45122-1st_Jul_2012_to_30th_Jun_2013-PD.XLSX

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Health Insurance Services
Solicitation number
STC10014R0001-1
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Synopsis_FBO_Award.pdf PDF
45122-1st_Jul_2011_to_30th_Jun_2012-PD_(2).xlsx XLSX spreadsheet
45122-1st_Jul_2013_to_30th_June_2014-PD.XLSX XLSX spreadsheet
Qs_ _As_additional_2.pdf PDF
Qs_ _As_additional.pdf PDF
SF30_-_Amendment_1.pdf PDF
Health_Insurance_Solicitation_REVISED.pdf PDF
New_Table_of_Benefits.pdf PDF
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List_of_Active_Members.xls XLS spreadsheet
US_Embassy_LR.PDF PDF
Exhibit__A_-_List_of_Health_Insurance_Coverage_REVISED.pdf PDF
Meeting_Minutes_STC10014R0001.pdf PDF
Qs_ _As.pdf PDF
Exhibit_F_-_Employees_Statistics.xls XLS spreadsheet
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Exhibit_B_-_ORE_Staff_Rider.pdf PDF
Cover_Letter.pdf PDF
Exhibit_E_-__List_of_Exclusions.pdf PDF
Exhibit_C_-_AEEA_Staff_Rider.pdf PDF
Exhibit__A_-_List_of_Health_Insurance_Coverage.pdf PDF
Exhibit_D_-__MSG_Staff_Rider.pdf PDF
Exhibit_F_-_Employees_Statistics.xls XLS spreadsheet
Health_Insurance_Solicitation.pdf PDF
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CS Claims Analysis
Policy number: 45122-
Paid date
from : 2012-07-01to : 2013-06-30
Claims Range/USDNo.of claimsPaid Amount
<= 1006,015279,147
101-2501,405265,055
251-500394129,225
501-10007752,347
1001-250039116,072
2501-50001863,845
5001-10000798,723
10001-50000127,748
Total7,9561,032,163
Top 10 DiagnosisNo.of ClaimantPaid Amount% of Total
DIABETES MELLITUS (DM)6352,5826.4%
URINARY TRACT OR KIDNEY TUMOR - MALIGNANT331,2743.8%
UPPER RESPIRATORY INFECTION (URTI / URI)22430,1253.6%
ANTENATAL CARE / PREGNANCY (MATERNITY)3329,0403.5%
HYPERTENSION6728,4733.4%
HYPERLIPIDEMIA/DISPLIPIDEMIA9428,2233.4%
KNEE PAIN1519,8342.4%
BRONCHITIS ACUTE11516,6202.0%
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY113,9961.7%
VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS)6712,6451.5%
Top 10262,81225.5%
Others769,35174.5%
Total1,032,163100.0%
CS Claims Analysis
Policy number: 45122-
Paid date
from : 2012-07-01to : 2013-06-30
Top 10 ClaimantPaid Amount% of TotalMajor Conditions
131,2183.8%ABDOMINAL PAIN
URINARY TRACT OR KIDNEY TUMOR - MALIGNANT
217,4402.1%ANAL / RECTAL FISSURE
BRONCHIAL ASTHMA
BRONCHITIS ACUTE
CARDIOMYOPATHY
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CHEST PAIN (UNSPECIFIC REASON)
DIABETES MELLITUS (DM)
HEADACHE / HEAD PAIN
HYPERLIPIDEMIA/DISPLIPIDEMIA
HYPERTENSION
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
NECK PAIN / CERVICALGIA
PALPITATIONS
UPPER RESPIRATORY INFECTION (URTI / URI)
312,8861.6%ACNE
ACNE VULGARIS
BACK PAIN
CONJUNCTIVAL DEGENERATION
DERANGEMENT MENISCUS
EAR UNSPECIFIC DISORDER (ENT - UNSPECIFIC)
GASTRITIS
HAND SPRAIN
HIDRADENITIS / HIDRADENITIS SUPPORATIVA
HYPERTENSION
INTERVERTEBRAL DISC
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
KERATITIS
LIPOID METABOLISM DISORDER
MASTODYNIA / MASTALGIA / BREAST PAIN
OSTEOARTHRITIS
OSTEOPOROSIS
SINUSITIS ACUTE
SPONDYLOSIS CERVICAL
SPONDYLOSISUNSPECIFIC
UPPER RESPIRATORY INFECTION (URTI / URI)
URINARY TRACT INFECTION (UTI)
UTERINE LEIOMYOMA / FIBROID UTERUS
UTERUS TUMOR - BENIGN
412,1021.5%ARTHROPATHY / ARTHRITIS
BRONCHITIS ACUTE
CHEST PAIN (UNSPECIFIC REASON)
CHONDROMALACIA OF PATELLA
DERANGEMENT MENISCUS
GASTRITIS
JOINT PAIN
KNEE PAIN
MYOFASCITIS / MYALGIA
OTHER CHEST PAIN
UPPER RESPIRATORY INFECTION (URTI / URI)
VITAMIN DEFICIENCY -UNSPECIFIC
WOUND
511,1231.3%CERVIX EROSION / ECTROPION
FOOT AND TOE INJURY
GASTROENTERITIS / ENTERITIS OR COLITIS
HALLUX VALGUS
NECK MASS / CERVICAL LUMP / PALATE MASS / NOSE MASS
ORTHOPEDIC UNSPECIFIC DISORDER
OSTEOPOROSIS
OVARIAN CYST
SKIN TAGS
UPPER RESPIRATORY INFECTION (URTI / URI)
VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS)
610,8821.3%DIABETES MELLITUS (DM)
DUODENAL ULCER
HYPERLIPIDEMIA/DISPLIPIDEMIA
HYPERTENSION
INTERVERTEBRAL DISC
LUMBAGO / LOW BACK PAIN
SPINAL STENOSIS
SPONDYLOLISTHESIS / SPONDYLOLYSIS
SURG COMP - HYPERTENSION
710,7101.3%ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER
BACTERIAL INFECTION, UNSPECIFIED
BRONCHITIS ACUTE
CHONDRITIS
CONJUNCTIVITIS, CHRONIC
CONSTIPATION
CORPUS UTERINE POLYP / ENDOMETRIAL POLYP
DERMATITIS (& CONTACT) / ECZEMA
GASTRIC ULCER
HEADACHE / HEAD PAIN
HYPERLIPIDEMIA/DISPLIPIDEMIA
INGROWING NAIL
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
KERATITIS
LARYNGOPHARYNGITIS
LIPS ABSCESS / CELLULITIS / HYPERTROPHY / OF MUCOCELE
MIGRAINE
MUSCLE WEAKNESS (GENERALIZED)
NECK PAIN / CERVICALGIA
OSTEOMALACIA
OTHER DYSPNEA AND RESPIRATORY ABNORMALITIES
PELVIC INFLAMMATORY DISEASE / PELVIC CONGESTION
PLANTAR WARTS / VERRUCA PLANTARIS
SALPINGITIS / OOPHORITIS
SHOULDER / ARM SPRAIN
SHOULDER PAIN
SINUSITIS ACUTE
SORE THROAT / PHARYNGITIS ACUTE
STREPTOCOCCUS - UNSPECIFIC
TENDINITIS / CAPSULITIS
UNSPECIFIED TEAR FILM INSUFFICIENCY
UPPER RESPIRATORY INFECTION (URTI / URI)
VAGINITIS / VULVO-VAGINITIS / VULVITIS
VARICOSE VEINS LEG
VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS)
VULVO-VAGINAL MONILIASIS
810,3371.3%ALLERGIC RHINITIS / RHINORRHEA / HAY FEVER
BACK PAIN
CARDIAC DYSRHYTHMIA
CHOLESTEREMIA - CHOLESTEROLEMIA - HYPERCHOLESTEROLEMIA
CONJUNCTIVITIS ACUTE
CORONARY ATHEROSCLEROSIS / ARTERIOSCLEROSIS
ELBOW FOREARM AND WRIST INJURY
FOOT AND TOE INJURY
GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD)
HAND INJURY
HYPERLIPIDEMIA/DISPLIPIDEMIA
HYPERTENSION
KNEE (& LEG) SPRAIN
KNEE PAIN
ORTHOPEDIC UNSPECIFIC DISORDER
OSTEOARTHRITIS
UNSPECIFIED DISORDER OF EYELID
UPPER RESPIRATORY INFECTION (URTI / URI)
910,0811.2%ABDOMINAL PAIN
ACUTE IRIDOCYCLITIS / IRITIS
BACK PAIN
BRONCHIAL ASTHMA
GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD)
GOITER - NON TOXIC
HEADACHE / HEAD PAIN
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
JOINT PAIN
KERATITIS
LUMBAGO / LOW BACK PAIN
MASTODYNIA / MASTALGIA / BREAST PAIN
NASAL TURBINATE HYPERTROPHY
NECK PAIN / CERVICALGIA
PALPITATIONS
PELVIC INFLAMMATORY DISEASE / PELVIC CONGESTION
PELVIC PAIN / LOWER ABDOMINAL PAIN
RHEUMATISM
ROUTINE EXAMINATION OF SPECIFIC SYSTEM
SACROILIITIS
SHORTNESS OF BREATH (SOB) / DYSPNEA
SINUSITIS CHRONIC
SPONDYLITIS / SPONDYLOPATHY- INFLAMMATORY
SPONDYLOSIS CERVICAL
SPRAINS AND STRAINS NECK / CERVICAL SPRAIN
THROAT PAIN
VAGINITIS / VULVO-VAGINITIS / VULVITIS
VITAMIN D DEFICIENCY UNSPECIFIED / (RICKETS)
109,8681.2%ANEMIA IN THE MOTHER CLASSIFIABLE ELSEWHERE
ANTENATAL CARE / PREGNANCY (MATERNITY)
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
EARLY OR THREATENED LABOR
EXCESSIVE VOMITING IN PREGNANCY
LIVEBORN
NVD WITH OTHER PROBLEMS ASSOCIATED WITH AMNIOTIC CAVITY AND MEMBRANES
OTHER CURRENT CONDITIONS IN THE MOTHER CLASSIFIABLE ELSEWHERE
POSTPARTUM CARE - MATERNITY
POSTPARTUM HEMORRHAGE
SPOTTING COMPLICATING PREGNANCY
THREATENED ABORTION (MATERNITY).
Top 10136,64813.2%
Others895,51586.8%
Total1,032,164100.0%
CS Claims Analysis
Policy number: 45122-
Paid date
from : 2012-07-01to : 2013-06-30
4512200000
Top 10 ProvidersPaid Amount% of Total
NMC Specialty Hospital -Abu Dhabi80,90810.3%
Al Noor Hospital - Khalifa Abu Dhabi38,8835.0%
Al Noor Hospital-Airport Road36,6164.7%
Advanced Cure DiagnosticCenter34,5664.4%
Gulf Diagnostic Center Hospital31,4764.0%
Burjeel Hospital30,8073.9%
USA Facility30,4423.9%
Al Zahra Hospital25,6703.3%
Mediclinic City Hospital24,6283.1%
LLH HOSPITAL LLC23,6513.0%
Top 10357,64645.7%
Others674,51854.3%
4512200000 's Total1,032,164100.0%
CS Claims Analysis
Policy number: 45122-
Paid date
from : 2012-07-01to : 2013-06-30
CASH ClaimsPaid Amount
4512200000Total
U.A.E.
AMERICA1,3271,327
ASIA5,8245,824
COUNTRY30,24730,247
GULF9494
MIDEAST6,3916,391
CASH ClaimsClaim Count
4512200000Total
U.A.E.
AMERICA55
ASIA3333
COUNTRY183183
GULF11
MIDEAST4242
PPO ClaimsPaid Amount
4512200000Total
U.A.E.
Assigned Provider36,75336,753
BLUE56,30156,301
GOLD314,292314,292
GREEN158,856158,856
SILVER216,224216,224
PPO ClaimsClaim Count
4512200000Total
U.A.E.
Assigned Provider1414
BLUE660660
GOLD1,9361,936
GREEN3,3043,304
SILVER1,7781,778
CS Claims Analysis
Policy number: 45122-
Paid date
from : 2012-07-01to : 2013-06-30
OPIPPsychiatricMaternityDentalOpticalOtherTOTAL% of Total
Employees410,96374,83540926,27904281,892514,80749.9%
Spouse219,44934,08344,4320262298,22628.9%
Child183,97433,222201134581,541219,13021.2%
Total claims814,386142,14061070,84604863,6951,032,164100.0%
AgePaid AmountClaim count
MaleFemaleTotalMaleFemaleTotal
Under 2174,32975,735150,0641,1531,1332,286
21-252021,50121,5211147148
26-305,24224,55529,79644236280
31-3536,31354,40990,723282471753
36-4048,218204,697252,915373521894
41-45155,64259,626215,2686236651,288
46-5044,70658,139102,844430525955
51-5523,46233,25256,714267271538
56-6038,35919,36257,721364162526
61-6531,1774,76935,94718831219
66-6910,88210,8822727
70 and above1,4826,2867,768202242
Total469,831562,3321,032,1633,7724,1847,956
Note: PPO - Preferred Provider Organization, IP - In Patient, OP - Out Patient
User: Gulf_CRN_Admin7 of 7Oct 2, 2014 8:54:26 AM

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