MEDICAL INSURANCE PLAN MIP UNDP, Monrovia, Liberia September 2005

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MEDICAL INSURANCE PLAN (MIP)UNDP, Monrovia,
LiberiaSeptember 2005
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MEDICAL INSURANCE PLAN (MIP)
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• A plan established in 1987 by the GA to assist
  subscribers and the eligible dependents in
  meeting health related expenses.

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MIP Participants

• National staff contracted for more than three
  months and eligible dependents
  
• Former staff members who separated at the
  minimum age of 55, provided they participated for
  at least five years plus eligible dependents
  

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MIP Participants (contd.)

• Former staff in receipt of a Disability Benefit
• Surviving spouses and children.

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Categories of Coverage

• 1. Subscriber only
• 2. Subscriber plus one eligible dependent
• 3. Subscriber plus two, three, four or five
  dependents
  
• 4. Subscriber plus six or more dependents.

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Premiums

• Both the subscriber and employer contribute to
  the scheme at different ratios.
  
• Category 1 1.10/3.10
• Category 2 1.40/3.90
• Category 3 2.00/7.25
• Category 4 2.50/9.25

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Post January 1 2004

• MIP administration outsourced to GMCS Henner
  Group of Companies
  
• Operates from three locations Paris, Singapore
  and Washington.
  

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Why Outsourced?

• Increased confidentiality
• Control fraud tendencies
• Lack of expertise at CO levels
• Lack of IT system and high cost of developing
  one
  
• High number of salary advances to cater for
  medical costs due to lack of medical network.

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Main Changes

• Subscribers send claims directly to GMCS
• Subscriber and enrolled dependents get ID cards
• Once a claim is screened GMCS advises the
  subscriber electronically an Explanation of
  Benefits
  
• Any hospitalization requires a Prior Agreement
  Form

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Main Changes (contd.)

• Around the clock emergency phone help-line and a
  dedicated website
  
• CO no longer required to screen any claims or
  submit any reports/records to HQ.

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Role of the CO

• To ensure enrolment and change of coverage
• Continue billing and collecting premiums from
  ASHI and SLWOP
  
• Effect payment on receipt of payment order from
  GMCS.
  

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Enrolment/Change of Coverage

• Complete MIP Application/Request for Change Form
  within thirty days
  
• Submit to your Human Resources Associate

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Cessation of Coverage

• Contract termination
• Eligible family members may be withdrawn upon
  written request
  
• Re-entry permitted during Annual MIP campaign
• A child over 25 years of age.

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Reimbursement

• 80 for outpatient
• 100 for admission cases
• Full list of reimbursable and non-reimbursable
  items is normally published annually
  
• Currently available on the GMCS Website.

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Reimbursement Process

• Complete GMCS Refund Claim Form
• Attach original receipts and prescription
• Send to GMCS, Paris.

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Reimbursable Medical Expenses

• Services provided by a qualified physician
• Drugs, medicines, lab tests
• Hospitalization (at least one night)
• Dental Services
• Mental and Nervous care
• Treatment for substance abuse (GMCS prior
  approval)
  
• Corrective Optical lenses (two year waiting
  period)
  
• Hearing aid (one year waiting period)

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Reimbursables (contd.)

• One routine eye exam every two years
• Two VCT per year
• Well child care (routine exams depend on age)
• One Well man care (routine urological exams inc
  PSA) per year
  
• One Well woman care (gynaeocological, pap smear
  and mammography) per year
  

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Non Reimbursables

• Eyeglass frames
• Cosmetic treatments
• Plastic surgery
• Injuries from m/v racing
• Home/family help from unqualified personnel
• Hospital charges for telephone etc.

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Non-Reimbursables (contd.)

• Food and dietary products
• Any charges for services not prescribed or
  approved by a physician.
  
• Full list of reimbursable and non reimbursable
  items published every year and available from
  GMCS website http//www.henner.com/undp/mip
  

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MIP Reference Salary

• Top step of the highest GS level at the duty
  station (G.7 Step X) as at January of each year.
  
• Reference salary determines MIP ceiling/limit for
  one eligible patient in any one calendar year
  

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Hospitalizations/Medical Evacuations

• Ensure Prior Agreement Form is submitted to
  GMCS
  
• Obtain Letter of Guarantee

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Way Forward

• Please make a regular visit to
• http//wwww.henner.com/undp/mip
• for any updates on MIP.

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Thank you for your attention.