Costing of the Vanbreda programme
The Vanbreda programme is a self-funded health benefit plan, not an insured programme, meaning that all medical service costs for staff members are shared equally between the United Nations and the plan participants, as approved by the General Assembly The programme's expenses are directly linked to the medical services utilized by participants, with yearly contributions from both staff and participating United Nations entities covering claim costs and an administrative fee to Vanbreda International (VBI).
Vanbreda International is a provider of benefits consulting and administrative services, not an insurance company The United Nations collaborates with Vanbreda under an administrative services only (ASO) contract, leveraging their expertise in eligibility and claims processing This partnership allows the UN to access discounted services that Vanbreda has negotiated with various international providers.
Renewal provisions for 2012
3 There will be a 1 per cent increase in the current premiums for Vanbreda beginning 1 January 2012.
(a) Increase daily room and board ceiling from $400 to $450 for admissions in countries belonging to rate group 2 (Chile and Mexico);
(b) Increase daily room and board ceiling from $750 to $900 for admissions in countries belonging to rate group 3 (countries in Western Europe);
The proposed changes include implementing an annual deductible of $200 for individuals and $600 for families for basic and major medical services in the United States Additionally, there will be a new out-of-pocket maximum of $1,000 for individuals and $3,000 for families specifically for major medical services.
As of January 1, 2012, reimbursement for expenses can now be processed in various currencies beyond the United States dollar and euro, provided that the expenses were incurred in the requested currency and specified on the claim form The expanded list of eligible currencies includes the Australian dollar, Canadian dollar, Swiss franc, Danish krone, Egyptian pound, pound sterling, Hong Kong dollar, Indonesian rupiah, Jordanian dinar, Moroccan dirham, New Zealand dollar, Philippine peso, Swedish krona, Singapore dollar, Tunisian dinar, and West African CFA franc.
Note that reimbursement in a non-United States dollar currency must always be effected by bank transfer.
1 See resolution 1095 (XI) of 27 February 1957.
Other important information for 2012
The Vanbreda worldwide programme undergoes an annual review to maintain competitive benefit provisions aligned with those of major international organizations and government entities, focusing on health insurance protection, deductibles, and co-payment levels Following the standard consultative process within the Health and Life Insurance Committee, several changes were implemented in the Vanbreda programme in 2010 and 2011.
6 (a) Reimburse orthodontic treatments/surgeries after accidents as any other surgery under the major medical benefit plan;
(b) Increase reimbursement for hearing aid to $750 per apparatus every 36 months;
(c) Reimburse all birth control devices that require a prescription;
(d) Reimburse frames for eyeglasses and increase the maximum benefit for optical care to $250 per 24 months;
(e) Allow a one-year carry-over of unspent annual balance under the dental benefits of the Vanbreda plan; namely, the unspent balance for dental care on
31 December 2011 can be carried over and used in 2012;
Eliminate reimbursement caps for essential mental health and substance abuse treatments that are deemed medically necessary and pre-certified by Vanbreda, as outlined in the "Outpatient Mental Health Care" section under No 12.4 of Annex I.
(g) Reimburse immunizations against hepatitis A, hepatitis B, hepatitis A+B, yellow fever, tetanus (diphtheria) and pneumococcal disease.
7 (a) Annual routine physical exams will be reimbursed at the rate of 100 per cent and the ceiling will be raised to $750;
Members covered under the Vanbreda plan will have access to educational programs aimed at raising awareness and improving management of chronic illnesses, with 80 percent of the costs reimbursed.
(c) HIV/AIDS tests will be reimbursed at the rate of 100 per cent, with no limit on the number of tests allowed in a plan year;
(d) The ceiling on optical coverage will be raised to $150 per plan year and lenses will be replaced when there is a change in dioptre;
Traditional Chinese medicine and alternative therapies may qualify for reimbursement when a medical condition necessitates such treatment, provided that the treatment is administered by a licensed medical doctor in the country where the care is given, and that the treatment is acknowledged as a legitimate medical practice by the relevant health authorities in that country.
(f) There will be no ceiling on home health-care services following inpatient hospitalization
Vanbreda eligibility applies for residents of all nations except the United States of America
The Vanbreda programme provides coverage for staff members and former staff members living globally, excluding the United States Those residing in the U.S., along with their dependants, are not eligible for this coverage, except for dependent children enrolled in educational institutions that mandate participation in their health insurance plans In such cases, the school's insurance will be primary, while Vanbreda will serve as secondary coverage Staff members not meeting these criteria must transition to a U.S.-based insurance plan.
Financial risk to staff members who incur medical expenses in the United States
Staff members enrolled in the Vanbreda worldwide program are advised against seeking medical care in the United States due to inadequate coverage, which is limited to an annual reimbursement of $250,000 The high costs of medical care in the U.S exceed the premiums of the Vanbreda plan, resulting in staff being liable for any expenses beyond the benefit limits To mitigate these issues, prior notification is essential, allowing Vanbreda International to explore alternative options and negotiate discounts Regular users of U.S medical services must transition to a U.S.-based health plan for better coverage.
The United Nations insurance programme does not cover costs that are or will be reimbursed by other insurance plans or social security For members with multiple insurance plans, the programme coordinates benefits to maximize coverage without exceeding incurred expenses Members are required to inform third-party administrators when a claim can be filed with another insurer.
Fraud or abuse of the plan by any member will lead to immediate monetary recovery, disciplinary actions in line with the United Nations Staff Regulations and Rules, and potential suspension or forfeiture of benefits.
Eligible staff members should note that the 2012 annual enrolment campaign is the sole opportunity this year to enroll themselves and their eligible family members in the Vanbreda plan Scheduled for June 2012, this campaign applies to staff members stationed globally.
Vanbreda dedicated website/Vanbreda identification cards/official designation
Vanbreda offers dedicated web pages for the United Nations worldwide Vanbreda plan, accessible at http://www.vanbreda-international.com Members can log in using their personal reference number found on their Vanbreda membership card to access detailed information about the plan.
(b) How to arrange for direct billing;
(c) How to submit a claim and how to receive your settlement online;
(d) Provision for the downloading of forms, for example, claim forms;
(f) A provider list enabling a participant to select medical providers based upon location and medical specialization;
This article provides essential information on the symptoms and treatment of several chronic diseases, including diabetes, HIV/AIDS, Parkinson’s disease, asthma, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD) United Nations staff members seeking personal medical advice are encouraged to reach out to Vanbreda’s panel of international medical doctors via an online form.
(h) Plan members and human resources administrators will be able to print a personal insurance certificate using a simple tool available on Vanbreda’s website.
The Vanbreda identification card, sent to all participants, allows hospitals and clinics to directly arrange billing for hospitalization or expensive outpatient treatments with Vanbreda If participants do not possess an identification card, they should reach out to Vanbreda for assistance.
15 The existing rules and terms governing eligibility and enrolment for theVanbreda plan are summarized in paragraphs 20 to 42.
2012 premiums
Premiums for the United Nations programme are determined based on the claims incurred by participants, along with necessary administrative costs These claims, which vary globally, lead to the establishment of three distinct premium rate groups This structure ensures that the premiums align with the anticipated overall claims for each geographic area represented in the groups.
The financial performance of the program during the previous policy period was positive, leading to a 1 percent increase in premiums for 2012 to accommodate anticipated costs for the plan year running from January 1 to December 31, 2012.
The Vanbreda health insurance programme operates on a cost-sharing model, where expenses are equally divided between participants and the Organization, adhering to the General Assembly's 50:50 cost-sharing requirement Participants' premium contributions are calculated by multiplying their medical net salary by the specified contribution rate, as detailed in paragraph 19 This approach aligns with the calculation methods used for staff contributions in other United Nations insurance programmes.
19 The schedule of premiums that will become effective on 1 January 2012, as well as the related staff contribution rates, is set out in the table below
Monthly premium (United States dollars) Percentage of medical net salary Effective 1 January Effective 1 January
Staff member and one family member 283 286 2.33 2.33
Staff member and two or more eligible family members 467 472 3.67 3.67
Staff member and one family member 480 485 3.73 3.73
Staff member and two or more eligible family members 793 801 5.86 5.86
Staff member and one family member 461 466 3.88 3.88
The article outlines three rate groups for staff members and their eligible family members Rate group 1 encompasses all locations outside the United States, excluding those specified in rate groups 2 and 3 Rate group 2 includes Chile and Mexico, while rate group 3 consists of Andorra, Austria, Belgium, Crete, Cyprus, Denmark, and Finland.
France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Turkey (European portion) and the United Kingdom of Great Britain and Northern Ireland.
General rules
20 The annual enrolment campaign will offer the only general opportunity in
2012 for eligible staff members to enrol themselves and eligible family members in the Vanbreda plan The annual enrolment campaign for the Vanbreda plan for staff
The medical net salary is calculated by taking the gross salary, subtracting the staff assessment, and adding applicable allowances such as language, non-resident, and post adjustment Importantly, a staff member's contribution will not exceed 85 percent of the total premium for their specific coverage type Additionally, the assignment of members to duty stations worldwide is tentatively set for June 2012.
All staff members with appointments of three months or longer, except those stationed in the United States and those receiving a fixed monthly cash amount for health insurance, can enroll themselves and their eligible family members in the Vanbreda plan Additionally, staff on temporary contracts that cumulatively last three months or more can also enroll from the start of their qualifying contract Staff members with temporary appointments of less than three months may opt for the Vanbreda short-term medical insurance plan individually.
Eligible staff members must enroll in the Vanbreda plan within 31 days of their initial appointment date if they hold positions lasting three months or longer For those with temporary appointments under three months, enrollment is required within 31 days after the start of a contract that meets the three-month minimum It is important to note that staff members are not eligible for coverage under the plan if these conditions are not met.
Vanbreda plan if they or any of their covered dependants reside in the United States For enrolment purposes, applicants will be required to present (a) a
To enroll eligible family members in the Vanbreda application process, applicants must submit a completed application form along with a personnel action (PA) document from their personnel or administrative officers, confirming their current contractual status Additionally, evidence of the family members' eligibility is required, which is typically included in the personnel action form.
Eligible family members for insurance purposes
"Eligible family members" for staff benefits include a recognized spouse and dependent children, excluding those of temporary staff with appointments shorter than three months or occasional workers Dependent children must be biological, legally adopted, or stepchildren listed in the Integrated Management Information System (IMIS) of UN Headquarters, the Atlas system of UNDP, or the SAP system of UNICEF Coverage for children continues until the end of the calendar year they turn 25, provided they are unmarried and not employed full-time Disabled children may receive extended coverage beyond age 25, contingent upon a disability assessment by the Medical Services Division.
Change in residence or duty station
Staff members at the United Nations Headquarters in New York can enroll in the Vanbreda plan while serving in field offices or missions abroad However, upon returning to a position based in the United States, they are required to reapply for a United Nations health insurance program specific to the U.S.
Staff members stationed outside the New York Headquarters in the U.S are required to enroll in a United Nations health insurance program based in the United States Upon the conclusion of their stay in the U.S., they have the option to reapply for coverage under the Vanbreda program.
A change in coverage will take effect on the first day of the month following your arrival at a new residence or duty station after a mission assignment.
It's important to understand that your insurance may not automatically continue under certain circumstances, such as a change in your payroll office Therefore, whenever there is a change in your country of residence or duty station, you should verify with your personnel or administrative office whether you need to submit an application to continue or modify your insurance coverage.
Enrolment at times other than upon entry on duty
Staff members and their eligible family members must enroll within 31 days of their entry on duty or eligibility If they miss this window, they can enroll once a year during the annual enrollment period The insurance coverage for applications made during this period becomes effective on July 1st.
Outside the annual enrollment period, staff members with fixed-term or temporary appointments of three months or more can enroll themselves and their eligible family members in the Vanbreda plan if certain qualifying events occur, provided they apply for enrollment within 31 days of the event.
(a) Transfer from one duty station to another;
(b) Return from special leave without pay (see para 35 below);
(c) Assignment to a mission under certain conditions (see para 36 below);
(d) Marriage, birth or legal adoption of a child, for coverage of the related family member.
Loss of coverage under a spouse’s health insurance due to the spouse's job loss qualifies for enrollment in a United Nations health plan To enroll, individuals must apply within 31 days of this qualifying event Applications must include an official letter from the spouse's employer, confirming the termination of employment and its effective date.
Staff members who were on mission, annual, or sick leave during the annual enrollment period are eligible to enroll within 31 days of returning to their duty station.
Applications submitted outside the designated enrolment opportunity periods, or those not received within 31 days of the event that establishes eligibility, will not be accepted.
Commencement and termination dates of health insurance coverage
New coverage for staff members enrolled in the Vanbreda plan begins on the first day of a qualifying contract If the contract starts after the first day of the month, coverage can either begin on that day or the first day of the following month Coverage cannot start before the contract's first day, and monthly premiums will not be prorated Health insurance coverage ends at the month's conclusion when the qualifying contract terminates, and it only covers illnesses that arise during the contract period Treatments for conditions that develop after the contract ends are not covered, except when a contract ends before the last day of the month, in which case coverage continues until the end of that month.
Staff transferred to another duty station
Staff members transferring to a new duty station without prior medical insurance can enroll themselves and their eligible family members in the United Nations health insurance plan upon transfer The application for enrollment must be submitted within 31 days of the transfer date, with coverage becoming effective on the same date at the new duty station This policy also applies to transfers to Headquarters, where new enrollments must be in one of the health insurance plans available at that location.
Staff members should be aware that transferring to a different duty station that requires a switch to a new payroll system necessitates submitting a new insurance application to maintain insurance benefits Failure to submit this application will result in the expiration of insurance coverage at the end of the month when premium deductions stop in the previous payroll system.
Staff on special leave without pay
Staff members on special leave without pay should be aware that they have the option to maintain their health insurance coverage during this time or choose to discontinue it for the duration of their leave.
Staff members wishing to maintain their insurance coverage during special leave without pay must notify the Health and Life Insurance Section or the relevant administrative office in writing at least one month before the leave begins This notification must include evidence of the approved special leave and payment for the total cost of the retained coverage, which encompasses both the staff member's contribution and the Organization's share, as no subsidies are provided during this leave period.
If a staff member chooses to discontinue their insurance coverage during a special leave without pay, no action is necessary when the special leave begins.
Upon returning to duty after a period of special leave without pay, it is crucial for staff members to re-enrol in their insurance plans with the Health and Life Insurance Section This applies regardless of whether they chose to maintain or cancel their insurance coverage during their leave Staff at Headquarters must complete this process in person, while those stationed elsewhere can do so in writing.
Staff members must complete the necessary steps within 31 days of returning to duty to ensure their participation in the insurance plan(s) If this deadline is missed, they will not be able to rejoin the plan until the next annual enrollment period in June.
Staff members on mission assignment
Staff member married to another staff member
37 Staff members are reminded that in the case of a staff member who is married to another staff member, the insurance coverage, whether at the two-person or family level, must be carried by the higher-salaried staff member (based on grade level, not steps within the same grade) Separate coverage at the single rate may be maintained It should also be noted that if one spouse retires from service with theOrganization before the other spouse and coverage is at the two-party or family level, the spouse who remains in active service must become the subscriber even if the retired spouse had been the subscriber up to the date of retirement and is eligible for after-service health insurance benefits following separation from service The spouse in active service must complete the appropriate insurance application form to ensure continuity of coverage for both self and spouse.
Staff members with dependants residing in the United States of America
Staff members living outside the United States are reminded that the Vanbreda plan offers hospital, medical, and dental coverage specifically for them However, those with eligible dependents residing in the U.S., excluding school or university students covered by their institution's health insurance, must enroll in a Headquarters health insurance program It is important to note that the Headquarters dental program is distinct from the medical program, and if dental coverage is needed, the appropriate sections of the group medical and dental insurance application form must be completed.
Cessation of family members’ coverage
Staff members must promptly notify the insurance office in writing if a family member becomes ineligible due to changes such as divorce, a child reaching 25, marrying, or gaining full-time employment While staff can discontinue coverage for other reasons at any time, it is discouraged The responsibility for changing coverage, such as adjusting from "staff member and spouse" to "staff member only," lies with the staff member Timely notification is crucial to potentially reduce premium contributions, with changes taking effect on the first of the month after notification Retroactive adjustments are not possible for late notifications to the Health and Life Insurance Section or the administrative office.
After-service health insurance
Eligibility for participation in the United Nations after-service health insurance programme is detailed in administrative instruction ST/AI/2007/3, effective from 1 July 2007 Staff members hired before this date must have at least 5 years of prior contributory coverage to qualify for unsubsidized after-service health insurance and 10 years for subsidized coverage, while those recruited after must have a minimum of 10 years of prior contributory coverage All staff must be at least 55 years old at separation and have opted for a retirement benefit from the United Nations Joint Staff Pension Fund Additionally, only family members enrolled at retirement are eligible for coverage, and service under a 300-series appointment of limited duration does not count towards eligibility.
Former staff members living in the United States should note that they are ineligible for the Vanbreda plan and must transition to a Headquarters plan within 31 days of establishing residency in the U.S.
Retirees who return to active service
Conversion privileges
43 A “conversion” privilege is part of the United Nations group contract withVanbreda This privilege allows staff members (subscribers) who cease employment with the United Nations and do not qualify for after-service health insurance benefits to “convert” their group medical insurance with Vanbreda to an individual short-term health insurance policy The individual conversion policy is guaranteed- issue This means that no proof of the subscriber’s good health is required; the insurer cannot refuse to insure an eligible subscriber who applies in a timely manner for a conversion policy Application for an individual policy under the conversion privilege must be made within 31 days of termination of coverage under the UnitedNations group policy The availability of this privilege does not mean that the same insurance premium rates or schedule of benefits in effect for the United Nations group policy will be offered in respect of the individual health insurance policy.
The Vanbreda conversion privilege offers temporary health insurance coverage for up to 36 months during the transition to more permanent plans It is important to note that this coverage is not subsidized by the United Nations.
44 Staff members (subscribers) may apply for a policy of individual coverage under the conversion privilege for themselves only or for themselves and their covered eligible dependants Moreover, eligible dependants may apply on their own behalf in the following circumstances:
Children who lose their health insurance coverage upon turning 25 can apply for a conversion policy if they remain financially dependent on their parents, are unmarried, and are not employed full-time.
(b) A staff member’s spouse whose eligibility for insurance ceases as the result of divorce and who is not employed full-time may also apply.
The application for an individual conversion policy must be submitted within 31 days of termination of coverage under the United Nations group medical programme.
45 Details concerning conversion to an individual insurance policy may be obtained by communicating directly with Vanbreda at the following address:
Vanbreda International Plantin en Moretuslei 299
Tel: +32 3 217 5742Fax: +32 3 272 3969E-mail: gp1@vanbreda.com
Claims and enquiries
46 Claims must be received within 24 months of the date of service in order to be reimbursed Claims received after 24 months of service will not be reimbursed.
Basis for claim reimbursement in United States dollars
47 The default currency for claim reimbursement is United States dollars, converted from the currency in which the hospital, medical or dental expenses have been incurred Vanbreda International will also reimburse members in another currency for costs incurred and/or payments made in that currency Valid currencies are the United States dollar, the euro, the Australian dollar, the Canadian dollar, the Swiss franc, the Danish krone, the Egyptian pound, the pound sterling, the Hong Kong dollar, the Indonesian rupiah, the Jordanian dinar, the Moroccan dirham, the New Zealand dollar, the Philippine peso, the Swedish krona, the Singapore dollar, the Tunisian dinar and the West African CFA franc.
(a) Reimbursement in a non-United States dollar currency must always be effected by bank transfer;
(b) Only one currency per claim form will be allowed;
If the claim form lacks a selected reimbursement currency or has insufficient data for the chosen payment method, the default reimbursement will be issued in United States dollars.
48 Reimbursements are based on the United Nations operational rate of exchange in effect on the date that the medical and dental expenses are incurred and, in the case of hospital expenses and doctors’ fees incurred during the hospitalization, on the date that the hospital bill is rendered.
49 In order to guarantee a smooth processing of their claims, Vanbreda International would like to encourage all plan participants to use the settlement details online together with electronic fund transfers (direct deposit into the member’s bank account).
50 The latest version of the claim form and more information on settlement details online can be found under “Plan members” on the Vanbreda International dedicated web pages (see http://www.vanbreda-international.com).
51 Participants must inform their administrative office of any change in their mailing address in order to ensure that identification cards, reimbursements and explanations of benefits are delivered promptly and appropriately.
Where to address claims and benefit enquiries
52 Although the staff of the insurance office are available to assist staff members in administrative matters concerning participation in the Vanbreda plan, claims questions should always be taken up on the first instance directly with Vanbreda International Information on the claims filing procedure and contact details can be found under “Plan members” on the Vanbreda International dedicated web pages (see http://www.vanbreda-international.com).
Claims address and enquiries about claims
Antwerp office Kuala Lumpur office Miami office www.vanbreda-international.com mcc001@vanbreda.com
In certain countries, Vanbreda International provides toll-free telephone lines.
A complete list can be found under “Plan members” on the Vanbreda International dedicated web pages (see http://www.vanbreda-international.com) or in annex IV to the present document.
Member services and general enquiries
In certain countries, Vanbreda International provides toll-free telephone lines.
A complete list can be found under “Plan members” on the Vanbreda International dedicated web pages (see http://www.vanbreda- international.com) or in annex IV to this document.
Fax: +32 3 272 3969 Dedicated e-mail address: gp1@vanbreda.com
Vanbreda International website http://www.vanbreda-international.com
Availability of claims settlement details online
53 Vanbreda International offers the opportunity for members to receive their settlement details online Applying for this service can be done on the Vanbreda International dedicated web pages under the section entitled “claims” (see http://www.vanbreda-international.com) In order to guarantee a smooth processing of claims, Vanbreda International would like to encourage all plan participants, particularly those that will avail themselves of the option of receiving reimbursements in another currency other than the United States dollar to use the combination of settlement details online and electronic fund transfers (direct deposit into the member’s bank account).
54 Vanbreda International offers 24-hour customer service with its extended business hours in Antwerp, Belgium, and its service platforms in Kuala Lumpur and Miami, United States Multilingual staff have been specifically trained to respond immediately to all queries that United Nations staff members may have The Vanbreda service platform has been organized so that the main international languages are accessible 24 hours a day.
55 Annex I contains a summary of the benefits payable under the Vanbreda plan.
56 Annex II contains details pertaining to hospitalization in the United States of America.
57 Annex III describes the Vanbreda direct deposit programme.
58 Annex IV is a listing of Vanbreda International toll-free telephone numbers.
1 The Vanbreda insurance programme indemnifies members, within the limits of the plan, for reasonable and customary charges in respect of medical, hospital and dental treatment for illness, an accident or maternity The aggregate reimbursement in respect of the total expenses covered by the plan that are incurred by an insured participant shall not exceed $250,000 in any calendar year The provisions set forth below shall be subject to this limitation In addition to the maximum reimbursement per calendar year, certain maxima per treatment, procedure, supplies or other services may also apply, depending on the type of service, as described in the paragraphs below.
2 The programme reimburses only treatment, supplies or other services that are widely and generally accepted as medically necessary and appropriate for the condition being treated, and when such treatment, supplies or other services are prescribed by a licensed, qualified medical professional Vanbreda International has the fiduciary duty and discretionary authority to determine, on behalf of the United Nations, what constitutes a covered service or plan benefit under the programme.
3 Prior approval from Vanbreda medical consultants is required for all non-emergency hospitalizations Prior approval means that reimbursement is guaranteed only in cases where, on the basis of the medical justification, as well as a cost estimate furnished by the beneficiary at least one week prior to the admission date of the hospitalization in question, Vanbreda medical consultants grant explicit approval for the treatment In the case of a medical emergency, approval can be obtained post factum, on the basis of the same medical criteria Other benefits that require the prior approval of Vanbreda medical consultants include acupuncture, speech therapy, home health care, durable medical equipment or orthopaedic appliances, and vitamins, minerals and food/nutritional supplements.
4 The United Nations health insurance plan provides for two levels of coverage each, namely, the Basic Medical Benefit Plan (BMBP) and the Major Medical Benefits Plan (MMBP) in two different geographic areas, namely the United States and the rest of the world Both the BMBP and the MMBP coverage periods run from
From January 1 to December 31, medical expenses can be reimbursed under the BMBP and MMBP programs Reimbursement is available for services provided by licensed paramedical professionals or licensed midwives in maternity cases, but these services must be prescribed by a qualified medical professional.
5 For services received in countries other than the United States, the major medical component does not apply in the case of outpatient mental health treatment that is medically necessary and pre-certified by Vanbreda based on a detailed medical prescription (see “Outpatient mental health care” under No 12.4 of annex I), treatment for substance abuse (alcohol and/or drug), expenses for hearing aids, or expenses for optical lenses, nor does MMBP apply for costs that are reimbursed at 100 per cent under BMBP (for example, other hospital expenses and hospital stay), as there is no balance left on these charges Also, expenses that are subject to a maximum reimbursement (for example, dental care for illnesses not related to an accident, optical care, psychotherapy, etc.) are also not subject to a reimbursement under the MMBP component MMBP covers 80 per cent of the difference between the accepted costs and the amount reimbursed under BMBP In order to be entitled to any reimbursement under MMBP, an out-of-pocket (OOP) maximum of $200 per insured person or $600 per family has to be satisfied All payments under MMBP are applied automatically and do not require submission of a claim by the United Nations staff member.