Informations Administratives 29.03.2000	N° 30-2000 INTERINSTITUTION + AGENCES + ÉCOLES EUROPÉENNNES + PENSIONNÉS + UNIVERSITÉ DE FLORENCE.
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RÉGIME COMMUN D'ASSURANCE MALADIE COMMUNIQUÉ DU BUREAU CENTRAL Changes regarding dental Rules (forms + agreement with dentists practising in Belgium) Advice for submitting your medical claims DENTAL TREATMENT 1.1. Forms New forms for dental treatment ( estimate and dentist's bill) will be in use from 1St April 2000 and will be available on http://www.europateam.cc.cec/guide/assmal/formulaires.htm. For those who don't have access to Europateam, the old forms can still be used. From now on, the bill completed by your dentist must be sent with a claim for reimbursement. Members are reminded that before any major treatment (fixed or removable prostheses, periodontal treatment, orthodontic treatment ...) an estimate completed, dated and signed by your dentist must always be presented to the Settlements Office. It is important to indicate the patient's surname, the member's surname and personnel number. In reply, you will obtain authorisation for the treatment, with the amount to be reimbursed, or the refusal. Please remember that, the costs relating to the fitting of dental implants (the implant, the surgery involved, the anaesthesia, etc.) are not reimbursed. 1.2. Agreement with dentists practising in Belgium The agreement with the dentists foresees an annual indexation of the maximum fees to be charged, in line with the movements in the retail price index. The tables setting out the new maximum fees applicable from 1 April 2000, together with the amounts reimbursable by the JSIS, are attached at annex. It is in the interests of members to check, if the dentist concerned has accepted the agreement (see list on Europateam), that the probable fees mentioned on the compulsory estimate do not exceed the maximum under agreement. Members are not, of course, obliged to seek treatment from a dentist who has accepted the agreement, knowing that, in that case, the fees can be higher or lower than the maximum fees fixed in the agreement. The table 2. ADVICE FOR SUBMITTING YOUR MEDICAL CLAIMS In order to deal with your claims for reimbursement more efficiently, you are kindly asked to take account of the following points: All claims for reimbursement must be presented on a 'claim for medical reimbursement' form. Please do not forget to indicate your name and personnel number. Use separate application forms to claim the reimbursement of medical costs in case of serious illness (100 %) or incurred as a result of an accident, stating respectively the reference of the decision and the date of the accident. Ensure that the documents (original medical prescription, bill and proof of payment) follow the order of the treatments mentioned on your claim. Keep a copy of the documents. Send in your claims regularly as soon as you have seven or eight items and try to avoid, if possible, submitting claims for a total amount less then Eur 75 (around BEF 3,000), being careful to respect the reimbursement time limit. Submit your claims at least once a year. Given that each piece of paper is scanned in our office, please try to use paper clips instead of staples. Prior authorisation is required for the following treatments: Plastic surgery Costs of accompanying someone in hospital Costs of a stay in a nursing home Costs of medical appliances (sprays, respirators, glucometers, blood pressure gauges, etc.) Nursing attendance Convalescence, thermal cures, cures for delicate children Orthopaedic shoes Wheelchairs and similar appliances (zimmer frame, commode, special bed, etc.) Non urgent transport costs and travelling expenses Treatments listed in Annex IV.B: Laser therapy, ultraviolet radiation, chiropractic, osteopathy, medical chiropody - podology, psychotherapy, logopaedics, graphomotor therapy, psychomotor therapy Where the maximum number of sessions reimbursable in Annex IV.A has been exceeded Treatment not mentioned in the Rules such as lymphatic drainage, orthoptic re-education, etc.

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Auteur : Personnel et Administration Direction B : Assurance maladie et accidents Editeur : Personnel et Administration Direction C : Ateliers de reproduction Page créée le 23/03/2000 12:09:34, dernière modification le 23/03/2000 14:09:54