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Document Sample
CERN
Long-Term Care
Scheme
Conference of the Staff Associations
of Internationals Organizations
29-30 September 2005
CSAIO6 / 09 - 2005 1 CERN Staff Association
Contents
CERN Health Insurance Scheme
Nature of the CHIS
Basic principles of the CHIS
Scheme administration & responsibilities
Long-Term Care Scheme
Background of the LTC
Actuarial studies (scheme choice)
Nature of the LTC
Actuarial scenarios (no LTC; with LTC)
Financing of the LTC
Benefits of the LTC
Advantages of the LTC
Some LTC statistics from 2001 - 2005
Some CHIS – LTC statistics from 1988 – 2004
The future of the LTC
Conclusions
CSAIO6 / 09 - 2005 2 CERN Staff Association
CERN Health Insurance Scheme (1)
Nature of the CHIS
Funding of the CHIS
Contribution of active staff – share between Staff
& Organisation : 4.02% & 6.35% of basic salary
Contribution of pensioners – share between
pensioners & Organisation : 4.02% & 6.35% of
the last indexed monthly basic salary
Contribution of spouses when they receive an
income
External administrator (UNIQA)
Claims reimbursement
Daily administration of the CHIS services
CSAIO6 / 09 - 2005 3 CERN Staff Association
CERN Health Insurance Scheme (2)
It is obligatory
Basic principles of the CHIS
Obligatory, everyone must participate
Contributions are based on salaries only,
independent of age of beneficiaries
and of number of beneficiaries
in the household It is a mutual
scheme
All members of the family (spouse & dependent
children are cover).
CSAIO6 / 09 - 2005 4 CERN Staff Association
CERN Health Insurance Scheme (3)
Freedom of choice of health Freedom of choice
care providers &
world-wide coverage
Responsibility of each CHIS member
the level of reimbursement
shall not exceed the level Collective
of contributions responsibility
CHIS = Insurance
CSAIO6 / 09 - 2005 5 CERN Staff Association
CERN Health Insurance Scheme (5)
Scheme administration & responsibilities
CERN has the full control of the scheme
CERN monitors the scheme
CERN lays down the policies & proposes modifications
as needed
UNIQA acts as a daily administrator of the scheme
UNIQA implements the policies & applies the CHIS rules
UNIQA produces statistics and gives feedback
CSAIO6 / 09 - 2005 6 CERN Staff Association
Long-Term Care scheme
Background of the LTC
Before 2001 the CERN Staff Association worked
to elaborate a LTC scheme and studied several
scheme types
Several actuarial reviews to obtain a forecast &
foresee the future evolution
In 2001 CERN set up a Long-Term Care scheme,
which is part of the CHIS
The LTC scheme was set up as a result of the
2000 five yearly review
CSAIO6 / 09 - 2005 7 CERN Staff Association
LTC : Actuarial studies
Technical basis
Use available mortality tables for
(non)dependents
Do not include (big) safety margins the insurance
companies include
Aim at ~60% of standard full-board Swiss cost
(100 CHF)
Three levels of dependency
No adjustment foreseen for home care allowance
CSAIO6 / 09 - 2005 8 CERN Staff Association
LTC : Actuarial studies
Collective scheme versus individual commercial
proposal
CHF per month Guarantee Solidarity total Individual
First year insurance
> 65 Y. old 1800 -600 1800 2400 to 4000
30 to 50 Y. 0 75 75 475 to 1160
51 to 64 Y. 775 300 1075 1200 to 2300
Regarding the CERN population this scheme is cheaper but
the solidarity between the young and the old generations is
not fully warranty
CSAIO6 / 09 - 2005 9 CERN Staff Association
Long-Term Care scheme (1)
Nature of the LTC
All CHIS members are insured, regardless of
their age and medical history
Three levels of dependency
Low level
According to the
Not 3 Medium level
member’s degree of
ability to perform some
Not 4 High level
life essential actions
Not 5
Getting up, sitting down, getting into bed Taking food & drink
Mobility Going to the lavatory
Washing & grooming Coherence & ability to communicate
Dressing & undressing Orientation in space & time
CSAIO6 / 09 - 2005 10 CERN Staff Association
LTC : Actuarial Scenarios
No LTC (only standard health coverage)
52 CHF per day for home care with 2580 CHF
per year for paramedical expenses
Hospitalization cost 1000 CHF per day
100 days per year for dependant are spend in
hospital
With LTC
85 CHF per day for home care
Up to 2500 CHF per for paramedical expenses
LTC scheme eliminates hospitalization cost
CSAIO6 / 09 - 2005 11 CERN Staff Association
LTC : Actuarial Studies results
No LTC (standard health coverage) With LTC
18 cases / Year MCHF MCHF
Home care 0.36 5.88
Paramedical 0.05 0.54
Hospitalization 1.8
Total for the first year 2.21 6.42
231 cases after 20 Y - Total 302.86 186.80
Average / Year 15.14 Paramedical: 3.73
over 20 years Home-care : 5.61
Total : 9.34
40% CHIS reduction cost with the LTC scheme
CSAIO6 / 09 - 2005 12 CERN Staff Association
Long-Term Care scheme (2)
Financing of the LTC
Affiliation and contribution are compulsory for CHIS
members
Increase by 0.6% of the CHIS rate contribution for
all staff contributors
Enlargement of the basis of contribution for the
pensioners (0.6% corresponds to 1.2% of pension)
Creation of a capitalized LTC Fund to pay the
home care allowance
Staff members of the scheme are the single contributors
But the Organization is paying a contribution for pensioners
CSAIO6 / 09 - 2005 13 CERN Staff Association
Long-Term Care scheme (3)
Benefits * Not paid during hospitalization
Low level Medium level High level
Medical
No change
treatment
Paramedical Up to Up to Up to
treatment 1’000 CHF 1’500 CHF 2’500 CHF
per month per month per month
Home care* 34 CHF 51 CHF 85 CHF
allowance per day per day per day
50% of standard full-board Swiss cost
70% of standard full-board French cost
CSAIO6 / 09 - 2005 14 CERN Staff Association
Long-Term Care scheme (4)
Advantages of the LTC
Cost reduction of increase in hospital bills
Authorize the improvement of the long-term
financial balance of the Organization’s
health insurance scheme
Better cover for dependent persons
Keep the CHIS equivalent to the LAMAL
scheme
CSAIO6 / 09 - 2005 15 CERN Staff Association
Long-Term Care scheme (5)
Some LTC Statistics from 2001 – 2004
Number of Low Medium High Total Actuarial
cases level level level forecasts
before 2001 16
12-2001 32 ~60
12-2002 13 18 16 47 ~88
12-2003 21 23 19 63 ~95
12-2004 29 20 22 71 ~106
2026 : 243 cases foreseen (3.1% of CHIS members)
37 cases evaluated in 2003 / 20 cases evaluated in 2004
CSAIO6 / 09 - 2005 16 CERN Staff Association
Long-Term Care scheme (6)
Some LTC Statistics from 2001 – 2004
MCHF Contributions Payment Fund
before 2001 0 0.65 0
12-2001 5.60 0.80 4.80
12-2002 5.90 1.40 11.70
12-2003 6.10 1.50 15.50
12-2004 6.20 1.64 22.10
Actuarial study 20 MCHF foreseen end of 2004
CSAIO6 / 09 - 2005 17 CERN Staff Association
Long-Term Care scheme (7)
Some LTC Statistics in 2004 by age & sex
nombres gpe age
niveau LTC sexe 19-25 26-30 31-35 56-60 61-65 66-70 71-75 76-80 81-85 86-90 Total
faible F 1 5 1 6 2 15
M 1 1 1 5 2 3 1 14
faible Total 1 1 1 6 6 8 3 3 29
grave F 1 1 1 1 1 1 6
M 1 1 1 2 1 3 4 1 14
grave Total 2 1 2 1 2 2 4 4 2 20
moyen F 1 1 4 2 3 11
M 1 2 1 4 3 11
moyen Total 2 3 5 4 2 6 22
Total 3 2 2 3 3 9 13 16 9 11 71
nb d'assurés 678 558 827 1105 1403 1203 769 473 179 44 11868
au 31-12-2004 soit 0.4% 0.4% 0.2% 0.3% 0.2% 0.7% 1.7% 3.4% 5.0% 25.0% 0.6%
CSAIO6 / 09 - 2005 18 CERN Staff Association
Long-Term Care scheme (8)
Some CHIS – LTC statistics from 1988 -2004
Evolution
cost
Large increase
for
hospitalization
in 15 years
CSAIO6 / 09 - 2005 19 CERN Staff Association
Long-Term Care scheme (9)
The future of the LTC
Actuarial study in 2006 to review the
scheme and take a decision on adapting
the daily allowance
Looking for preferential providers in the
field of nursing & home help in France
CSAIO6 / 09 - 2005 20 CERN Staff Association
Conclusions
The number of cases is in line with the forecast
The LTC scheme meets needs. Some difficulties
reported in the assessment of low dependency level
The current financing of the LTC scheme is sound
from an actuarial point of view.
Adapt continuously the scheme to the future
evolution of society, also to keep the LTC and CHIS
equivalent to the LAMAL Swiss health scheme
CSAIO6 / 09 - 2005 21 CERN Staff Association
END
I am at your disposal for questions
Joel LAHAYE
CERN Staff Association
Joel.lahaye@cern.ch
CSAIO6 / 09 - 2005 22 CERN Staff Association
