Transcript Vanbreda International

Vanbreda International
MBP 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
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
To help the people we serve improve their
health, well-being and sense of security.
Regional claims offices
Local representations
Vanbreda International and
the World Bank Group
Role of the
World Bank
Group
 MBP benefit design
 Eligibility rules
 Member
enrollment/changes
 Collection of MBP
premiums
 Medical evacuations
(HSD)
Role of
Vanbreda
International
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MBP administration
Claims processing
Medical network
Member service and
support
 Coordination with HSD
on medical evacuations
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
Enrollment MBP
 Through the World Bank, contact MBP
Administrator for:
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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
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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
submission
 Provider network
 Coverage highlights
Change of look & feel Vanbreda website
Your personal webpages at www.vanbreda-international.com
Where can I find information?
Your personal webpages at www.vanbreda-international.com
Where can I find information?
Your personal webpages at www.vanbreda-international.com
9 digits: UPI with
leading zeros
Where can I find information?
Your personal webpages at www.vanbreda-international.com
Where can I find information?
Your personal webpages at www.vanbreda-international.com
Online services: Settlement details online
Your personal webpages at www.vanbreda-international.com
Online services: Online claiming
Your personal webpages at www.vanbreda-international.com
Online services: Downloads
Your personal webpages at www.vanbreda-international.com
Online services: My Profile
Your personal webpages at www.vanbreda-international.com
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
What to do in case of …?
Hospitalisation, emergency &
major outpatient treatment (> 200 USD)
Direct payment
based on GOP
(in advance)
Minor outpatient services (< 200 USD/EUR)
In-network
In-scope(*)
Out-ofscope
Direct payment
based on card
(OP ..%)
Pay & claim
(*) In-scope: consultations, imaging, lab, medication
What to do in case of …?
Hospitalisation, emergency &
major outpatient treatment (> 200 USD)
Direct payment
based on GOP
(in advance)
Minor outpatient services (< 200 USD/EUR)
In-network
In-scope(*)
Out-ofscope
Direct payment
based on card
(OP ..%)
Pay & claim
(*) In-scope: consultations, imaging, lab, medication
Inpatient direct payment procedure
Patient
Ask the provider to
contact Vanbreda
International
Hospital
Sends a Cost
estimate form to
Vanbreda International
Sends a Guarantee of
payment (GOP) to the
provider and patient at
100%
Upon admission, show
your membership card
and GOP
Sends the bill to
Vanbreda International
Pays the bill to the
provider
Pays the patient portion
(if any): deduction from
payroll
Sends a claim
settlement note to the
provider and patient
Inpatient direct payment procedure:
Cost Estimate form
Contact us before admission
Send to
Emergency direct payment procedure
Patient
Hospital
Informs or asks to
inform Vanbreda
International
Sends a Guarantee of
payment to the provider
and patient at 100%
Sends the bill to
Vanbreda International
Pays the bill to the
provider
Pays the patient
portion (if any):
deduction from payroll
Sends a claim
settlement note to the
provider and patient
Outpatient treatment >200 USD
Patient
Hospital
Informs or asks to
inform Vanbreda
International
Sends a Guarantee of
payment to provider
and patient at actual
coverage (80%)
Sends the bill to
Vanbreda International
Pays the remaining
patient portion
(if any)
Pays the covered part
of the bill to the
provider
Sends a claim
settlement note to the
provider and patient
What to do in case of …?
Hospitalisation, emergency &
major outpatient treatment (> 200 USD)
Direct payment
based on GOP
(beforehand)
Minor outpatient services (< 200 USD/EUR)
In-network
In-scope(*)
Out-ofscope
Direct payment
based on card
(OP ..%)
Pay & claim
(*) In-scope: consultations, imaging, lab, medication
Outpatient direct payment procedure (up
to 200 USD)
Patient
Shows his/her
membership card to
the provider
Provider
Fills out the ‘Provider claim form
for direct payment of outpatient
medical services’
Signs the form and
pays the remaining
patient portion
Sends the form and bill(s)
to Vanbreda International
Pays the covered part
of the bill to the
provider
Sends a claim
settlement note to the
provider and patient
Outpatient direct payment in scope
 The following treatments
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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
What to do in case of …?
Hospitalisation, emergency &
major outpatient treatment (> 200 USD)
Direct payment
based on GOP
(beforehand)
Minor outpatient services (< 200 USD/EUR)
In-network
In-scope(*)
Out-ofscope
Direct payment
based on card
(OP ..%)
Pay & claim
(*) In-scope: consultations, imaging, lab, medication
Reimbursement procedure
Patient
Settles the bill with
the provider
Completes a Claim form
and sends it to Vanbreda
International
Reimburses the amount covered
by the plan through WBG Payroll
Sends a claim settlement
note
Reimbursement procedure: Claim form
Go to www.vanbreda-international.com
Send to
 Add originals
 Submit by Dec. 31 of the year
following the date of treatment
Reimbursement procedure: Online
claiming
Your personal webpages at www.vanbreda-international.com
How can I review my claim settlements?
Your personal webpages at www.vanbreda-international.com
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
 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’s network of
medical service providers
Search for a provider at www.vanbreda-international.com
Ongoing expansion - network of
medical service providers
New client
preference
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
 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
Benefits information online
Your personal webpages at www.vanbreda-international.com
Can I obtain treatment outside my duty
country?
 Yes, in the following cases:
 Accident/sudden illness when abroad
 During Developmental Assignment (DA) or Shortterm 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?