Appendix_C_(3-_Embassy_Egypt_CS_Claims_Analysis__1MAY2015_through_30APR2016).pdf

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Appendix C (3- Embassy Egypt CS Claims Analysis__1MAY2015 through 30APR2016)

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Appendix_D_(Cairo_ORE_Staff).xlsx XLSX spreadsheet
Appendix_A_(Questions_and_Answers).docx DOCX document
Appendix_C_(5-_Embassy_Egypt_CS_Claims_Analysis__1MAY2017_through_30APR2018).pdf PDF
Appendix_C_(1-_Embassy_Egypt_CS_Claims_Analysis__1MAY2013_through_30APR2014).pdf PDF
Appendix_D_(Cairo_USAID_Employees_and_Dependents_Data).xls XLS spreadsheet
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Appendix_B_(SAM_registration_guide).pdf PDF
Appendix_C_(2-_Embassy_Egypt_CS_Claims_Analysis__1MAY2014_through_30APR2015).pdf PDF
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GMC_medical_insurance_Solicitation_19EG3019R0001_Apr_04_2019.pdf PDF
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CS Claims Analysis by Client and Sub office Client code: 0312* Paid date from : 2015-5-1 to : 2016-4-30

Claims Paid by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total % of Total

0312A 001 AMERICAN EMBASSY 1,473,335 1,228,111 2,715,805 46,027 146,579 90,116 5,699,973 38% 0312B 001 AMERICAN EMBASSY 1,983,582 1,918,429 2,219,915 342,679 194,843 129,764 4,032 6,793,245 45%

0312C 001 AMERICAN EMBASSY 211,610 139,490 244,610 1,511 800 598,021 4%

0312D 001 AMERICAN EMBASSY 61,063 127,301 227,990 3,811 13,570 11,085 444,820 3%

0312E 001 AMERICAN EMBASSY 184,664 196,439 260,185 7,439 14,250 16,025 679,002 4%

0312G 001 AMERICAN EMBASSY 11,294 17,413 1,000 800 30,507 0%

0312H 001 AMERICAN EMBASSY 20,851 23,828 19,694 8,433 120 800 73,726 0%

0312I 001 AMERICAN EMBASSY USAID 36,389 79,209 159,159 15,060 33,916 21,887 116 345,736 2% 0312J 001 AMERICAN EMBASSY USAID 77,282 84,212 120,926 12,397 33,739 23,630 2,269 354,456 2%

0312F 001 AMERICAN EMBASSY 7,270 50,861 58,131 0%

0312K 001 AMERICAN EMBASSY 7,222 7,580 654 15,456 0%

0312M 001 A.E.C.W.A 7,930 12,779 20,709 0% 0312N 001 A.E.C.W.A 7,997 4,194 12,191 0% Total 4,048,775 3,838,733 6,061,109 435,848 439,527 295,561 6,418 15,125,971 100%

Inpatient 27%

Outpatient 25%

Op Medication 40%

Maternity 3%

Dental 3%

Optical 2%

Other Ser...

0%

Inpatient 27%

Outpatient 25%

Op Medication 40%

Maternity 3%

Dental 3%

Optical 2%

Other Ser...

0%

PercentagePaid_usd

Inpatient Outpatient Op Medication Maternity Dental Optical Other Services

Cash vs. PPO Claims

Client / Suboffice CASH PPO Total % of Total

0312A 001 AMERICAN EMBASSY 387,096 5,312,877 5,699,973 38%

0312B 001 AMERICAN EMBASSY 667,460 6,125,785 6,793,245 45%

0312C 001 AMERICAN EMBASSY 23,192 574,829 598,021 4%

0312D 001 AMERICAN EMBASSY 31,899 412,921 444,820 3%

0312E 001 AMERICAN EMBASSY 38,921 640,081 679,002 4%

0312G 001 AMERICAN EMBASSY 5,311 25,196 30,507 0%

0312H 001 AMERICAN EMBASSY 2,543 71,183 73,726 0%

0312I 001 AMERICAN EMBASSY USAID 94,012 251,724 345,736 2%

0312J 001 AMERICAN EMBASSY USAID 163,452 191,003 354,456 2%

0312K 001 AMERICAN EMBASSY 1,867 13,589 15,456 0%

0312F 001 AMERICAN EMBASSY 58,131 58,131 0%

0312M 001 A.E.C.W.A 20,709 20,709 0% 0312N 001 A.E.C.W.A 12,191 12,191 0% Total 1,415,752 13,710,219 15,125,971 100%

CASH

9%

PPO

91%

CASH

9%

PPO

91%

CASH

PPO

User: Maged Hamdy 1 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Cash Claims by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total % of Total

0312A 001 AMERICAN EMBASSY 51,565 50,317 15,648 32,872 146,579 90,116 387,096 27% 0312B 001 AMERICAN EMBASSY 124,328 73,462 66,603 74,478 194,843 129,764 3,982 667,460 47%

0312C 001 AMERICAN EMBASSY 2,933 2,127 15,821 1,511 800 23,192 2%

0312D 001 AMERICAN EMBASSY 1,287 2,343 534 3,080 13,570 11,085 31,899 2%

0312E 001 AMERICAN EMBASSY 4,586 538 3,522 14,250 16,025 38,921 3%

0312G 001 AMERICAN EMBASSY 2,645 866 1,000 800 5,311 0%

0312H 001 AMERICAN EMBASSY 1,267 266 90 120 800 2,543 0%

0312I 001 AMERICAN EMBASSY USAID 7,922 20,105 4,653 5,413 33,916 21,887 116 94,012 7% 0312J 001 AMERICAN EMBASSY USAID 66,288 24,018 3,871 9,637 33,739 23,630 2,269 163,452 12%

0312K 001 AMERICAN EMBASSY 1,008 205 654 1,867 0%

Total 255,589 180,876 108,829 129,002 439,527 295,561 6,367 1,415,752 100%

Inpatient 18%

Outpatient 13%

Op Medication 8%

Maternity 9%

Dental 31%

Optical 21%

Other Ser...

0%

Inpatient 18%

Outpatient 13%

Op Medication 8%

Maternity 9%

Dental 31%

Optical 21%

Other Ser...

Op Medication Maternity Dental Optical Other Services

PPO Claims by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication Maternity Other Services Total % of Total

0312A 001 AMERICAN EMBASSY 1,421,770 1,177,794 2,700,157 13,155 5,312,877 39%

0312B 001 AMERICAN EMBASSY 1,859,254 1,844,967 2,153,312 268,201 50 6,125,785 45%

0312C 001 AMERICAN EMBASSY 208,677 137,363 228,789 574,829 4%

0312D 001 AMERICAN EMBASSY 59,776 124,958 227,456 731 412,921 3%

0312E 001 AMERICAN EMBASSY 184,664 191,853 259,647 3,918 640,081 5%

0312H 001 AMERICAN EMBASSY 19,583 23,562 19,605 8,433 71,183 1%

0312I 001 AMERICAN EMBASSY USAID 28,467 59,104 154,505 9,647 251,724 2%

0312J 001 AMERICAN EMBASSY USAID 10,994 60,194 117,055 2,761 191,003 1%

0312F 001 AMERICAN EMBASSY 7,270 50,861 58,131 0%

0312G 001 AMERICAN EMBASSY 8,649 16,547 25,196 0%

0312K 001 AMERICAN EMBASSY 6,214 7,375 13,589 0%

0312M 001 A.E.C.W.A 7,930 12,779 20,709 0% 0312N 001 A.E.C.W.A 7,997 4,194 12,191 0% Total 3,793,186 3,657,856 5,952,280 306,846 50 13,710,219 100%

Inpatient 28%

Outpatient 27%

Op Medication 43%

Maternity 2%

Other Ser...

0%

Inpatient 28%

Outpatient 27%

Op Medication 43%

Maternity 2%

Other Ser...

Op Medication Maternity Other Services

User: Maged Hamdy 2 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Monthly Claims Paid Amount

Year- Month

Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total

May-2015 338,467 303,889 519,080 29,483 35,750 15,750 1,534 1,243,954 Jun-2015 269,456 301,005 566,467 22,446 42,244 11,175 368 1,213,162 Jul-2015 232,692 252,398 356,148 24,307 45,882 22,215 196 933,838 Aug-2015 523,022 338,558 529,328 40,527 35,597 15,107 473 1,482,611 Sep-2015 444,949 323,232 460,880 62,320 38,657 35,264 50 1,365,351 Oct-2015 253,725 331,796 448,856 29,355 23,009 19,155 251 1,106,147 Nov-2015 399,935 271,972 481,829 49,155 35,205 24,940 210 1,263,247 Dec-2015 245,022 370,214 682,039 44,123 47,251 41,000 315 1,429,965 Jan-2016 159,417 301,594 491,777 20,640 31,935 31,395 744 1,037,502 Feb-2016 408,682 353,759 460,685 42,042 35,424 28,965 2,078 1,331,635 Mar-2016 436,294 311,787 544,730 27,989 42,612 38,190 198 1,401,801 Apr-2016 337,114 378,528 519,289 43,461 25,961 12,405 1,316,759 Total 4,048,775 3,838,733 6,061,109 435,848 439,527 295,561 6,418 15,125,971

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

May-2015 Jun-2015

Jul-2015 Aug-2015

Sep-2015 Oct-2015

Nov-2015 Dec-2015

Jan-2016 Feb-2016

Mar-2016 Apr-2016

Benefit_Category Inpatient Outpatient Op Medication Maternity Dental Optical Other Services

Year-Month

Pa id

_u sd

Monthly Claims Count

Year-Month Inpatient Outpatient Op Medication Maternity Dental Optical Other Services May-2015 47 2,019 2,878 103 79 21 6 Jun-2015 48 2,067 2,821 92 81 16 2 Jul-2015 41 1,641 1,841 111 87 32 2 Aug-2015 63 2,203 2,543 110 74 20 1 Sep-2015 36 1,838 1,948 102 84 50 1 Oct-2015 23 1,953 2,159 116 47 28 1 Nov-2015 62 1,823 2,428 107 83 40 1 Dec-2015 48 2,473 3,319 121 99 55 1 Jan-2016 32 2,001 2,556 76 82 43 4 Feb-2016 45 2,521 2,460 98 78 41 4 Mar-2016 52 2,046 2,699 92 89 51 1 Apr-2016 45 2,264 2,698 107 59 18 Total 542 24,849 30,350 1,235 942 415 24

1,000

2,000

3,000

4,000

5,000

6,000

7,000

May-2015 Jun-2015

Jul-2015 Aug-2015

Sep-2015 Oct-2015

Nov-2015 Dec-2015

Jan-2016 Feb-2016

Mar-2016 Apr-2016

Benefit_Category Inpatient Outpatient Op Medication Maternity Dental Optical Other Services

Year-Month

Cl ai m _c ou nt

User: Maged Hamdy 3 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Claims based on Paid Amount Range

Paid Amount Range No.of claims %of total claims Paid Amount % of Total

<= 250 45,686 79% 3,954,420 26%

251-500 6,877 12% 2,419,129 16%

501-1000 3,787 7% 2,673,425 18%

1001-2500 848 1% 1,265,855 8%

2501-5000 268 0% 972,964 6%

5001-10000 182 0% 1,248,130 8%

>=10000 109 0% 2,592,049 17%

Total 57,757 100% 15,125,971 100%

Top 10 Daignosis Codes based on Paid Amount

Top 10 Diagnosis Number of Claimant

Paid Amount % to Total

HYPERTENSION 552 1,203,471 8%

DIABETES MELLITUS (DM) 455 1,032,860 7%

ISCHEMIC HEART DISEASE (IHD) 177 692,393 5%

HYPERLIPIDEMIA 529 531,608 4%

DENTAL 703 437,906 3%

LUMBAGO / LOW BACK PAIN 776 393,197 3%

OSTEOARTHRITIS 415 356,118 2%

BREAST TUMOR - MALIGNANT -FEMALE 18 309,591 2%

BRONCHIAL ASTHMA 367 304,951 2%

HEPATITIS C 50 297,061 2%

Top 10 5,559,156 37%

Others 9,566,815 63%

Summary 15,125,971 100%

User: Maged Hamdy 4 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

1 383,555 3% BRONCHITIS, ACUTE

CEREBROVASCULAR DISEASE ( STROKE )

DIABETES MELLITUS (DM)

DYSURIA

FEVER

SHORTNESS OF BREATH (SOB) / DYSPNEA

UPPER RESPIRATORY INFECTION (URTI / URI)

2 177,366 1% ABDOMINAL PAIN

ANAEMIA IRON DEFICIENCY

ASTHMATIC BRONCHITIS

BRONCHIAL ASTHMA

BRONCHITIS, ACUTE

CHEST PAIN (UNSPECIFIC REASON)

CONSTIPATION

COUGH

DENTAL

DERMATITIS (& CONTACT) / ECZEMA

DRY EYE

ESOPHAGAL REFLUX

GASTRITIS

HEMATURIA

HEPATITIS C

HYPERLIPIDEMIA

HYPERTENSION

INFLAMMATION OF MALE GENITAL ORGANS (SCROTUM, SPERMATIC CORD, TESTIS)

ISCHEMIC HEART DISEASE (IHD)

JOINT PAIN

KIDNEY CALCULUS

LUMBAGO / LOW BACK PAIN

MYOFASCITIS / MYALGIA

NEURALGIA / NEURITIS

NEUROPATHY UNSPECIFIC

PARATHYROID UNSPECIFIC DISEASE / DISORDER

REFLUX ESOPHAGITIS

RENAL COLIC

RENAL FAILURE, CHRONIC

SORE THROAT / PHARYNGITIS, ACUTE

User: Maged Hamdy 5 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

2 177,366 1% TONSILLITIS, ACUTE

URINARY TRACT INFECTION (UTI)

VITAMIN DEFICIENCY -UNSPECIFIC

VOMITING

WARTS / VERRUCA

3 166,672 1% ABDOMINAL PAIN

ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER

BRONCHITIS, ACUTE

CHEST PAIN (UNSPECIFIC REASON)

CONJUNCTIVITIS, ACUTE

DIABETES MELLITUS (DM)

FEVER

GASTRITIS

GASTROENTERITIS / ENTERITIS OR COLITIS

GENERALIZED WEAKNESS

HEADACHE / HEAD PAIN

HELICOBACTER PYLORI INFECTION

HYPERTENSION

HYPOTENSION

ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

LIMBS WEAKNESS / HEMI-AKINESIA

LUMBAGO / LOW BACK PAIN

NEURALGIA / NEURITIS

NEUROPATHY UNSPECIFIC

PAIN IN LIMBS / HAND PAIN / LEG PAIN

PNEUMONIA / PNEUMONITIS

SINUSITIS, CHRONIC

SORE THROAT / PHARYNGITIS, ACUTE

TACHYCARDIA

UPPER RESPIRATORY INFECTION (URTI / URI)

URINARY TRACT INFECTION (UTI)

VERTIGO / DIZZINESS / GIDDINESS

VOMITING

4 150,901 1% BREAST (MALE & FEMALE) TUMOR - BENIGN

BREAST TUMOR - MALIGNANT -FEMALE

BRONCHITIS, ACUTE

User: Maged Hamdy 6 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

4 150,901 1% CHEST PAIN (UNSPECIFIC REASON)

COUGH

DERMATITIS (& CONTACT) / ECZEMA

EDEMA / OEDEMA

GASTRITIS

GENERALIZED WEAKNESS

HYPERTENSION

MITRAL VALVE DISEASE

PELVIC PAIN / LOWER ABDOMINAL PAIN

RHEUMATIC HEART DISEASE

SORE THROAT / PHARYNGITIS, ACUTE

TRAUMA DUE TO ANY CAUSE

WOUND

5 143,868 1% ABDOMINAL PAIN

ABSCESS / CELLULITIS

ANAEMIA UNSPECIFIC

BREAST MASS / LUMP

BREAST TUMOR - MALIGNANT -FEMALE

BRONCHITIS, ACUTE

BRONCHITIS, CHRONIC

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

CONJUNCTIVITIS, ACUTE

COUGH

DERMATITIS (& CONTACT) / ECZEMA

DIABETES MELLITUS (DM)

DRY EYE

GASTRITIS

GASTROENTERITIS / ENTERITIS OR COLITIS

GENERAL SYMPTOMS

GLAUCOMA

HEADACHE / HEAD PAIN

HIP (& THIGH) SPRAIN

HYPERTENSION

HYPOCALCEMIA

ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

User: Maged Hamdy 7 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

5 143,868 1% ISCHEMIC HEART DISEASE (IHD)

LUMBAGO / LOW BACK PAIN

MALAISE / FATIGUE

MASTODYNIA / MASTALGIA / BREAST PAIN

MUMPS

NEURALGIA / NEURITIS

OSTEOARTHRITIS

OVARIAN CYST

OVARIAN TUMOR - MALIGNANT

PELVIC PAIN / LOWER ABDOMINAL PAIN

PERITONEUM TUMOR - MALIGNANT

REFLUX ESOPHAGITIS

THRUSH

TUMOR OF UNSPECIFIED SITE

VOMITING

6 108,968 1% ABDOMINAL PAIN

ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER

ANTERIOR CRUCIATE LIGAMENT TEAR (ACL)

ARTHRALGIA

ARTHROPATHY / ARTHRITIS

ASTHMATIC BRONCHITIS

BRONCHIAL ASTHMA

BRONCHITIS, ACUTE

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

CONJUNCTIVITIS, ACUTE

CONTUSION / SKIN HAEMATOMA

COUGH

DENTAL

DERMATITIS (& CONTACT) / ECZEMA

GASTRITIS

GOUT / HYPERURICEMIA

HEADACHE / HEAD PAIN

HEPATITIS C

HYPERTENSION

INFLAMMATION OF MALE GENITAL ORGANS (SCROTUM, SPERMATIC CORD, TESTIS)

User: Maged Hamdy 8 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

6 108,968 1% INJURY

KNEE (& LEG) SPRAIN

KNEE PAIN

LUMBAGO / LOW BACK PAIN

MEDIAL MENISCUS TEAR

NEURALGIA / NEURITIS

OPTICAL

ORCHITIS / EPIDIDYMITIS

OSTEOARTHRITIS

PROSTATITIS, ACUTE

REFLUX ESOPHAGITIS

RENAL CALCULUS, UNSPECIFIC

RENAL COLIC

SHORTNESS OF BREATH (SOB) / DYSPNEA

SHOULDER PAIN

SINUSITIS, ACUTE

SORE THROAT / PHARYNGITIS, ACUTE

TINNITUS

TRAUMA DUE TO ANY CAUSE

UPPER RESPIRATORY INFECTION (URTI / URI)

VARICOSE VEINS LEG

VOMITING

WOUND

7 107,638 1% ANGINA PECTORIS

ARTHROPATHY / ARTHRITIS

ASTHMATIC BRONCHITIS

BRONCHITIS, ACUTE

CEREBROVASCULAR DISEASE ( STROKE )

CHEST PAIN (UNSPECIFIC REASON)

DIABETES MELLITUS (DM)

DIABETES WITH KETOACIDOSIS

GLAUCOMA

HEADACHE / HEAD PAIN

HYPERTENSION

ISCHEMIC HEART DISEASE (IHD)

LUMBAGO / LOW BACK PAIN

NEURALGIA / NEURITIS

User: Maged Hamdy 9 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

7 107,638 1% PERIPHERAL VASCULAR DISEASE / ISCHEMIA

PLEURISY / PLURAL EFFUSION

SHORTNESS OF BREATH (SOB) / DYSPNEA

TRANSIENT CEREBRAL ISCHEMIA (TIA)

UPPER RESPIRATORY INFECTION (URTI / URI)

VERTIGO / DIZZINESS / GIDDINESS

8 106,007 1% ALLERGY

ANAEMIA IRON DEFICIENCY

ANAEMIA UNSPECIFIC

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

DIABETES MELLITUS (DM)

EDEMA / OEDEMA

ESOPHAGAL REFLUX

ESOPHAGITIS

GASTRITIS

HEPATITIS C

HYPERTENSION

PAIN IN LIMBS / HAND PAIN / LEG PAIN

PULMONARY EMBOLISM

REFLUX ESOPHAGITIS

RENAL FAILURE, CHRONIC

SHOULDER AND ARM INJURY

TRAUMA DUE TO ANY CAUSE

VARICOSE VEINS LEG

VENOUS THROMBOSIS / DEEP VENOUS THROMBOSIS (DVT)

WOUND

9 98,812 1% ABDOMINAL PAIN

ALLERGY

ANAEMIA IRON DEFICIENCY

ANAEMIA UNSPECIFIC

BRONCHIAL ASTHMA

BRONCHITIS, ACUTE

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

CONSTIPATION

CONTUSION / SKIN HAEMATOMA

User: Maged Hamdy 10 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

9 98,812 1% EPILEPSY / EPILEPTIC CONVULSIONS / FITS OR SEIZURES

ESOPHAGAL REFLUX

HERNIA, UMBILICAL

ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS

OSTEOCHONDROSIS

POLYARTHRITIS

REFLUX ESOPHAGITIS

RENAL FAILURE UNSPECIFIC

RENAL FAILURE, CHRONIC

RHEUMATIC HEART DISEASE

10 91,853 1% ARTHROPATHY / ARTHRITIS

BACK PAIN

BRONCHITIS, ACUTE

CARDIAC / HEART DISEASE UNSPECIFIC

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

CORONARY ARTERY DISEASE (CAD)/ CORONARY INSUFFICIENCY

EPILEPSY / EPILEPTIC CONVULSIONS / FITS OR SEIZURES

GASTRITIS

HYPERLIPIDEMIA

HYPERTENSION

IMPACTED CERUMEN /EAR WAX

ISCHEMIC HEART DISEASE (IHD)

KNEE PAIN

LUMBAGO / LOW BACK PAIN

MEDIAL MENISCUS TEAR

NECK PAIN / CERVICALGIA

NEURALGIA / NEURITIS

OSTEOARTHRITIS

SHORTNESS OF BREATH (SOB) / DYSPNEA

SHOULDER / ARM SPRAIN

TRAUMA DUE TO ANY CAUSE

Top 10 1,535,641 10%

Others 13,590,330 90%

Summary 15,125,971 100%

User: Maged Hamdy 11 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Providers based on Paid Amount

Top 10 Providers Paid Amount Claim_Count % of Total

EZABY PHARMACY 2,316,283 5,248 17%

AS-SALAM INT'L HOSPITAL 2,015,765 844 15%

Dr. El Hakim Pharmacy 1,119,783 2,367 8%

Al Nakheel Hospital 797,724 563 6%

CAIRO MEDICAL CENTRER 792,688 295 6%

CLEOPATRA HOSPITAL 750,033 449 5%

ANEES & RAMZY PHARMACY 622,789 1,681 5%

AL SALAM HOSPITAL 550,584 452 4%

DR. KAMAL HUSSIEN PHARMACY 522,747 1,138 4%

ALFA SCAN 242,594 101 2%

Top 10 9,730,989 71%

User: Maged Hamdy 12 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

001 A.E.C.W.A Top 10 Providers Paid Amount % of Total

EZABY PHARMACY 13,104 40%

Al Nakheel Hospital 5,225 16%

AL SALAM HOSPITAL 2,393 7%

CLEOPATRA HOSPITAL 2,121 6%

Dr. El Hakim Pharmacy 1,525 5%

AL AMAL HOSPITAL 900 3%

Mostafa Ateya Soliman 840 3%

SEIF PHARMACY 718 2%

MOHAMED A.HAKIM ABOU SHADY 640 2%

CAIRO SCAN 630 2%

Top 10 28,096 85%

Others 4,804 15%

001 A.E.C.W.A 32,900 100%

001 AMERICAN EMBASSY

Top 10 Providers Paid Amount % of Total

EZABY PHARMACY 2,234,296 17%

AS-SALAM INT'L HOSPITAL 1,990,554 15%

Dr. El Hakim Pharmacy 1,116,316 8%

CAIRO MEDICAL CENTRER 792,043 6%

Al Nakheel Hospital 781,072 6%

CLEOPATRA HOSPITAL 735,372 6%

AL SALAM HOSPITAL 541,873 4%

DR. KAMAL HUSSIEN PHARMACY 519,178 4%

ANEES & RAMZY PHARMACY 462,858 3%

ALFA SCAN 224,518 2%

Top 10 9,398,081 71%

Others 3,836,511 29%

001 AMERICAN EMBASSY 13,234,592 100%

001 AMERICAN EMBASSY USAID

Top 10 Providers Paid Amount % of Total

ANEES & RAMZY PHARMACY 159,481 36%

EZABY PHARMACY 68,883 16%

AS-SALAM INT'L HOSPITAL 25,011 6%

ALFA SCAN 17,814 4%

ROUSHDY PHARMACIES 15,741 4%

Al Hayat Medical Center 14,777 3%

User: Maged Hamdy 13 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Top 10 Providers Paid Amount % of Total

CLEOPATRA HOSPITAL 12,539 3%

Eye Subspeciality Center 11,810 3%

DAR AL FOUAD HOSPITAL 11,801 3%

Al Nakheel Hospital 11,427 3%

Top 10 349,284 79%

Others 93,444 21%

001 AMERICAN EMBASSY USAID 442,727 100%

User: Maged Hamdy 14 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

CASH Claims Detail CASH Claims - Paid Amount Paid Amount america 001 AMERICAN EMBASSY 8,095

AMERICAN EMBASSY USAID 1,027

Sub total 9,122 asia 001 AMERICAN EMBASSY 1,642

Sub total 1,642

Country 001 AMERICAN EMBASSY 1,144,051

AMERICAN EMBASSY USAID 256,437

Sub total 1,400,488

001 AMERICAN EMBASSY 4,501

Sub total 4,501

Total 1,415,752

CASH Claims - Claim Count Claim_Count america 001 AMERICAN EMBASSY 5

AMERICAN EMBASSY USAID 2

Sub total 7 asia 001 AMERICAN EMBASSY 2

Sub total 2

Country 001 AMERICAN EMBASSY 2,903

AMERICAN EMBASSY USAID 573

Sub total 3,476

001 AMERICAN EMBASSY 8

Sub total 8

Total 3,493

PPO Claims Detail PPO Claims - Paid Amount Paid Amount

Country 001 A.E.C.W.A 32,900

AMERICAN EMBASSY 13,234,592

AMERICAN EMBASSY USAID 442,727

Sub total 13,710,219

Total 13,710,219

PPO Claims - Claim Count Claim_Count

Country 001 A.E.C.W.A 223

AMERICAN EMBASSY 56,530

AMERICAN EMBASSY USAID 2,185

Sub Total 58,938

User: Maged Hamdy 15 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

CASH Claims Detail

PPO Claims Detail

PPO Claims - Claim Count Claim_Count

Total 58,938

User: Maged Hamdy 16 of 17 May 5, 2019 6:09:39 PM

Paid date from : 2015-5-1 to : 2016-4-30

Claims by Insured Type Insured Op Medication Outpatient Inpatient Maternity Dental Optical Other Services Total % of Total

Employees 3,490,832 1,683,347 1,778,182 65,314 203,605 130,317 116 7,351,714 49%

Spouse 1,807,848 1,263,020 1,623,321 368,719 130,405 77,329 5,270,643 35%

Child 762,428 892,366 647,272 1,815 105,517 87,915 6,301 2,503,615 17%

Total 6,061,109 3,838,733 4,048,775 435,848 439,527 295,561 6,418 15,125,971 100%

Claims by Age Range Age Range Paid Amount Claim count

Male Female Total Female Male Total

Under 21 952,124 804,751 1,756,875 6,670 7,427 14,097

21-25 342,531 318,635 661,165 1,308 826 2,134

26-30 124,560 269,808 394,368 1,230 577 1,807

31-35 243,682 504,563 748,244 2,382 1,371 3,753

36-40 424,983 927,624 1,352,606 3,420 2,391 5,811

41-45 802,174 855,112 1,657,286 2,912 4,016 6,928

46-50 951,474 748,611 1,700,084 2,782 3,594 6,376

51-55 822,234 994,638 1,816,871 2,390 2,828 5,218

56-60 2,248,817 836,862 3,085,679 2,091 5,097 7,188

61-65 1,447,097 391,407 1,838,504 858 3,312 4,170

66-69 46,287 13,605 59,892 73 94 167

70 and above 54,396 54,396 108 108

Total 8,460,356 6,665,615 15,125,971 26,116 31,641 57,757

Note: All amounts are in Policy Currency

User: Maged Hamdy 17 of 17 May 5, 2019 6:09:39 PM

File details come from the government source that posted it.