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Vanbreda International

UN Group medical, hospital and dental scheme for staff members away from headquarters

UN Worldwide Plan (UN WWP)

Manual for HR and Operations Department Version June 2010

INTRODUCTION The UN group medical, hospital and dental scheme for staff members away from headquarters (UN Worldwide Plan - UN WWP) is a self-insured programme offering medical coverage for both active and retired staff members and their dependants. The UN outsourced the administration of the claims processing and premiums collecting of the UN WWP to Vanbreda International. This document is intended to inform HR and Operations departments’ staff of the benefits and impact of this outsourcing on their own work and to help them address questions from staff members. For any additional questions, you can send an e-mail to [email protected].

Vanbreda International – Confidential and Proprietary UN Worldwide Plan – June 2010 p. 2/21

CONTENT 1. VANBREDA INTERNATIONAL ............................................................................................................................4

1.1. Introduction of Vanbreda International ....................................................................................................4 1.2. Organisation ............................................................................................................................................5

2. UN WORLDWIDE PLAN: STRUCTURE...............................................................................................................7 2.1. UN WWP, a self-insured Plan .................................................................................................................7 2.2. Vanbreda International, administrator of the UN WWP ..........................................................................7 2.3. Plan participation and eligibility ...............................................................................................................7 2.4. Unique identification of Plan Members....................................................................................................8 2.5. Antwerp, Miami and Kuala Lumpur .........................................................................................................8 2.6. Contact information for Plan Members....................................................................................................9 2.7. Languages offered ..................................................................................................................................9 2.8. Membership card...................................................................................................................................10

2.8.1. Content and use................................................................................................................................10 2.8.2. Distribution of membership cards .....................................................................................................11

2.9. Information about the UN WWP............................................................................................................11 2.9.1. Brochure............................................................................................................................................11 2.9.2. Website .............................................................................................................................................11

2.10. Forms to be used by Plan Members .....................................................................................................14 2.10.1. Claim form ....................................................................................................................................14 2.10.2. Cost Estimate form .......................................................................................................................14 2.10.3. Application or request for change of coverage form.....................................................................14 2.10.4. Notification of Accident form.........................................................................................................14

3. MEDICAL CLAIMS PROCEDURE.......................................................................................................................15 3.1. Submitting a claim.................................................................................................................................15 3.2. Claims reimbursement ..........................................................................................................................15 3.3. Payment ................................................................................................................................................16

4. PROVIDER NETWORK, SAVINGS AND DIRECT PAYMENT....................................................................................18 4.1. Provider Network and Savings..............................................................................................................18 4.2. Direct payment ......................................................................................................................................18

5. Q & A..........................................................................................................................................................21


1. VANBREDA INTERNATIONAL

1.1. Introduction of Vanbreda International Vanbreda International is an independent market leading consultant and administrator of cross-border employee benefits solutions, with headquarters in Antwerp, Belgium. We provide our clients with reliable counsel and tailor-made worldwide coverage, such as medical and dental care, short and long-term disability, long-term care, pension plans. The company serves its customers on a 24/7/365 basis through Claims Processing Offices in Antwerp, Kuala Lumpur and Miami. Our claims processing procedures are ISO 9001:2000 certified (SGS n° BE 98/1053.QA) which means that our claims handling is being closely monitored, measured and controlled by an international audit firm. It is important to note that Vanbreda International is not an insurance company. The UN WWP is a non-insured health benefits Plan administered by Vanbreda International. As such, the cost of the medical services covered by the Plan are borne by the United Nations and the Plan Members.


1.2. Organisation Vanbreda International’s client services are organised around three core functions: • our Medical Claims Center is dealing with all medical claims handling; • our Group Plans department is responsible for client relationships and contract management; • our Provider Relations team manages our medical service provider network.

Paul DebrabandereKeyAccount Manager

Gwen VerbeeckHead Claims Unit

Antwerp

Sook Kuan LeongOff ice and Team Leader

Kuala Lumpur

Lily MartinOff ice and Team Leader

Miami

Medical Claims Center Provider RelationsGroup Plans

Bénédicte Floor Head

Vera VanderavoortCustomer Service

Representative

Medical Claims Center The Medical Claims Center is responsible for the Plan Member’s claims handling. Its structure involves:

First line customer service Our Contact Center ensures first line service to Plan Members and provides them information on coverage, procedures with regard to guarantees of payment or direct payment, the status of claims being processed and balances, etc. We guarantee seamless accessibility to our in-house Contact Center, 24 hours a day, 7 days per week, all year round (including public holidays). All staff of our in-house Contact Center are Vanbreda International employees. A dedicated Claims Unit We assign a dedicated in-house Claims Unit to every client. We select the claims handling team based on the location(s) of the client, the specific knowledge that location requires and the client’s preferred language(s). Each client will be serviced by dedicated Customer Service Representatives, Senior Claims Analysts and Claims Analysts, with designated back-up.


Depending on the country of residence of the Plan Member, claims will be handled by our Antwerp, Kuala Lumpur or Miami office. All offices use an integrated claims processing platform and a centralised database allowing them to work from the same data sets.

Central administrative

platform

In countries with important concentrations of staff, our Plan Members are being serviced by one of our local representatives, which facilitates claims intake (in the widest sense), case management and communication between our Plan Members, their HR admins and the care providers (doctors, hospitals, …). At present, we have set up a network of local representatives in those countries where most of the admissions take place:

• Kenya; • Chile; • Thailand (Kuala Lumpur); • South Africa.

Besides our local representative in South Africa, we have recently hired a medical doctor who operates in entire Africa. Group Plans department Our Group Plans department is in close contact with the contracting party, the participating UN agencies as employer and organisation. The department’s Account Managers and Customer Service Representatives are in contact with HR and Operations representatives on a daily basis. They manage all eligibility information (indicating which staff members are members in the Plan) that the UN provides to Vanbreda International. In addition, the Account Managers provide in-depth Plan analyses in order to help the UN better understand the dynamics of the insurance Plan and to improve and fine-tune the Plan’s coverage. Provider Relations department Vanbreda International provides Plan Members with easy and affordable access to worldwide health care through our proprietary network that counts more than 10,000 in- and outpatient health care providers. The Provider Relations department is responsible for sustaining and expanding our worldwide network of Medical Providers through Direct Payment and Preferential Rates Agreements.


2. UN WORLDWIDE PLAN: STRUCTURE

2.1. UN WWP, a self-insured Plan The UN WWP is a health Plan operated by the UN and related organisations such as UNDP, UNICEF, UNOV, UNON, ESCWA, etc, for the benefit of their internationally active staff members and former staff members (and their eligible family members). The UN WWP is a self-insured Plan. This means that the UN does not buy insurance coverage on the insurance market. The yearly contributions from Plan Members and UN agencies are not paid as an insurance premium to an insurance company, but are paid into a fund. The fund is used to pay the reimbursements as identified by the UN WWP. If at the end of a year the contributions paid into the fund exceed the level of reimbursements, the surplus is allocated to a reserve that can be used in the following years. If on the contrary reimbursements exceed contributions, money can be drawn from the reserve fund to cover all reimbursements.

Q: Why are some expenses not covered by Vanbreda International? A: What is covered and what excluded is the UN’s decision, in consistency with worldwide best practices. Since the UN WWP is a self-insured Plan, Vanbreda International only applies the coverage as determined by the UN.

2.2. Vanbreda International, administrator of the UN WWP The UN outsourced part of the administration of the UN WWP to Vanbreda International. The key services that Vanbreda International delivers for the UN WWP include: • claims handling according to the rules governing the UN WWP; • premium collection with approximately 30 self-declaring entities (UN, UNON, UNOV, ECLAC, ESCWA, etc); • collecting and updating eligibility information from these entities; • communication to Plan Members; • reporting on the experience of the UN WWP and advising the UN on Plan design, trends in medication, etc.

Q: How can Plan Members be sure of a good service by Vanbreda International? A: Vanbreda International guarantees a quality service by continuously monitoring the service levels offered to Plan Members and performance guarantees agreed upon with the UN.

2.3. Plan participation and eligibility The rules for participating in the UN WWP as well as the contribution levels are determined by the UN. Information on the rules and premium rates governing the UN WWP can be found in the annual information circular issued by the UN Insurance Section. A copy of this circular is posted on the UN dedicated website which can be accessed by the Plan Member through www.vanbreda-international.com or www.un.org/insurance.


http://www.vanbreda-international.com/

To be able to reimburse claims, Vanbreda International disposes of eligibility information about the Plan Members, staff members, retirees and their dependants. The UN WWP covers approximately 30 premium and eligibility declaring entities such as UN NY, UNON, IMO, ECLAC, etc. Besides a few exceptions, all retired staff members and their eligible family members are administered by the UN Insurance Section in NY.

Q: How does Vanbreda International know who is covered by the UN WWP? A: The standard procedure for eligibility declarations implies that the UN Insurance Section in New York informs Vanbreda International of UN Plan Members on a biweekly basis. Vanbreda International needs this information in order to reimburse claims. It is therefore important for HR departments to keep this information up-to-date.

2.4. Unique identification of Plan Members Each family covered by the UN WWP has a unique identification number provided by Vanbreda International. This personal reference number has the following structure: 001/******. • The three digits (001) are UN WWP’s client number with Vanbreda International; • followed by a 6 digit combination which refers to the family’s personal reference number.

2.5. Antwerp, Miami and Kuala Lumpur UN WWP members are serviced by Vanbreda International’s offices in Miami, Antwerp and Kuala Lumpur. Depending on the country of residence, Plan Members are being encouraged to send their claims to their dedicated office. All our Claims Processing Offices use the same integrated back-office systems allowing Claims Analysts and Customer Service Representatives to access all Plan and Plan Member relevant information in real time.

Q: What if a Plan Member based in Asia or the Americas needs urgent assistance when the respective office is closed? A: Our 24/7/365 service guarantees that a Plan Member’s call is automatically transferred to the office that is operating at that moment. The person in charge at that time will have access to the Plan Member’s personal information and will be able to help him/her.


2.6. Contact information for Plan Members As we have Claims Processing Offices in three time zones, you can reach us 24 hours a day, 7 days a week, 365 days a year. In case of emergency or if you simply have a question, you can contact our multilingual staff in several ways. Our contact details are also mentioned on the Plan Member’s dedicated website and membership card.

Antwerp office Kuala Lumpur office Miami office

www.vanbreda-international.com

[email protected]

+ 32 3 217 68 42 + 60 3 2178 05 55 + 1 305 908 91 01

Vanbreda International NV P.O. Box 69 2140 Antwerpen Belgium

Vanbreda International Sdn. Bhd. P.O. Box 10612 50718 Kuala Lumpur Malaysia

Vanbreda International LLC P.O. Box 260790 33126 Miami, FL USA

Toll-free numbers Wherever feasible, Plan Members can call us for free through a toll-free number. If there is no toll-free number available for the country of stay, they can use the UN dedicated phone number, which is also mentioned on their membership card. The full list of available toll-free numbers per country is available on the UN’s dedicated website.

2.7. Languages offered Plan Members have access to written information in English, Spanish and French. They can find Plan related information via the UN dedicated website, the brochure, settlement notes, forms (available in English/Spanish and French/Arabic) and the membership cards. Claims and supporting documentation do not have to be translated into one of these languages. The Claims Center can handle claims in any official language. In terms of verbal communication, Vanbreda International can offer many more languages. Our agents at the Contact Center speak at least those languages which are commonly used in the time zone that is being served at that time of day (e.g. for the Americas, Spanish, Portuguese and English will be available).



Q: Does a Plan Member have to speak English when contacting Vanbreda International? A: No, the Plan Member can be served in more languages by the Contact Center. If at the time of the call there is no agent available who speaks the Plan Member’s preferred language, (s)he can ask to be called back by someone who does speak that language or the Contact Center agent can call upon the support of an interpreter. With the ‘live’ help of an interpreting service Vanbreda International can offer its services in more than 100 additional languages.

2.8. Membership card Every Plan Member and his dependants receive a membership card (see example below). This is a plastic card, the size of a standard credit card.

2.8.1. Content and use The membership card contains two sets of important information: the Plan Member’s personal data such as personal reference number and Vanbreda International contact information. This card is not a proof of coverage, as is mentioned on the back side.

Q: What happens if a Plan Member or his/her dependant loses his/her membership card? A: In case of loss, a new membership card can be requested by sending an e-mail to [email protected].

Q: If a Plan Member has a membership card, does this mean that (s)he is covered? A: Not necessarily. The membership card does not contain validity of Plan coverage information and Vanbreda International does not ask the Plan Member to return the card at the end of the eligibility period. The back of the card clearly states that the card is not a proof of coverage. Q: When does a Plan Member have to use his/her membership card? A: A Plan Member can contact Vanbreda International by using the contact information mentioned on the card. A medical service provider e.g. hospital can contact Vanbreda International by using the contact data and ask Vanbreda International for a Guarantee of Payment. Finally, the card contains a Plan Member’s membership number (also called personal reference number). This is his/her unique identification with Vanbreda International. For a smooth service, we advise the Plan Member to use this number in all his/her communication with Vanbreda International.


2.8.2. Distribution of membership cards Based on the eligibility information we receive from the declaring agencies, Vanbreda International provides membership cards for new members on a weekly basis. Before distributing these cards, Vanbreda International sends a welcome e-mail to the staff member including his/her personal reference number and guidelines on how to access the UN dedicated website for more information about the Plan. The staff member is asked to either confirm or correct his/her address. If no answer is received within four days, the membership cards will be sent to the initial address. Note For countries located in DPKO, Vanbreda International receives updated eligibility information from the UN Insurance Section in NY. Where possible, their membership cards are sent to the duty station. Vanbreda International’s contact persons at the duty station then deliver the cards to the staff members, retirees and dependants.

2.9. Information about the UN WWP Plan information is available in the Plan brochure and on a UN WWP dedicated website which is updated on a regular basis.

2.9.1. Brochure Vanbreda International sends a brochure to every new Plan Member of the UN WWP. The brochure contains information about the membership card, the submission and reimbursement of claims, the dedicated website as well as contact details.

2.9.2. Website The Plan Member can access the dedicated website via ‘Member Access’ on www.vanbreda-international.com. The Plan Member will be requested to fill in his/her personal reference number and date of birth (dd/mm/yyyy). Plan Members’ dependants should also use the date of birth of the staff member to access the site and not their own date of birth. All information regarding the UN WWP is gathered on the dedicated website. Basically, everything Plan Members need to know is easily available in one place that is accessible at any time from anywhere in the world, in 3 languages: English, French and Spanish. The web visitor can select the language of his/her preference at the bottom of the page.



This dedicated website also offers online services: Plan Members can search our worldwide medical service provider network for a particular provider, download forms and consult their settlement details. The website includes several sections which can be accessed via the menu at the top of the page..Each section deals with a specific subject, subdivided in several chapters. Each chapter can be accessed via the menu in the left column of the page. Through the search function visitors can look up a specific topic or word in the page that is being consulted or throughout the whole site. The following information is provided in the different sections: • Cover

This section includes detailed information on the Plan’s coverage and eligibility, frequently asked questions, a list of toll-free telephone lines as well as a copy of the latest UN information circular.

• Direct payment

This section explains the concept of direct payment and how it applies. • Claims

This section includes information on how to submit claims, which forms and supporting documentation to use, the settlement and reimbursement of claims, and how to subscribe to the online settlement details service.

• Provider List

This section includes a 3-step process to search a medical service provider in Vanbreda International’s network.

• Information on chronic diseases and possibility to contact our Medical Consultant

We help raise awareness about the risk of developing serious or chronic diseases like diabetes, cardiovascular disorders or cancer. Plan Members that need personal advice are encouraged to contact our Medical Consultant.

• Contacts The contacts section, accessible via the menu at the bottom of the page, includes all relevant contact information.

• My Pages This section contains all our online services, categorised in 3 subdivisions:

- Downloads

Forms are available in English, English/Spanish and French/Arabic and can be downloaded from the website. There are specific forms for Asia (to be sent to the Kuala Lumpur office) and the rest of the world. When a form is downloaded from the website, the name and personal reference number are filled in automatically and a corresponding barcode is printed on the form allowing Vanbreda International to easily process the claim.


- Settlement Details Online Whenever a claim is settled, the Plan Member receives a settlement note with settlement and payment details. Plan Members can choose to have these settlements available online instead of a paper copy. To this end, they have to subscribe to the Settlement Details Online service via the UN WWP dedicated website. The registration form can be found in the My Pages section under Settlements. The Plan Member has to provide his/her e-mail address. (S)he can also choose the language in which (s)he wants to consult the settlement details. After submitting the registration form, the Plan Member will receive an initial password via e-mail that (s)he has to use to access this service. (S)he will be asked to change this password at his/her first visit. Whenever a claim is processed, the Plan Member will receive an e-mail notification. The settlement details online service offers many advantages: 24/7 accessibility from anywhere in the world You can check your settlement details 24 hours a day, 7 days a week from anywhere in the world. Notification by e-mail We will notify you every time new settlement information becomes available. Faster availability Settlement information is available online immediately after your claim has been processed. Search and print functionality You can use a filter functionality to consult settlements by date, by family member or by payee in the online archive. If you still prefer to have a hard copy of your settlement details, you can simply click the printing function. Online archive Vanbreda International archives all reimbursement information for you. Contribution to a better environment You will be contributing to a better environment because we will not need to send your settlement statements by mail.

- My Profile

In this section you can change your e-mail address and your password.


2.10. Forms to be used by Plan Members There are four forms: the Claim form, the Cost Estimate form, the Notification of Accident form, the Application or request for change of coverage form. These forms can be found and downloaded via the ‘Downloads’ section on the website. The forms are specifically developed for the UN WWP and should only be used by UN WWP members. For staff members or retirees who do not have an easy internet access, an electronic pdf-version of the forms will be sent to every duty station. The HR/Operations department can use these electronic versions to distribute the forms.

2.10.1. Claim form The Plan Member has to use the Claim form to submit a medical claim to Vanbreda International for reimbursement. A separate form should be completed for every Plan Member for who bills are submitted. Every Claim form should contain the Plan Member’s personal reference number and should be signed by him/her. The Claim form should be submitted together with any useful supporting documentation allowing Vanbreda International to assess the claim, apply the right level of coverage and calculate the amount to be reimbursed.

2.10.2. Cost Estimate form The Plan Member has to use the Cost Estimate form when (s)he would like Vanbreda International to pay the bill directly to the medical service provider (see also Direct Payment). This form is very important to properly arrange for direct payment from the medical service provider to Vanbreda International. It should be completed by the treating physician and/or hospital and/or Plan Member. Based on the information provided in this form, Vanbreda International can determine the level of coverage that needs to be applied and what will be reimbursed. It also allows us to inform the medical service provider of the invoice details and the amount that will be paid by Vanbreda International.

2.10.3. Application or request for change of coverage form The Application or request for change of coverage form can be used to enrol a staff member and/or his dependants.

2.10.4. Notification of Accident form The Plan Member has to use the Notification of Accident form only when medical costs are incurred for injuries resulting from an accident involving a third party. When a Plan Member is involved in such an accident and is injured, (s)he should provide as much information as possible about the accident and other involved parties. With this information, Vanbreda International can try to recover some of the costs from the liable third party.


3. MEDICAL CLAIMS PROCEDURE

3.1. Submitting a claim In order to obtain reimbursement for medical costs, a Claim form should be submitted to Vanbreda International. We recommend that Plan Members use the electronic Claim forms available on the UN WWP dedicated website as these are customised for their personal use. If a Plan Member submits claims for different family members, (s) he will have to use a form for every person for who a claim is submitted. E.g. when a Plan Member wants to claim a reimbursement for doctors’ bills for himself and two of his children, three separate Claim forms need to be filled in and submitted. It is very important that the Plan Member: • provides his/her personal reference number. This is automatically filled in if the Claim form is downloaded

from the website; • encloses original settled invoices and prescriptions with each Claim form; • signs the Claim form.

Q: What if a Plan Member did not receive an invoice from his/her doctor? A: A claim can only be settled if an original invoice is provided to Vanbreda International. The Plan Member should ask his/her doctor for an invoice.

Q: How can a Plan Member provide a prescription if (s)he needs to take a certain medication for a long period? A: If the Plan Member has only one prescription for a longer treatment, it is sufficient to attach this prescription to the first claim. The prescription details will be stored in our claims system and will be checked for every new claim submission. The Plan Member can send the Claim form to the Medical Claims Center at Vanbreda International at his/her own expense by mail – the address to be used is mentioned on the Claim form – or (s)he can do this via the duty station who organises an express courier or pouch delivery to Vanbreda International. Many duty stations have a postbox at the disposal of Plan Members in which they can deposit their claims. The HR/Operations department will then assemble all claims and send them to Vanbreda International at regular times, depending on the volume. It is up to the duty station to decide this and the cost of the express delivery is at the expense of the duty station.

3.2. Claims reimbursement

Submitted claims are handled by a client dedicated team at the Medical Claims Center. Claims will be settled within 5 working days on average. When processing a claim, the Claims Analyst will first check whether the Plan Member is still eligible. If this is not the case, the documents will be returned to the Plan Member.


Q: What if a new staff member submits a claim and the new eligibility information has not yet been sent to Vanbreda International? A: Based on the Plan Member’s contact details on the Claim form, Vanbreda International will contact him/her or the duty station to check the Plan Member’s eligibility.

Consequently, based on country specific information, the medical bill will be checked to see whether the cost is ‘reasonable and customary’ and meets local billing practices. This is an important step to detect and prevent fraud. After these checks, the amount to be reimbursed will be automatically calculated by Vanbreda International’s claims system. Depending on the amount of reimbursement, additional controls will be performed. Once approved, the payment of the reimbursed amount will be processed automatically and a letter including the settlement details will be sent to the Plan Member who submitted the claim. If necessary, additional information will be requested in this letter and/or an explanation will be added why certain costs will not be reimbursed (e.g. because a maximum is achieved for a certain type of costs). If the Plan Member opted for the Settlement Details Online service, (s)he will be notified that new settlement information is available online.

3.3. Payment By default, claims will be reimbursed in USD. Upon request, costs incurred in EUR, can also be reimbursed in EUR. Costs incurred for hospital, medical or dental treatments in other currencies will be converted to USD. USD amounts will be calculated using the UN operational rate of exchange which is in effect on the date that the medical and dental expenses are incurred and, in case of hospital expenses and doctors’ fees incurred during the hospitalisation, on the date that the hospital bill is issued. It should be noted that only one currency per Claim form is allowed and that claims will be reimbursed in USD if no reimbursement currency is indicated or if the data needed to make the payment in EUR are insufficient.

Q: What funds does Vanbreda International use to reimburse Plan Members? A: Vanbreda International collects the premiums from the participating agencies. These funds are used to make reimbursements to Plan Members. Q: How long does it take to process a claim? A: The speed of handling claims is measured by the turn-around-time. This is the number of days between the moment the claim arrives at Vanbreda International and the moment the payment is made and the settlement details are sent out. It has been agreed with the UN Insurance Section that claims will be handled within 5 days on average.


Q: How long will it take before I receive the payment on my account after I submitted the claim? A: The claims processing consists of several steps. It takes a certain time for a claim to arrive at Vanbreda International, depending on the speed of the mail service. Secondly Vanbreda International needs a number of days to handle the claim. Finally the payment takes another few days to arrive at the beneficiary’s account. In any case, the payment transfer is the most time consuming process in the claims handling cycle. Q: Can I request to be paid by cheque? Can I request to be paid in EUR? A: Yes, this is not a problem. On the Claim form, the Plan Member can indicate the preferred payment method (cheque or bank transfer) and currency (USD or EUR). Reimbursements in EUR are only possible if expenses have been paid in EUR.


4. PROVIDER NETWORK, SAVINGS AND DIRECT PAYMENT

4.1. Provider Network and Savings Vanbreda International has established its proprietary network of Medical Providers, which means that, in principle, we do not subcontract or lease networks of other companies. We have agreements and working relationships with thousands of medical service providers all over the world. The agreements with Medical Providers in our network concern the Direct Payment of hospital bills. Today, almost 80% of all admissions worldwide (+ 30,000 per year) are settled directly with the Medical Provider, whether direct payment was requested or not. Client-specific reporting by country can be provided. In addition, Vanbreda International negotiates the fees and rates which will apply for Plan Members serviced by Vanbreda International with all Medical Providers. The Plan Member can consult the list of medical service providers on the UN WWP dedicated website, under the ‘Provider list’ section. Detailed information is provided for every medical service provider in the Vanbreda International network. They can be searched per country, city and specialty. All but a few medical service providers in the network accept direct payment, meaning that the costs covered by the Plan will be billed to Vanbreda International directly. The Plan Member will only need to pay his/her own share of the cost. If a Plan Member cannot find a specific medical service provider, (s)he can send an e-mail to [email protected] asking Vanbreda International to contact that provider in order to conclude a network / direct payment agreement. This allows Vanbreda International to continuously expand its medical service provider network. Based on input from clients, Plan Members and our own research, we sign agreements with and add new medical service providers to our provider database on an ongoing basis. Therefore it is useful to regularly check the provider list on the website.

Q: What does a provider agreement with Vanbreda International entail? A: By signing an agreement, a medical service provider becomes part of the Vanbreda International network. The provider knows Vanbreda International and its procedures and agrees to send its medical bills directly to Vanbreda International for payment. In addition, specific fee arrangements can be part of the agreement.

4.2. Direct payment Direct payment means that the patient does not have to advance the full medical bill and submit a claim for reimbursement afterwards. Direct payment is valid for the costs covered by the UN WWP. The Plan Member has to take the initiative to use the direct payment procedure as (s)he needs to ask the medical service provider to send the medical bill directly to Vanbreda International. Since the amount covered by the UN WWP can vary over time (e.g. after a previous treatment, a certain maximum could have been reached), it is important that the Plan Member asks the medical service provider to complete the Cost Estimate form when (s)he would like the medical provider to send the medical bill directly to


Vanbreda International. Alternatively, the Plan Member can provide the following information to Vanbreda International: • contact details of the medical service provider (name, address, telephone number, fax number, e-mail

address); • diagnosis / reason for admission; • planned treatment; • planned admission date and expected length of stay; • a detailed estimate of the charges (both hospital charges and doctors’ fees).

The Cost Estimate form will allow Vanbreda International to provide as much information as possible on what is covered by the UN WWP and what will be at the expense of the Plan Member. If the Plan Member is unable to provide this information, Vanbreda International will contact the medical service provider on behalf of the Plan Member as soon as we have been informed about the planned admission. As soon as the level of coverage has been determined, Vanbreda International will send a Guarantee of Payment to the medical service provider so the provider can send its invoices directly to Vanbreda International for settlement. In addition, we will send a copy of this guarantee to the Plan Member to inform him/her in advance of the available benefits and his/her share of the cost. Costs made for personal comfort as well as charges exceeding ‘reasonable and customary’ limits will always be at the expense of the Plan Member. It could occur that the medical service provider will ask the Plan Member for a deposit or a guarantee cheque to be sure that expenses that are not covered by the Plan will be paid. The direct payment procedure does not apply to outpatient treatment. This type of treatment will always have to be settled by the patient first and be claimed afterwards. Exceptions can be made in case of expensive outpatient treatment, e.g. if a patient needs to receive a chemotherapy treatment requiring many subsequent treatments at a high cost per treatment, Vanbreda International will be happy to arrange for direct payment with the hospital.

Q: Is there a prior notification rule for hospital admissions? A: Contacting Vanbreda International and obtaining prior approval before a non-emergency hospital admission is required and beneficiary for the Plan Members as they can benefit from our preferential rates. Tip: In case of emergency, patients should show their Vanbreda International membership card to the medical service provider upon admission. If the provider is familiar with Vanbreda International (in many cases they are), they will contact us immediately. Q: Will the Plan Member need to pay the hospital bill in case of an emergency hospitalisation if Vanbreda International has a direct payment agreement with the hospital? A: When a patient is admitted to a hospital and shows his/her membership card, the hospital will contact Vanbreda International using the contact information on the card. The hospital can contact us 24/7/365. Vanbreda International will then send a Guarantee of Payment to the hospital mentioning the level of coverage provided by the Plan. The hospital will charge the Plan Member for what is not covered by the UN WWP. In some countries the Plan Member will need to pay this portion upon dismissal from the hospital; in other countries the hospital will send an invoice to the Plan Member afterwards.


Q: If Vanbreda International has a direct payment agreement with a hospital or clinic, can a Plan Member choose to pay 100% for a hospitalisation or emergency and then submit the claim to Vanbreda International for reimbursement? A: Yes, as it is up to the Plan Member to take the initiative to benefit from direct payment, (s)he can decide to pay the total bill first and claim a reimbursement with Vanbreda International afterwards. Q: Can a Plan Member pay her/his part (patient portion) of an ambulatory treatment only if a physician works and receives patients in a hospital or clinic with who Vanbreda International concluded a direct payment agreement? A: This depends on the agreement or contract the physician has with the hospital. In many countries the patient can contact a physician directly or be referred to the physician by the hospital. In most cases, when the patient makes an appointment with the physician directly, the direct payment agreement we have with the hospital will not be applicable; even when the bill might be issued by the hospital. In this case the hospital only acts as a billing agency. Therefore we advice the patient, in case (s)he wants to make an appointment with a certain physician, to do this through the hospital. The advantage is that not only direct payment will apply, but also that the cost of the consultation will probably be smaller, due to agreements between the hospital and the physicians. Q: If a Plan Member travelling outside his/her home country requires emergency treatment or hospitalisation, will (s)he be able to use the membership card in a clinic or hospital of that country with who Vanbreda International has a direct payment agreement? Will this avoid that the staff member pays directly to the hospital or clinic? A: Any Plan Member who has an membership card and is still covered by the UN WWP can benefit from the direct payment agreements we have with hospitals worldwide. The hospital however has the right to ask the patient to pay for the part of the costs that is not covered by the Plan. Q: Why is there no direct payment procedure for outpatient expenses? A: Direct payment is not applied for outpatient expenses (e.g. pharmacies). The most important reason for this is that outpatient treatment costs are not covered at 100%. This means that the medical service provider would have to obtain payment from two parties. Most medical service providers do not want to set up this type of complex agreement. Q: How long will it take before the hospital receives a Guarantee of Payment? A: Vanbreda International’s Contact Center can be reached 24/7/365 and in urgent cases, it can issue a Guarantee of Payment within maximum 2 hours. The Contact Center has access to all information needed to issue this guarantee. For planned admissions, we advise that the Plan Member sends us a notice at least 5 days prior to the admission. This allows Vanbreda International and the hospital to apply all necessary procedures. Q: Can direct payment only be applied to hospitals with which Vanbreda International signed an agreement? A: No, Vanbreda International will perform direct payment to any hospital in the world. It is important that the Plan Member him/herself asks the hospital to get in contact with Vanbreda International. The Guarantee of Payment, regardless of whether a hospital is part of the Vanbreda International network or not, will ask the hospital to send the bills directly to Vanbreda International.


5. Q & A With this manual we tried to answer as many questions as possible. If you have additional questions, please have a look on the UN dedicated website which offers a FAQ chapter in the section Cover and Forms. For any other question, feel free to contact us via [email protected]. We will answer them as quickly as possible.


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