remplace par limite mensuelle (voir Annexe V
2.01)
d) Auxiliaires mdicaux autres que ceux rgle gnrale selon A1.1.03 3300 CHF par
mentionns aux points 6 a) c) anne civile
30
AUTORISATION
PREALABLE DU
TAUX DE
TIERS-
ADMINISTRATEUR
-MENT
section 2)
7. Traitements hospitaliers stationnaires
(frais de sjour et de traitement)
a) Hospitalisation dans un tablissement 100%
public, hors secteur priv ou semi-
priv
b) Hospitalisation dans un tablissement 80% Supplment pour chambre individuelle la charge
hospitalier priv non-agr exclusive du membre
c) Toute autre hospitalisation rgle gnrale
d) Frais de sjour l'hpital d'un des 70% 132 CHF par jour
deux parents dont la prsence est
exige par l'hospitalisation de leur
enfant de moins de sept ans
e) Frais de sjour l'hpital d'un des 70% OUI 132 CHF par jour En absence d'accord pralable, ce remboursement peut tre
membres de la famille autre que l'un exceptionnellement accept par le Tiers-Administrateur si
des deux parents dont la prsence est le mdecin traitant l'hpital estime ncessaire la prsence
exige par l'hospitalisation d'un de ce membre de famille.
enfant de moins de sept ans
8. Cures et sjours de convalescence, de Conformment au Chapitre VIII Section 3.
radaptation, en unit d'accueil
temporaire et en unit d'attente de
placement
a) Frais de sjour en cure 100% OUI 10 CHF par jour
b) Frais de sjour en convalescence 100% OUI 80 CHF par jour
c) Frais de sjour en maison de 100% OUI 120 CHF par jour Frais de sjour en tablissement spcialis pour
radaptation radaptation sociale, par exemple aprs une cure de
dsintoxication (drogue, alcool).
d) Frais de sjour en Unit d'Accueil rgle gnrale OUI Prestation non cumulable avec l'allocation journalire pour
Temporaire ou en Unit d'Attente de dpendance.
Placement
e) Frais mdicaux et pharmaceutiques rgle gnrale selon A1.1.03
31
AUTORISATION
PREALABLE DU
TAUX DE
TIERS-
ADMINISTRATEUR
-MENT
section 2)
9. Optique
a) Lunettes (verres et monture) et rgle gnrale 500 CHF par Sur prescription.
lentilles de contact correctives, y anne civile, Comme mesure transitoire pour les membres affilis au
compris les lentilles jetables cumulable sur Rgime avant le 1er janvier 2012, le plafond annuel sera
3 ans. augment comme suit :
- pour 2012 : par un montant de 1000 CHF, duquel seront
dduites les dpenses encourues en 2010 et 2011,
- pour 2013 : par un montant de 500 CHF, duquel seront
dduites les dpenses encourues en 2011.
Larticle VII 4.04 relatif au calcul des plafonds prorata
temporis sapplique ces augmentations.
b) Chirurgie rfractive rgle gnrale OUI 2000 CHF par Pas de remboursement avant 12 mois d'affiliation au
il pour toute la regime.
priode de
couverture
10. Location ou achat de moyens rgle gnrale OUI 11000 CHF par
auxiliaires tels que : appareils anne civile,
orthopdiques, prothses autres que cumulable sur
dentaires, appareils acoustiques, 2 ans
extracteurs d'oxygne, appareils de
dialyse, etc...
11. Location ou achat de moyens rgle gnrale OUI 11000 CHF par Les moyens concerns sont les suivants :
auxiliaires servant dvelopper anne civile, fauteuils roulants ;
l'autonomie personnelle dans le cas cumulable sur installations sanitaires complmentaires automatiques
d'une invalidit, incapacit de gain ou 2 ans lorsque le Membre ne peut faire sa toilette seul quau
dpendance reconnues. moyen de cet appareil ;
lvateurs pour malades pour utilisation au domicile priv
lits lectriques (avec sommier, mais sans matelas ni
autres accessoires) pour utilisation au domicile priv ;
amnagement de la demeure du membre : pose de barres
dappui, suppression de seuils, construction de rampes de
seuils, dplacement de montants de portes, installations et
systmes signaux lumineux pour les sourds et les
dficients auditifs graves, systme dappel pour les sourds-
aveugles ;
amnagement d'un vhicule permettant au membre de se
deplacer.
32
AUTORISATION
PREALABLE DU
TAUX DE
TIERS-
ADMINISTRATEUR
-MENT
section 2)
12. Soins dentaires, prothses et rgle gnrale OUI* 3300 CHF par * Sur avis pralable, si les frais sont suprieurs CHF 800,
orthodontie anne civile, sauf en cas durgence.
cumulable sur
3 ans
13. Frais de transport : en ambulance ou

vhicule sanitaire (exceptionnellement en
taxi)
a) du domicile ou du lieu de l'accident rgle gnrale
l'tablissement hospitalier appropri
le plus proche, ou tout autre transport
prsentant un caractre d'urgence
b) d'un hpital un autre rgle gnrale OUI

c) un tablissement de rducation rgle gnrale OUI
d) tout autre transport mdicalement rgle gnrale OUI
ncessaire
C. PREVENTION 100% pas applicable Uniquement pour les examens et traitements selon la liste
dans AI 1.04.
D. ALLOCATION INCAPACITE DE GAIN pas applicable Voir Annexe 2.

d'un membre de famille
E. ALLOCATION DEPENDANCE pas applicable Voir Annexe 5.

F. INDEMNITE EN CAS DE DECES
a) dun titulaire pas applicable 14000 CHF 3 fois le salaire de base avec un plafond de 14000 CHF
b) dun membre de la famille du titulaire pas applicable 1600 CHF
33
Annexe II - Allocation pour Incapacit de Gain
A II 1.01 Au sens de la prsente Annexe, le terme "incapacit de gain" se dfinit comme une
DEFINITION diminution de la capacit de gain, prsume permanente ou de longue dure, qui rsulte
dune atteinte la sant physique ou mentale provenant dune infirmit congnitale, dune
maladie ou dun accident empchant la personne concerne daccomplir ses travaux
habituels.
A II 1.02 Un membre de la famille, tel que dfini par les Statut et Rglement du Personnel du CERN,
PERSONNES ELIGIBLES dun membre du personnel actif, pensionn, dcd, ou au bnfice de lArticle III 2.04
peut rclamer le paiement dune allocation pour incapacit de gain ds lors que les
conditions suivantes sont remplies cumulativement au moment de la demande :
le membre du personnel doit tre (ou avoir t, dans le cas danciens membres du
personnel) titulaire, boursier ou apprenti ;
le membre du personnel doit avoir, ou avoir eu, au moins deux annes de service
ininterrompues auprs de lOrganisation. Cette priode de deux ans inclut la
dure totale des contrats ininterrompus en tant que membre du personnel titulaire,
boursier ou apprenti ;
le membre du personnel et la personne ligible doivent tre Membres au bnfice
de la couverture dAssurance maladie normale depuis au moins un an ;
la personne ligible ne doit pas tre membre du personnel du CERN ;
toutes les tentatives de restauration de la capacit de gain ou de travail de
lintress doivent stre avres totalement ou partiellement inoprantes ;
la personne ligible doit avoir atteint lge de 18 ans mais ne doit pas avoir atteint
lge limite de la retraite tel que fix dans les Statut et Rglement du Personnel
du CERN.
A II 1.03 La personne ligible peut demander lallocation ds lors quelle prsente

CONDITIONS OUVRANT une incapacit permanente de gain de 50% au moins ; ou,
DROIT A ds quelle a subi une incapacit de travail de 50% au moins en moyenne pendant
LALLOCATION 360 jours sans interruption notable (cest--dire plus de 30 jours conscutifs), et
quelle prsente encore une incapacit de gain de 50% au moins.
A II 1.04 La demande de lallocation pour incapacit de gain peut tre formule tout moment pour
DEMANDE autant que les conditions fixes dans la prsente Annexe soient remplies.
DALLOCATION
Si la demande est accepte, la date deffet est le premier jour du mois durant lequel la
demande est formule. Lallocation peut tre verse rtroactivement pour une priode
maximale de 12 mois si la personne concerne prouve que les conditions justifiant le
paiement taient remplies de faon continue.
A II 1.05 Toute personne revendiquant le paiement de lallocation doit fournir au Tiers-

PIECES JUSTIFICATIVES Administrateur, ses frais, un rapport mdical dtaill de lautorit nationale comptente
exposant la cause, la nature, le dbut, le cours et la dure probable de la maladie, ainsi que
les lsions corporelles ou lamoindrissement des forces intellectuelles et physiques de
lintress. Ce rapport doit galement indiquer le degr dincapacit de gain constat par le
mdecin ainsi quune attestation des chances de gurison de lintress. Le Tiers-
Administrateur a le droit dexiger toutes informations et preuves utiles ; il peut, aux frais du
Rgime, procder lui-mme des recherches et faire examiner par des mdecins de son
choix la personne concerne.
A II 1.06 Dans un dlai de six semaines dater de la rception des pices justificatives requises ci-
RECONNAISSANCE DU dessus, le Tiers-Administrateur informe par crit la personne concerne et, le cas chant,
DROIT A le CERN, sil accepte daccorder une allocation pour incapacit de gain et, dans
LALLOCATION laffirmative, dans quelle mesure et compter de quelle date.
Le Tiers-Administrateur a le droit de diffrer la dcision dune anne au plus aprs la n du

traitement mdical, si le rapport mdical laisse subsister des doutes quant une incapacit
de gain permanente et son degr.
A II 1.07 La personne concerne a droit a une allocation entire si elle prsente une incapacit de
ALLOCATION ENTIERE gain des deux tiers au moins.
34
A II 1.08 La personne concerne a droit a une demi-allocation si elle prsente une incapacit de gain
DEMI-ALLOCATION de 50% au moins.
A II 1.09 Lallocation est gale lallocation minimale que verserait lAI (Assurance Invalidit) de la
MONTANT DE Confdration Helvtique dans les mmes circonstances, quel que soit lEtat de rsidence
LALLOCATION de la personne concerne.
A II 1.10 Tout bnficiaire dune allocation prvue par la prsente Annexe est tenu dinformer sans
OBLIGATION DE dlai le Tiers-Administrateur de toute allocation, pension ou capital dincapacit de gain,
RENSEIGNER dinvalidit ou de vieillesse quil peroit mais qui ne rsulte pas dune assurance volontaire
contracte titre priv et onreux.
A II 1.11 Toute allocation, pension, ou capital dincapacit de gain, dinvalidit ou de vieillesse

NON-CUMUL DES reue par une personne concerne vient en dduction de lallocation attribue en
PRESTATIONS application de la prsente Annexe, pour autant quelle ne rsulte pas dune assurance
volontaire contracte titre priv et onreux. Toutefois, la pension dorphelin handicap,
servie en application des Statuts de la Caisse de Pensions du CERN, se cumule avec les
prestations vises par la prsente Annexe.
A II 1.12 Le Tiers-Administrateur doit tre immdiatement inform de toute amlioration de la

AMELIORATION DE LA capacit de gain ou de travail. Le rtablissement ou lamlioration de la capacit de travail
CAPACITE DE GAIN OU entrane la diminution ou la suppression de lallocation. Toute allocation indment perue
DE TRAVAIL par la personne concerne doit tre rembourse conformment lArticle VII 4.08.
A II 1.13 Lorsque ltat de sant du bnficiaire dune allocation pour incapacit de gain partielle se
DETERIORATION DE LA dtriore de sorte que lincapacit de gain atteint deux tiers au moins, lallocation devient
CAPACITE DE GAIN OU entire.
DE TRAVAIL
A II 1.14 Une modification du degr dincapacit de gain dploie ses effets compter du jour o
DATE DEFFET cette modification est mdicalement constate.
A II 1.15 Le Tiers-Administrateur peut tout moment exiger les preuves quil juge ncessaires et
PREUVE ET EXAMEN faire examiner, au frais du Rgime, le Membre concern par tout mdecin choisi par ses
MEDICAL soins. Sur demande du Membre concern, son mdecin traitant peut assister un tel
examen.
A II 1.16 Lallocation est refuse, rduite ou retire, temporairement ou dfinitivement, si la

MOTIFS DE REFUS, personne concerne a caus ou aggrav son incapacit de gain, intentionnellement ou par
REDUCTION OU faute grave, ou en commettant un crime ou un dlit.
SUPPRESSION DE
LALLOCATION
A II 1.17 La personne concerne doit se voir refuser lallocation de faon temporaire ou permanente
REFUS DE MESURES DE si elle se soustrait ou soppose des mesures de radaptation auxquelles on peut
READAPTATION raisonnablement exiger quelle se soumette et dont on peut attendre une amlioration
notable de sa capacit de gain ou de travail.
A II 1.18 Lallocation est verse tant que la personne concerne demeure Membre au bnfice de la
FIN DU DROIT couverture dAssurance maladie normale et tant que subsistent les conditions prvues aux
Articles A II 1.02 et A II 1.03. Le paiement cesse le dernier jour du mois o le droit steint
et, en tout tat de cause, ds que la personne concerne a atteint lge limite de la retraite tel
que fix dans les Statut et Rglement du Personnel du CERN.
A II 1.19 Pour lexcution et linterprtation des dispositions de la prsente Annexe, les parties se
DROIT APPLICABLE rfreront, par ordre de priorit :
la prsente Annexe ;
au prsent Rglement, sans prjudice des dispositions de son Article I 1.08 ;
la lgislation suisse sur lassurance-invalidit, tant entendu que le terme
"incapacit de gain" utilis dans la prsente Annexe correspond au terme
"invalidit" utilis dans la LAI (loi sur lassurance-invalidit) ;
aux lois et rglements en matire dassurances applicables en Suisse.
35
Annexe III - Couverture dAssurance Maladie Court Terme
AIII.1.01 Les taux de remboursement selon les Frais charge de lAssur (FCA, tel que dfini l'Article II.1.30) cumuls par Membre durant une anne civile sont
TAUX DE REMBOURSEMENT les suivants :
SELON LA REGLE GENERALE FCA cumuls Taux de remboursement
jusqu 500 CHF inclus 80 %
plus de 500 CHF et jusqu 3'000 CHF inclus 90 %
3'001 CHF 100 %
AIII.1.02 Afin de favoriser l'utilisation de prestataires de soins dans les Etats membres o le cot de la sant est le moins lev, le taux de remboursement 80 ou
BONUS POUR PRESTATIONS 90% est augment de 5% pour certaines prestations ambulatoires (dfinies dans la table ci-dessous), si elles ont t dispenses dans un des Etats membres
AMBULATOIRES suivants :
Allemagne, Autriche, Belgique, Bulgarie, Espagne, Finlande, France, Grce, Hongrie, Isral, Italie, Pays-Bas, Pologne, Portugal, Royaume-Uni,
Rpublique slovaque, Rpublique tchque, Roumanie, Sude.
AUTORISATION
PREALABLE DU
TAUX DE TIERS-
PRESTATIONS BONUS PLAFOND AUTRES CONDITIONS
REMBOURSEMENT ADMINISTRATEUR
section 2)
A. MALADIES ET ACCIDENTS 100% pas applicable Sans limitation ni plafond, mais avec accord ou avis
PROFESSIONNELS pralable pour les prestations concernes, comme en B
ci-dessous.
Supplment pour chambre individuelle la charge
exclusive du membre.
B. ACCIDENTS ET MALADIES
NON PROFESSIONNELS
1. Honoraires de mdecins rgle gnrale selon AIII.1.02
2. Frais pharmaceutiques rgle gnrale selon AIII.1.02 Reconnus comme tels dans lEtat dans lequel ils ont t
prescrits.
Les cots des mdicaments non rembourss n'entrent pas
dans le calcul des Frais charge de lAssur (FCA).
36
AUTORISATION
PREALABLE DU
TAUX DE TIERS-
PRESTATIONS BONUS PLAFOND AUTRES CONDITIONS
REMBOURSEMENT ADMINISTRATEUR
section 2)
3. Imagerie mdicale rgle gnrale selon AIII.1.02
4. Analyses et travaux de rgle gnrale selon AIII.1.02
laboratoire
5. Traitements hospitaliers
stationnaires (frais de sjour et
de traitement)
a) Hospitalisation dans un 100%
tablissement public, hors
secteur priv ou semi-priv
b) Hospitalisation dans un 80% Supplment pour chambre individuelle la charge
tablissement hospitalier exclusive du membre.
priv non-agr
c) Toute autre hospitalisation rgle gnrale
6. Soins dentaires urgents rgle gnrale 300 CHF

(prothses et orthodontie sont
exclues)
7. Frais de transport : en
ambulance ou vhicule sanitaire
(exceptionnellement en taxi)
a) du domicile ou du lieu de rgle gnrale
l'accident l'tablissement
hospitalier appropri le plus
proche, ou tout autre
transport prsentant un
caractre d'urgence
b) d'un hpital un autre rgle gnrale OUI
c) un tablissement de rgle gnrale OUI
rducation
d) tout autre transport rgle gnrale OUI
mdicalement ncessaire
37
Annexe IV - Taux de Cotisation
Section 1 - Cotisations et taux de cotisation

A IV 1.01 Conformment aux Articles III 5.09 et IV 5.01, le taux de cotisation pour la couverture des
TAUX DE COTISATION accidents et maladies non professionnels est le pourcentage suivant des salaires de
POUR LES rfrence dfinis au Chapitre IX Section 1 pour (a) les bnficiaires de la Caisse de
COUVERTURES Pensions du CERN, et (b) tous les autres membres
DASSURANCE (a) (b)
MALADIE NORMALE ET pour lanne 2011 11,66% 10,86%
REDUITE pour lanne 2012 12,07% 11,27%
pour lanne 2013 12,48% 11,68%
pour lanne 2014 12,91% 12,11%
pour lanne 2015 13,37% 12,57%
A IV 1.02 Pour lanne 2011,

REPARTITION DE LA (a) Le Membre paie 4,27% des salaires de rfrence dfinis pour les membres du
COTISATION POUR LA personnel titulaires, les boursiers, les tudiants et les bnficiaires de la Caisse de
COUVERTURE Pensions du CERN,
DASSURANCE (b) LOrganisation paie
MALADIE NORMALE 1. 6,59% des salaires de rfrence dfinis pour les membres du personnel
titulaires, les boursiers et les tudiants, et
2. 7,39% des salaires de rfrence dfinis pour les bnficiaires de la Caisse de
Pensions du CERN.
Par la suite, cette rpartition sera porte aux pourcentages suivants des salaires de rfrence
respectifs :
(a) (b)1. (b)2.
pour lanne 2012 4,41% 6,86% 7,66%
pour lanne 2013 4,55% 7,13% 7,93%
pour lanne 2014 4,70% 7,41% 8,21%
pour lanne 2015 4,86% 7,71% 8,51%
La cotisation verser pour les apprentis est paye 100 pourcent par lOrganisation.
Lorsquune cotisation complmentaire est calcule sur le salaire de rfrence V, seul le

membre concern verse une cotisation dont le taux est dfini ci-dessus selon (a) ci-dessus.
Au cours des priodes de cong spcial dun mois calendaire complet ou plus, la rpartition
des cotisations est dtermine dans chaque cas individuel par accord mutuel entre
lOrganisation et le membre du personnel du CERN concern.
Dans tous les autres cas, sauf indication contraire, le Membre concern paie 100% de la
cotisation.
A IV 1.03 La cotisation pour la couverture dAssurance maladie court terme est de 13 CHF par
COTISATION POUR LA Membre et par journe entire (de 0 heure 24 heures) ou 330 CHF par mois (30 jours
COUVERTURE conscutifs) par Membre.
DASSURANCE
MALADIE A COURT
TERME
A IV 1.04 Le taux de cotisation pour les accidents et maladies professionnels, conformment

TAUX DE COTISATION lArticle VI 5.02, est de 0,12% des salaires de rfrence dfinis au Chapitre IX Section 1.
POUR LES ACCIDENTS
ET MALADIES
PROFESSIONNELS
38
Annexe V - Prestations Dpendance
Section 1 - Conditions d'octroi et aspects procduraux

A V 1.01 Sauf indication contraire, les conditions du Rgime dassurance maladie sappliquent la
CONDITIONS prsente Annexe.
GENERALES
A V 1.02 Tout Membre affili la couverture dAssurance maladie normale et se considrant en

PERSONNES ELIGIBLES situation de dpendance peut demander le bnfice des prestations dpendance dtailles
la Section II de la prsente Annexe.
A V 1.03 Au sens de la prsente Annexe, Membre concern signifie le Membre lui-mme ou toute
MEMBRE CONCERNE personne expressment mandate pour le reprsenter, sauf lorsquil ressort clairement du
contexte que les dispositions en question visent exclusivement le Membre lui-mme.
A V 1.04 La demande doit tre adresse par crit au Tiers-Administrateur. Elle doit prciser si le
FORME DE LA Membre concern rside domicile ou en institution spcialise ainsi que les nom et
DEMANDE adresse du mdecin traitant.
A V 1.05 La reconnaissance dun tat de dpendance sappuie sur lvaluation dune commission
PROCEDURE DE mdico-sociale compose dun reprsentant du service des Affaires sociales du CERN,
RECONNAISSANCE DUN dun mdecin-conseil du Tiers-Administrateur spcialiste en griatrie et dpendance
ETAT DE DEPENDANCE nomm dun commun accord avec le CERN, ainsi que dun reprsentant du Tiers-
Administrateur.
Lvaluation de l'tat de dpendance par la commission se base sur deux questionnaires : un

questionnaire mdical complt par le mdecin traitant de lassur et un questionnaire
mdico-social complt par le Membre concern et/ou son entourage. Le cas chant, la
commission peut demander toute information complmentaire qui lui parat ncessaire.
La commission mdico-sociale distingue trois tats de dpendance (faible, moyenne ou

grave), selon le degr dincapacit du Membre concern accomplir seul les actes de la vie
courante suivants :
se lever, sasseoir et se coucher ;
se dplacer ;
faire sa toilette personnelle ;
shabiller et se dshabiller ;
se nourrir ;
se rendre aux toilettes ;
la cohrence et la capacit de communication ;
lorientation spatio-temporelle.
La commission dtermine en outre la date de survenance de la dpendance.
A V 1.06 La reconnaissance dun tat de dpendance par le Tiers-Administrateur sur avis de la

RECONNAISSANCE DUN commission mdico-sociale fait lobjet dune notification crite au Membre concern et
ETAT DE DEPENDANCE donne droit aux prestations dpendance correspondantes dtailles la Section II de la
prsente Annexe.
A V 1.07 Les prestations dpendance sont octroyes la date de lintroduction de la demande sous
DATE DEFFET rserve que ltat de dpendance soit mdicalement reconnu comme ayant affect le
Membre concern cette date.
Lorsque la date de reconnaissance dun tat de dpendance est postrieure celle de la

demande, les prestations dpendance ne sont verses qu partir de la date de
reconnaissance.
A V 1.08 Le Membre concern est tenu dinformer le Tiers-Administrateur de tout changement

CHANGEMENT DE durable (aggravation ou amlioration) pouvant affecter ltat de dpendance. Ce
LETAT DE changement doit tre attest par un certificat mdical.
DEPENDANCE
La commission mdico-sociale peut, tout moment, procder une nouvelle valuation de
ltat de dpendance dun Membre.
39
A V 1.09 La reconnaissance par le Tiers-Administrateur dun changement de ltat de dpendance

DATE DEFFET DUN prend effet compter du jour o ce changement dtat est mdicalement constat.
CHANGEMENT DE
LETAT DE
DEPENDANCE
A V 1.10 Toute prestation de mme nature perue travers une affiliation obligatoire un rgime
REGLE DE NON-CUMUL national de protection sociale vient en dduction de lallocation dpendance prvue la
Section II de la prsente Annexe.
Le cas chant, le Membre concern est tenu den informer le Tiers-Administrateur.
A V 1.11 Toute dcision concernant la reconnaissance d'un tat de dpendance est prise au nom du
RECOURS CONTRE UNE Directeur gnral de lOrganisation et peut tre conteste selon la procdure de recours
DECISION dtaille ci-aprs.
CONCERNANT LA
RECONNAISSANCE DUN Au cours de la procdure dtaille ci-aprs, les donnes mdicales personnelles sont
ETAT DE DEPENDANCE soumises la confidentialit, telle quindique lArticle I 1.06.
Le Directeur gnral, ou la personne laquelle il a dlgu son autorit, peut proroger les
dlais spcifis dans la procdure dtaille ci-aprs, lorsque les circonstances lexigent. Il
en informe ds lors le Membre concern.
Le Membre concern introduit le recours en saisissant le Directeur gnral par crit dans
les 60 jours civils suivant la notification de la dcision conteste.
La lettre de recours doit tre signe par le Membre concern et envoye par courrier
recommand. Elle doit inclure une copie de la dcision conteste et un expos des motifs de
recours.
Le litige est alors examin par un mdecin spcialiste en griatrie et dpendance,

conjointement dsign par la personne concerne et par lOrganisation dans les 15 jours
civils suivant lintroduction du recours.
Si les parties nont pu saccorder sur le choix du mdecin spcialiste, la dsignation sera
effectue par toute autorit mdicale comptente dans le Canton de Genve.
Lorsque le mdecin spcialiste a t dsign, il commence lexamen du cas dans les 15

jours civils.
Le mdecin spcialiste peut prendre toutes mesures dinstruction qui lui paraissent
ncessaires pour lexamen du cas.
Le mdecin spcialiste :
Les honoraires du mdecin spcialiste et de tout expert consult sont pris en charge par le
Rgime.
Le mdecin spcialiste tablit un rapport quil transmet au Directeur gnral dans les 15
jours civils suivant la clture de la procdure dinstruction. Le rapport comprend les
lments suivants :
rsum des conclusions des experts consults ;
considrations du mdecin spcialiste ;
recommandation.
Le Directeur gnral notifie par crit sa dcision au Membre concern, en y joignant une
copie du rapport soumis par le mdecin spcialiste, dans les 15 jours civils suivant la
rception dudit rapport.
La dcision du Directeur gnral est dfinitive.
Une requte contre cette dcision peut tre introduite devant le Tribunal Administratif de
lOrganisation Internationale du Travail (TAOIT) conformment aux Statut et Rglement
dudit Tribunal.
40
A V 2.01 En cas de reconnaissance dun tat de dpendance conformment la procdure dcrite la
PRESTATIONS Section I de la prsente annexe, les prestations suivantes sont octroyes en supplment de
celles de la couverture normale dassurance maladie prvues lAnnexe I du prsent
Rglement, exception faite des points 6 c) [garde-malades domicile ] et 6 d) [auxiliaires
mdicaux autre que ceux mentionns aux points 6 a) 6 c)].
PRESTATIONS PARAMEDICALES
6 c) garde-malades domicile
6 d) auxiliaires mdicaux autre que
ceux mentionns aux points 6a 6c de
lAnnexe I
Taux de Plafonds
remboursement
dpendance faible rgle gnrale 1100 CHF par mois

dpendance moyenne rgle gnrale 1650 CHF par mois
dpendance grave rgle gnrale 2750 CHF par mois
ALLOCATION DEPENDANCE
Montant Conditions
dpendance faible 48 CHF / jour Lallocation dpendance nest pas verse

dpendance moyenne 72 CHF / jour pendant les priodes dhospitalisation
dpendance grave 120 CHF / jour
41

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Chis Rules 2016

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ORGANISATION EUROPENNE POUR LA RECHERCHE NUCLAIRE

EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH

Laboratoire Europen pour la Physique des Particules

The Director-General of the European Organization for Nuclear Research,

Considering the Council decision of 16 December 2010 to make certain modifications to

CHAPTER I GENERAL PROVISIONS ................................................................................................................. 4

CHAPTER IX FINANCIAL PROVISIONS ........................................................................................................... 25

ANNEX II ALLOWANCE FOR REDUCED EARNING CAPACITY ......................................................................... 35

ANNEX III SHORT-TERM HEALTH INSURANCE .............................................................................................. 37

ANNEX IV CONTRIBUTION RATES ................................................................................................................ 39

Chapter I General Provisions

Section 1 General Provisions

In particular, professional medical secrecy shall be preserved.

Any personal physical effort resulting in physical injury to a Member is regarded as an

II 1.07 Any establishment providing medical, surgical or functional rehabilitation treatment

II 1.10 Any public hospital as defined in Article II 1.08, or

II 1.14 Provision of a certificate provided by a medical practitioner attesting to a specific medical

II 1.27 Any payment from an old age insurance scheme.

II 1.28 The following are regarded as similar health insurance:

Chapter III Normal Health Insurance Cover

Section 1 General Description

III 2.01 Membership of the Normal Health Insurance is compulsory for:

Notwithstanding the foregoing, former staff members receiving unemployment benefits

Section 3 Territorial Scope

Doctors fees during hospitalisation shall be reimbursed according to the conditions in

Staff members, fellows, students:

Section 6 Obligation to Furnish Information

Chapter IV Reduced Health Insurance Cover

Section 1 General Description

Section 3 Territorial Scope

Chapter V Short-term Health Insurance Cover

Section 1 General Description

Section 3 Territorial Scope

Children up to the age of 18 shall be entitled to a 50% reduction.

Chapter VI Occupational Illnesses and Accidents

Section 1 General Description

Section 3 Territorial Scope

VI 4.02 No medical treatment resulting from occupational illnesses contracted or accidents

Chapter VII Common Provisions

Section 1 Non-concurrence of Benefits Rule

Section 2 Cosmetic Treatment and Surgery

Section 3 Grounds for Refusal, Reduction or Withdrawal of

Section 4 General Insurance Provisions

VII 4.05 No benefits are paid in the event of missed appointments.

An initial guarantee is given for 14 calendar days of hospitalisation.

Where hospitalisation is in an unapproved hospital pursuant to Article II 1.11, the Third-

Section 5 Duration of Membership

Chapter VIII Procedures

Section 1 Medical Expense Reimbursement Claims

When submitting a request to the Scheme for a complementary reimbursement, the

Section 2 Prior Approvals and Opinions

Section 3 Cures and Convalescence Cures

Cures must be undergone in establishments recognized by the competent authorities of the

Section 4 Settlement of Disputes

In disputes of an administrative nature, the Director-General shall convene the Health

In disputes of a medical nature, a medical practitioner shall be appointed in accordance

The Chairman represents the Board for all legal proceedings.

The Board shall:

This report shall include the following elements:

The medical practitioner shall:

Communication of information and documents of a medical nature, including within the

The decision of the Director-General shall be final.

Chapter IX Financial Provisions

Section 1 Reference Salaries