GROUP MEDICAL INSURANCE - Conditions for Coverage of ...
GROUP MEDICAL INSURANCE - Conditions for Coverage of “Other Insured Persons”
ELIGIBILITY:
"Other insured persons" are persons insured with a staff member participating in the group medical insurance on virtue of the fact that they are living in the same household and are financially dependent on the staff member. "Other insured persons" may comprise the following persons:
□ unmarried children over 25 years of age (a child away for educational purposes shall be regarded as living in the staff member's household);
□ persons financially dependent on the staff member but not recognized as dependants within the meaning of the staff rules for the purpose of payment of a dependency allowance (i.e. a parent, brother, sister, life's companion);
□ non-Austrian live-in household helps or domestic servants.
CONDITIONS OF COVERAGE:
a) Application by the staff member on basis of a medical questionnaire completed by the applicant and a medical certificate of good health from the treating physician. Persons not meeting the medical standards of the Insurer may be refused coverage. Coverage will start as of the month indicated by the Insurer.
b) (i) In case of continuous coverage, persons insured as eligible dependants may convert to coverage as "other insured persons" with uninterrupted entitlement to benefits (e.g. coverage as eligible dependant may end on 31 December of the calendar year in which a child reaches age 25 and coverage as "other insured person" would commence on 1 January thereafter). No medical certificate is required for continuous coverage.
(ii) Persons whose stay in the staff member's household will be
of long duration (at least one year) shall be entitled to benefits immediately after enrolment.
(iii) Persons whose stay in the staff member's household will be
temporary (less than one year but at least six months) shall be entitled to benefits only three months after enrolment, except for treatment resulting from an accident sustained after the date of enrolment.
c) Minimum length of coverage:
in case of b) (i) and (ii) above: one year
in case of b) (iii) above: six months
Coverage ceases when the eligibility criteria for the "other insured person" are no longer applicable, upon request by the staff member after the minimum length of coverage, or separation from service of the staff member, whichever is earlier.
d) The coverage shall comprise the benefits as described in the Group Medical Insurance plan except that the uncovered expenses in respect of the "other insured person" will not be considered in the calculation of major (catastrophic) medical expenses.
e) Fixed premiums according to age and sex are payable as of the date of enrolment. Premiums are not subsidized by the Organization and are payable in full by the staff member through payroll deduction.
Premium Structure for "OTHER INSURED PERSONS"
(Austrian Schillings/per month)
Effective 1 January 2001
1. Age Men Women
(at time of enrolment)
16 - 30 years 1.740,- 2.467,-
31 - 45 years 2.091,- 2.820,-
46 - 55 years 2.467,- 3.029,-
56 - 60 years 2.820,- 3.029,-
61 - 65 years 3.173,- 3,029,-
over 65 years 3.571,- 3.245,-
2. Children (below the age of 16 years)
One child 1.268,-
Two children 2.492,-
Three children or more 3.500,-
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