Paid Claims 22-23.xls

This is a paid claims summary report for health insurance policies covering the American Embassy and American Embassy USAID from November 1, 2022 through October 31, 2023. The report details claims data across eight policy numbers (4031201001, 4031201002, 4031201003, 4031202001, 4031202002, 4031203001, 4031203002, and 4031204001-004) with claims denominated in Egyptian Pounds (EGP).

The report aggregates claims across multiple benefit categories including outpatient services (examinations, investigations, medicine, physiotherapy, surgeries, and doctor visits), inpatient services (anesthetist, intensive care, investigations, room and board, medicine, surgeries, treatments, and doctor visits), dental services (crowns, extractions, fillings, gum treatments, endodontics, examinations, and x-rays), maternity benefits (abortion, complications, normal delivery, and caesarian sections), psychiatric services, and other services (vaccinations and additional benefits). Across all policies, total claimed amounts reached EGP 27.7 billion, with EGP 23.4 billion approved and EGP 21.3 billion ultimately paid after deductibles, co-payments, coinsurance deductions, and denials. The largest claim volumes occurred in outpatient medicine and investigations, while the highest claim counts involved outpatient initial doctor visits. Co-insurance charges totaled approximately EGP 1.76 billion across all policies, indicating significant cost-sharing requirements for beneficiaries.