Transcript Presentation_LTC_CERN.ppt

CERN
Long-Term Care
Scheme
Conference of the Staff Associations
of Internationals Organizations
29-30 September 2005
CSAIO6 / 09 - 2005
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CERN Staff Association
Contents
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CERN Health Insurance Scheme
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Long-Term Care Scheme
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Nature of the CHIS
Basic principles of the CHIS
Scheme administration & responsibilities
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
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CERN Staff Association
CERN Health Insurance Scheme (1)
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Nature of the CHIS
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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

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External administrator (UNIQA)
Claims reimbursement
 Daily administration of the CHIS services

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CERN Staff Association
CERN Health Insurance Scheme (2)
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Basic principles of the CHIS
It is obligatory
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Obligatory, everyone must participate
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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).
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CERN Staff Association
CERN Health Insurance Scheme (3)
Freedom of choice

Freedom of choice of health
care providers &
world-wide coverage
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Responsibility of each CHIS member
the level of reimbursement
Collective
shall not exceed the level
responsibility
of contributions
CHIS = Insurance
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CERN Staff Association
CERN Health Insurance Scheme (5)
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Scheme administration & responsibilities
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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
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CERN Staff Association
Long-Term Care scheme
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Background of the LTC
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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
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CERN Staff Association
LTC : Actuarial studies
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Technical basis
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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
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CERN Staff Association
LTC : Actuarial studies
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Collective scheme versus individual commercial
proposal
CHF per month
First year
Guarantee
Solidarity
total
Individual
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
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CERN Staff Association
Long-Term Care scheme (1)
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Nature of the LTC
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All CHIS members are insured, regardless of
their age and medical history
Three levels of dependency
According to the
member’s degree of
ability to perform some
life essential actions
Low level
 Medium level
Not 3
Not 4  High level

Not 5
 Taking food & drink
 Going to the lavatory
 Coherence & ability to communicate
 Orientation in space & time
 Getting up, sitting down, getting into bed
 Mobility
 Washing & grooming
 Dressing & undressing
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CERN Staff Association
LTC : Actuarial Scenarios
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No LTC (only standard health coverage)
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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
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85 CHF per day for home care
Up to 2500 CHF per for paramedical expenses
LTC scheme eliminates hospitalization cost
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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
over 20 years
Paramedical: 3.73
Home-care : 5.61
Total
: 9.34
40% CHIS reduction cost with the LTC scheme
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CERN Staff Association
Long-Term Care scheme (2)
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Financing of the LTC
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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
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CERN Staff Association
Long-Term Care scheme (3)
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* Not paid during hospitalization
Medium level High level
Benefits
Low level
Medical
treatment
No change
Paramedical
treatment
Up to
1’000 CHF
per month
Up to
1’500 CHF
per month
Up to
2’500 CHF
per month
Home care*
allowance
34 CHF
per day
51 CHF
per day
85 CHF
per day
50% of standard full-board Swiss cost
70% of standard full-board French cost
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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
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CERN Staff Association
Long-Term Care scheme (5)
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Some LTC Statistics from 2001 – 2004
Number of
cases
Low
level
Medium High
level level
Total
Actuarial
forecasts
before 2001
16
12-2001
12-2002
12-2003
13
21
18
23
16
19
32
47
63
~60
~88
~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
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CERN Staff Association
Long-Term Care scheme (6)
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Some LTC Statistics from 2001 – 2004
MCHF
before 2001
Contributions Payment Fund
0
0.65
0
12-2001
5.60
0.80
4.80
12-2002
5.90
6.10
1.40
1.50
11.70
15.50
6.20
1.64
22.10
12-2003
12-2004
Actuarial study 20 MCHF foreseen end of 2004
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CERN Staff Association
Long-Term Care scheme (7)
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Some LTC Statistics in 2004 by age & sex
nombres
gpe age
niveau LTC
sexe
faible
F
M
1
1
1
F
1
1
M
1
grave Total
moyen
26-30
1
faible Total
grave
19-25
2
1
31-35
61-65
66-70
71-75
76-80
1
5
1
6
1
5
2
6
6
8
1
1
1
1
81-85
86-90
Total
2
15
3
1
14
3
3
29
1
6
1
1
2
1
3
4
1
14
2
1
2
2
4
4
2
20
2
3
11
3
11
F
1
1
4
M
1
2
1
4
2
3
5
4
2
6
22
13
16
9
11
71
moyen Total
Total
3
nb d'assurés
au 31-12-2004
56-60
soit
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2
3
3
9
678
558
827
1105
1403
1203
769
473
179
44
11868
0.4%
0.4%
0.2%
0.3%
0.2%
0.7%
1.7%
3.4%
5.0%
25.0%
0.6%
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CERN Staff Association
Long-Term Care scheme (8)
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Some CHIS – LTC statistics from 1988 -2004
Evolution 1988-2004 des dépenses par groupes de prestations
sur base 100 en 1988 pour les prestations versées par année
Evolution
cost
600
500
médecins
400
pharmacies
indices
soins_analyses
dentistes
300
hosp 90%
hosp 100%
total
LTC
200
Large increase
for
hospitalization
in 15 years
100
0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
CSAIO6 / 09 - 2005
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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
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CERN Staff Association
Conclusions
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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
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CERN Staff Association
END
I am at your disposal for questions
Joel LAHAYE
CERN Staff Association
[email protected]
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CERN Staff Association