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Reimbursement of medical expenses
Reimbursement of medical expenses
Are COVID-19 coronavirus treatment costs fully covered under the Healthcare plan? Are there any limits on reimbursements?


COVID-19 coronavirus treatment costs are covered in the same way as any medical condition, whether for consultations, lab work, medical imaging or hospitalization. The percentage of reimbursement and, where applicable, the reimbursement limits are set out in the description of the Healthcare benefits provided under the plan.
Under my Healthcare plan, is the COVID-19 coronavirus classed as an unforeseen illness?


Yes, the COVID-19 coronavirus is classed as an unforeseen illness under your healthcare plan. 
Is testing for the COVID-19 coronavirus covered under the Healthcare plan? If so, what supporting documents are required?


Testing for the COVID-19 coronavirus is covered, if it has been medically prescribed and is medically necessary, in accordance with the legal standards and regulations of the World Health Organization and local governments.

To claim your reimbursement, please send us the medical prescription accompanied by an invoice specifying the date on which the test was performed and the amount paid.
Are the prevention expenses usually not covered by French Social Security (protective masks, gloves, hand sanitizer, etc.) covered under my plan?


Prevention costs which are not usually covered by French Social Security (protective masks, gloves, hand sanitizer, etc.) are not covered under your healthcare plan in relation to the COVID-19 coronavirus pandemic, unless they are prescribed during a stay in hospital.
If I am covered under a healthcare plan and have the COVID-19 coronavirus, how should I notify MSH International?


The usual procedures apply both for precertification requests and claims for reimbursement. The COVID-19 coronavirus diagnosis should be mentioned on precertification requests and also on claims for reimbursement. 
Are medical expenses related to the COVID-19 coronavirus reimbursed during a stay in a third country (not covered by the plan)?


You should refer to the general terms and conditions of your "medical expenses" plan. Most plans cover medical care in the event of an emergency or unforeseen illness, when travelling to a third country (i.e. a country not usually covered under the plan), for a limited number of days per year, which may vary from one insurer to another.
General advice from MSH
What specific measures has MSH put in place to deal with the current COVID-19 coronavirus pandemic?


To help us cope with the unprecedented situation created by the spread of the COVID-19 coronavirus, our group continues to provide all of its services and has been operating on a full teleworking basis using collaborative communication tools for several days now. 

In view of the recent decisions taken by the public authorities in France to combat the spread of this virus, all of our employees will be working remotely until further notice. 

All of our meetings are held remotely and access to our premises is restricted to authorized employees only.

Our information systems and our IT platform in particular have shown themselves to be more than equal to the task of ensuring secure communications and supporting our commercial and administrative relations. 

In these exceptional and evolving circumstances, your usual contacts remain online and reachable at the usual numbers and email addresses to continue providing you with the highest quality of service.

Rest assured that we are doing everything possible to continue operating our business and providing our services in these exceptional times. 
What is the process if you (or a family member) have COVID-19 coronavirus symptoms? Call the repatriation assistance company of the plan? MSH International call centre?
 

  • The first thing to do is to strictly follow the COVID-19 coronavirus medical procedures defined by the country where you live and to call a local doctor/hospital if you or any family member have symptoms. 

  • The second option is to activate the telemedicine service directly available from your Members’ Area, under the “Your Healthcare/Medical teleconsultations” section.

  • The medical assistance and repatriation company of the plan can be contacted for all medical questions that have not been answered by the local health authorities hotlines, and not just in the case of an emergency. They will assess what action needs to be taken.


MSH International can be contacted for information on the medical providers (please refer in the FAQ to the question specially dedicated to this subject of access to medical providers), information on administrative process such as obtaining a letter of guarantee for hospital admission, the level of coverage of the plan.
Medical assistance & Repatriation
What are the criteria for deciding a medical evacuation? Who decides? MSH International or the repatriation assistance company of the plan?


A medical evacuation is decided for any life-threatening medical condition in a country that is unable to treat the patient. Regarding COVID-19, it could be - for example – a real difficulty in breathing, in a country without well-equipped Intensive Care Units. Decision to evacuate is done made by the repatriation assistance company of the plan in coordination with MSH International.
If you (or a family member) become infected by COVID-19 coronavirus and need to be admitted to hospital in a country where the medical system is not satisfactory or not able to treat you, what is the procedure?
 

  • First of all, please verify that a medical instruction has been effectively given to go to the hospital, since, in most cases, it is recommended that infected people stay at home when they are only affected by the most common harmless version of COVID-19 coronavirus.  You should avoid to go to hospital by yourself and should first check the local medical procedures of your country of residence.

  • In case of emergency, you are advised to call the assistance company of the plan. MSH International can be contacted for information on the medical providers (please refer in the FAQ to the question specially dedicated to this subject of access to medical providers), information on administrative process such as obtaining a letter of guarantee for hospital admission, the level of coverage of the plan.

What is the process if you (or a member of your family), on assignment in a high-risk country and with an underlying medical condition, contracts the disease?  Is medical evacuation envisaged?


It is recommended that any member with an underlying medical condition (pulmonary condition, cardiovascular condition…) living in a “High risk” country leaves this country as soon as possible. However the travel expenses will not be covered by the repatriation assistance benefits as ‘’Preventive’’ medical evacuations are not covered under repatriation assistance plans (please refer to the other question on this topic in the FAQ).
If you (or a member of your family) are admitted to hospital and don’t speak the local language, what linguistic support can be given to you to understand and be understood by a local health professional?


The repatriation assistance provider of the plan can act - on a case by case basis - as an intermediary over the phone, to help you better understand the diagnosis made by a local doctor and to better interact with him/her. The repatriation assistance provider will make its best efforts to provide this service, without guarantee of success in the current context.

By default, this service may also be provided by the medical teleconsultation service of your contract, or even by the medical teams of MSH International, on a case by case basis.
Is medical evacuation possible if you (or a member of your family), on assignment in a country with high health risk and with an underlying medical condition, have not contracted COVID 19?


In this case, the repatriation assistance plan does not cover the costs of the medical evacuation, as your medical situation is not a medical emergency.

Regardless of this, if you have been sent on a mission by your company or any other governmental or supranational entity, the latter may decide to organize - at his own expense - the repatriation of its employees, with the support of the repatriation assistance company, provided that it has the capacity to do so (due to flight restrictions, border closings, shortages of air staff...).
How do the repatriation assistance company and MSH International coordinate in the event of your medical evacuation?


In the event of a medical emergency, the repatriation assistance provider of the plan, who is available 24/7, should be contacted first.

It will then determine - in full agreement with the recommendations of the local health authorities and in coordination with MSH medical team - the degree of medical emergency of the situation and will decide either:

  • to organize your repatriation to the country offering both the best medical options nearby and corresponding best to your wishes,

  • to refer you to a local hospital or a local doctor in your country of residence who is best able to treat you,

  • to refer you to the MSH International medical teleconsultation service.


In all cases, the repatriation assistance company will place your health above all other considerations and will do everything possible to preserve your physical integrity.
In the event of a major evacuation plan, how can we be sure that the repatriation assistance company of the plan will have sufficient resources (admin staff, medical staff, equipment, access to flights…)?


In the exceptional situation created by the current coronavirus COVID-19 pandemic, the repatriation assistance company of the plan has the obligation to deploy all the medical, human and technical means at its disposal to provide assistance to insured members.

However, due to flight restrictions, possible border closings or even shortages of air staff..., it cannot be held to an obligation of results. All its efforts are nevertheless focused on preserving the physical integrity of the insured members and health considerations are placed above all others.

Please note that the situation is evolving everyday and that countries are taking measures on a daily basis that can impact the capabilities of the repatriation assistance company.
What are the recommendations if you (or a member of your family) live in a country with high health risks but are not affected by COVID 19?


We recommend that you self-confine, have enough food for at least a fortnight and don’t go to the local hospitals if symptoms similar to those of coronavirus COVID-19 appear, but contact instead by phone the repatriation assistance company of your plan or the local health authorities of your country of residence.
Administrative management of the plan
Administrative management of the plan
If I have individual plan membership, can I cancel my insurance if I decide to cancel my trip because of the COVID-19 coronavirus - or can I get a refund if I return home earlier than planned?


In view of the major health crisis we are currently facing, we have decided - as an exceptional gesture - to relax the contractual terms of our insurance plans.

If you have a First'Expat or Relais'Expat plan, we are giving you the option of:

  • either postponing the effective date of your coverage for as long as you wish, with no time limit. As soon as this health crisis is over, all you will have to do is tell us the new date on which you want your coverage to start. To avoid any unnecessary admin, we will keep your premium - unless you tell us otherwise - which means we will be able to honor your payment as soon as you inform us of your new effective date.

  • or you can cancel your plan. We will then refund the full amount of the premium already paid in respect of your plan as soon as possible. Of course, when this health crisis is over, we would be pleased to arrange a coverage solution to suit your new stay abroad.


Whatever your decision, please let us know by return email - as soon as possible - which option you would like to choose and the date on which you (or your dependent) returned to your country of origin, enclosing a copy of your return flight ticket.

If you have a Start'Expat insurance plan you may cancel your insurance. We will then refund the full premium already paid for in respect of your plan as soon as possible. Of course, as soon as this health crisis is over, we would be pleased to arrange a coverage solution to suit your new stay abroad.
Medical network
Medical network
Does MSH have a list of clinics or hospitals in each country of expatriation that are particularly recommended for treating infectious diseases such as COVID-19 coronavirus?


Each country has put in place its own response to the pandemic. MSH has established a list of hospitals recommended* by each country to diagnose and/or treat Coronavirus COVID-19 patients. This list is regularly updated as the situation is evolving as per the information provided by the countries local authorities. It can be provided upon request for most countries of expatriation.

* In some countries, the insured member may not have the choice of the hospital where he/she will be treated if he suffers from the severe form of the Coronavirus COVID 19.
COUNTRY-SPECIFIC MEASURES
What measures have been taken by different countries around the world to deal with COVID-19?
What measures have been taken by different countries around the world to deal with COVID-19?
What air traffic restrictions have been put in place to deal with COVID-19?


All information on air traffic restrictions can be found on the website of the International Air Transport Association (IATA).
GENERAL HEALTH ADVICE
General information on the COVID-19 epidemic
What types of people are most at risk of developing a serious form of COVID 19-coronavirus infection?


The French Public Health Council (Haut conseil de la santé publique or HCSP) considers that the persons most at risk of developing a serious form of COVID-19 infection are the following:

  • Persons aged 70 and over (although patients between 50 and 70 years of age should be monitored more closely);

  • Patients with chronic kidney failure who are on dialysis or with NYHA class III or IV heart failure;

  • Patients with class B, or more severe, cirrhosis;

  • Patients with a history of cardiovascular disease: high blood pressure, a history of strokes or coronary artery disease or who have undergone heart surgery;

  • Insulin-dependent diabetics or those with complications in addition to their condition (micro or macroangiopathy);

  • Patients with chronic respiratory disorders being treated with oxygen therapy, or who have asthma or cystic fibrosis or any chronic respiratory condition likely to worsen during a viral infection;

  • Pregnant women;

  • Persons who are morbidly obese (body mass index > 40kg/m2: by analogy with A(H1N1) influenza;

  • Persons with a compromised immune system:

    • undergoing immunosuppressive therapy: chemotherapy for cancer, immunosuppressive chemotherapy, biotherapy and/or immunosuppressive doses of corticotherapy;

    • with uncontrolled HIV infection at CD4 <200/mm3;

    • who have had solid organ or hematopoietic stem cell transplantation;

    • who are undergoing treatment for malignant hemopathy;

    • who have metastatic cancer;



What are the symptoms most often associated with COVID-19?


Fever, dry cough, fatigue, sputum production (sputum is a thick mucus coughed up from the lungs), shortness of breathe, muscle pain or joint pain (myalgia or arthralgia), sore throat, headache and chills... are the most common signs and symptoms of COVID-19. To find more on this topic:
Why are there still new cases developing in the countries were they implemented the mask in early days of the pandemic?


Masks are only one of several possible prevention measures and should not be the only measure. Masks must be worn very properly, covering nose and mouth and going under the chin. Once removed, they should be changed.
What effectiveness can improvised or home-made masks have?


The CDC (Centers for Disease Control and Prevention) have published a specific article on the subject. It is of course obvious that improvised masks are less effective than commercial surgical masks, yet these do appear likely to decreased exposure to wearers.
Is warm weather a factor to eliminate the virus from spreading?


Although it has been seen that to this stage southern countries have less cases in general, it’s very hard to determine if the weather is the main factor that explains this. In those countries, the policies for confinement and testing are very different and hence, it’s hard to know in which extent the weather is the only explanation of the difference of the disease incidence. Furthermore, the World Health Organization has published a warning around this subject.



What about air conditioning and its ability to transport the virus?


The CDC (Centers for Disease Control and Prevention) in United States have published a study done in China describing an outbreak seemingly associated with air flow and air conditioning. At the moment, we don’t have enough information to say if this is a situation that occurred due to some very specific reasons or if a more generalizable risk may be present.
If infected, do you need to have all the symptoms mentioned or few or only one?


In detecting COVID-19, healthcare professionals are faced with the following problems:

  • Not all patients have symptoms. Some persons are positive for COVID-19 and don’t have symptoms at all;

  • The symptoms described are not all present in the same person;

  • They are not present at the same time. For example, someone can cough for a few days and have fever only afterwards, when no more cough persists.


The symptoms can only be seen as clues that are suggestive of a diagnosis to healthcare professionals, in order to determine the likelihood of having been infected by the COVID-19. The more symptoms or risk factors (e.g. exposure to a patient or to a crowded environment) the more likely the diagnosis becomes.
Return to work tips
Our tips for organizing return to work
Why is temperature measurement good practice when it only gives an indication at a given time?


Temperature is an interesting measure, not so much when it’s negative but more so when it’s positive.



If a person doesn’t have temperature (no fever), we don’t know if he/she has COVID-19 or not but with all the other preventive measures in place, it can be assumed that the likelihood of being infected is less.



If a person has a temperature (fever), we still don’t know if he/she has COVID-19 but it is then more likely as compared to if there was no fever. So the temperature simply provides more information that will make it easier for an employer to recommend a course of action such as advise to stay at home and/or do testing and/or enter self-quarantine.
Should we generalize the temperature measurement of employees at the entrance to the company?


Local regulations will address this in some instances. If local regulations do not demand this, then company decisions need to be made in the context of local regulations surrounding individual privacy protection. In some instances, public health benefits (andfor example in contexts of declarationss of a “state of emergency”) will outweigh or change the balance of public interest vs. personal privacy.
What about building group immunity?


Group immunity occurs when at least 60% / 70% of population is immune (naturally or via immunization). Unfortunately, due to virulence of the COVID-19, aiming for group immunity at this point in time (that is to say prior to a vaccine being available) implies a very significant number of people will be hospitalized and/or die in this process. As long of an effective vaccine remains out of reach, group immunity cannot be reached without unacceptably high harms to society (and to some employees of the company).
Would you recommend wearing disposable gloves by all employees in the office space?


Gloves can sometimes make sense if people are manipulating many “external” objects from outside the company (e.g. in the case of a logistic platform or opening mail, etc.). For the employees working in administrative sector, regularly washing hands (e.g. hourly) and using one’s own keyboard, etc., (and not touching the face) should suffice. Furthermore, use of gloves doesn’t protect the person from touching his / her face and being contaminated.
Once it will be allowed to travel again between countries, would you still recommend to avoid travelling for business and replace them as much as possible by video conference?


Yes. The distribution of disease is different between countries, so a travel to a country where the dissemination of the virus is higher will generate a risk for the person to either be sick in a foreign country or not being able to return to his / her home country without requiring self-quarantine to prevent transmission. Similar discussions may be considered concerning travel between cities and/or regions within a given country.
How to practically adapt the workstation when returning to work?


Work stations should allow for a distance of at least 1 meter between workers, preferably more. This differs for people working in a manufactory or in administrative departments. Each person should have individual equipment (keyboard, mouse, etc.). Desks should be cleaned regularly and only be used by one person. To find more on this topic:



World Health Organization: Getting your workplace ready for COVID-19 factsheet
For companies whose activity allows it, do you recommend the continuation of telework beyond the official dates fixed by the governments?


Yes. In order to minimize the number of people potentially exposed to the virus through use of public transportation, it is advised that telework should be extended beyond such official dates. It remains important to be sensitive to various personalities and capacity to adapt to such measures. An individual risk-benefit assessment (depression, demotivation vs. productivity, decreased risk of exposure to virus) balance should be sought in order to define groups of people that will be prioritized to go back to the physical office.
Should employees be gradually asked to come back to the company by sub-categories, based on their relative capacity to telework?


A gradual return to work is advisable. Not all employees should return at once. Even as the percentage of employees who have returned to the office increase, recall that this is not “one direction” meaning that, depending on what is happening in the broader environment, there may be need for employees to “return to home” for telework. This may be very dynamic. Thus a prioritization is needed for different subgroups, and decisions need to be flexible over time.
Does it make sense to have employees and their family members go for COVID-19 preventive testing?


No. The tests nowadays are not very helpful for this situation. Testing at one point in time will not change what preventive measures should be taken as infection can just as easily occur after testing. For people already showing antibodies (from newer “serology testing”), it is still unknown how many antibodies are needed to be protective, nor how long such protection will last.
Has the employer an obligation to provide the masks to his/her employees?


The term obligation relates to a specific legislation on a matter. An employer is obliged to take measures necessary in order to protect the employees yet if, for example, there is a national shortage of masks then the employer cannot be responsible for that lack of masks. Hence, due to such variability in the capacity for an employer to implement the measure, it’s unlikely that there will truly be such an obligation imposed.