Appendix_C_(5-_Embassy_Egypt_CS_Claims_Analysis__1MAY2017_through_30APR2018).pdf

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Appendix C (5- Embassy Egypt CS Claims Analysis__1MAY2017 through 30APR2018)

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Appendix_D_(Cairo_ORE_Staff).xlsx XLSX spreadsheet
Appendix_A_(Questions_and_Answers).docx DOCX document
Appendix_C_(1-_Embassy_Egypt_CS_Claims_Analysis__1MAY2013_through_30APR2014).pdf PDF
Appendix_D_(Cairo_USAID_Employees_and_Dependents_Data).xls XLS spreadsheet
Appendix_D_(Cairo_AECWA_Staff).xlsx XLSX spreadsheet
Appendix_E_(Past_Requirements).pdf PDF
Appendix_D_(Cairo_Dependents_Data).xlsx XLSX spreadsheet
Appendix_C_(4-_Embassy_Egypt_CS_Claims_Analysis__1MAY2016_through_30APR2017).pdf PDF
Appendix_B_(SAM_registration_guide).pdf PDF
Appendix_C_(2-_Embassy_Egypt_CS_Claims_Analysis__1MAY2014_through_30APR2015).pdf PDF
Appendix_D_(Cairo_Employees_Data).xlsx XLSX spreadsheet
Appendix_C_(3-_Embassy_Egypt_CS_Claims_Analysis__1MAY2015_through_30APR2016).pdf PDF
SF30.pdf PDF
Appendix_C_(6-_Embassy_Egypt_CS_Claims_Analysis__11NOV2018_through_30APR2019).pdf PDF
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 : 2017-5-1 to : 2018-4-30

Claims Paid by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total % of Total

0312A 001 AMERICAN EMBASSY 3,189,419 2,536,072 4,142,932 47,190 258,648 132,774 10,307,035 37% 0312B 001 AMERICAN EMBASSY 2,696,001 3,361,357 3,752,305 588,052 366,480 210,843 556 10,975,594 40% 0312C 001 AMERICAN EMBASSY 1,136,717 384,345 722,807 9,991 4,810 3,066 2,261,737 8%

0312D 001 AMERICAN EMBASSY 374,840 129,096 340,567 20,934 8,276 873,713 3%

0312E 001 AMERICAN EMBASSY 285,035 326,311 356,730 32,155 21,950 14,767 1,036,947 4%

0312F 001 AMERICAN EMBASSY 68,558 54,125 119,716 1,000 800 244,199 1%

0312G 001 AMERICAN EMBASSY 99,401 9,890 24,875 1,602 135,769 0%

0312H 001 AMERICAN EMBASSY 10,522 20,611 14,734 546 46,414 0%

0312I 001 AMERICAN EMBASSY USAID 76,554 224,532 278,636 12,532 46,833 17,722 656,810 2% 0312J 001 AMERICAN EMBASSY USAID 472,661 248,937 218,399 11,365 36,699 22,171 1,010,231 4%

0312K 001 AMERICAN EMBASSY 5,136 6,307 415 270 12,128 0%

0312O 001 AMERICAN EMBASSY 199,855 145 200,000 1%

Total 8,609,564 7,300,413 9,978,152 701,285 759,917 410,688 556 27,760,575 100%

Inpatient 31%

Outpatient 26%

Op Medication 36%

Maternity 3%

Dental 3%

Optical 1%

Other Ser...

0%

Inpatient 31%

Outpatient 26%

Op Medication 36%

Maternity 3%

Dental 3%

Optical 1%

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 553,971 9,753,063 10,307,035 37%

0312B 001 AMERICAN EMBASSY 896,252 10,079,342 10,975,594 40%

0312C 001 AMERICAN EMBASSY 340,490 1,921,246 2,261,737 8%

0312D 001 AMERICAN EMBASSY 49,604 824,109 873,713 3%

0312E 001 AMERICAN EMBASSY 58,246 978,701 1,036,947 4%

0312F 001 AMERICAN EMBASSY 1,075 243,124 244,199 1%

0312G 001 AMERICAN EMBASSY 2,194 133,575 135,769 0%

0312H 001 AMERICAN EMBASSY 694 45,720 46,414 0%

0312I 001 AMERICAN EMBASSY USAID 95,037 561,773 656,810 2%

0312J 001 AMERICAN EMBASSY USAID 131,399 878,833 1,010,231 4%

0312K 001 AMERICAN EMBASSY 415 11,713 12,128 0%

0312O 001 AMERICAN EMBASSY 200,000 200,000 1%

Total 2,129,377 25,631,198 27,760,575 100%

CASH

8%

PPO

92%

CASH

8%

PPO

92%

CASH

PPO

User: Maged Hamdy 1 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Cash Claims by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total % of Total

0312A 001 AMERICAN EMBASSY 191,403 91,759 11,026 16,287 191,479 52,017 553,971 26% 0312B 001 AMERICAN EMBASSY 126,125 153,759 32,763 226,088 261,626 95,335 556 896,252 42%

0312C 001 AMERICAN EMBASSY 198,664 125,848 13,573 2,405 340,490 16%

0312D 001 AMERICAN EMBASSY 20,394 2,359 1,061 19,119 6,670 49,604 2%

0312E 001 AMERICAN EMBASSY 1,295 4,320 3,373 19,300 20,733 9,225 58,246 3%

0312F 001 AMERICAN EMBASSY 35 40 1,000 1,075 0%

0312G 001 AMERICAN EMBASSY 304 287 1,602 2,194 0%

0312H 001 AMERICAN EMBASSY 168 526 694 0%

0312I 001 AMERICAN EMBASSY USAID 2,302 16,393 3,014 10,186 45,544 17,599 95,037 4% 0312J 001 AMERICAN EMBASSY USAID 13,412 52,432 5,314 6,810 32,795 20,636 131,399 6%

0312K 001 AMERICAN EMBASSY 415 415 0%

Total 553,596 447,377 70,450 278,672 577,244 201,482 556 2,129,377 100%

Inpatient 26%Outpatient

21%

Op Med...

3%

Maternity 13%

Dental 27%

Optical 9%

Other Ser...

0%

Inpatient 26%Outpatient

21%

Op Med...

3%

Maternity 13%

Dental 27%

Optical 9%

Other Ser...

0%

Op Medication Maternity Dental Optical Other Services

PPO Claims by Benefit Category

Client / Suboffice Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total % of Total

0312A 001 AMERICAN EMBASSY 2,998,016 2,444,313 4,131,906 30,903 67,168 80,756 9,753,063 38% 0312B 001 AMERICAN EMBASSY 2,569,876 3,207,599 3,719,542 361,963 104,854 115,508 0 10,079,342 39% 0312C 001 AMERICAN EMBASSY 938,053 258,497 709,234 9,991 2,404 3,066 1,921,246 7%

0312D 001 AMERICAN EMBASSY 354,445 126,737 339,507 1,815 1,605 824,109 3%

0312E 001 AMERICAN EMBASSY 283,740 321,990 353,358 12,855 1,217 5,542 978,701 4%

0312H 001 AMERICAN EMBASSY 10,522 20,443 14,734 20 45,720 0%

0312I 001 AMERICAN EMBASSY USAID 74,252 208,139 275,622 2,346 1,290 123 561,773 2% 0312J 001 AMERICAN EMBASSY USAID 459,248 196,505 213,085 4,555 3,905 1,535 878,833 3%

0312F 001 AMERICAN EMBASSY 68,558 54,090 119,675 800 243,124 1%

0312G 001 AMERICAN EMBASSY 99,401 9,586 24,588 133,575 1%

0312O 001 AMERICAN EMBASSY 199,855 145 200,000 1%

0312K 001 AMERICAN EMBASSY 5,136 6,307 270 11,713 0%

Total 8,055,968 6,853,036 9,907,702 422,613 182,673 209,206 0 25,631,198 100%

Inpatient 31%

Outpatient 27%

Op Medication 39%

Maternity 2%

Dental 1%

Optical 1%

Inpatient 31%

Outpatient 27%

Op Medication 39%

Maternity 2%

Dental 1%

Optical 1%

Op Medication Maternity Dental Optical Other Services

User: Maged Hamdy 2 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Monthly Claims Paid Amount

Year- Month

Inpatient Outpatient Op Medication

Maternity Dental Optical Other Services

Total

May-2017 684,861 712,284 855,588 60,459 82,676 23,970 2,419,837 Jun-2017 982,408 436,367 535,572 59,535 50,505 9,050 0 2,073,436 Jul-2017 553,029 590,489 778,556 72,266 55,271 12,514 0 2,062,124 Aug-2017 896,068 462,268 900,916 37,665 73,398 16,898 2,387,213 Sep-2017 273,358 563,058 624,995 46,572 33,511 21,844 315 1,563,653 Oct-2017 1,095,106 676,727 899,398 49,812 55,587 64,920 2,841,550 Nov-2017 454,060 620,335 955,536 50,400 60,117 10,313 136 2,150,898 Dec-2017 828,805 641,636 888,172 64,296 69,388 60,274 2,552,572 Jan-2018 602,288 656,983 623,077 41,853 66,697 41,878 2,032,775 Feb-2018 354,876 487,788 972,387 53,286 66,856 31,369 1,966,562 Mar-2018 937,464 826,691 1,037,093 79,922 83,538 55,346 3,020,055 Apr-2018 947,242 625,786 906,862 85,220 62,374 62,311 105 2,689,901 Total 8,609,564 7,300,413 9,978,152 701,285 759,917 410,688 556 27,760,575

400,000

800,000

1,200,000

1,600,000

2,000,000

2,400,000

2,800,000

3,200,000

May-2017 Jun-2017

Jul-2017 Aug-2017

Sep-2017 Oct-2017

Nov-2017 Dec-2017

Jan-2018 Feb-2018

Mar-2018 Apr-2018

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-2017 59 3,218 3,749 84 148 30 Jun-2017 45 1,831 1,896 43 77 13 1 Jul-2017 49 2,394 2,877 84 102 18 1 Aug-2017 68 2,274 3,606 69 128 21 Sep-2017 29 2,478 2,502 59 75 29 1 Oct-2017 83 3,254 3,246 92 123 90 Nov-2017 51 2,877 3,630 54 131 18 3 Dec-2017 79 2,793 3,380 68 136 99 Jan-2018 55 2,712 2,570 78 133 76 Feb-2018 44 2,445 3,755 77 140 50 Mar-2018 66 3,039 3,657 101 188 72 Apr-2018 65 2,643 3,531 76 151 90 1 Total 693 31,958 38,399 885 1,532 606 7

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

May-2017 Jun-2017

Jul-2017 Aug-2017

Sep-2017 Oct-2017

Nov-2017 Dec-2017

Jan-2018 Feb-2018

Mar-2018 Apr-2018

Benefit_Category Inpatient Outpatient Op Medication Maternity Dental Optical Other Services

Year-Month

Cl ai m _c ou nt

User: Maged Hamdy 3 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Claims based on Paid Amount Range

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

<= 250 53,304 72% 5,571,088 20%

251-500 10,287 14% 3,588,702 13%

501-1000 7,084 10% 5,075,146 18%

1001-2500 1,873 3% 2,652,623 10%

2501-5000 453 1% 1,656,722 6%

5001-10000 291 0% 1,980,315 7%

>=10000 259 0% 7,235,979 26%

Total 73,551 100% 27,760,575 100%

Top 10 Daignosis Codes based on Paid Amount

Top 10 Diagnosis Number of Claimant

Paid Amount % to Total

DIABETES MELLITUS (DM) 482 1,862,814 7%

HYPERTENSION 650 1,732,291 6%

LUMBAGO / LOW BACK PAIN 1,318 906,045 3%

DENTAL 1,127 760,597 3%

CHEST PAIN (UNSPECIFIC REASON) 401 679,886 2%

OSTEOARTHRITIS 546 666,861 2%

BRONCHIAL ASTHMA 472 532,805 2%

ISCHEMIC HEART DISEASE (IHD) 154 515,938 2%

RENAL FAILURE, CHRONIC 17 503,355 2%

HIP DISLOCATION - OPEN 2 501,702 2%

Top 10 8,662,295 31%

Others 19,098,281 69%

Summary 27,760,575 100%

User: Maged Hamdy 4 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

1 400,000 1% ARTHROPATHY / ARTHRITIS

ASPRAINS AND STRAINS NKLE / ANKLE & FOOT SPRAIN

DENTAL

HIP DISLOCATION - OPEN

HIP JOINT REPLACEMENT

MUSCLE WEAKNESS (GENERALIZED)

OSTEOARTHRITIS

UPPER RESPIRATORY INFECTION (URTI / URI)

URINARY TRACT INFECTION (UTI)

URINE INCONTINENCE / ENURESIS

2 243,320 1% ABDOMINAL PAIN

ARTHROPATHY / ARTHRITIS

DIABETES MELLITUS (DM)

FATTY LIVER

HEPATIC COMA

HEPATITIS C

JAUNDICE / HYPERBILIRUBINEMIA

LIVER CIRRHOSIS

LIVER TUMOR - MALIGNANT

OSTEOARTHRITIS

OTHER UNSPECIFIED SECONDARY HYPERTENSION

URINARY TRACT INFECTION (UTI)

3 233,771 1% ABDOMINAL PAIN

ABDOMINAL PAIN UNSPECIFIED SITE

ABSCESS / CELLULITIS

ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER

ANAEMIA IRON DEFICIENCY

ANEMIA UNSPECIFIED

ARTHROPATHY / ARTHRITIS

ARTHROPATHY IN BEHCET'S SYNDROME SITE UNSPECIFIED

BEHCET'S SYNDROME

BRONCHITIS, ACUTE

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CEREBROVASCULAR DISEASE ( STROKE )

CHEST PAIN (UNSPECIFIC REASON)

CONJUNCTIVITIS, UNSPECIFIC

COUGH

User: Maged Hamdy 5 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

3 233,771 1% DERMATITIS (& CONTACT) / ECZEMA

DERMATOLOGY /SKIN GENERAL

DERMATOMYCOSIS / SKIN FUNGUS INFECTION

DIABETES MELLITUS (DM)

EDEMA / OEDEMA

EPILEPSY / EPILEPTIC CONVULSIONS / FITS OR SEIZURES

GASTRITIS

GASTROENTERITIS / ENTERITIS OR COLITIS

GOUT / HYPERURICEMIA

HERPES ZOSTER / ZONA

HYPERLIPIDEMIA

HYPERTENSION

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

ISCHEMIC HEART DISEASE (IHD)

JOINT PAIN

KIDNEY / URINARY SYSTEM CONGENITAL ANOMALIES

KNEE PAIN

LUMBAGO / LOW BACK PAIN

MALAISE / FATIGUE

NEURALGIA / NEURITIS

OPTICAL

OSTEOARTHRITIS

OSTEOPOROSIS

PELVIC INFLAMMATORY DISEASE / PELVIC CONGESTION

POLYARTHRITIS

REFLUX ESOPHAGITIS

RENAL COLIC

RENAL FAILURE, CHRONIC

RHEUMATOID ARTHRITIS

SHORTNESS OF BREATH (SOB) / DYSPNEA

SORE THROAT / PHARYNGITIS, ACUTE

SPONDYLOSIS, CERVICAL

TINEA

TONSILLITIS, ACUTE

ULCERATIVE COLITIS

UPPER RESPIRATORY INFECTION (URTI / URI)

URINARY TRACT INFECTION (UTI)

User: Maged Hamdy 6 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

3 233,771 1% VAGINITIS / VULVO-VAGINITIS / VULVITIS

VARICOSE VEINS LEG

VIRAL INFECTION UNSPECIFIC

VITAMIN D DEFICIENCY (RICKETS)

VITAMIN DEFICIENCY -UNSPECIFIC

4 231,299 1% ABDOMINAL PAIN

ANAEMIA IRON DEFICIENCY

ANAEMIA UNSPECIFIC

BREAST MASS / LUMP

BREAST TUMOR - MALIGNANT -FEMALE

BRONCHITIS, ACUTE

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CONJUNCTIVITIS, ACUTE

CONJUNCTIVITIS, UNSPECIFIC

DENTAL EXAMINATION

DIABETES MELLITUS (DM)

FEVER

GASTRITIS

GASTROINTESTINAL HAEMORRHAGE / GI BLEEDING

GLAUCOMA

HALLUCINATIONS

HEADACHE / HEAD PAIN

HEPATITIS

HYPERTENSION

ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS

INTERNAL HEMORRHOIDS WITHOUT MENTION OF COMPLICATION

INTESTINAL PARASITE / WORMS

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

LUMBAGO / LOW BACK PAIN

MALAISE / FATIGUE

NAUSEA WITH VOMITING

NEURALGIA / NEURITIS

POLYDACTYLY OF FINGERS

RENAL COLIC

UNSPECIFIED GASTRITIS AND GASTRODUODENITIS WITHOUT MENTION OF HEMORRHAGE

UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHY

UTERINE LEIOMYOMA / FIBROID UTERUS

User: Maged Hamdy 7 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

4 231,299 1% VOMITING

5 222,316 1% ABDOMINAL PAIN

BREAST TUMOR - MALIGNANT -FEMALE

CONJUNCTIVITIS, ACUTE

DIABETES MELLITUS (DM)

GASTRITIS

HEADACHE / HEAD PAIN

ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

TINNITUS

VAGINITIS / VULVO-VAGINITIS / VULVITIS

6 206,179 1% ABDOMINAL PAIN

ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER

ANAEMIA IRON DEFICIENCY

ANAL / RECTAL FISSURE

ANTERIOR CRUCIATE LIGAMENT TEAR (ACL)

ARTHROPATHY / ARTHRITIS

BACK PAIN

BACTERIAL INFECTION UNSPECIFIED

BLADDER CALCULUS

BRAIN TUMOR - MALIGNANT

BRONCHITIS, ACUTE

BRONCHUS / LUNG TUMOR - MALIGNANT

CARBUNCLE / FURUNCLE

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

CONNECTIVE / SOFT TISSUE TUMOR - MALIGNANT

DIABETES MELLITUS (DM)

GASTRITIS

GOUT / HYPERURICEMIA

HELICOBACTER PYLORI INFECTION

HYPERTENSION

HYPOTHYROIDISM - ACQUIRED

INTERVERTEBRAL DISC

INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY CERVICAL REGION

IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)

JOINT PAIN

User: Maged Hamdy 8 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

6 206,179 1% KIDNEY CALCULUS

KNEE PAIN

LUMBAGO / LOW BACK PAIN

MALAISE / FATIGUE

MYOFASCITIS / MYALGIA

NECK PAIN / CERVICALGIA

NEURALGIA / NEURITIS

OSTEOARTHRITIS

OTHER ACUTE POSTOPERATIVE PAIN

OTHER EARLY COMPLICATIONS OF TRAUMA

OTITIS MEDIA

PAIN IN LIMBS / HAND PAIN / LEG PAIN

PALPITATIONS

PROSTATITIS, ACUTE

RENAL COLIC

RENAL FAILURE, CHRONIC

SORE THROAT / PHARYNGITIS, ACUTE

SWELLING OF LIMB

THYROTOXICOSIS / HYPERTHYROIDISM

TRAUMA DUE TO ANY CAUSE

TUMOR OF UNSPECIFIED SITE

URINARY TRACT INFECTION (UTI)

URTICARIA

VENOUS THROMBOSIS / DEEP VENOUS THROMBOSIS (DVT)

7 200,000 1% CHEST PAIN (UNSPECIFIC REASON)

HYPERTENSION

8 194,352 1% PERIPHERAL VASCULAR DISEASE / ISCHEMIA

9 184,161 1% ABDOMINAL PAIN

ABSCESS / CELLULITIS

ACUTE IRIDOCYCLITIS / IRITIS

ANEMIA UNSPECIFIED

ASPRAINS AND STRAINS NKLE / ANKLE & FOOT SPRAIN

BRONCHITIS, ACUTE

BURN

CATARACT

CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS

CHEST PAIN (UNSPECIFIC REASON)

User: Maged Hamdy 9 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Claimant based on Paid Amount

Top 10 Claimant

Paid Amount % of Total

Major Conditions

9 184,161 1% CHOLESTEREMIA - CHOLESTEROLEMIA - HYPERCHOLESTEROLEMIA

CONJUNCTIVITIS, ACUTE

CONJUNCTIVITIS, UNSPECIFIC

CONTUSION / SKIN HAEMATOMA

DENTAL

DERMATITIS (& CONTACT) / ECZEMA

DERMATOMYCOSIS / SKIN FUNGUS INFECTION

DIABETES MELLITUS (DM)

DIABETIC ULCER (ANY SITE)

DRY EYE

EYELIDS ECTROPION

GASTROENTERITIS / ENTERITIS OR COLITIS

HYPERTENSION

ISCHEMIC HEART DISEASE (IHD)

KERATODERMA (ACQUIRED) / HYPERKERATOSIS / KERATOSIS

LUMBAGO / LOW BACK PAIN

NEURALGIA / NEURITIS

OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE

OPTICAL

OSTEITIS / OSTEOMYELITIS

OTHER CHRONIC ALLERGIC CONJUNCTIVITIS

PAIN IN LIMBS / HAND PAIN / LEG PAIN

PROLIFERATIVE DIABETIC RETINOPATHY

RETINOPATHY UNSPECIFIED

TINEA PEDIS

TRAUMA DUE TO ANY CAUSE

UNSPECIFIED DISORDER OF EYELID

WARTS / VERRUCA

WOUND

10 181,336 1% HIP DISLOCATION - OPEN

Top 10 2,296,735 8%

Others 25,463,840 92%

Summary 27,760,575 100%

User: Maged Hamdy 10 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

Top 10 Providers based on Paid Amount

Top 10 Providers Paid Amount Claim_Count % of Total

AS-SALAM INT'L HOSPITAL 4,032,000 1,222 16%

EZABY PHARMACY 3,066,747 6,427 12%

Dr. El Hakim Pharmacy 1,912,040 3,909 8%

Al Nakheel Hospital 1,876,025 876 7%

CLEOPATRA HOSPITAL 1,432,637 586 6%

ANEES & RAMZY PHARMACY 1,221,799 2,812 5%

SAUDI GERMAN HOSPITAL 955,458 393 4%

DR. KAMAL HUSSIEN PHARMACY 895,809 1,624 4%

AL SALAM HOSPITAL 672,104 475 3%

ROUSHDY PHARMACIES 532,279 1,986 2%

Top 10 16,596,899 65%

User: Maged Hamdy 11 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

001 AMERICAN EMBASSY

Top 10 Providers Paid Amount % of Total

AS-SALAM INT'L HOSPITAL 3,726,090 15%

EZABY PHARMACY 2,995,107 12%

Dr. El Hakim Pharmacy 1,906,203 8%

Al Nakheel Hospital 1,841,672 8%

CLEOPATRA HOSPITAL 1,398,844 6%

SAUDI GERMAN HOSPITAL 951,178 4%

ANEES & RAMZY PHARMACY 933,248 4%

DR. KAMAL HUSSIEN PHARMACY 890,513 4%

AL SALAM HOSPITAL 646,266 3%

ROUSHDY PHARMACIES 486,569 2%

Top 10 15,775,691 65%

Others 8,414,901 35%

001 AMERICAN EMBASSY 24,190,593 100%

001 AMERICAN EMBASSY USAID

Top 10 Providers Paid Amount % of Total

AS-SALAM INT'L HOSPITAL 305,910 21%

ANEES & RAMZY PHARMACY 288,551 20%

AL SHOROUK HOSPITAL 150,748 10%

NOZHA INTERNATIONAL HOSPITAL 88,020 6%

EZABY PHARMACY 71,640 5%

ALFA SCAN 52,951 4%

Alfa Lab 51,334 4%

International Medical Center 45,983 3%

ROUSHDY PHARMACIES 45,710 3%

Al Nakheel Hospital 34,354 2%

Top 10 1,135,201 79%

Others 305,404 21%

001 AMERICAN EMBASSY USAID 1,440,605 100%

User: Maged Hamdy 12 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

CASH Claims Detail CASH Claims - Paid Amount Paid Amount america 001 AMERICAN EMBASSY USAID 500

Sub total 500

Country 001 AMERICAN EMBASSY 1,783,198

AMERICAN EMBASSY USAID 225,936

Sub total 2,009,133

Gulf 001 AMERICAN EMBASSY 119,744

Sub total 119,744

Total 2,129,377

CASH Claims - Claim Count Claim_Count america 001 AMERICAN EMBASSY USAID 1

Sub total 1

Country 001 AMERICAN EMBASSY 2,705

AMERICAN EMBASSY USAID 552

Sub total 3,257

Gulf 001 AMERICAN EMBASSY 2

Sub total 2

Total 3,260

PPO Claims Detail PPO Claims - Paid Amount Paid Amount

Country 001 AMERICAN EMBASSY 24,190,593

AMERICAN EMBASSY USAID 1,440,605

Sub total 25,631,198

Total 25,631,198

PPO Claims - Claim Count Claim_Count

Country 001 AMERICAN EMBASSY 73,017

AMERICAN EMBASSY USAID 3,671

Sub Total 76,688

Total 76,688

User: Maged Hamdy 13 of 14 May 5, 2019 4:38:41 PM

Paid date from : 2017-5-1 to : 2018-4-30

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

Employees 5,504,767 3,400,688 4,732,734 66,370 347,172 170,007 14,221,739 51%

Spouse 3,152,836 2,082,676 2,925,255 634,720 217,892 102,661 46 9,116,085 33%

Child 1,320,548 1,817,049 951,574 195 194,854 138,020 511 4,422,751 16%

Total 9,978,152 7,300,413 8,609,564 701,285 759,917 410,688 556 27,760,575 100%

Claims by Age Range Age Range Paid Amount Claim count

Male Female Total Female Male Total

Under 21 2,050,078 1,536,593 3,586,671 9,002 10,464 19,466

21-25 387,215 469,285 856,500 1,581 881 2,462

26-30 259,089 755,145 1,014,235 2,308 924 3,232

31-35 744,218 1,056,989 1,801,207 3,260 2,432 5,692

36-40 1,052,496 1,729,699 2,782,194 4,267 3,702 7,969

41-45 1,577,794 2,253,442 3,831,235 3,999 5,083 9,082

46-50 2,135,133 1,326,120 3,461,253 3,510 4,877 8,387

51-55 2,108,318 1,184,971 3,293,288 2,365 3,806 6,171

56-60 3,708,341 1,350,405 5,058,746 2,535 5,820 8,355

61-65 1,288,957 629,786 1,918,743 534 2,026 2,560

66-69 60,751 8,137 68,888 24 115 139

70 and above 87,614 87,614 36 36

Total 15,460,004 12,300,571 27,760,575 33,385 40,166 73,551

Note: All amounts are in Policy Currency

User: Maged Hamdy 14 of 14 May 5, 2019 4:38:41 PM

File details come from the government source that posted it.