45122-1st_Jul_2011_to_30th_Jun_2012-PD_(2).xlsx

XLSX spreadsheet 33 KB Posted Oct 2, 2014

Attached to: Health Insurance Services
Solicitation number: STC10014R0001-1
Issued by: Department of State US Embassy Abu Dhabi

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Claim Reports

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File	Type	Posted
Synopsis_FBO_Award.pdf	PDF	Dec 17, 2014
45122-1st_Jul_2013_to_30th_June_2014-PD.XLSX	XLSX spreadsheet	Oct 2, 2014
Qs_ _As_additional_2.pdf	PDF	Oct 2, 2014
45122-1st_Jul_2012_to_30th_Jun_2013-PD.XLSX	XLSX spreadsheet	Oct 2, 2014
Qs_ _As_additional.pdf	PDF	Sep 30, 2014
SF30_-_Amendment_1.pdf	PDF	Sep 26, 2014
Health_Insurance_Solicitation_REVISED.pdf	PDF	Sep 26, 2014
New_Table_of_Benefits.pdf	PDF	Sep 26, 2014
Existing_Table_of_Benefits__.pdf	PDF	Sep 26, 2014
List_of_Active_Members.xls	XLS spreadsheet	Sep 26, 2014
US_Embassy_LR.PDF	PDF	Sep 26, 2014
Exhibit__A_-_List_of_Health_Insurance_Coverage_REVISED.pdf	PDF	Sep 26, 2014
Meeting_Minutes_STC10014R0001.pdf	PDF	Sep 26, 2014
Qs_ _As.pdf	PDF	Sep 26, 2014
Exhibit_F_-_Employees_Statistics.xls	XLS spreadsheet	Sep 26, 2014
SF33_cover_page.pdf	PDF	Sep 5, 2014
Exhibit_B_-_ORE_Staff_Rider.pdf	PDF	Sep 5, 2014
Cover_Letter.pdf	PDF	Sep 5, 2014
Exhibit_E_-__List_of_Exclusions.pdf	PDF	Sep 5, 2014
Exhibit_C_-_AEEA_Staff_Rider.pdf	PDF	Sep 5, 2014
Exhibit__A_-_List_of_Health_Insurance_Coverage.pdf	PDF	Sep 5, 2014
Exhibit_D_-__MSG_Staff_Rider.pdf	PDF	Sep 5, 2014
Exhibit_F_-_Employees_Statistics.xls	XLS spreadsheet	Sep 5, 2014
Health_Insurance_Solicitation.pdf	PDF	Sep 5, 2014
Synopsis_FBO.pdf	PDF	Aug 21, 2014

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Page1

CS Claims Analysis
	Policy number: 45122-
Paid date
from : 2011-07-01	to : 2012-06-30
Claims Range/USD	No.of claims	Paid Amount
<= 100	3,976	197,224
101-250	1,164	219,971
251-500	317	103,913
501-1000	63	40,908
1001-2500	18	29,047
2501-5000	15	92,737
5001-10000	4	76,178
10001-50000	1	17,677
Total	5,558	777,654

Top 10 Diagnosis	No.of Claimant	Paid Amount
DIABETES MELLITUS (DM)	50	32,223
HYPERTENSION	52	30,512
URINARY TRACT OR KIDNEY TUMOR - MALIGNANT	1	29,731
C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY)	5	26,640
UPPER RESPIRATORY INFECTION (URTI / URI)	192	23,299
HYPERLIPIDEMIA/DISPLIPIDEMIA	60	19,388
BRONCHITIS ACUTE	100	13,286
ANTENATAL CARE / PREGNANCY (MATERNITY)	25	12,584
NORMAL DELIVERY ADMISSION (MATERNITY)	8	12,130
ABDOMINAL PAIN	57	10,038
Top 10		209,829	27.0%
Others		567,825	73.0%
Total		777,654	100.0%

Page2

CS Claims Analysis
	Policy number: 45122-
Paid date
from : 2011-07-01	to : 2012-06-30
Top 10 Claimant	Paid Amount	Major Conditions
1	41,663	C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY)
		ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
		UNSPECIFIED DISORDER KIDNEY&URETER
		URINARY TRACT INFECTION (UTI)
		URINARY TRACT OR KIDNEY TUMOR - MALIGNANT
2	9,260	ANTENATAL CARE / PREGNANCY (MATERNITY)
		C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY)
3	8,904	ANEMIA IRON DEFICIENCY
		ANTENATAL CARE / PREGNANCY (MATERNITY)
		ASTIGMATISM
		BONE AND JOINT DISORDERS OF BACK
		BURN
		C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY)
		CHALAZION / MEIBOMIAN CYST
		CONGENITAL CARDIOVASCULAR DISORDERS IN THE MOTHER CLASSIFIABLE ELSEWHERE
		CONJUNCTIVAL CYSTS
		CONJUNCTIVAL DEGENERATION
		DERMATITIS (& CONTACT) / ECZEMA
		FOLLICULITIS
		GYNE / OBSTETRIC UNSPECIFIC DISORDER / DISEASE
		INTERVERTEBRAL DISC
		NECK PAIN / CERVICALGIA
		PELVIC PAIN / LOWER ABDOMINAL PAIN
		PILONIDAL SINUS WITHOUT ABSCESS
		UNSPECIFIED FOLLOW-UP EXAMINATION
		WHEEZING
4	8,898	ACNE VULGARIS
		BRONCHITIS ACUTE
		CHRONIC PHARYNGITIS
		COLITIS, ENTERITIS, AND GASTROENTERITIS OF PRESUMED INFECTIOUS ORIGIN
		CONJUNCTIVAL DEGENERATION
		DYSFUNCTIONAL UTERINE BLEEDING (DUB)
		GASTRITIS
		GOUT / HYPERURICEMIA
		HERPES (SIMPLEX) / HERPETIC FEVER
		HYPERTENSION
		INFECTIOUS COLITIS ENTERITIS AND GASTROENTERITIS
		INTERVERTEBRAL DISC
		JOINT PAIN
		LARYNGITIS, ACUTE
		LUMBAGO / LOW BACK PAIN
		MEMORY LOSS
		MYOFASCITIS / MYALGIA
		NASAL TURBINATE HYPERTROPHY
		OSTEOARTHRITIS
		OSTEOPOROSIS
		OTHER PHYSICAL THERAPY
		POSTMENOPAUSAL BLEEDING
		ROUTINE EXAMINATION OF SPECIFIC SYSTEM
		SACROILIITIS
		SPONDYLOSIS CERVICAL
		URINARY TRACT INFECTION (UTI)
5	8,675	ABDOMINAL PAIN
		ADHESIVE CAPSULITIS OF SHOULDER/ FROZEN SHOULDER
		ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER
		BACTERIAL INFECTION, UNSPECIFIED
		BRONCHIAL ASTHMA
		BRONCHITIS ACUTE
		CERVICAL POLYP
		CERVICITIS / ENDOCERVICITIS
		COLITIS, ENTERITIS, AND GASTROENTERITIS OF PRESUMED INFECTIOUS ORIGIN
		DEHYDRATION / HYPOVOLEMIA
		DERMATITIS (& CONTACT) / ECZEMA
		DYSFUNCTIONAL UTERINE BLEEDING (DUB)
		EUSTACHIAN TUBE DYSFUNCTION
		GASTRITIS
		HEADACHE / HEAD PAIN
		HYPOTENSION
		IMPETIGO
		INGROWING NAIL
		INTERVERTEBRAL DISC
		LEUKORRHEA / PER VAGINAL DISCHARGE (PVD)
		LIPOID METABOLISM DISORDER
		LUMBAGO / LOW BACK PAIN
		METRORRHAGIA
		MUSCLE WEAKNESS (GENERALIZED)
		NECK MASS / CERVICAL LUMP / PALATE MASS / NOSE MASS
		NECK PAIN / CERVICALGIA
		OTITIS EXTERNA / EXTERNAL EAR ABSCESS
		SINUSITIS ACUTE
		SORE THROAT / PHARYNGITIS ACUTE
		SPONDYLOSIS CERVICAL
		TRACHEITIS
		UNSPECIFIED FOLLOW-UP EXAMINATION
		UNSPECIFIED SYMPTOM ASSOCIATED WITH FEMALE GENITAL ORGANS
		UPPER RESPIRATORY INFECTION (URTI / URI)
		VAGINITIS / VULVO-VAGINITIS / VULVITIS
		VARICOSE VEINS LEG
		VERTIGO / DIZZINESS / GIDDINESS
		VULVO-VAGINAL MONILIASIS
		WARTS / VERRUCA
6	8,441	ABDOMINAL PAIN
		ANEMIA IRON DEFICIENCY
		BREAST FIBROSCLEROSIS
		CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
		DERMATITIS (& CONTACT) / ECZEMA
		DYSFUNCTIONAL UTERINE BLEEDING (DUB)
		DYSPEPSIA / HYPERACIDITY
		ENDOMETRIOSIS
		EPIGASTRIC PAIN
		GASTRITIS
		GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD)
		GYNE / OBSTETRIC UNSPECIFIC DISORDER / DISEASE
		IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
		JOINT PAIN
		OPTICAL
		PELVIC PAIN / LOWER ABDOMINAL PAIN
		REFLUX ESOPHAGITIS
		SPRAINS AND STRAINS ANKLE / ANKLE & FOOT SPRAIN OR INJURY
		UTERINE LEIOMYOMA / FIBROID UTERUS
		VAGINITIS / VULVO-VAGINITIS / VULVITIS
7	7,983	ANTENATAL CARE / PREGNANCY (MATERNITY)
		C/S DELIVERY ADMISSION (MEDICALLY NECESSARY) (MATERNITY)
		CONJUNCTIVITIS, CHRONIC
		GASTRITIS
		NVD WITH ABNORMALITY OF ORGANS AND SOFT TISSUES OF PELVIS
		OSTEOPOROSIS
		PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
		ULCERATIVE COLITIS
		URINARY TRACT INFECTION (UTI)
		VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS)
8	7,471	ANEMIA IRON DEFICIENCY
		DIABETES MELLITUS (DM)
		DIABETIC RETINOPATHY
		OTHER POSTPROCEDURAL STATES
		PYODERMA
		UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE
9	7,335	BRONCHIAL ASTHMA
		BRONCHITIS ACUTE
		COUGH
		DIAPER OR NAPKIN RASH
		FINGER INJURY
		INJURY
		OPEN WOUND FINGER
		OTITIS MEDIA
		PNEUMONIA / PNEUMONITIS
		SKIN GRANULOMA
		SORE THROAT / PHARYNGITIS ACUTE
		UPPER RESPIRATORY INFECTION (URTI / URI)
10	6,359	BLEPHARITIS
		DIABETES MELLITUS (DM)
		EAR ACHE / OTALGIA / EAR PAIN
		ENDOMETRIAL HYPERPLASIA
		VAGINITIS / VULVO-VAGINITIS / VULVITIS
Top 10	114,989	14.8%
Others	662,664	85.2%
Total	777,653	100.0%

Page3

CS Claims Analysis
	Policy number: 45122-
Paid date
from : 2011-07-01	to : 2012-06-30
4512200000
Top 10 Providers	Paid Amount
Al Noor Hospital - Khalifa Abu Dhabi	160,119
NMC Specialty Hospital -Abu Dhabi	58,096
USA Facility	39,754
Al Noor Hospital-Airport Road	35,422
Mediclinic Welcare Hospital	33,550
Gulf Diagnostic Center Hospital	24,906
Mediclinic City Hospital	21,113
LLH HOSPITAL LLC	20,604
Ahalia Hospital - Abu Dhabi	14,237
American Hospital	12,833
Top 10	420,634	54.1%
Others	357,019	45.9%
4512200000 's Total	777,653	100.0%
User: Gulf_CRN_Admin	5 of 7	Oct 2, 2014 8:54:05 AM

Page4

CS Claims Analysis
	Policy number: 45122-
Paid date
from : 2011-07-01	to : 2012-06-30
CASH Claims	Paid Amount
	4512200000	Total
	U.A.E.
AMERICA	641	641
ASIA	15,654	15,654
COUNTRY	45,774	45,774
MIDEAST	664	664
CASH Claims	Claim Count
	4512200000	Total
	U.A.E.
AMERICA	8	8
ASIA	47	47
COUNTRY	226	226
MIDEAST	7	7

PPO Claims	Paid Amount
	4512200000	Total
	U.A.E.
Assigned Provider	41,538	41,538
BLUE	32,848	32,848
GOLD	218,497	218,497
GREEN	87,493	87,493
SILVER	156,893	156,893
PPO Claims	Claim Count
	4512200000	Total
	U.A.E.
Assigned Provider	18	18
BLUE	469	469
GOLD	1,361	1,361
GREEN	1,873	1,873
SILVER	1,549	1,549

Page5

CS Claims Analysis
	Policy number: 45122-
Paid date
from : 2011-07-01	to : 2012-06-30
	OP	IP	Psychiatric	Maternity	Dental	Optical	Other	TOTAL	% of Total
Employees	293,384	43,129	593	32,031	0	41	1,738	370,916	47.7%
Spouse	194,858	13,819		22,070		0	349	231,096	29.7%
Child	160,092	12,242	679		0	54	2,573	175,641	22.6%
Total claims	648,334	69,191	1,272	54,101	0	95	4,659	777,653	100.0%
Age	Paid Amount			Claim count
	Male	Female	Total	Male	Female	Total
Under 21	58,262	55,888	114,150	922	876	1,798
21-25	426	2,117	2,543	9	36	45
26-30	1,079	8,965	10,043	9	124	133
31-35	13,084	53,824	66,909	193	319	512
36-40	19,822	152,802	172,624	230	379	609
41-45	93,866	55,631	149,497	412	406	818
46-50	88,967	39,890	128,857	283	339	622
51-55	23,843	25,212	49,055	223	191	414
56-60	27,894	19,377	47,271	251	117	368
61-65	23,016	2,650	25,667	150	23	173
66-69	5,036	279	5,315	30	1	31
70 and above	2,418	3,307	5,724	23	12	35
Total	357,713	419,941	777,654	2,735	2,823	5,558

Note: PPO - Preferred Provider Organization, IP - In Patient, OP - Out Patient
User: Gulf_CRN_Admin	7 of 7	Oct 2, 2014 8:54:05 AM

File details come from the government source that posted it. Updated Nov 14, 2017.