Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Vanbreda International MBP Insurance Plan Administrator as of July 1, 2011."— Presentation transcript:

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

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

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 on life event (e.g. birth of a child, marriage, etc.)  Vanbreda International uses eligibility data provided by 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 local MBP 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

12 Where can I find information? Your personal webpages at NEW

13 Where can I find information?NEW 9 digits: UPI with leading zeros Your personal webpages at

14 Where can I find information?NEW Your personal webpages at

15 Where can I find information?NEW Your personal webpages at

16 Online services: Settlement details online Your personal webpages at

17 Online services: Online claimingNEW Your personal webpages at

18 Online services: Downloads Your personal webpages at

19 Online services: My Profile Your personal webpages at

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

22 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-scope: consultations, imaging, lab, medication Pay & claim Minor outpatient services (< 200 USD/EUR) NEW In-network In-scope (*) Out-of- scope

23 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

24 Inpatient direct payment procedure: Cost Estimate form Contact us before admission Send to

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

26 Patient Hospital Outpatient treatment >200 USD Informs or asks to inform Vanbreda International Sends the bill to Vanbreda International Sends a Guarantee of payment to provider and patient at actual coverage (80%) Sends a claim settlement note to the provider and patient Pays the covered part of the bill to the provider Pays the remaining patient portion (if any)

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

28 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 Sends a claim settlement note to the provider and patient 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

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

31 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

32 Reimbursement procedure: Claim form Go to  Add originals  Submit by Dec. 31 of the year following the date of treatment Send to

33 Reimbursement procedure: Online claimingNEW Your personal webpages at

34 How can I review my claim settlements? Your personal webpages at

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 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

40 Ongoing expansion - network of medical service providers New client preference 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

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?


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

Similar presentations


Ads by Google