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1102308001_UNITED NATIONS_MH002017_BS.pdf MAJOR COST SHARING PROVISIONS PARTICIPATING PROVIDER Benefit Period Maximum Out-of-Pocket Limit Plan Year Covered in full $6,600 Individual / $13,200 Family PCP Office visits Specialist Office visits Covered in full Hospital admission No Copayment Emergency Room copay (waived if Hospital admission) Covered in full Prescription Drug Deductible Not Applicable Prescription drugs – 30 day supply $5 generic / $5 brand Prescription drugs – 90 day supply $7.50 generic / $7.50 brand INPATIENT HOSPITAL SERVICES PARTICIPATING PROVIDER • Hospital and physician services • Semi-private room and board Subject to Hospital Admission Copayment Physician Services Covered in Full Included in Hospital Admission Copayment • Operating and recovery room, intensive and special care units, general nursing care, prescribed drugs,anesthesia, X-rays, lab tests, mastectomy care, cardiac and pulmonary rehabilitation and end of life care Included in Hospital Admission Copayment • Inpatient Rehabilitation & Habilitation Services (Physical,Speech and Occupational Therapy) Subject to Hospital Admission Copayment; 90 days combined therapies • Human organ transplants Included in Hospital Admission Copayment MATERNITY AND NEW BORN CARE PARTICIPATING PROVIDER • Prenatal care Covered in full • Inpatient Hospital Services and Birthing Center Covered in full • Physician and Midwife Services for Delivery Covered In Full • Breast Pump Covered in full • Postnatal care Covered in full Medical Deductible Not Applicable SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 (continued on next page) MH002017 SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 • Postnatal care Covered in full SURGICAL SERVICES PARTICIPATING PROVIDER • Inpatient Hospital Surgery Covered in full • Outpatient Hospital Surgery Covered in full • Surgery performed in a PCP Office Covered in full • Surgery performed in a Specialist Office Covered in full • Surgery performed at an Ambulatory Surgical Center Covered in full CARDIAC REHABILITATION PARTICIPATING PROVIDER • Performed as Inpatient Hospital Services Included as part of Inpatient Hospital Service Cost-Sharing • Performed as Outpatient Hospital Services Covered in full ; 32 visits, combined with Specialist Officelimits • Performed in a Specialist Office Covered in full ; 32 visits, combined with OutpatientHospital limits OUTPATIENT MEDICAL CARE PARTICIPATING PROVIDER • PCP office visits Covered in full • Specialists office visits Covered in full • Preventive care, including well-child visits and immunizations, adult annual physical examinations, adult immunizations, routine gynecological services/well woman exams, mammograms, screening and diagnostic imaging for the detection of breast cancer, sterilization procedures for women, and bone density testing Covered in full • Laboratory Procedures, • Performed in a PCP Office • Performed in Specialist Office • Performed in a Free Standing Laboratory • Performed as Outpatient Hospital Services Covered in full Covered in full Covered in full Covered in full • Diagnostic Radiology • Performed in a PCP Office • Performed in Specialist Office • Performed in a Free Standing Radiology Facility • Performed as Outpatient Hospital Services Covered in full Covered in full Covered in full Covered in full • Diagnostic Testing • Performed in a PCP Office Covered in full (continued on next page) MH002017 SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 • Performed in a PCP Office • Performed in Specialist Office • Performed as Outpatient Hospital Services Covered in full Covered in full Covered in full • Advanced Imaging Services (PET scans, MRI, nuclear medicine, CAT scans) • Performed in a Specialist Office • Performed in a Free Standing Radiology Facility • Performed as Outpatient Hospital Services Covered in full Covered in full Covered in full • Infusion Therapy • Performed in a PCP Office • Performed in a Specialist Office Referral required • Performed as Outpatient Hospital Services • Home Infusion Therapy Covered in full Covered in full Covered in full Covered in full • Ambulatory surgery center facility Covered in full • Outpatient hospital surgery facility Covered in full • Preadmission testing Covered in full • Second opinions on the diagnosis of cancer, surgery and other 90 visits, combined therapies • Outpatient Habilitation Services Covered in full • Performed in a PCP Office • Performed in a Specialist Office • Performed as Outpatient Hospital Services Covered in full Covered in full Covered in full • Radiation therapy • Performed in a Specialist Office • Performed in a Free Standing Radiology Facility Covered in full Covered in full • Performed as Outpatient Hospital Services Covered in full OUTPATIENT MEDICAL CARE PARTICIPATING PROVIDER (continued on next page) MH002017 SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 • Performed as Outpatient Hospital Services Covered in full • Chemotherapy • Performed in a PCP Office • Performed in a Specialist Office Covered in full Covered in full • Performed as Outpatient Hospital Services Covered in full • Outpatient Rehabilitation Services(physical therapy,occupational therapy, speech therapy, pulmonary rehabilitation) • Performed in a PCP Office • Performed in a Specialist Office Covered in full Covered in full • Performed as Outpatient Hospital Services Covered in full • Allergy Testing and Treatment • Performed in a PCP Office Covered in full • Performed in a Specialist Office Covered in full • Acupuncture Not Covered • Telemedicine Program Provided by a Telemedicine Physician Not Covered MENTAL HEALTH AND ALCOHOL AND SUBSTANCE USE SERVICES PARTICIPATING PROVIDER • Mental Health Care • Inpatient Covered in full, Unlimited Days • Outpatient Covered in full, Unlimited Visits • Substance Use Services • Inpatient Covered in full, Unlimited Days • Outpatient Covered in full SPECIAL KINDS OF CARE PARTICIPATING PROVIDER Urgent Care Center Covered in full Non-Emergency Ambulance Services Covered in full Pre-Hospital Emergency Medical Services (Ambulance Services) Covered in full 90 visits, combined therapies OUTPATIENT MEDICAL CARE PARTICIPATING PROVIDER (continued on next page) MH002017 SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 Pre-Hospital Emergency Medical Services (AmbulanceServices) Covered in full Home health care Covered in full; 200 visits Hospice care Skilled Nursing Facility (including cardiac and pulmonary rehabilitation) Covered in full, Unlimited Days Dialysis treatment • Performed in PCP Office • Performed in Specialist Office $10 Copayment $10 Copayment • Performed in Free Standing Center $10 Copayment • Performed as Outpatient Hospital Services $10 Copayment Diabetes equipment, supplies, Insulin and education Covered in full Chiropractic Services Covered in full Family Planning Services Covered Vasectomy Covered in full Infertility Diagnosis and Treatment 3 Cycles IVF, Per Lifetime, Subject To ApplicableCopayment Dental Care • Preventive Dental Preventive Included Durable Medical Equipment and Braces No Deductible, Covered In Full Prosthetics Covered In Full Orthotics Covered In Full Medical Supplies Covered in full External Hearing Aids Not Covered Cochlear Implants No Copayment - One (1) per ear per time Covered Optical Care • Refractive Eye Exams Covered in full / Once per covered period • Eyeglasses Eyeglasses $35 Every 24 Months ABA Treatment for Autism Spectrum Disorder Covered in full Assistive Communication Devices for Autism Spectrum Disorder Covered in full Covered in full, 210 days SPECIAL KINDS OF CARE PARTICIPATING PROVIDER (continued on next page) MH002017 SUMMARY OF BENEFITS HIP Prime Network UNITED NATIONS PrimeHMO for NY CT and NJ Residents 1102308 Assistive Communication Devices for Autism SpectrumDisorder Covered in full ADDITIONAL BENEFITS PARTICIPATING PROVIDER • Nurse Advice Line Not Covered • WellSpark Not Covered • Gym Reimbursement Not Covered FOOTNOTES Drugs are dispensed in accordance with EmblemHealth’s Drug Formulary.
Language:English
Score: 1330872.2 - https://www.un.org/insurance/s.../files/hip_medical_plans_0.pdf
Data Source: un
It is possible to order kit components separately using direct order LTA: Glucometer: S0000590 Photometer,HemoCue Glucose 201+/SET Haemoglobinometer: S0000591 Photometer,HemoCue Hb 301/SET 3. Nutrition Kit for Outpatient Therapeutic Feeding Centre The Nutrition Kit for Outpatient Therapeutic Feeding Centre consists of three (3) Anthropometric Nutrition Kits (S0114050) plus two (2) additional modules containing consumables that can be ordered separately: Module 1: S0114055 Nut.kit,outpatient,module-registration Module 2: S0114056 Nut.kit,outpatient,module-equipment This kit is sufficient for five (5) outpatient therapeutic feeding centres intended for 500 severely acute malnourished children for a period of three (3) months. If more than five (5) sites are to be covered, supplementary anthropometric equipment should be ordered separately. Module 1: Outpatient Registration Module (S0114055) Contains medical stationery and identification equipment for an outpatient therapeutic feeding centre. This module consists of two cartons each: 600x400x600 mm, 20kg, 144L. Module 2: Outpatient Equipment Module (S0114056) Contains cooking and feeding material for an outpatient therapeutic feeding centre.
Language:English
Score: 1322748 - https://www.unicef.org/supply/...on-kits-technical-bulletin.pdf
Data Source: un
By the end of this year, GED project plans to implement these measures on 11 more public buildings in the Sarajevo Canton, including on the following healthcare and education institutions, cultural and sports centers: Outpatient Clinic Rajlovac,  Cultural-sports center and Radio Ilijaš,  Elementary School „Stari Ilijaš“ – Regional school „Misoča“,  Cultural-sports center „Amel Bečković“ Ilidža,     Outpatient Clinic Binježevo,  Elementary School „Grbavica II“,  Elementary School „Amer Ćenanović“,  Outpatient Clinic Hrastovi-Mrkovići,  Outpatient Clinic Podhrastovi,  Outpatient Clinic Gazin Han, and  Franciscan theology Sarajevo.            
Language:English
Score: 1256423.3 - https://www.undp.org/bosnia-he...blic-buildings-sarajevo-canton
Data Source: un
AVAILABILITY OF TREATMENT SERVICES IN SECOND-TIER ADMINISTRATIVE UNIT Status of National SAM Management Programme PILOT SCALING UP PROGRAMMING AT SCALE Inpatient care X (10 hospitals in 20 districts provide services with a good referral system) Outpatient care X(all 20 districts) Community case management Geographical Coverage % of Facilities Offering SAM Treatment, by Year, 2010-2015 INPATIENT CARE OUTPATIENT CARE TOTAL NATIONAL PROGRAM TARGET (NUMBER) CURRENTLY COVERED (NUMBER; PERCENTAGE) NATIONAL PROGRAM TARGET CURRENTLY COVERED (NUMBER; PERCENTAGE) District level Seven district hospitals for inpatient and 10 district hospitals for outpatient Tertiary/ secondary level hospitals Three referral hospitals for inpatient care Primary health centres/ sub-centres Nil Others (ECD centres) Nil Community case management units Nil REMARKS As per current guidelines in Bhutan, children admitted at paediatric ward if diagnosed SAM are referred and enrolled into a Nutrition Rehabilitation Unit located in one of the 10 hospitals mentioned above. Once the child becomes stabilised they are referred to outpatient unit in one of the 20 district hospitals, where these children are treated with F100 and then counselled to feed on home food by nutrition focal point. (...) There are no separate targets for inpatient and outpatient care at present. Key SAM Treatment Performance Indicators NUMBER OF CHILDREN ACCESSING SAM MANAGEMENT SERVICES (ADMISSION BY YEAR) TREATMENT OUTCOMES (CURED, DEFAULTER, DEATH AND NON-RESPONDERS BY YEAR) REMARKS Standard global guidelines and programme performance indicators (cure, defaulter, death and non responders) are not practiced in Bhutan.
Language:English
Score: 1240610.7 - https://www.unicef.org/rosa/media/4676/file
Data Source: un
Ensures that the sum is 100% | 9 | Top down approach example Disease Attributable Fraction calculated by utilization only Number of outpatient visits Disease A at given provider X Total OP expenditure at given provider = Disease A expenditures at given provider Total number of outpatient visits at given provider Number of outpatient visits Disease B at given provider X Total OP expenditure at given provider = Disease B expenditures at given provider Total number of outpatient visits at given provider Number of outpatient visits Disease C at given provider X Total OP expenditure at given provider = Disease C expenditures at given provider Total number of outpatient visits at given provider Etc…. … Sum above = Total expenditures at given provider.
Language:English
Score: 1240610.7 - https://www.who.int/pmnch/medi.../2013/expenditure_tracking.pdf
Data Source: un
An ordinary Tuesday at the Outpatient Nutrition Unit in Dosseye refugee camp, Chad. (...) Mairo Bouba, 36, is a regular client of the outpatient nutrition unit (UNA) of the health centre located in the Dosseye refugee camp. (...) Within it, there is an outpatient nutrition unit supported by UNICEF with financial support from ECHO and USAID/Food for Peace.
Language:English
Score: 1236900.3 - https://www.unicef.org/wca/sto...nutrition-dosseye-refugee-camp
Data Source: un
An ordinary Tuesday at the Outpatient Nutrition Unit in Dosseye refugee camp, Chad. (...) Mairo Bouba, 36, is a regular client of the outpatient nutrition unit (UNA) of the health centre located in the Dosseye refugee camp. (...) Within it, there is an outpatient nutrition unit supported by UNICEF with financial support from ECHO and USAID/Food for Peace.
Language:English
Score: 1236900.3 - https://www.unicef.org/chad/st...nutrition-dosseye-refugee-camp
Data Source: un
Abbreviations used in this document ARV - Anti Retroviral drugs CH - Child Health CoIA - Commission on Information and Accountability for Women's and Children's Health GAVI - The Global Alliance for Vaccines and Immunization GDP – Gross Domestic Product GGHE - General Government Health Expenditures HMIS - Health Management Information System ICD - International Classification of Diseases IMCI - Integrated Management of Childhood Illness IPD - Inpatient days ITN - Insecticide Treated Net JRF - Joint Reporting Form (for Immunization) MNH - Maternal and Neonatal Health MNCH – Maternal, Neonatal and Child Health MNCAH - Maternal Newborn Child and Adolescent Health MOH - Ministry of Health NHA - National Health Accounts NASA - National AIDS Spending Assessment NIDI - Netherlands Interdisciplinary Demographic Institute OPV - Outpatient visits PG – WHO National Health Accounts Producers Guide RMNCH - Reproductive, Maternal, Newborn, and Child Health RMNCH-GET - Reproductive, Maternal, Newborn, and Child Health Government Expenditure (and budget) Tracking tool RTI - Reproductive Tract infection SRH - Sexual and Reproductive Health STI - Sexually Transmitted Infection UNFPA - United Nations Population Fund WHO – World Health Organization 3 Responsibilities and Acknowledgments The methodology outlined in this document was developed jointly by staff members from the following Departments of the World Health Organization: Child and Adolescent Health (CAH) Global Malaria Programme (GMP) Health Systems Financing (HSF) Immunizations, Vaccines and Biologicals (IVB) Making Pregnancy Safer (MPS) Reproductive Health and Research (RHR) For questions please contact Karin Stenberg, Technical Officer, Department of Health Systems Financing, World Health Organization (E-mail: stenbergk@who.int). (...) These expenditures can be further split into outpatient care and inpatient care. Child health expenditure: expenditures during a specified period of time on goods, services and activities delivered to the child after birth or its caretaker whose primary purpose is to restore, improve and maintain the health of children in the nation between zero and less than five years of age.
Language:English
Score: 1232474.4 - https://www.who.int/choice/gettool.pdf
Data Source: un
Expenditures for outpatient treatment from public sector providers (B) consist of public sector expenditure for outpatient treatment, and household expenditure to purchase medicines and other medical goods and services in relation to outpatient visits to government healthcare facilities. (...) It is also necessary to take into account the potential interaction between inpatient and outpatient utilisation rates. The major reason that Sri Lanka has such a high inpatient admission rate is probably that its outpatient primary care services are over-burdened, resulting in risk-averse doctors in hospital outpatient clinics admitting any patients they have diagnostic doubts about. (...) The baseline (2005) is assumed to be the same as the share of outpatient utilisation reported in the CB CFS 2003/2004 for 2003/2004; this was 44% for outpatient visits.
Language:English
Score: 1225113.1 - https://www.un.org/development...apers/bp_wess2007_srilanka.pdf
Data Source: un
It is driven mainly by out-of-pocket payments for outpatient medicines, followed by outpatient care and dental care. (...) The factors that undermine access and financial protection, with a disproportionate impact on poorer and older households, include: long-standing issues in the governance of coverage policy – multiple and overlapping coverage schemes, combined with regional variation in waiting times and co-payments, favor people in work and wealthier households; complex and heavy co-payments for almost all health services, with inadequate protection mechanisms; gaps in coverage and weaknesses in purchasing outpatient medicines; and relatively low levels of public investment in health. To reduce unmet need and financial hardship, policy should focus on limiting co-payments for outpatient care, especially primary care; improving protection from all co-payments for poorer households and people with high need for healthcare; and strengthening supply-side policies to promote better prescribing, dispensing and use of medicines.
Language:English
Score: 1201913.4 - https://www.who.int/finland/pu...lications/i/item/9789289056007
Data Source: un