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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.

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Vanbreda International

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  1. Vanbreda International MBP Insurance Plan Administrator as of July 1, 2011

  2. 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

  3. 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

  4. Vanbreda International To help the people we serve improve their health, well-being and sense of security. Regional claims offices Local representations

  5. 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 Role of the World Bank Group Role of Vanbreda International

  6. 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

  7. Enrollment MBP • Through the World Bank, contact MBP Administrator for: • New enrollment • Enrollment in CMBP • Enrollment in RMBP • Report onlifeevent (e.g. birth of a child, marriage, etc.) • Vanbreda International useseligibility data providedby the World Bank.

  8. 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

  9. Where do I get a certificate/verification of coverage? • Contact your localMBP Administrator

  10. 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

  11. Change of look & feel Vanbreda website Your personal webpages at www.vanbreda-international.com

  12. Where can I find information? Your personal webpages at www.vanbreda-international.com NEW

  13. Where can I find information? NEW Your personal webpages at www.vanbreda-international.com 9 digits: UPI with leadingzeros

  14. Where can I find information? NEW Your personal webpages at www.vanbreda-international.com

  15. Where can I find information? NEW Your personal webpages at www.vanbreda-international.com

  16. Online services: Settlement details online Your personal webpages at www.vanbreda-international.com

  17. Online services: Online claiming NEW Your personal webpages at www.vanbreda-international.com

  18. Online services: Downloads Your personal webpages at www.vanbreda-international.com

  19. Online services: My Profile Your personal webpages at www.vanbreda-international.com

  20. 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

  21. What to do in case of …? NEW Hospitalisation, emergency & major outpatient treatment (> 200 USD) Minor outpatient services (< 200 USD/EUR) In-networkIn-scope(*) Out-of-scope Direct payment based on GOP(in advance) Direct payment based on card (OP ..%) Pay & claim (*) In-scope: consultations, imaging, lab, medication

  22. What to do in case of …? NEW Hospitalisation, emergency & major outpatient treatment (> 200 USD) Minor outpatient services (< 200 USD/EUR) In-network In-scope(*) Out-of- scope Direct payment based on GOP(in advance) Direct payment based on card (OP ..%) Pay & claim (*) In-scope: consultations, imaging, lab, medication

  23. Inpatient direct payment procedure Ask the provider to contact Vanbreda International Sends a Cost estimate form to Vanbreda International Sends a Guarantee of payment (GOP) to the provider and patient at 100% Hospital Uponadmission, show yourmembership card and GOP Sends the bill to Vanbreda International Pays the bill to the provider Sends a claim settlement note to the provider and patient Pays the patient portion (if any): deduction from payroll Patient

  24. Inpatient direct payment procedure: Cost Estimate form Contact us beforeadmission Send to

  25. Emergency direct payment procedure Informs or asks to inform Vanbreda International Sends a Guarantee of payment to the provider and patient at 100% Hospital 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 Patient

  26. Outpatient treatment >200 USD Informs or asks to inform Vanbreda International Sends a Guarantee of payment to provider and patient at actual coverage (80%) Hospital 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 Patient

  27. What to do in case of …? NEW Hospitalisation, emergency & major outpatient treatment (> 200 USD) Minor outpatient services (< 200 USD/EUR) In-networkIn-scope(*) Out-of- scope Direct payment based on card (OP ..%) Direct payment based on GOP(beforehand) Pay & claim (*) In-scope: consultations, imaging, lab, medication

  28. Outpatient direct payment procedure (up to 200 USD) Patient Shows his/her membership card 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 Provider 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

  29. 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

  30. What to do in case of …? NEW Hospitalisation, emergency & major outpatient treatment (> 200 USD) Minor outpatient services (< 200 USD/EUR) Out-of-scope In-network In-scope(*) Pay & claim Direct payment based on GOP(beforehand) Direct payment based on card (OP ..%) (*) In-scope: consultations, imaging, lab, medication

  31. Reimbursement procedure NEW 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

  32. Reimbursement procedure: Claim form Go to www.vanbreda-international.com Send to • Add originals • Submit by Dec. 31 of the yearfollowing the date of treatment

  33. Reimbursement procedure: Online claiming NEW Your personal webpages at www.vanbreda-international.com

  34. How can I review my claim settlements? Your personal webpages at www.vanbreda-international.com

  35. 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

  36. 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

  37. 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

  38. 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

  39. Vanbreda International’s network of medical service providers Search for a provider at www.vanbreda-international.com

  40. Ongoing expansion - network of medical service providers New clientpreference Constant monitoring

  41. 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

  42. 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

  43. 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

  44. Benefits information online Your personal webpages at www.vanbreda-international.com

  45. 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

  46. 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

  47. Questions?

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