MEDICAL EVACUATION (MEDEVAC) TABLE OF CONTENTS

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I. General..........................................................................................................................................1 Purpose...........................................................................................................................................1 Eligibility .......................................................................................................................................1 Escorts............................................................................................................................................1 Donor .............................................................................................................................................2 Duration .........................................................................................................................................2 Destination and Costs.....................................................................................................................2 Children born while Mother is on MEDEVAC ............................................................................3 Repatriation of Mortal Remains.....................................................................................................3 II. Mode of Transportation ..............................................................................................................4 Travel by Air..................................................................................................................................4

III. Daily Subsistence Allowance (DSA) ...........................................................................................4 Recognized Regional Medical Centre of MEDEVAC ..................................................................5 Place of Home Leave or Within Country of Recruitment for Locally Recruited Staff..................5 Place of Staff Member's Choice ....................................................................................................5 IV. Terminal and Other Expenses ....................................................................................................7 V. Related Entitlements....................................................................................................................7 Leave Status ..................................................................................................................................7 Special Leave Without Pay (SLWOP)...........................................................................................7 Annual Leave / Home Leave .........................................................................................................7 VI. Procedure......................................................................................................................................7 Approving Authority .....................................................................................................................7 Medical Evacuation Requests .......................................................................................................8 Availability of the UNHCR Medical Service ...............................................................................8 Confidentiality of Medical Information ........................................................................................8 Practical Measures .........................................................................................................................8 Visas...............................................................................................................................................9 Travel Authorization (PT-8) .........................................................................................................9 Purchase of Tickets .......................................................................................................................9 DSA Advances ............................................................................................................................10 Travel Claim ...............................................................................................................................11 Payment of Advances in Order to Settle Medical Bills ..............................................................12 Recovery of Salary Advances for Medical Expenses ..................................................................12 Record-Keeping ..........................................................................................................................13

Annexes

A. Summary table: DSA payable on MEDEVAC ...........................................................................14

B. Recognized Regional Medical Centre of MEDEVAC ................................................................15

C. Emergency Chartered Medical Evacuation Services (International SOS) ..................................17

D. Guidelines for Physicians Advising on Medical Evacuation ......................................................19

E. Contact Information for Medical Service – UNHCR Geneva ....................................................20

F. Medical Evacuation Request Form (to be completed by Head of Office) ...................................21

G. Medical Evacuation Request Form (to be completed by the attending physician) .....................22

H. Medical Evacuation Report Form (to be completed by the staff member) .................................25

I. Medical Evacuation Final Medical Report (to be completed by the attending physician) ..........26

J. Sample Authorization for MEDEVAC........................................................................................28

K. Control Sheet for Audit purposes ................................................................................................29

L. Checklist to be attached to Payment Voucher for Settlement of MEDEVAC Travel Claim ......30

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I. General Purpose

1. The purpose of a medical evacuation (MEDEVAC) is to allow staff members and eligible

dependants the opportunity to secure essential medical care or treatment for a severe illness or injury requiring medical intervention that is locally unavailable or inadequate.

Eligibility 2. Internationally Recruited Staff Members. Internationally recruited staff members, their

spouses and dependent children residing at the duty station, as well as internationally recruited consultants (for service-incurred accidents only), may be evacuated in case of an acute illness or injury for the purpose of securing essential medical care or treatment which cannot be secured locally because of inadequate medical facilities.

3. Internationally recruited staff members, their spouses and dependent children should plan all

elective surgical, medical or dental procedures in conjunction with their home leave or family visit travel.

4. Locally Recruited Staff Members. Locally recruited staff members, their spouses and

dependent children, for whom the organization has not assumed a responsibility for relocation to or from the duty station, will normally be expected to avail themselves of the facilities available locally1. However, when an acute life-threatening medical emergency has occurred, MEDEVAC will be considered when the available local facilities offer an inadequate response.

5. Staff on Mission and/or in Receipt of SOLAR 2: Staff members on mission status are eligible

for MEDEVAC as per paragraphs 2 to 4 above. 6. Entry/Periodic/Exit Medical Examinations are not covered by MEDEVAC. Where

adequate medical facilities are not available at the duty station, staff members may be authorized to travel to the nearest city where adequate medical facilities exist for the purpose of undergoing the required medical examination. Such travel will be authorized locally. DSA and travel entitlements will be covered under Account 621250 – Medical examinations.

7. United Nations Volunteers and any other category of staff not specifically mentioned above are

not covered by the provisions of this IOM/FOM.

Escorts 8. Medical Escort. A physician or a nurse may be authorized to escort the evacuee only when

medical attention is required during travel. 9. Family Member Escort. A family member may be authorized to travel with the evacuee under

the following circumstances:

a) in psychiatric cases;

b) for children under 18 years of age;

1 As per IOM 48/98- FOM 52/98 of 1 July 1998 “Redeployment of locally recruited staff between duty

stations in the same country”, a redeployed staff member and his/her eligible dependants will be entitled to MEDEVAC within-country in accordance with local conditions and subject to the approval of JMS.

2 See IOM 91/2000 – FOM 93/2000 dated 28 December 2000: “Special Operations Approach”

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c) for evacuees who cannot look after themselves (e.g. stretcher or paralytic cases). Donor 10. In cases of transplant or other medical intervention, the travel of a donor may be authorized.

The Head of Office should consult with PAPS for DSA and travel entitlements for the donor. Duration 11. As payment of DSA should normally not exceed 45 days, maximum care should be exercised in

determining the place of evacuation based on the expected duration. When MEDEVAC is expected to exceed this period, or for any extension of MEDEVAC beyond 45 days, authorization must be obtained from UNHCR Medical Service. For this purpose, all relevant medical documentation must be forwarded to Medical Service.

12. Once authorized, normally not more than one follow-up MEDEVAC will be approved for the

same condition or in respect of surgical procedures (e.g. removal of stitches, etc). Medical Service should be contacted when further follow-up evacuations are required.

Destination and Costs

Recognized Regional Medical Centre: 13. The list of Recognized Regional Medical Centers, in line with ST/IC/2000/70, is provided in

Annex B. Any departures from the ST/IC list will be noted and filed as “exception” by the Medical Service. Medical Service is aware that exceptions have to be justified for reason of inadequacy of medical treatment of the particular medical condition at the point of origin and the adequacy or otherwise at the nearest recognized centre, the latter will prompt an exceptional authorization to a third point. Urgent life threatening situations will be dealt, as always, as per the determination by the Medical Service.

14. MEDEVAC is normally authorized to the Recognized Regional Medical Centre. All

authorizations, from Medical Service, for medical evacuations will carry a sequential medevac authorization number – YY/MS/0XX; any extensions thereof will also carry the same authorization number – YY/MS/0XX add.1. All travels under medevac must be fully documented for audit purposes.

15. Travel costs to the nearest Recognized Regional Medical Centre are borne by the organization

in respect of the evacuee and any authorized escort. 16. If difficulties arise in obtaining an entry visa to the Recognized Regional Medical Centre (see

paragraph 54), an alternative destination within the region will be authorized. Country of Home Leave:

17. In the case of internationally recruited staff members, MEDEVAC may be authorized to the country of home leave in cases of:

a) high-risk pregnancies;

b) psychiatric conditions;

c) illnesses requiring a long period of convalescence. 18. Travel costs are borne by the organization in the cases mentioned in paragraph 17 in respect of

the evacuee and any authorized escort, and covered under Account 621710 (i.e. travel on

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MEDEVAC will not be offset against the staff member’s home leave or family leave entitlement).

Place of Staff Member’s Choice:

19. A patient may choose to be evacuated to:

a) the country of home leave (if the case is not covered under paragraph 17); or

b) any country of the staff member’s choice, subject to approval by Medical Service. 20. The staff member will be required to produce satisfactory medical evidence of proper medical

care or treatment received at the chosen place. 21. Travel costs for the staff member and any eligible family member to the country of home leave,

or the country of family visit, or the alternate country of home leave, may be paid in the form of advance home leave or family visit, provided all applicable requirements for either of those entitlements are met. Travel costs in excess of those required for evacuation to the Recognized Regional Medical Centre will be borne by the staff member when the staff member has already exhausted his or her home leave or family visit entitlement.

22. When travel is to a country of the staff member’s choice, UNHCR will only pay whichever of

the following two costs is lower and the staff member will be responsible for any difference:

a) from the duty station to the place of the staff member’s choice, and return;

b) from the duty station to the Recognized Regional Medical Centre of MEDEVAC, and return.

23. Emergency Medical Evacuation. For emergency medical evacuations, the Head of Office, in

consultation with UNHCR Medical Centre determines the place of evacuation, which should normally be the nearest Recognized Regional Medical Centre. In addition, a separate arrangement exists with International SOS for MEDEVAC in extreme emergencies. The procedures for MEDEVAC by International SOS are summarized in Annex C.

Children Born while Mother is on MEDEVAC 24. In the case of a child born during MEDEVAC, UNHCR will pay, in respect of the new-born

child, whichever of the following two costs is lower:

a) travel from the Recognized Regional Medical Centre of MEDEVAC to the duty station; or

b) travel from the place where the mother exercised MEDEVAC to the duty station. Repatriation of Mortal Remains 25. In the unfortunate event of the patient’s death during MEDEVAC, UNHCR will cover the costs

of transportation from the place of death:

a) for an international staff member, spouse or dependent child:

• to the staff member’s place of home leave • to the duty station • to any other place, provided the cost of transportation does not exceed from place

of death to place of home leave, in which case the extra costs will be paid by the surviving family members;

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b) for a local staff member, spouse or dependent child, to the duty station.

II. Mode of Transportation Travel by Air 26. The mode of travel, irrespective of the duration of the flight, will normally be in economy class

in accordance with the least costly airfare structure regularly available or its equivalent. The class immediately below first class may be authorized by the Head of Office (see paragraph 42), when medically recommended.

27. Chartered Transportation. In extreme emergencies, and when traditional commercial or

other UN means of transportation and facilities cannot be used or are inappropriate given the seriousness of the case (e.g. in field duty stations where commercial airline schedules are infrequent or unreliable), chartered air transportation may be used. This may be done by requesting the services of:

a) local/regional companies specializing in emergency chartered medical evacuations, as set

out in the local MEDEVAC plan; or

b) International SOS [See Annex C “Emergency Chartered Medical Evacuation Services”]. 28. Chartered air transportation services should be used very cautiously, as they are very costly.

III. Daily Subsistence Allowance (DSA)

See Annex A “DSA payable on Medical Evacuation” (Summary table)

29. In all cases of MEDEVAC, payment of subsistence allowance will be subject to the provision of receipts for a hotel/commercially registered accommodation in order to determine the appropriate rate.

30. Staff members in receipt of SOLAR3: No DSA will be paid to staff members in receipt of

SOLAR, who travel on MEDEVAC to their administrative place of assignment (APA) in view of the fact that they are deemed to have been installed at these locations. Staff members traveling on MEDEVAC to a place other than the APA will continue to receive SOLAR plus any applicable DSA for up to a maximum of 15 continuous nights of absence from the duty station. SOLAR will cease to be paid from the 16th night until the staff member returns to his/her duty station, or to another location where SOLAR is applicable. Any applicable DSA will be paid in lieu of SOLAR.

31. However, if the evacuation is expected to last 15 days or more, SOLAR will be discontinued

effective from the date of departure on MEDEVAC, and any applicable DSA will be paid.

3 See IOM 91/2000 – FOM 93/2000 of 28 December 2000, “Special Operations Approach”.

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Recognized Regional Medical Centre of MEDEVAC 32. When MEDEVAC is authorized to the nearest Recognized Regional Medical Centre which is

not the staff member’s place of home leave, DSA may be paid, upon presentation of hotel receipts, at the rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, actual expenses for hotel may be reimbursed on

the basis of receipts up to 50 per cent of the standard DSA rate applicable to the authorized place of evacuation;

b) for the evacuee when hospitalized, one third of the standard DSA rate applicable to the authorized place of evacuation;

c) for the family member escort authorized to accompany the evacuee,

• if the patient is not hospitalized, up to 50 per cent of the standard DSA rate applicable to the authorized place of evacuation; and

• if the patient is hospitalized, up to 100 per cent of the standard DSA rate applicable to the authorized place of evacuation;

d) for the medical escort authorized to accompany the evacuee, 100 per cent of the standard DSA rate applicable to the authorized place of evacuation, limited to two to three days depending on travel time.

Place of Home Leave, or Country of Recruitment for Locally Recruited Staff 33. When MEDEVAC is authorized to the staff member’s place of home leave, or within country

for locally recruited staff, actual expenses for hotel or other commercially registered accommodation may be reimbursed on the basis of receipts at the rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, up to 50 per cent of the standard DSA rate

applicable to (i) the staff member’s place of home leave, or (ii) the actual place of evacuation within country for locally recruited staff;

b) for the evacuee when hospitalized, no DSA is paid;

c) for the family member authorized to accompany the evacuee:

• if the patient is not hospitalized, up to 25 per cent of the standard DSA rate applicable to (i) the staff member’s place of home leave, or (ii) the actual place of evacuation within country for locally recruited staff; and

• if the patient is hospitalized, up to 50 per cent of the standard DSA rate applicable to (i) the staff member’s place of home leave, or (ii) the actual place of evacuation within country for locally recruited staff.

d) for the medical escort authorized to accompany the evacuee, 100 per cent of the standard DSA rate applicable to the authorized place of evacuation is paid, limited to two to three days depending on travel time.

Place of Staff Member’s Choice 34. When advance home leave or family visit is authorized instead of MEDEVAC, normally no

DSA is paid except to the medical escort who receives 100 per cent of the standard DSA rate applicable to the place of evacuation, limited to two to three days depending on travel time.

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35. Actual expenses for hotel or other commercially registered accommodation may be reimbursed on the basis of receipts at the rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, whichever of the following two costs is lower:

• up to 50 per cent of the DSA rate applicable at the place of home leave; or • up to 50 per cent of the DSA rate applicable at the nearest Recognized Regional

Medical Centre of MEDEVAC.

b) for the evacuee when hospitalized, no DSA is paid;

c) for the family member authorized to accompany the evacuee,

• if the patient is not hospitalized, up to 25 per cent of the standard DSA rate applicable at the staff member’s place of home leave or 50 per cent of the rate applicable at the Recognized Regional Medical Centre of MEDEVAC, whichever is the lower; or

• if the patient is hospitalized, up to 50 per cent of the standard DSA rate applicable at the staff member’s place of home leave or 100 per cent the rate applicable at the Recognized Regional Medical Centre of MEDEVAC, whichever is the lower;

d) for the medical escort authorized to accompany the evacuee, 100 per cent of the standard DSA rate applicable to the authorized place of evacuation, limited to two to three days depending on travel time.

36. When MEDEVAC is authorized to the place of the staff member’s choice, which is not the staff

member’s place of home leave, DSA may be paid, upon presentation of hotel receipts, at the rates shown below. Without receipts, no reimbursement will be made.

a) for the evacuee when not hospitalized, actual expenses for hotel may be reimbursed on the basis of receipts up to 50 per cent of whichever of the following two costs is lower:

• the standard DSA rate applicable at the place of the staff member’s choice; or

• the standard DSA rate applicable at the Recognized Regional Medical Centre;

b) for the evacuee when hospitalized, one third of whichever of the following two costs is lower:

• the standard DSA rate applicable at the place of the staff member’s choice; or

• the standard DSA rate applicable at the Recognized Regional Medical Centre;

c) for the family member authorized to accompany the evacuee,

• if the patient is not hospitalized, up 50 per cent of the standard DSA rate applicable at the place of the staff member’s choice or the Recognized Regional Medical Centre, whichever is the lower; or

• if the patient is hospitalized, up to 100 per cent of the standard DSA rate applicable at the place of the staff members’ choice or the Recognized Regional Medical Centre whichever is the lower;

d) for the medical escort authorized to accompany the evacuee, 100 per cent of the standard DSA rate applicable to the authorized place of evacuation, limited to two to three days depending on travel time.

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IV. Terminal and Other Expenses 37. Terminal and other expenses shall be paid in accordance with SAMM chapter VII.

V. Related Entitlements Leave Status 38. Based on the medical certificate to be submitted by the staff member and duly certified by

Medical Service, absence on MEDEVAC will be charged to sick leave. 39. If a staff member accompanies a family member on MEDEVAC, the absence will be charged to

annual leave. At the staff member’s request, the absence may be charged to family leave4 and/or taken as Special Leave Without Pay (SLWOP), as appropriate (see SAMM chapter VI and procedure 6.2.).

Special Leave Without Pay (SLWOP) 40. No MEDEVAC will be authorized during SLWOP. It is the responsibility of the staff member

to take out adequate insurance coverage during SLWOP. Annual Leave

41. No MEDEVAC will be authorized during annual leave when the staff member is away from the

duty station or place of mission. It is the responsibility of the staff member to take out adequate insurance coverage during annual leave.

VI. Procedure

(Initiate Medical Evacuation Checklist – See Annex L)

Approving Authority 42. Authority to approve MEDEVAC to the Recognized Regional Medical Centre within the

region (see Annex B) or to the country of home leave, on the recommendation of the UN designated physician, is delegated to the Heads of Offices, in consultation with UNHCR Medical Service. The information which is forwarded to UNHCR Medical Service is confidential, and should under no circumstances be filed in a staff member’s file (PER/IND).

43. Guidelines for physicians advising on MEDEVAC are outlined in Annex D. 44. MEDEVAC to any other place will require the prior approval of UNHCR Medical

Service.

4 See IOM/FOM 08/98-10/98 dated 1 February 1998 – “Introduction of a Family Leave Option”

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Medical Evacuation Requests 45. In cases where the prior approval of UNHCR Medical Service is required, the Medical

Evacuation Request Forms (attached as Annex F and G) should be completed and submitted to UNHCR Medical Service. It should contain the following information:

a) staff member’s name, employment status (local or international), duty station, and index number;

b) patient’s name (if not the staff member) with relationship to staff member;

c) Nearest Recognized Regional Medical Centre of MEDEVAC;

d) requested place of evacuation;

e) proposed date of evacuation and expected duration;

f) patient’s current clinical condition;

g) tentative diagnosis by the treating physician;

h) laboratory tests;

i) treatment initiated;

j) specific purpose of the evacuation; and

k) recommendation of the local UN designated Physician. 46. It is essential that correct and complete information be communicated to UNHCR Medical

Service to avoid unnecessary delays. Each request for MEDEVAC will be reviewed individually, taking into consideration the recommendation of the UN-designated physician and any other medical information at hand.

Availability of UNHCR Medical Service 47. UNHCR Medical Service or the designated Duty Officer at Headquarters is available for

consultation and assistance in all cases, 24 hours a day, and may be reached by telephone, fax, telex, or e-mail (see Annex E).

Confidentiality of Medical Information 48. Medical information is confidential and should be treated as such, whether within offices or in

the transmission to UNHCR Medical Service, other offices or medical facilities. Practical measures 49. Once MEDEVAC has been approved, the Human Resources/Administrative Officer at the staff

member’s duty station must send the following information/documentation to the Human Resources/Administrative Officer in the receiving country:

a) staff member’s name; employment status (local or international), duty station, and index number;

b) if applicable, name of accompanying family member and/or medical escort;

c) date of arrival, name of airline, flight number, and estimated time of arrival for patient and, if applicable, accompanying family member and/or medical escort;

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d) estimated date of departure, name of airline, flight number and estimated time of departure for patient and, if applicable, accompanying family member and/or medical escort;

e) whether hotel accommodation arrangements are required for the patient and, if applicable, accompanying family member and/or medical escort;

f) whether transportation arrangements to and from airport are required for the patient and, if applicable, accompanying family member and/or medical escort; and

g) whether patient is covered under UNSMIS or MIP. UNSMIS or MIP can issue a letter of guarantee in case medical centres request a guarantee of payment in advance.

50. The Human Resources/Administrative Officer at the staff member’s duty station must remind

the staff member to retain all receipts for accommodation, for submission with the Travel Claim.

51. In addition, a copy of the Travel Authorization (PT-8) reflecting travel advances granted,

must be faxed to the Human Resources/Administrative Officer in the receiving country (see paragraph 55).

52. In non-emergency cases, travel should not commence until the appointment with the pertinent

specialist has been made. As far as possible, evacuation should be avoided on weekends and holidays when, as a rule, only emergency services are available in many hospitals.

53. The patient should have with him/her all necessary medical documents and records. Visas 54. Prior to departure on MEDEVAC, the Human Resources/Administrative Officer should ensure

that any required visas have been obtained. Travel Authorization (PT-8) 55. The Human Resources/Administrative Officer is responsible for issuing the travel authorization

(PT-8) in respect of MEDEVAC travel, based on the authorization received from UNHCR Medical Service. Evacuees and accompanying family members and/or medical escorts must be in possession of a signed PT-8 prior to undertaking MEDEVAC. Travel that has been undertaken on oral instructions should be confirmed as soon as possible by the issuance of a PT-8. For account codes, please refer to paragraph 66 below.

56. If the conditions of travel necessitate a deviation from the authorized route and if such a change

results in a higher cost, the traveler should contact and obtain prior authorization from the Head of Office/Human Resources/Administrative Officer.

57. When travel on home leave or family visit is authorized in order to allow the patient to undergo

medical treatment, the authorization to travel will be given by Personnel Administration & Payroll Section (PAPS) in the normal way.

Purchase of Tickets 58. Unless staff members are specifically authorized to make other arrangements, all tickets for

transportation involving MEDEVAC will be purchased by UNHCR, directly through its authorized agents, in advance of the actual travel.

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59. When a staff member requests a standard of accommodation in excess of his/her entitlement, or is authorized to travel for reasons of personal preference or convenience, by other than the approved route or mode of transportation, the staff member will be required to pay, directly to the Travel Agent, any additional costs in advance of travel.

DSA Advances 60. The maximum initial DSA that may be authorized by Field Offices is limited to 15 days.

However, the initial advance against DSA should never be more than the number of days of the expected duration of the evacuation, as certified by the treating physician. An advance of 100 per cent against the estimated entitlement to DSA may be made to the traveler and recorded on the original PT-8. No extension of DSA payments beyond 15 days may be authorized, nor any advances made, without the prior approval of Personnel Administration & Payroll Section (PAPS).

61. If the MEDEVAC period is extended, the staff member’s Human Resources/ Administrative

Officer may request UNHCR’s office at the place of evacuation to provide an additional travel advance which must be recorded on the traveler’s PT-8.

62. The Human Resources/Administrative Officer should inform staff members of any restrictions

on traveler’s cheques and credit cards at their destination. 63. Travelers who encounter personal emergencies or extraordinary expenses may contact the

UNHCR Head of Office at the place of evacuation. Staff members should not contact UNDP offices except in extreme emergencies and may do so only where there is no UNHCR office.

64. Advances made by Field Offices in respect of medical evacuation travel or DSA should be

charged as follows: a) Staff assigned to posts and local temporary assistance (including staff members in

receipt of SOLAR): All advances should be debited using the following chartfields when payments are made to him/her either at their duty station or outside his/her duty station: Cost Center - (Duty Station) Programme - VF Account - 240018 Open Item - Staff Member's last name. (Please note when travel ticket has been purchased by the Office, then that cost need not be charged as an advance but should be treated as expenditure)

b) UNHCR staff on mission status, internationally recruited staff on temporary assistance and consultants: all advances charged to the pertaining cost centre on the relevant PT-8.

65. Where the advance is made by the UNHCR office at the place of evacuation, the appropriate

country and location code of the duty station of the staff member should also be quoted in the payment voucher. Copies of any payment voucher should be forwarded to the staff member’s duty station to ensure recovery. All advances should be recorded on the original of the PT-8, and a copy of any payment voucher given to the staff member.

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Travel Claim 66. Travel expenses should be charged directly to the appropriate account code as follows:

a) Staff assigned to posts: Pertaining cost centre, using 621710 as Account.

b) Staff on mission:

(1) Headquarters PT8: An addendum to the mission PT8 authorizing travel to the mission area, charging the pertaining cost centre with Account 621710 should be issued. The third and fourth copies should be forwarded to Travel and Visa Unit (HQAU01), with box 18 fully completed and the amount of the advance received indicated in box 13.

(2) Local PT8:

(2.1.) Missions lasting 1-60 days: Pertaining cost centre of the staff member, using 621710 as Account.

(2.2.) Missions of 61 days or more:

(2.2.1.) If in receipt of SOLAR, charge the same account code as SOLAR using 621710 as Account.

(2.2.2) If not in receipt of SOLAR, charge the pertaining cost centre for the staff member’s salary5 using 621710 as Account.

c) Local staff on temporary assistance: Charge Account 620320.

d) Internationally recruited staff on temporary assistance and consultants: Authorization issued as an addendum to the mission PT-8 covering travel to the mission area, charging the pertaining cost centre as indicated on the original.

67. Where MEDEVAC is within the country of the duty station, settlement will normally be

effected in local currency in accordance with normal procedure. Where travel is outside the country of the duty station, settlement of the travel claim will normally be made in US dollars.

68. Where travel claims are settled locally, copies of all documents should be retained in the Field

Office for future audit inspections. 69. Travel claims of staff assigned to posts or local temporary assistance should be submitted

immediately upon return to the duty station and settled by the Field Office that issued the original PT-8.

70. Travel claims for MEDEVAC in respect of internationally recruited staff on temporary

assistance, staff members on mission with Headquarters PT8s and consultants, must be part of the final travel claim and submitted upon completion of the mission/assignment.

71. The following documents must be attached to all travel claims:

a) medical certificate from the UN designated physician and the approval from UNHCR Medical Service which should indicate:

(i) exact number of days of sick leave recommended;

(ii) number of days of hospitalization;

(iii) number of days the patient was required to stay at the place of evacuation;

5 This would normally be the pertaining cost centre for the mission location, not the staff member’s own post.

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b) copies of all payment vouchers relating to any advances received or payments made, whether by the UNHCR office at the place of evacuation or by the duty station of the staff member, to or on behalf of the patient, in respect of travel, DSA or medical expenses

c) original PT-8

d) ticket stubs and/or any unused airline ticket(s) for immediate refund

e) original hotel receipts (to enable calculation of the DSA rate) and/or declaration of any free or subsidized accommodation, meals or transportation provided by UNHCR, by government or a related institution, or by an airline.

72. The payment voucher pertaining to the final settlement should clearly indicate:

a) maximum DSA entitlements;

b) all other related travel expenses;

c) recovery of any advances;

d) full allotment account code. Payment of Advances in Order to Settle Medical Bills 73. It is the responsibility of the staff member to settle his/her own medical expenses. 74. However, where the medical expenses are expected to be high, Field Offices may be authorized

to settle medical bills charging the suspense account 240006, followed by the staff member's name and/or employee ID. Payments in this respect will be considered as salary advances, and authorized as follows:

a) Locally recruited staff members: upon receipt of authorization from the releasing

office;

b) Internationally recruited staff members and consultants: upon receipt of authorization from Personnel Administration & Payroll Section (PAPS).

75. The UNHCR office at the place of evacuation should send copies of all relevant payment

vouchers reflecting advances, made either to the staff member or on his/her behalf, to the staff member’s duty station or Personnel Administration & Payroll Section (PAPS), as applicable, to ensure reimbursement of the advance(s).

76. When making advances for the purposes of settling medical bills on behalf of locally recruited

staff members or their eligible family members who are covered by the Medical Insurance Plan (MIP), Field Offices should always bear in mind that reimbursement of medical expenses during one calendar year is limited to the MIP ceiling.

77. When specifically authorized by Personnel Administration & Payroll Section (PAPS), medical

expenses incurred for service-incurred injuries (see SAMM chapter 6.5), may be charged to suspense account 240005, pending a final decision from the UN Advisory Board on Compensation Claims.

Recovery of salary advances for medical expenses 78. In cases where advances have been made in respect of medical bills, the releasing office should

ensure that the staff member submits forthwith a claim for reimbursement of medical expenses (MIP or UNSMIS). Advances for medical expenses will be recovered as follows:

a) Staff members covered by MIP: Upon settlement of the medical claim;

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b) Locally recruited staff covered by UNSMIS: Upon receipt of authorization for reimbursement from UNSMIS Geneva;

c) Internationally recruited staff covered by UNSMIS: In all instances, claims must be sent to their Human Resources Officer who will request direct reimbursement from UNSMIS.

d) Medical expenses incurred for potential service-incurred illness or accident: The staff member should complete and submit, within the four-month time limit, form P.72 rev.4 “Claim for Compensation under Appendix D to the Staff Rules”, attaching original medical bills and related payment vouchers. When the illness or accident has been Recognized by the Advisory Board on Compensation Claims as service-incurred, advances will be offset accordingly at Headquarters. If the illness or accident is not Recognized as service-incurred, the supporting documentation will be returned to the staff member who should proceed as per a) or c) above.

79. Failure by the staff member to submit claims for reimbursement will result in the

deduction of the total amount of all advances from the staff member's salary. Record-Keeping 80. Within two weeks following the return of the evacuee to the duty station, the staff member

should ensure that a complete medical report delivered by the attending physician at the place of evacuation is forwarded to UNHCR Medical Service (see Annex I).

81. It is the responsibility of the Head of Office to ensure that the control sheet, which is attached as

Annex K, is kept up to date at all times for audit purposes. 82. Upon completion of the medical evacuation i.e. upon settlement of the travel claim, the Human

Resources/Administrative Officer at the Field Office must send, referring to the MEDEVAC Authorization Number, scanned copies of the travel claims along with necessary documentation (excluding medical reports), to the GroupWise mailbox HQMS00@unhcr.org copied to MEDEVAC@unhcr.org. This information will help PAPS in providing reliable statistics pertaining to medical evacuations.

14

Annex A

DSA PAYABLE ON MEDICAL EVACUATION (Upon presentation of hotel receipts – Refer to paragraph III of IOM/FOM)

Evacuation to

RECOGNISED REGIONAL MEDICAL CENTRE or other exceptional destination in EXTREME cases

Evacuation to

COUNTRY OF HOME LEAVE or WITHIN COUNTRY for LOCALLY RECRUITED STAFF

Evacuation to staff member’s CHOSEN PLACE (other than place of home leave, or outside country of duty station for locally recruited staff)

When evacuee is NOT hospitalised

When evacuee is hospitalised

When evacuee is NOT hospitalised

When evacuee is hospitalised

When evacuee is NOT hospitalised

When evacuee is hospitalised

International staff and

eligible family members

Actual expenses based on hotel receipts, but not to exceed 50% of DSA of Recognized centre

1/3 of DSA of recognised centre

Actual expenses for hotel or other accommodation based on receipts, but not to exceed 50% of DSA of place of Home Leave

No DSA

Actual expenses based on hotel receipts, but not to exceed 50% of lower of:

1) DSA of chosen place, or

2) DSA of recognised centre

1/3 of lower of:

1) DSA of chosen place, or

2) DSA of recognised centre

E V A

C U E E

Local staff and eligible

family members

If evacuation is to place outside country of duty

station: Actual expenses based on hotel

receipts, but not to exceed 50% of DSA of

Recognized centre

If evacuation is to place outside country of duty

station:

1/3 of DSA of recognised centre

Actual expenses for hotel or other accommodation based on receipts, but not to exceed 50% of DSA of place of evacuation

No DSA

Actual expenses based on hotel receipts, but not to exceed 50% of lower of:

1) DSA of chosen place, or

2) DSA of recognised centre

1/3 of lower of:

1) DSA of chosen place, or

2) Applicable rate of DSA of recognised centre

Family escort 50% of DSA of

recognised centre 100% DSA of

recognised centre

25% of DSA of Place of Home Leave place, or of within-country place of evacuation for locally recruited staff

50% of DSA of place of Home Leave place, or of within-country place of evacuation for locally recruited staff

50% of lower of:

1) DSA of chosen place, or

2) Applicable rate of DSA of recognised centre

100% of lower of:

1) DSA of chosen place, or

2) Applicable rate of DSA of recognised centre

E S C O R T

Medical escort (doctor

or nurse) 100% DSA of authorised place of evacuation up to a maximum of 2-3 days depending on travel time

15

Annex B

Countries with inadequate medical facilities justifying medical evacuation to recognized regional medical centres

Countries Recognized regional medical centres

A. Central America

Belize, El Salvador, Honduras, Nicaragua Mexico

B. South America

Bolivia Chile

Guyana Trinidad and Tobago and Venezuela

C. Caribbean

Haiti Dominican Republic

D. Arab States

Iraq Libyan Arab Jamahiriya Yemen

Jordan, Lebanon Egypt, Tunisia

Egypt, Saudi Arabia

E. Africa

Benin Burkina Faso Cape Verde Central African Republic Chad Congo Democratic Republic of the Congo Equatorial Guinea Gambia Ghana Guinea Guinea-Bissau Liberia Mali Mauritania Nigeria Niger Sao Tome and Principe Sierra Leone Togo

Cameroon Côte d’Ivoire

Gabon Senegal

South Africa

16

Countries Recognized regional medical centres

Burundi Djibouti Eritrea Ethiopia Rwanda Somalia Sudan Uganda United Republic of Tanzania

Egypt Kenya

South Africa

Angola Botswana Lesotho Malawi Mozambique Swaziland Zambia

South Africa

Comoros Madagascar

Île de la Réunion

F. Asia

Armenia Azerbaijan Georgia Kyrgyzstan

Turkey

Afghanistan Bangladesh Bhutan Kazakhstan Nepal Turkmenistan Uzbekistan

India, Pakistan

Maldives India, Sri Lanka

Cambodia Lao People’s Democratic Republic Myanmar Viet Nam

Thailand

Democratic People’s Republic of Korea Mongolia

China

G. Micronesia and Melanesia

All countries Australia, New Zealand

17

Annex C EMERGENCY CHARTERED MEDICAL EVACUATION SERVICES –

International SOS

Medical Evacuation Travel in EXTREME emergencies 1. UNHCR has a contract with International SOS, based in Switzerland, which provides air

ambulance services for medical evacuations of extreme urgency. However, in view of the extremely high costs (minimum US$50,000) of using this service, it should only be resorted to in very exceptional circumstances. Until further notice therefore, all requests for SOS flights should continue to be addressed to UNHCR Medical Service who will liaise with CSSS.

2. Wherever possible, evacuation of emergency cases should be carried out through commercial

air services. 3. The Head of Office is authorized, should the need arise, to arrange medical evacuation travel via

International SOS without reference to UNHCR Medical Service in extreme medical emergency where a life-threatening condition exists, and where an evacuation by normal commercial air-services cannot be organized in view of the gravity of the illness or injury. The Head of Office is authorized to request the services of International SOS for the emergency evacuation of the following categories of staff:

a) Internationally recruited staff members;

b) The recognized spouse and dependent children of staff in a) above who reside at the duty station and whom the Organization has an obligation to repatriate, i.e. UNHCR paid their travel expenses to the duty station;

c) Internationally recruited consultants;

d) Locally recruited staff members, provided the illness or injury is established to have been service-incurred.

e) In all other cases, the prior authorization of UNHCR Medical Service will be required.

4. In summoning International SOS, the following factors must be considered:

a) Gravity of medical risk (e.g. Serious accident, rape, etc.);

b) Speed with which the patient must be evacuated;

c) Costs involved.

5. A password is required before International SOS will take any action. A new password will be sent shortly to each Head of Office assigned in a representational capacity, who, in his/her absence, has the authority to provide the password to the Officer-in-Charge.

18

Contacting International SOS (24 hours a day) 6. Telephone: (41) (22) 785 64 64

Fax: (41) (22) 785 64 26

All newly assigned Regional Representatives, Representatives, Chiefs of Mission and Heads of Liaison Office will have access to the International SOS Directory Listing through the protected internet website pages of SOS International upon receipt of the password from the SOS International. Reference is made to IOM/FOM/32/2003.

7. When contacting SOS, the responsible Officer must indicate:

a) the password (as provided to all Heads of Office);

b) the name of the patient;

c) the nature of the problem;

d) the whereabouts and contact number of the patient and attending physician;

e) the contact number of the UN examining physician (if applicable).

Return to duty station 8. Normally the patient should not return to the duty station until the treating physician at the place

of evacuation certifies that he/she is fit to do so. This certificate must, in due course, be forwarded to UNHCR Medical Service, and a copy should be attached to the travel claim, so that the appropriate DSA may be calculated. Other normal procedures, as outlined in the IOM/FOM, apply (including the completion of the Final Checklist).

9. In cases of serious illness or injury, only the UNHCR Medical Service at HQs has the authority

to approve the return of the patient to the duty station, and he/she may not return to the duty station before such approval is given.

19

Annex D

Guidelines for Physicians advising on Medical Evacuation

Beyond the typical acute life-threatening illness or injury, medical evacuation may be considered according to the following guidelines:

A. The following chronic conditions with potential for life-threatening outcomes or complications may be considered for medical evacuation:

• Cancers • Complications of diabetes mellitus • Cardiovascular diseases • Pulmonary diseases • Kidney diseases • Liver diseases • Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) • Organ and bone marrow transplants

N.B. The above-mentioned conditions may require repeated medical evacuations.

B. The following non-life-threatening chronic conditions are generally not considered for medical evacuation:

• Chronic eye conditions • Chronic ear, nose and throat/allergy conditions • Chronic back pains, osteoarthritis • Chronic gastrointestinal ailments • Chronic urological conditions • Chronic skin conditions

Any request in this category must be submitted for review to UNHCR Medical Service before any action is taken.

C. The following conditions do not qualify for medical evacuation:

• Infertility treatments • Plastic surgeries (unless in the context of disfigurement) • Orthodontic treatments • All chronic/congenital medical conditions that are stable and non-life-threatening

20

Annex E

Address, telephone and fax numbers of the UNHCR Medical Service

Geneva

as at November 2007

Name/Title

E-mail

Telephone during working

hours

Fax

Telephone after working hours/ mobile telephone

Dr Michel Baduraux Medical Director Dr. Pascal Achard Medical Officer

baduraux@unhcr.org achard@unhcr.org

41 22 739 8952

+41 22 739 8403

41 22 739 7334

As above

41 79 217 31 22

41 79 202 23 19

Sinead O’Donovan-Rogerson Nurse

rogerson@unhcr.org 41 22 739 8953 As above 41 79 217 31 21

Duty Officer Not applicable 41 22 739 8000 Not applicable 41 22 739 8111

41 22 (0)79 217 3123

If the medical service is closed you should contact the UNHCR Switchboard +41 22 739 8111 who will be able to give you the contact number of the Duty Officer and/or the External Duty Doctor.

Annex F

21

MEDICAL EVACUATION

Medico-Administrative Request Form

Please send to the UNHCR Medical Service by:

Fax No.: 004122 739-7334 E-mail HQMS00@unhcr.org Telephone: 004122 739-7010

THIS FORM MUST BE COMPLETED BY THE UNHCR HEAD OF OFFICE REQUESTING THE MEDICAL EVACUATION Duty Station: Country: Name of Evacuee (FAMILY NAME, First Name): Date of Birth:

Gender: M F

Name of Staff Member: Job Title of Staff Member:

Index No:

The Medical Evacuation Medical Request Form should be addressed to the Medical Service, as above. Reasons for the request:

Can the evacuee travel alone?

Yes No If no, who is accompanying the evacuee?

Doctor

Nurse

Family Member

Other (please describe)

Indicate in all instances: Nearest/Recognized place of evacuation (see Annex B):

Indicate if applicable: In case of need to extend evacuation, please indicate staff member’s place of home leave:

Expected duration of medical evacuation as recommended by the attending physician (indicate number of days and dates):

Name of Physician who has recommended the evacuation (please print in capitals):

Contact details

Telephone: E-mail: Fax: Mobile Name of Head of Office (please print in capitals) Telephone: Fax: Mobile: E-mail:

Signature of Head of Office Date: (dd/mm/y)

Please note this page should be duly completed. Failure to comply will result in request being denied MS3(a)

22

Annex G MEDICAL EVACUATIONS

Medical Request Form

To be completed by the attending physician and sent directly to the UNHCR Medical Service (Geneva), under confidential cover by fax or e-mail

To: UNHCR Medical Service Fax No.: 004122 739-7334 E-mail: HQMS00@unhcr.org Concerns: Patient (Family Name, First Name):--------------------------------------------------------------- Date of Birth: -------------------------------------- Gender: ------------------------------------ Staff Member’s Name: -------------------------------------------------------------------------------- Duty Station: -------------------------------------------------------------------------------------------- Index No:__________________________ The information included below should be relevant to the pathology requiring the medical evacuation.

I. CLINICAL FINDINGS

1. Present complaints: 2. Significant past history:

3. General Appearance:

4. Cardiovascular system:

5. Respiratory system:

Please note this page should be duly completed. Failure to comply will result in request being denied MS3(b)

23

6. Digestive system:

7. Nervous system:

8. Eyes:

9. Ear, Nose and Throat:

10. Genito-urinary system:

11 Musculo-Skeletal system:

II. LATEST LAB RESULTS (IF ANY)

III. TREATMENT INITIATED (IF ANY)

IV. REASONS FOR JUSTIFICATION OF MEDICAL EVACUATION

MS3(b)

Please note this page should be duly completed. Failure to comply will result in request being denied

24

V. REQUESTED OR SUGGESTED PLACE OF EVACUATION

Name (please print in capitals) ______________________________________ Address in full: _____________________________________________________ __________________________________________________________________ __________________________________________________________________ Tel. No: ________________________________________ Fax No.:________________________________________ E-mail: _________________________________________ Mobile: _________________________________________ Signature of Attending Physician: _______________________________________ Date___________________________________________ Please note this page should be duly completed. Failure to comply will result in request being denied

MS3(b)

25

Annex H

MEDICAL EVACUATIONS

Medical-Administrative Report Form

Please send to the UNHCR Medical Service by:

Fax No. 004122 739-7334 E-mail: HQMS00@unhcr.org Tel. No. 004122 739-7010 In order to enable the Medical Service to authorize the return to work of the staff member, the following information is required: THIS PART IS TO BE COMPLETED BY THE STAFF MEMBER

Name of evacuee Family Name, First Name (please print): _______________________________________________ ____________________________________________________________________________________________________________ Date of birth: _____________________________________________________________________________________ Family Name, First Name of staff member (if different from evacuee) (please print): ________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Job title of staff member: ____________________________________________________________________________ Duty station: ______________________________________________________________________________________ Place of evacuation: ________________________________________________________________________________ Date of arrival at the place of evacuation: ________________________________________________________________ Date of return to the duty station: ______________________________________________________________________ Date of resumption of duty: ___________________________________________________________________________

Please note this page should be duly completed. Failure to comply will result in request being denied

MS3(c)

26

Annex I

MEDICAL EVACUATIONS

Final Medical Report

To be completed by the attending physician and sent directly to the UNHCR Medical Service (Geneva), under confidential cover by fax or e-mail

To: UNHCR Medical Service Fax No. 004122 739-7334 E-mail: HQMS00@unhcr.org Tel. 004122-739-7110 Concerns: Patient (Family Name, First Name) (please print):__________________________ __________________________________________________________________________ Date of birth: _______________________ Gender: _____________________ Staff Member’s Name and Relationship: __________________________________ Duty Station: _______________________________________________________ Index No: __________________________________________________________

Signs and symptoms presented by the patient on arrival: Emergency treatment started:

Results of investigations (if any), please attach:

Evolution of condition post treatment:

Prognosis

Recommendations:

Limitations:

MS3(d) Please note this page should be duly completed. Failure to comply will result in request being denied

27

Date of first medical consultation: _____________________________________________________________________ Place of hospitalization (if any): _______________________________________________________________________ Dates of hospital admission: _____________ ______________ Date of hospital discharge: ________________________ Dates of consultations as an outpatient:: ________________________________________________________ _________________________________________________________________________________________________ Date of final medical consultation: _____________________________________________________________________ The patient is fit to travel on: __________________________________________________________________________ Sick leave (indicate precise dates) from:: to: Date of Medical Service e-mail authorization:_____________________________________________________________

Name (Family Name, First Name) (please print):___________________________

__________________________________________________________________

Address in full: _____________________________________________________

__________________________________________________________________

__________________________________________________________________

Tel. No: ________________________________________

Fax No.:________________________________________

E-mail: _________________________________________

Mobile: _________________________________________

Signature of Attending Physician: _______________________________________

Date:___________________________________________

MS3(d)

Please note this page should be duly completed. Failure to comply will result in request being denied

28

MEDICAL SERVICE

Annex J

MEDICAL SERVICE AUTHORIZATION FOR MEDICAL EVACUATIO N Authorization References No.07/MS/00_ Date: 12:00:00 AM Subject: Medical Evacuation Request in respect of: Mr./Mrs./Ms. Duty station : / UNHCR MEDICAL SERVICE FILE NUMBER : HCR/0 I refer to the above mentioned case. In accordance with the documents in our possession, the evacuation of the following person is authorized as follows:

1. Name of the patient: 2. Evacuation authorized from: 3. The Evacuation is authorized to up to cost Is it the place of home leave ? Is it authorized exceptionally ? {Note: Any additional cost due to deviation from the up to cost authorized place (as per paragraph 3 above) is to be borne by the staff member.}

4. The duration of the evacuation is estimated ____0________ days. 5. The following person(s) is/are authorized to accompany the patient. : SOS used : Air Ambulance used : Note for the field:

(a) At the end of medical evacuation, a detailed medical report from the treating physician should be send

under confidential cover only to the Medical Service (by fax 41.22.739.73.34 or e-mail HQMS00@UNHCR.ORG)

(b) A medical certificate precisely indicating the sick leave period. (c) Only non-medical administrative documents, including the travel claim settlement form, should be

sent to the GroupWise Mailbox medevac@unhcr.org as scanned attachments, noting the above authorization number as subject of the e-mail.

Thank you for your kind cooperation in this matter.

UNHCR Medical Service, Headquarters, 94 rue de Montbrillant, cp 2500, 1211 Geneve 2 Tel. : + 41 22 739 70 10 (sec.) Fax : + 41 22 739 73 34 Email : HQMS00@unhcr.org

29

Annex K

CONTROL SHEET FOR MEDICAL EVACUATIONS INTERNATIONALLY AND LOCALLY RECRUITED STAFF AND DEP ENDENTS

(To be completed and retained for Audit purposes by the releasing office)

Country Office: (City and Country) Period Covering: 1 January to 31 December ORG1

SM’s Name (last in CAPS)

Index No.

Status Local / Int’l

Name of Evacuee (Patient)

Family relation

Name / status of escort

Actual Place of

MEDEVAC

MEDEVAC N /E

H/L / FVT Auth. No of days

Total Cost of

MEDEVAC

Remarks2

1 Organization (UNHCR, UNDP, etc.) 2 Use additional page if necessary

30

Annex L MEDICAL EVACUATION CHECK-LIST

(To be completed by the releasing Office and attached to the Final Travel Claim) Staff member’s name: Index: Functional Title: Grade/Step: Patient’s name: EOD: Duty station: Nearest Recognized Regional Medical Centre MEDEVAC: Place of HL (if applicable): Place of s/m’s choice: Action Date Action/Comments/References 1. Recommendation of UN Designated

Physician

2. Approval by Head of Office 3. MEDEVAC Request Forms (Annex F & G)

sent to Medical Service as necessary

4. Approval by Medical Service for MEDEVAC where required

5. Expected duration of MEDEVAC REGULAR MEDEVAC 6. Name of traveler 7. Name of accompanying person 8. Visa requested 9. PT8 issued 10. DSA/Advance Given EMERGENCY MEDEVAC 11. Name of traveler 12. Name of accompanying person 13. Visa requested 14. PT8 issued 15. DSA/Advance Given 16. Invoice forwarded to Chief PAPS

(if applicable)

SERVICE-INCURRED Refer to SAMM procedure 6.5 EXTENSION OF MEDEVAC 17. Interim medical report sent to MS on: (if

applicable)

18. Final medical report sent to MS on: 19 Certified sick leave form received from MS

on:

20. Attendance record card updated on: 21. Authorization by MS for the extension of

MEDEVAC received on:

22. Travel claim (including necessary receipts) received on:

23. Travel claim settled on: 24 25.

Claim for UNSMISS/MIP submitted: Scanned copies of travel claim and relevant docs sent electronically to GroupWise Mailbox HQMS00@unhcr.org copied to MEDEVAC@unhcr.org

NB: Step 21 must be completed before final payment is made.

MEDEVAC Checklist prepared by:

Signature:

Date: