CERN LongTerm Care Scheme Conference of the Staff

CERN Long-Term Care Scheme Conference of the Staff Associations of Internationals Organizations 29 -30 September 2005 CSAIO 6 / 09 - 2005 1 CERN Staff Association

Contents l CERN Health Insurance Scheme n n n l Long-Term Care Scheme n n n n n l 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 CSAIO 6 / 09 - 2005 2 CERN Staff Association

CERN Health Insurance Scheme (1) l Nature of the CHIS n Funding of the CHIS Contribution of active staff – share between Staff & Organisation : 4. 02% & 6. 35% of basic salary u Contribution of pensioners – share between pensioners & Organisation : 4. 02% & 6. 35% of the last indexed monthly basic salary u Contribution of spouses when they receive an income u n External administrator (UNIQA) Claims reimbursement u Daily administration of the CHIS services u CSAIO 6 / 09 - 2005 3 CERN Staff Association

CERN Health Insurance Scheme (2) l Basic principles of the CHIS n n n It is obligatory 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). CSAIO 6 / 09 - 2005 4 CERN Staff Association

CERN Health Insurance Scheme (3) n n Freedom of choice of health care providers & world-wide coverage Freedom of choice Responsibility of each CHIS member the level of reimbursement Collective shall not exceed the level responsibility of contributions CHIS = Insurance CSAIO 6 / 09 - 2005 5 CERN Staff Association

CERN Health Insurance Scheme (5) l Scheme administration & responsibilities n n n 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 CSAIO 6 / 09 - 2005 6 CERN Staff Association

Long-Term Care scheme l Background n n 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 CSAIO 6 / 09 - 2005 7 CERN Staff Association

LTC : Actuarial studies l Technical basis n n n 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 CSAIO 6 / 09 - 2005 8 CERN Staff Association

LTC : Actuarial studies l 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 CSAIO 6 / 09 - 2005 9 CERN Staff Association

Long-Term Care scheme (1) l Nature n n of the LTC 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 u Medium level Not 3 Not 4 u High level u Not 5 Ø Taking food & drink Ø Going to the lavatory Ø Coherence & ability to communicate Ø Orientation in space & time Ø Getting up, sitting down, getting into bed Ø Mobility Ø Washing & grooming Ø Dressing & undressing CSAIO 6 / 09 - 2005 10 CERN Staff Association

LTC : Actuarial Scenarios l No LTC (only standard health coverage) n n n l 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 n n n 85 CHF per day for home care Up to 2500 CHF per for paramedical expenses LTC scheme eliminates hospitalization cost CSAIO 6 / 09 - 2005 11 CERN Staff Association

LTC : Actuarial Studies results No LTC (standard health coverage) With LTC 18 cases / Year 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 CSAIO 6 / 09 - 2005 15. 14 12 CERN Staff Association

Long-Term Care scheme (2) l Financing n n 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 CSAIO 6 / 09 - 2005 13 CERN Staff Association

Long-Term Care scheme (3) l Benefits * Not paid during hospitalization Medium level High level 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 CSAIO 6 / 09 - 2005 14 CERN Staff Association

Long-Term Care scheme (4) l Advantages of the LTC Cost reduction of increase in hospital bills n Authorize the improvement of the long-term financial balance of the Organization’s health insurance scheme n Better cover for dependent persons n Keep the CHIS equivalent to the LAMAL scheme n CSAIO 6 / 09 - 2005 15 CERN Staff Association

Long-Term Care scheme (5) l Some LTC Statistics from 2001 – 2004 Number of cases Low level Medium High 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 CSAIO 6 / 09 - 2005 16 CERN Staff Association

Long-Term Care scheme (6) l 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 CSAIO 6 / 09 - 2005 17 CERN Staff Association

Long-Term Care scheme (7) l 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 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 F 1 1 4 M 1 2 1 4 2 3 5 4 2 6 22 13 16 9 11 71 moyen Total 3 nb d'assurés au 31 -12 -2004 56 -60 soit CSAIO 6 / 09 - 2005 2 2 3 3 9 678 558 827 1105 1403 1203 769 473 179 44 11868 0. 4% 0. 2% 0. 3% 0. 2% 0. 7% 1. 7% 3. 4% 5. 0% 25. 0% 0. 6% 18 CERN Staff Association

Long-Term Care scheme (8) l Some CHIS – LTC statistics from 1988 -2004 Evolution cost Large increase for hospitalization in 15 years CSAIO 6 / 09 - 2005 19 CERN Staff Association

Long-Term Care scheme (9) l The future of the LTC Actuarial study in 2006 to review the scheme and take a decision on adapting the daily allowance n Looking for preferential providers in the field of nursing & home help in France n CSAIO 6 / 09 - 2005 20 CERN Staff Association

Conclusions l l 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 CSAIO 6 / 09 - 2005 21 CERN Staff Association

END I am at your disposal for questions Joel LAHAYE CERN Staff Association Joel. lahaye@cern. ch CSAIO 6 / 09 - 2005 22 CERN Staff Association