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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
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
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: 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
submission Provider network Coverage highlights
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
Where can I find information?
NEW
9 digits: UPI with
leading zeros
Your personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Where can I find information?
NEWYour personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Where can I find information?
NEWYour personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Online services: Settlement details online
Your personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Online services: Online claiming
NEWYour personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Online services: Downloads
Your personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
Online services: My Profile
Your personal webpages at www.vanbreda-international.comYour 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)
Direct payment based on card
(OP ..%)
In-networkIn-scope(*)
In-networkIn-scope(*)
Out-of-scopeOut-of-scope
(*) In-scope: consultations, imaging, lab, medication
Pay & claim
Minor outpatient services (< 200 USD/EUR)NEW
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-networkIn-scope(*)
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 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
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)
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-networkIn-scope(*)
In-networkIn-scope(*)
(*) In-scope: consultations, imaging, lab, medication
Minor outpatient services (< 200 USD/EUR)NEW
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
Sends a claim settlement note to the provider and patient
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
What to do in case of …?
Hospitalisation, emergency & major outpatient treatment (> 200 USD)
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(beforehand)
Direct payment based on card
(OP ..%)
In-networkIn-scope(*)
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
NEWYour personal webpages at www.vanbreda-international.comYour personal webpages at www.vanbreda-international.com
How can I review my claim settlements?
Your personal webpages at www.vanbreda-international.comYour 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.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
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.comYour 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 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?