vanbreda international mbp insurance plan administrator as of july 1, 2011

Vanbreda InternationalMBP Insurance Plan Administrator as of July 1, 2011

Contents

Who is Vanbreda International? Membership cards and enrollment How do I access Vanbreda International’s

website? Procedures for direct payment & claims

submission Provider network Coverage highlights

Vanbreda International

Regional claims offices

Local representations

To help the people we serve improve their health, well-being and sense of security.To help the people we serve improve their health, well-being and sense of security.

Role of Vanbreda

International

Role of Vanbreda

International

Role of the World Bank

Group

Role of the World Bank

Group

Vanbreda International andthe World Bank Group

MBP benefit design Eligibility rules Member

enrollment/changes Collection of MBP

premiums Medical evacuations

(HSD)

MBP administration Claims processing Medical network Member service and

support Coordination with HSD

on medical evacuations

Contents




Enrollment MBP

Through the World Bank, contact MBP Administrator for: New enrollment Enrollment in CMBP Enrollment in RMBP Report on life event (e.g. birth of a child,

marriage, etc.)

Vanbreda International uses eligibility data provided by the World Bank.

Membership card

For all MBP members Distributed through local MBP Administrator Photo needed Changes and corrections to data through HR Service Center Replacement of lost / stolen card through Vanbreda

International

Where do I get a certificate/verification of coverage?

Contact your local MBP Administrator

Contents

Who is Vanbreda International? Membership cards and enrollment How do I access Vanbreda

International’s website? Procedures for direct payment & claims


Change of look & feel Vanbreda website

Your personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com

Where can I find information?

Your personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.comNEW


NEW

9 digits: UPI with

leading zeros



NEWYour personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com

Online services: Settlement details online


Online services: Online claiming


Online services: Downloads


Online services: My Profile


Contents




What to do in case of …?

Hospitalisation, emergency & major outpatient treatment (> 200 USD)

Direct payment based on GOP

(in advance)

Direct payment based on card

(OP ..%)

In-networkIn-scope(*)


Out-of-scopeOut-of-scope

(*) In-scope: consultations, imaging, lab, medication

Pay & claim

Minor outpatient services (< 200 USD/EUR)NEW



Direct payment based on GOP

(in advance)


(OP ..%)


Pay & claim



Out-of-scope

Patient Hospital

Inpatient direct payment procedure

Ask the provider to contact Vanbreda International

Sends the bill to Vanbreda International

Sends a Guarantee of payment (GOP) to the provider and patient at 100%

Sends a Cost estimate form to Vanbreda International

Sends a claim settlement note to the provider and patient

Pays the bill to the provider

Pays the patient portion (if any): deduction from payroll

Upon admission, show your membership card and GOP

Inpatient direct payment procedure: Cost Estimate form

Contact us before admissionContact us before admission

Send to

Patient Hospital

Emergency direct payment procedure

Informs or asks to inform Vanbreda International


Sends a Guarantee of payment to the provider and patient at 100%


Pays the bill to the provider

Pays the patient portion (if any): deduction from payroll

Patient Hospital

Outpatient treatment >200 USD

Informs or asks to inform Vanbreda International


Sends a Guarantee of payment to provider and patient at actual coverage (80%)


Pays the covered part of the bill to the provider

Pays the remaining patient portion (if any)



Direct payment based on GOP(beforehand)


(OP ..%)





Out-of-scope

Pay & claim

Provider

Outpatient direct payment procedure (up to 200 USD)

Shows his/her membership card to the provider

Sends the form and bill(s) to Vanbreda International

Pays the covered part of the bill to the provider

Fills out the ‘Provider claim form for direct payment of outpatient medical services’

Signs the form and pays the remaining patient portion


Patient

Outpatient direct payment in scope

The following treatments Medical consultations Imaging (e.g. radiology) Laboratory, excluding preventive lab tests Prescribed medicines, including:

homeopathy HIV medication OTC (over-the-counter) medication on prescription

Outpatient HIV/AIDS treatment, including: medications testing Consultation

Costs </= 200 USD



Out-of-scopeOut-of-scope


Pay & claim


Direct payment based on GOP(beforehand)


(OP ..%)


Reimbursement procedure

Settles the bill with the provider

Sends a claim settlement note

Reimburses the amount covered by the plan through WBG Payroll

Patient

Completes a Claim form and sends it to Vanbreda International

NEW

Reimbursement procedure: Claim form

Go to www.vanbreda-international.comGo to www.vanbreda-international.com

Add originals Submit by Dec. 31 of the year

following the date of treatment

Send to

Reimbursement procedure: Online claiming


How can I review my claim settlements?


What if my reimbursement is lower?

No change in coverage If Vanbreda International interprets MBP

rules differently Send us a copy of GMC’s settlement note or

approval for the treatment We will verify If justified, we will correct and adapt our

interpretation

Outpatient treatment: Prior approval for specific services

Prior approval is needed for: Orthopaedic appliances

(bandages, corsets, soles, shoes, etc)

Orthodontic treatment for adults / therapeutic prostheses / crowns (3 or more at one time) / bridges

Paramedical treatment Infertility treatment

What to do in case of ongoing treatments?

Inform Vanbreda International Please inform us of any ongoing treatment or

prior approval given by GMC Send us an e-mail with

the nature of treatment the diagnosis the approval of the previous administrator

OR Add the information on the first claim

Contents




Vanbreda International’s network of medical service providers

Search for a provider at www.vanbreda-international.comSearch for a provider at www.vanbreda-international.com

Ongoing expansion - network of medical service providers

New clientpreferenc

e

Constant monitoring

Can I continue to visit my usual medical service provider?

Yes, you have free choice of provider

Vanbreda International network guarantees Direct payment Reasonable & customary tariffs

What if direct payment is not recognized by provider?

Pre-certification when possible

Contact Vanbreda to negotiate further with provider

Salary advance mechanism (see MBP website for details)

Through regional Resource Management

Contents




Benefits information online


Can I obtain treatment outside my duty country?

Yes, in the following cases: Accident/sudden illness when abroad During Developmental Assignment (DA) or Short-

term Assignment (STA) - Of at least three months During Medical Evacuation Travel (MET)

Approved by HSD

If care is not available locally and pre-approved by Vanbreda International

Otherwise, reimbursement limited to reasonable & customary level of duty country

What is the coverage for preventive packages?

Listed types of preventive care in the “Guide for preventative care” 100% coverage

Other preventive care 80% coverage

Overnight stay (for preventive care screening) Not covered

Packages Same principle as above

Questions?

vanbreda international mbp insurance plan administrator as of july 1, 2011

Documents

vanbreda international

scope slide

gop slide

payroll slide

usdeur new slide

usd direct payment

advance direct payment

enrollment mbp