Professional Documents
Culture Documents
INSTRUCTION
Location: http://mnlfnetapps.as.iom.net:7010/filenetaccess/viewDocument.do?controlNo=IN/0095
Initiated: HRM
Coordinated: OHU & LEG
Authorized: DRM & DGO
Distribution: All Missions Worldwide, All Departments at HQ
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CP
October 2010
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for payment of salary benefits in the case of temporary incapacity to work for a period not
exceeding 2 years from the date of the accident or the beginning of the illness;
Notification of accidents and occupational illnesses should be received in Manila no later than
8 days following the accident or the beginning of the illness suspected to be occupational;
Initial report shall be sent as soon as possible after the accident or the beginning of the illness;
Progress report from the attending physician shall be submitted monthly to the HIM Manila;
Final report from the attending physician shall be submitted to the HIM Manila on complete
recovery (if there is no invalidity), or when assessment of invalidity is possible, but not later than
two years from the date of the occupational accident or the beginning of the occupational illness.
CP
October 2010
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Paragraph no.
1.
2.
3.
4.
Paragraph no.
5. DEFINITION OF SALARY
6. TOTAL COST OF PARTICIPATION
Chapter 3: BENEFITS
Section 1:
GENERAL INFORMATION
Paragraph no.
Section 2:
Paragraph no.
Section 3:
7. GEOGRAPHICAL COVERAGE
8. REQUIREMENTS FOR NOTIFICATION AND REPORTING
9. OCCUPATIONAL ACCIDENT/ILLNESS
10. NON-OCCUPATIONAL ACCIDENT/ILLNESS
11. REIMBURSEMENT OF MEDICAL EXPENSES IN CASE OF
OCCUPATIONAL ACCIDENT/ILLNESS
12. REIMBURSEMENT OF MEDICAL EXPENSES IN CASE OF NONOCCUPATIONAL ACCIDENT/ILLNESS
13. DISABILTIY INDEMNITIES
14. DEATH INDEMNITY
Paragraph no.
15. EXCLUSIONS
16. DUPLICATION OF BENEFITS
17. EXCHANGE RATES
./
CP
October 2010
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Chapter 4: ADMINISTRATION
Paragraph no.
CP
October 2010
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Chapter 1
The provision granting the CP coverage must be included in the contract or, in
cases where no contract is issued, indicated in an official document issued by
IOM (e.g. the letter of invitation in the case of IOM-paid invitees).
2.2
3. CESSATION OF PARTICIPATION
3.1
Date of Exit
The date of exit is the last day in service of the staff member.
3.2
CP
October 2010
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The coverage of the Compensation Plan insurance ceases as from the first day
of the leave.
CP
October 2010
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Chapter 2
DEFINITON OF SALARY AND PREMIUM CONTRIBUTION
5.
DEFINITION OF SALARY
5.1
Compensation Plan premiums are calculated on the basis of the staff members salary.
For calculation of temporary incapacity, permanent disability and/or the death indemnity, the
salary on the date of the occupational accident or beginning of the occupational illness is
applicable. The following salaries are to be used:
5.1.1 For officials, the pensionable salary as per Annex E to the Staff Regulations and Rules
for Officials;
5.1.2
For employees in Switzerland, the salary as per Annex G to the Staff Regulations and
Rules for Employees in Switzerland, plus the amount of language allowance to which the
employee may be entitled (family allowance is excluded);
5.1.3
For employees in the field, the yearly base salary as per the effective salary scale in the
mission, plus the amount of language allowance to which the employee may be entitled,
if applicable, plus any bonuses to which the employee has a right (family allowance is
excluded);
5.1.4
For officials and employees serving under the terms of a special contract, temporary
contract and/or all inclusive contract, etc. which provides for participation in the
Compensation Plan insurance, the amount specified in the contract;
5.1.5
For experts and consultants, holding contract which provides for participation in the
Compensation Plan insurance, the amount specified in the contract;
5.1.6
For conference staff employed temporarily, holding a contract which provides for
participation in the Compensation Plan insurance, the amount specified in the contract;
5.1.7
For interns, volunteers and non-staff escorts, the reference to salary is taken to mean a
theoretical yearly amount equivalent to 36,000.-- Swiss Francs;
5.1.8
For participants who are not insured under items 5.1.1 to 5.1.7, the reference to salary is
taken to mean a theoretical yearly amount equivalent to 72,000.-- Swiss Francs.
5.2
CP
October 2010
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6.
The total cost of participation is 0.400% of salary as defined in paragraph 5 and is born in full by
the Organization.
As the CP premium is a direct cost, it should be projectized to the same project(s) and salary
expense GL code as the officials or employees salary and credited to the Staff Compensation
Plan liability account (GL code 211210) as part of the payroll process. Similarly for other
categories covered under the CP Plan, using the appropriate expense GL code: consultants,
experts, conference personnel, interns, casual workers, volunteers and escorts.
CP
October 2010
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Chapter 3
BENEFITS
Section 1:
GENERAL INFORMATION
7.
GEOGRAPHICAL COVERAGE
7.1
8.
8.2
8.2.4
8.2.5
Failure to comply with the above may lead to the partial or total loss of entitlement
to the relevant benefits.
CP
October 2010
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Section 2 :
AMOUNT OF REIMBURSEMENT AND INDEMNITIES
9.
An occupational accident shall be taken to mean any event beyond the control of the
participant which, through the sudden action of an external force, causes a detectable
physical and/or psychological injury, if the event occurs while the participant is
performing official duties on behalf of the Organization or commuting directly to or from
work.
The Chief of Mission/Field Manager confirms the accident took place either while
performing official duties on behalf of the Organization or during commuting
directly to or from work by signing the Notification of Accident. He/she explains why
he/she believes the accident is related to work. However, classification of the accident
under occupational or non-occupational is under the responsibility of the Medical
Officer of the Health & Insurance Medical Unit (HIM) Manila or the Occupational
Health Unit (OHU).
9.2
10.
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October 2010
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authorized duty travel outside the country of the established duty station and
such coverage only provides for reimbursement of medical expenses as
described in paragraph 12.
11. REIMBURSEMENT OF MEDICAL EXPENSES IN THE CASE OF AN
OCCUPATIONAL ACCIDENT OR AN OCCUPATIONAL ILLNESS
11.1
Reimbursement of medical expenses will be made as long as needed for a period not
exceeding five years from the date of the accident or the beginning of the illness.
The five year period is applicable to new cases of occupational accidents or occupational
illnesses occurring on or after 1 January 2009. For old cases the two years period continues to
apply.
11.2 Reimbursement at the rate of 100 per cent for all outpatient treatment, pharmaceutical and
hospital expenses;
11.3 The costs of transportation by ambulance and other means are reimbursable if the
circumstances so justify in the following cases:
a)
b)
Transport in an ambulance from the patient's home (or from the place
where the patient became ill/had an accident) to a hospital or the attending
doctor's place of practice and back, if the circumstances so justify;
c)
11.4 Claims may be submitted at the beginning and/or the end of the treatment, and/or during
the treatment. Transportation claims must be justifiable by a medical certificate, which
should be presented in advance whenever possible. It must mention place of pick up and
delivery, date, mode of transportation (seated or laying) and the need or not of medical
escort. A valid ambulance bill must also mention these details.
11.5 Reimbursement of expenses for the first purchase or repair of spectacles, hearing aids or
other orthopedic prosthetic appliances on a doctors prescription at the rate of 100 per cent
if the purchase or repair is required because of an occupational illness or an occupational
accident which causes an injury requiring treatment.
11.6 At the end of the five-year CP coverage no additional medical expenses will be covered by
the CP nor by the Medical Service Plan (MSP) for those who are covered by the MSP.
CP
October 2010
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12. REIMBURSEMENT OF MEDICAL EXPENSES IN THE CASE OF A NONOCCPATIONAL ACCIDENT OR A NON-OCCUPATIONAL ILLNESS
In the event of a non-occupational accident or a non-occupational illness suffered while on
authorized duty travel (TDY) outside the country of the established duty station (applies only
to local employees who are not covered by the Medical Service Plan (MSP), interns and
escorts). For those local employees who are covered by MSP, the MSP shall apply during the
TDY period.
12.1
Reimbursement of medical, pharmaceutical and hospital expenses for a period not exceeding
two years from the date of the accident or the beginning of the illness, up to a maximum
amount of 15,000.-- Swiss Francs per case, at the rate of
a) 100% of expenses incurred because of a non-occupational accident.
b) 100% of expenses incurred because of a non-occupational illness.
CP
October 2010
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The permanent total or partial disability benefit is paid when assessment of invalidity is
possible and is considered final but not later than two years from the date of the
occupational accident or the beginning of the occupational illness.
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DEATH INDEMNITY
For calculation of death indemnity, the salary on the date of the occupational accident or
beginning of the occupational illness is applicable. (see paragraph 5). Applicable to new
cases of occupational accidents or occupational illnesses occurring on or after 1 January
2008.
14.1 Participants with no dependants :
500
Section 3:
EXCLUSION AND OTHER INFORMATION
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EXCLUSION
In the event of accident or illness, the coverage of this insurance does not extend to expenses
related to:
15.1 Excess of alcohol, alcoholism and consumption of drugs or other toxics;
15.2 Wilful injuries or voluntary impairment to health caused on the insured person
by him/herself or by a third party with the consent of the insured person;
15.3 Injuries or impairment to health caused by radiation of any kind and in
particular from atomic radiation except in the case where such radiation is used
for radio-therapy or in the course of medical examination;
15.4 Injuries or impairment to health resulting from the active participation of the
insured person in armed conflicts, civil disorders, riots, brawls, affrays, duels,
etc.;
15.5 Injuries or impairment to health occurring during a period of voluntary military
service;
CP
October 2010
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16.
Participants in the Compensation Plan are free to receive benefits also from another insurance
scheme, but under the following conditions:
16.1 The participant should inform the Compensation Plan Administration Manila at
CPAdminMNL@iom.int that she/he belongs to another insurance and indicate the name
of the other scheme (including the national social security).
16.2 In the case of participation in a national social security scheme towards which the
Organization also contributes, the benefits of the Compensation Plan are due only to the
extent not payable by the national scheme.
16.3 When reimbursement of medical expenses is requested from both the Compensation Plan
and another scheme, the participant must supply documentary evidence of the amount
received or expected from the other scheme. In no case shall the amount paid by the
Compensation Plan plus the amount paid by the other scheme exceed the medical expenses
incurred.
16.4 If a third party is responsible for an accident, any right of the participant to claim
reimbursement of the medical expenses from the third party or his/her insurer must be
surrendered to the Organization as a condition for reimbursement of these expenses.
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CP
October 2010
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Should the third party or third party insurer reimburse the participant directly, the latter
must refund the amount to the Organization, unless s/he decides not to claim any
reimbursement from the Organization.
17.
EXCHANGE RATES
17.1
Medical claims:
Conversions are to be made at the IOM exchange rate prevailing on the date of payment.
17.2
Conversions are to be made at the IOM exchange rate prevailing on the date of the occupational
accident or on the date the occupational illness began.
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CP
October 2010
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Chapter 4
ADMINISTRATION
18.
18.2.2
18.2.3
18.2.4
Bills and prescriptions must show clearly the patient's surname and first
name, date of treatment/purchase which must be written in by the doctor, or
hospital, never by the patient.
18.2.5
Bills must also show the following information, which must be written in
legibly by the doctor, hospital or pharmacist:
Doctors bills: the date of each visit and the nature of the services
rendered (consultation, visit, night call), as well as the detailed price
of each service; laboratory bills must indicate the date of the detailed
lab tests rendered and price for each test;
Hospital bills: the period of hospitalization, the nature of the services
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CP
October 2010
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Participants are advised to keep for their own records a photocopy of each claim and all
the supporting documents.
18.4
18.4.1
18.4.2
Invalidity: The final medical report shall be considered as the participant's claim for
invalidity (if any).
18.4.3 Death benefits: Claims for death benefits shall be filed by the beneficiary (ies) within
six months after the date of death. There is no form for this.
19.
CP
October 2010
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22.
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CP
October 2010
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Interim reports
22.2.1 Must be sent by e-mail or telefax to the Health & Insurance Medical Unit (HIM)
Manila (as explained in paragraph 22.1 above) no later than 3 days following the
occupational accident or beginning of the illness suspected to be occupational;
22.2.2 Must be sent to the Health & Insurance Medical Unit (HIM) Manila by telephone,
e-mail or telefax immediately in case of an accidental death;
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CP
October 2010
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22.2.3 Must be followed by the complete notification on the form provided for that purpose
(annexed to this document) as soon as possible.
Interim reports on accidents should indicate (at least): the name of the insurance
scheme (Compensation Plan), name of the accident victim, date and place of the
accident, and a brief description of the event and injuries (keeping in mind the remark
in previous text about medical confidentiality).
Interim reports on illnesses should indicate (at least): the name of the insurance scheme
(Compensation Plan), name of the patient, date the symptoms of the illness began, a
brief description of the symptoms and indication of why the illness is suspected to be
occupational (keeping in mind the remark in previous text about medical
confidentiality).
22.3
Medical reports
All medical reports: Initial, progress and final (forms annexed to this document) concerning
an accident or an illness should be addressed to the Health & Insurance Medical Unit (HIM)
Manila (no copy for the Compensation Plan Administration Manila).
22.3.1 Initial report
An initial report of the attending physician shall be forwarded to the Health & Insurance
Medical Unit (HIM) Manila as soon as possible after the accident or the beginning of the
illness.
22.3.2 Progress report(s)
For any treatment/absence from work lasting for more than one month, progress reports from
the attending physician shall be submitted to the Health & Insurance Medical Unit (HIM)
Manila at monthly intervals.
Definition of "degree" on forms for initial and progress reports: Degree of temporary
incapacity to work expressed in percentage. For example: Not able to work at all
(= degree of 100%); able to work half days (= degree of 50%). Please ensure that this
information is not omitted by the treating physician.
22.3.3 Final report
A final report from the attending physician shall be submitted to the Health & Insurance
Medical Unit (HIM) Manila on complete recovery (if there is no invalidity), or when
assessment of invalidity is possible, but not later than two years from the date of the
occupational accident or the beginning of the occupational illness.
Definition of "degree" on the form for the final report: Estimated degree of partial
permanent invalidity expressed in a percentage. Please ensure that this information is
not omitted by the treating physician.
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CP
October 2010
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23.
Medical Expenses
As a general rule, medical expenses should be paid first by the insured person and then
claimed on the CP form provided for that purpose, supported by the original receipted bills.
Whenever justified, and after prior approval from HCP, Compensation Plan
Administration Manila, direct payments may be made by the field office on the condition
that claims are nevertheless submitted retroactively on the CP form with the original
supporting documents. Please address such requests to the Compensation Plan
Administration Manila.
23.2
No participant should suffer because s/he cannot afford to disburse the amount(s)
needed for medical care which is/are reimbursable under the terms of the CP
insurance.
Failure to submit the claim retroactively results in a financial loss for the
Organization (the amount disbursed by IOM cannot be recovered from the insurance
company without the original receipted bills).
Indemnities
Indemnity payments are subject to prior authorization from the Compensation Plan
Administration Manila
This rule applies also for the indemnity during temporary incapacity to work covering loss of
salary. These payments will be authorized upon presentation of the Notification of Accident
and relevant medical report(s) certifying that such absence is medically justified and
specifying the period(s) of incapacity to work as well as the degree (see definition of "degree"
under "Medical Reports" paragraph 22.3 above).
23.3
Accounting Codes
All amounts disbursed by the Organization (medical care, incapacity, disability and death
indemnities) should be charged to the Compensation Plan code 2355 for those missions who
do not access PRISM. For those missions who do access PRISM, amounts should be charged
to code 211540.
The salary should be coded as explained above in its entirety during periods when the staff
member is absent on a full-time basis. If the participant is working part-time because of a
partial temporary incapacity, the percentage of the salary for the time not worked should be
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CP
October 2010
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coded as explained above and the other percentage to the usual salary code.
23.4
24.
Failure to report such absences results in a financial loss for the Organization
(the salary disbursed by IOM will not be recovered from the insurance company
if unknown to the Compensation Plan Administration Manila).
FORMS
The following forms, which are annexed to this document, are also available upon
request from the Compensation Plan Administration Manila (Manila), Human
Resources Management (Geneva), and from the Chief of Mission or other designated
persons in field missions. Forms can be also downloaded from intranet HRM section.
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Notification of Accident
Notification of Occupational Illness
Initial Report of Attending Physician
Progress Report of Attending Physician
Final Report of Attending Physician
Claim for Reimbursement of Medical Expenses
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