In place since 1 January 2021, the electronic exchange of data between social insurance institutions in EU countries and Switzerland has had an impact on cover for non-occupational accident cases. As such, policy holders may be required pay up to 30% of costs incurred.
What does it all mean?
As of 1 January 2021, Switzerland must now implement the provisions relating to the electronic exchange of social security data (EESSI). This means that the costs of recovery are remunerated in accordance with the legislation of the state where the treatment is carried out.
In France, non-occupational accidents are covered by health insurance, which only covers around 70% of medical costs. Depending on the service provider, the policy holder will therefore be liable to pay.
How this affects insurance
Suva has written in detail on its website about its approach towards cover for medical treatment in France and its digital exchanges with the country’s relevant social insurance body from 1 January 2021.
They note that when it comes to compulsory social insurance, generally speaking, each insurer will have to comply with this principle of exchange and financial flow with the liaison body.
What this means for policy holders
This means a difference in the way occupational and non-occupational cases are handled. The following rule applied to accidents:
Occupational accidents
The cost of treatments carried out in France is fully reimbursed, because in France, occupational accidents are also recognised as accidents.
Non-occupational accidents
The cost of treatments carried out in France is only reimbursed at around 70%, because in France, non-occupational accidents are recognised as illnesses. Policy holders have the option of taking out additional insurance in France to cover the remaining 30%.
This rule also applies to other European countries on the Swiss border.
What to do in the event of a non-occupational accident?
It’s important to understand that policy holders have the right to choose the country where they receive their medical treatment!
All you have to know as a cross-border worker is:
- If you suffer a non-occupational accident and seek treatment in Switzerland, reimbursements will be covered in accordance with your LAA, or accident insurance (supplemented by a possible supplementary accident insurance contract – LAAC) as has been the case up to now.
- On the other hand, still with regard to non-occupational accidents, if you seek for treatment in France, you will be refunded in accordance with French CPAM (health insurance) legislation, because in France, non-occupational accidents are covered by health insurance (around 70% of medical costs covered) rather than accident insurance (100% of medical costs covered). Involvement by your employer’s supplementary accident cover may be considered depending on the insurance policy.
Our advice
Given the scope of services abroad, we would urge those wishing to undergo treatment abroad to seek prior agreement with your insurer, particularly if the treatment you require makes you unable to work. This will allow you to clarify your specific cover and check what this means for the choice you make. Loyco is of course available to support employees in this process.
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