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Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance

1

Step

Flowchart - Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance

Responsible Party
Template/Guideline

Flowchart - Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance

HR_Insurance Plans_Empire Blue Cross PPO Flowchart

Explanatory Notes

2

Step

Enrollment of staff: 

Application/ Request for Change Form completed and submitted together with supporting documents in respect of staff member’s participation, including his/her eligible family members, where relevant

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Staff members who have no insurance coverage under a United Nations plan or through a family member must be strongly urged to obtain medical insurance coverage for themselves and their eligible family members, as the cost of medical care can result in financial hardship for individuals who fall ill and/or injured and have no coverage 

If staff member or eligible family members are not enrolled within 31 days after an event that gives rise to an entitlement for coverage, an application for coverage may be submitted during the annual enrollment campaign. See UN ST/IC/2014/15 

In the case of a staff member 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 

Education of staff about the provisions under the insurance plan and distribution of materials by the person most familiar with the scheme is absolutely necessary 

If an office administers personnel on behalf of another agency, the same rules procedures for UNDP staff must be followed.

3

Step

Enrollment of staff: 

The completed application for enrollment form is certified and submitted to the Insurance and Disbursement Services within 31 days of eligibility for the entitlement

Responsible Party

BES/GSSC

Template/Guideline
Explanatory Notes

The administration of this category of employees is centralized in the Benefits & Entitlements Services Unit in GSSC BES in Copenhagen

The UN Health and Insurance Unit administers the workflow of enrollment and reporting directly with the Insurance Carrier on behalf of UNDP

4

Step

Enrollment of staff: 

Staff member records in Quantum are validated, contributions are computed, and coverage is activated

Responsible Party

UN Insurance Unit

Template/Guideline
Explanatory Notes

5

Step

Managing eligibility data in Quantum

Data on enrollment form is verified and validated and any change in coverage is processed into Quantum promptly

Responsible Party

UN Insurance Unit

Template/Guideline
Explanatory Notes

6

Step

Issue ID card: 

Identity cards are issued to the staff member and eligible dependent(s)

Responsible Party
Template/Guideline
Explanatory Notes

It is the responsibility of the staff member to ensure that the correct mailing address is submitted. Incomplete or incorrect mailing addresses in Quantum will result in misdirected mail or failure to receive important information.

7

Step

Claims:

Insurance claims are submitted, in a sealed envelope together with supporting documents, on a claim form directly to the insurance carrier, following the instructions on the claim form.

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Subscribers should note that claims for reimbursement must be submitted to the insurance carrier no later than two years from the date on which the medical expense was incurred. Claims received later than two years after the date on which the expense was incurred will not be eligible for reimbursement. 

The administration and management of the health insurance plans for internationally recruited staff governed by the UN Staff Regulations and Staff Rules are administered by the UN Health and Life Insurance Unit. Any questions/queries on the provisions under the plan or any disputes regarding claims must be submitted directly to this unit, located at 304 East 45th Street, 3rd Floor.

8

Step

Verification and reimbursement of claims: 

Insurance carrier reimburses staff member directly

Responsible Party
Template/Guideline
Explanatory Notes

Payment is made to the insured person, but, if the subscriber is no longer alive, payment will be made to his/her beneficiary as per P-2 Form Designation of Beneficiaries

9

Step

Request a review if a claim is denied: 

A claim denied in whole or in part must be submitted to the insurance carrier. The insurance carrier will provide the subscriber with a written notice explaining the reason for the denial and the appeal procedure

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

The request for review must be submitted in writing within 60 days of receipt of the notice. The subscriber should include the reasons for requesting the review and submit the request to the insurance carrier. The insurance carrier will review the claim and ordinarily notify the subscriber of its final decision within 60 days of receipt of the request. If special circumstances require an extension of time, notification will be given to that effect.

Flowchart - Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance

1

Step
Flowchart - Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance
Responsible Party
Template/Guideline
Explanatory Notes

Chartered Medical Evacuation Travel (CMET)

1

Step

Flowchart – Chartered Medical Evacuation Travel (CMET) Process

Responsible Party
Template/Guideline
Explanatory Notes

2

Step

Request approval for evacuation by chartered air transportation to Head of Office and advise HR Administrator

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

To avoid any delay in the emergency arrangements, staff members should not contact SOS directly. Only under very exceptional circumstances, when the UNDP authorizing officials cannot be reached, should the staff member contact SOS directly. Even so, it will still be necessary for SOS to attempt to locate the authorizing official at the duty station or an authorizing official in OHR.

3

Step

Verify eligibility of the staff member

Responsible Party
Template/Guideline
Explanatory Notes

International and national staff members with appointments governed by the UN Staff Regulations and Staff Rules and their eligible dependents.

4

Step

Consult with UN Examining Physician/UN Dispensary Physician on the need for Chartered MET

Responsible Party

Head of Office

Template/Guideline
Explanatory Notes

Head of Office (RR/Officer-in-Charge) 

The Head of Office may consult with the UN Medical Director, UN Medical Services Division (UNMSD); see Annex A. However, prior consultation with New York is not a requirement. The factors of degree of health risk, speed and cost will have to be taken into account. When in doubt, the health and life of the patient should be the overriding consideration.

5

Step

Evaluate and recommend MET for a staff member/ dependant on chartered air transportation to the Head of Office

Responsible Party

Physician

Template/Guideline
Explanatory Notes

Local Medical Officer 
or the UN Dispensary Physician 
or local UN Examining Physician


For acute medical emergency, when it is not possible to arrange normal medical evacuation. When in doubt, the health and life of the patient should be the overriding consideration.

6

Step

Approve Chartered MET

Responsible Party

Head of Office

Template/Guideline
Explanatory Notes

Head of Office (RR/Officer-in-Charge) 

The RR determines the destination of the MET, which should normally be the nearest recognized regional medical centre (see Annex B) or the place nearest the duty station where adequate medical facilities are available, bearing in mind the particular nature of the illness/injury involved and the type of treatment required. 

For chartered MET outside the region, the advice of the UN Medical Services should be sought.

7

Step

Approve MET outside the region

Responsible Party
Template/Guideline
Explanatory Notes

The UN Medical Services would advise on a suitable location outside the region, where applicable.

8

Step

Communicate approval to staff; 
Contact International SOS; 
Inform insurance company and organize evacuation; 
Ensure completed Prior Agreement Form is forwarded to medical insurance company (CIGNA);
Contact the UNDP office at MET destination;
Monitor the patient during MET;
Process Travel Authorization;
Process payment of invoice

Responsible Party
Template/Guideline
Explanatory Notes

When chartered air transportation is necessary, this may be done by requesting the services of: 
- International SOS (see policy above); or 
- local/regional companies specialized in emergency chartered medical evacuations (see Annex D, which contains the names, addresses and telephone numbers of some companies). 

The quickest way to contact SOS for assistance is by telephone. The SOS Alarm Control Centres are listed in Annex C. These offices are open 24 hours a day for service. Facsimile may also be used. In contacting SOS, the UNDP authorizing office should provide: 
- the name of the staff member; 
- UNDP’s SOS identification number (11BCMA000174); 
- the nature of the problem; and 
- the location and a telephone number where the patient or his/her attending physician and the designated physician can be reached. 

The Purchase Order is the official authorizing document that defines the entitlements and parameters of the approved travel and commits funds for these entitlements. 

Evacuees and accompanying family members and/or medical escorts must be in possession of a signed Purchase Order prior to undertaking chartered MET. Authorization that has been given verbally should be confirmed as soon as possible by the issuance of a Purchase Order.

SOS expenses should be charged to the same funding source against which the staff member’s salary is charged.

9

Step

Take Chartered MET

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Completes a cost estimate form if requested.
- If the staff member is unable to complete and/or sign the form, the staff member’s spouse or an adult family member may complete and sign the form on his/her behalf. If attempts to contact the staff member’s spouse or an adult family member have failed, the Head of Office (RR/ OiC) may sign on the staff member’s behalf. This measure should only be taken under circumstances where there is supporting documentation to show that efforts to contact the staff member’s spouse or adult family member were unsuccessful and where further delay could jeopardize the staff member’s well-being. When using this measure, the UNDP decision maker is responsible for communicating all medical information to the staff member until such time as a spouse or adult family member is contacted. 

Submits medical report to UN Medical Services through UN physician on return from Chartered MET.

10

Step

Forward Letter of Guarantee to the hospital

Responsible Party
Template/Guideline
Explanatory Notes

CIGNA will arrange for direct settlement of reimbursable expenses to the hospital.

11

Step

Submit invoice to Country Office for chartered air transportation

Responsible Party

International SOS

Template/Guideline
Explanatory Notes

SOS and/or the firm used by SOS to provide services will send the invoice(s) for the services rendered to the staff member’s office. Any invoice coming from individual firms other than SOS should have prior clearance and endorsement from SOS.

Medical Evacuation Travel (MET)

1

Step

Flowchart – Medical Evacuation Travel (MET) Process

Responsible Party
Template/Guideline
Explanatory Notes

2

Step

Request approval for MET to Head of Office and advise HR Administrator 

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Request for MET must be accompanied by a medical report from the attending physician that justifies medical necessity.

3

Step

Verify eligibility of patient for MET

Responsible Party

Template/Guideline
Explanatory Notes

International and national staff members with an appointment governed by the UN Staff Regulations and Staff Rules.

4

Step

Consult with UN Examining Physician/UN Dispensary Physician on the need for MET

Responsible Party

Head of Office

Template/Guideline
Explanatory Notes

Head of Office (RR/Officer-in-Charge) 

MET should be approved on the recommendation of the local Medical Officer of the Regional Commission/UN Examining Physician/UN Dispensary Physician.

5

Step

Evaluate and recommend MET

Responsible Party

Physician

Template/Guideline
Explanatory Notes

The local Medical Officer of the Regional Commission or 
the UN Dispensary Physician or 
local UN Examining Physician 
Guidelines for physicians on MET should be followed (Annex C); the recommendation for MET should be forwarded to the Head of Office for approval.

6

Step

Approve MET to a recognized regional medical centre within the region

Responsible Party

Head of Office

Template/Guideline
Explanatory Notes

If MET is not authorized, the HR Administrator should inform the staff member. 

MET to any other place will require the prior approval of the UN Medical Director.

7

Step

Evaluate request for MET outside the region and approve MET to any other place other than the recognized medical centre within the region

Responsible Party

UN Medical Director

Template/Guideline
Explanatory Notes

The Head of Office should forward a request to the UN Medical Director with the following information: 
- staff member’s name, agency, duty station and index number; 
- indication of whether the patient is the staff member or an eligible family member; if eligible family member, relationship to staff member; 
- proposed place and date of evacuation; 
- patient’s current clinical condition; 
- tentative diagnosis by the treating physician; 
- laboratory test; 
- treatment initiated; 
- specific purpose of the evacuation; and 
- recommendation of the local Medical Officer of the Regional Commission, the UN Dispensary Physician or the local UN Examining Physician. 

It is essential that correct and complete information be communicated to the UN Medical Director to avoid unnecessary delays. Each request for MET will be reviewed individually, taking into consideration the recommendation of the Medical Officer of the Regional Economic Commission, the UN Dispensary Physician or the local UN Examining Physician, and any other medical information at hand. 

If MET is not authorized outside the region, the RR would be advised to inform the staff member.

8

Step

Arrange MET: 
- Communicate approval to staff 
- Inform Cigna or GMCS of MET 
- If patient is unable to, forward completed and signed Cost Estimate form to Medical Insurance on behalf of patient 
- Organize MET of the patient and accompanying escort, if applicable 
- Organize purchase of tickets, confirmation of flights and DSA 
- Process salary advance for the staff member, if requested 
- Ensure that any required entry visas are obtained 
- Forward itinerary and MET approval to Finance for payment of DSA and terminal expenses 
- If the MET destination is in security level I or above, request security clearance for the patient and/or family member/ medical escort 
- Forward the travel details to the HR Administrator of the receiving office and request logistical arrangements for the patient: hospital appointment, hotel accommodation and transportation

Responsible Party

Template/Guideline
Explanatory Notes

In non-emergency cases, appointments with the hospital should be confirmed before the staff member or dependent leaves on MET; Cost estimate forms should be completed at least 10 days before hospitalization or no later than three days after hospitalization in cases of emergency 

All logistical arrangements should be put in place before departure and confirmed with the receiving UNDP office at the place of MET 

The following information should be forwarded to the receiving office: 
- patient’s name, date of birth and relationship to the staff member; 
- if applicable, name of accompanying family member and/or medical escort; 
- 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; 
- 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; 
- whether hotel accommodation arrangements are required for the patient and, if applicable, accompanying family member and/or medical escort; 
- whether transportation arrangements to and from the airport are required for the patient and, if applicable, accompanying family member and/or medical escort; and 
- whether patient is covered under Cigna, MIP or any of the New York Insurance Plans.

If the staff member is unable to complete and/or sign the form, the staff member’s spouse or an adult family member may complete and sign the form on his/her behalf. If attempts to contact the staff member’s spouse or an adult family member have failed, the UNDP RR, Country Director or OIC may sign on the staff member’s behalf. This measure should only be taken under circumstances where there is supporting documentation to show that efforts to contact the staff member’s spouse or adult family member were unsuccessful and where further delay could jeopardize the staff member’s well-being. When using this measure, the UNDP decision maker is responsible for communicating all medical information to the staff member until such time as a spouse or adult family member is contacted.

9

Step

Approve the application for hospitalization and direct billing;
Forward Letter of Guarantee to the hospital/clinic

Responsible Party

Template/Guideline
Explanatory Notes

Insurance Company Cigna, MIP or any of the New York Insurance Plans

For local staff covered under MIP, please refer to MIP Rules

For international staff covered under UN WWP (Cigna), please refer to UN  Worldwide Medical Insurance Plan.

10

Step

Take MET

Responsible Party

Staff member,

Dependent

Template/Guideline
Explanatory Notes

For local staff covered under MIP, please refer to MIP Rules.

For international staff covered under the UN WWP (Cigna),, please refer to UN  Worldwide Medical Insurance Plan

11

Step

For a patient covered under MIP, sign and forward the GMC Prior Agreement form completed by the doctor to GMC.

Responsible Party

Staff member,

Dependent

Template/Guideline
Explanatory Notes

For local staff covered under MIP, please refer to MIP Rules

For international staff covered under Vanbreda, please refer to UN  Worldwide Medical Insurance Plan.

12

Step

Request completion of ‘Medical Evacuation’ form (MS.39) by the attending physician at the place of evacuation, together with a complete medical report to the Medical Service through the attending physician at the staff member’s duty station within two weeks of the evacuee’s return to the duty station

Responsible Party

Staff member,

Dependent

Template/Guideline
Explanatory Notes

13

Step

Forward the ‘Medical Evacuation’ form (MS.39) and the medical report from the attending physician to the UN Medical Director when the staff member returns from MET

Responsible Party

Physician

Template/Guideline
Explanatory Notes

The local Medical Officer of the Regional Commission or 
the UN Dispensary Physician or 
local UN Examining Physician

A complete medical report delivered by the attending physician at the place of evacuation should be forwarded to the Medical Service within two weeks of the evacuee’s return to the duty station. 

The record will include all supporting documentation that may have been submitted to justify a request for MET in excess of 45 days.

14

Step

Maintain a complete record of the MET;
Forward the data on MET to the UN Medical Director each quarter

Responsible Party

Template/Guideline
Explanatory Notes

A written record must be kept by the local HR/Operations Manager of each MET, setting out the following information (which should be forwarded to UNMS):
- the name of the staff member, index number, name of the organization, whether locally or internationally recruited; 
​ - the name of the dependant and his/her relation to the staff member, if the evacuee was not the staff member; 
- the name of the Head of Office who authorized the evacuation; 
- the place of evacuation authorized by the Head of Office; 
- the actual place of evacuation; 
- the total cost of the MET, including travel expenses and DSA; and 
- the total medical costs during MET.

15

Step

Repatriation of mortal remains

Responsible Party

Template/Guideline
Explanatory Notes

The funding source for the authorized expenses related to the preparation and transportation of mortal remains is the same funding source against which the staff member’s salary is charged. Please be guided by Annex D

All expenses related to the staff member’s medical treatment are charged to MIP in accordance with the rules. 

Expenses related to the MET (e.g. staff member’s air ticket, nurse’s air ticket, DSA, ambulances etc.) are charged to the same funding source against which the staff member’s salary is charged.

Family Visit

1

Step

Flowchart - Family Visit

Responsible Party
Template/Guideline
Explanatory Notes

2

Step

Request family visit travel/annual leave or reverse family visit travel for spouse through UNALL

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Request for Leave (Quantum link - requires UNDP username and password)

4

Step

Approve absence from the office (annual leave) in Quantum self-service

Responsible Party

Template/Guideline
Explanatory Notes

Leave should be approved in Quantum self-service in accordance with the office’s leave plan
 

6

Step

Process entitlements

Responsible Party

GSSC/BES focal point

Template/Guideline
Explanatory Notes

When the staff member requests the lump sum option, he/she receives 75 percent of the least costly unrestricted economy air fare from his/her duty station to his/her recognized place of HL or chosen destination, whichever is less

7

Step

Embark on family visit travel

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

If the staff member is unable to travel, his/her spouse could take reverse family visit travel to the staff member’s duty station

8

Step

Record absence in the system

Responsible Party

Staff member,

Template/Guideline
Explanatory Notes

Compensation for Death, Injury or Illness – Appendix D

1

Step

Report accident

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

The staff member is responsible for reporting an accident as soon as possible to his/her HR administrator

The staff member should refer to all Appendix D documentation for information on the conditions under which compensation may be granted

2

Step

Fill in a Claim for Compensation form;
Attach all original supporting documentation;
Submit to HR administrator

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Staff members are personally responsible for payment of all medical expenses incurred and are expected to pay all bills, then claim reimbursement

Under no circumstances should physicians or hospitals be instructed to send bills to UNDP or the UN Health and Life Insurance Unit

TPAs (Blue Cross, Aetna, Cigna and HIP/HMO) are not required to provide coverage for service-related injuries or illness (as their insurance contracts exclude coverage of this nature), but may, upon request, do so, pending the outcome of the claim for compensation

All bills for medical, hospital, and related services must be listed and provided by the claimant

Reimbursement will be authorized only when original detailed bills are submitted

3

Step

Assist staff member in completing documentation;
Vet all forms and documentation submitted by the staff member

Responsible Party

Template/Guideline
Explanatory Notes

Upon vetting all documentation, the HR administrator must submit documentation to the respective HR associate GSSC

4

Step

Provide guidance to HR administrator;
Vet all forms and documentation submitted by the HR administrator;
Submit documentation to ABCC

Responsible Party

Template/Guideline
Explanatory Notes

The HR associate, GSSC is responsible for timely submission of forms and documentation to the ABCC 

Claims for compensation under Appendix D must be submitted to the ABCC no later than four (4) months after the date of injury or onset of illness

5

Step

Determination of eligibility and compensation

Responsible Party

ABCC

Template/Guideline
Explanatory Notes

The ABCC makes recommendations to the Secretary-General concerning claims for compensation under Appendix D

The Secretary-General can consult with the ABCC on any matter connected with the implementation and administration of Appendix D

The Secretary-General may require a medical examination of any person claiming, or in receipt of, compensation for injury or illness under Appendix D

Based on documentation provided, and documentation requested, the ABCC will make a determination on the case

6

Step

Announcement of decision (I)

Responsible Party

ABCC

Template/Guideline
Explanatory Notes

Upon making its decision, the ABCC notifies the Director, OHR

7

Step

Payment

Responsible Party

OHR Copenhagen

Template/Guideline
Explanatory Notes

Payment of compensation by UNDP to an eligible staff member is made in accordance with ABCC decision/direction

8

Step

Appeal

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

Reconsideration of the decision of the ABCC may be requested within 30 days of notice of the decision 

In exceptional circumstances, the ABCC may accept requests made at a later date 

Requests for reconsideration shall be accompanied by the name of the medical practitioner chosen by the staff member to represent him/her on the medical board

9

Step

Determination of compensation, if any, based on appeal

Responsible Party

ABCC

Template/Guideline
Explanatory Notes

If, after reviewing the report of the medical board and the recommendations of the ABCC, the Secretary-General alters his original decision in favour of the staff member, the UN will bear the medical fees and incidental expenses 

If the original decision is sustained, the staff member shall bear the medical fees and the incidental expenses of the medical practitioner whom he selected and half of the medical fees and expenses of the third (independent) medical practitioner on the medical board. The balance of the fees and expenses shall be borne by the UN.

10

Step

Announcement of decision (II)

Responsible Party

ABCC

Template/Guideline
Explanatory Notes

Upon making its decision, the ABCC notifies the Director, OHR, HR associate, GSSC and the HR administrator

11

Step

Payment (if applicable)

Responsible Party

OHR Copenhagen

Template/Guideline
Explanatory Notes

If the appeal by a staff member is successful, payment of compensation by UNDP is made in accordance with ABCC decision/direction

12

Step

Payment of costs (if applicable) related to appeal

Responsible Party

Staff member

Template/Guideline
Explanatory Notes

If the original decision by the ABCC is sustained, the staff member must pay:
- The medical fees and the incidental expenses of the medical practitioner whom the staff member selected
- Half of the medical fees and expenses of the third (independent) medical practitioner on the medical board

Certificate of Service

1

Step
Request a certificate of service in writing
Responsible Party

Staff member

Template/Guideline
Explanatory Notes
Submits a request to the person who administers the staff member’s contract (HR administrator)

2

Step
Process certificate of service HR administrator
Responsible Party

Template/Guideline
Explanatory Notes
Factual information, such as period of service, positions held, and earnings, in response to such inquiries will be given in a written statement on UNDP letterhead

Upon the staff member's written request, the statement also refers to the quality of his/her work and official conduct

Family Leave

1

Step
Request Leave
Responsible Party

Staff member

Template/Guideline
Explanatory Notes
  • Every effort should be made to inform the supervisor in advance of the proposed leave and of its duration; if this is not possible, the information should be provided on the first day taken as family leave
  • Request Family Leave in Atlas eServices
  • Staff member without access to Atlas eServices applies for family leave off-line in writing for approval by their supervisor and such records must be kept on file

2

Step
Approve, Deny or Request amendment for the family leave request
Responsible Party

Template/Guideline
Explanatory Notes
  • Absence on family leave is recorded as uncertified sick leave
  • Approve Family Leave in Atlas eServices
  • Approval, denial or request to amend family leave that is submitted manually off-line must be done in writing and such records must be kept on file
  • Staff member is automatically informed via email
  • Leave monitor is automatically informed via email upon approval

3

Step
Record Family Leave in Atlas eServices
Responsible Party

Staff Member without access to Atlas eServices

Template/Guideline
Explanatory Notes
A copy of the request and supervisor’s approval should be kept in the staff member’s file.

Advanced Annual Leave

1

Step
Request advance annual leave
Responsible Party

Staff member

Template/Guideline
Explanatory Notes
A staff member may, in exceptional circumstances, be granted advance annual leave up to a maximum of 10 working days, provided his/her service is expected to continue for a sufficient period to accrue the leave advanced.  If the staff member takes more than the maximum 10 working days that may be granted as advance leave, the entire period in excess of the accrued annual leave is to be considered as special leave without pay.

2

Step
Request for advance annual leave
Responsible Party

Template/Guideline
Explanatory Notes
Requests should be addressed to the Regional Bureau in New York through the Operations Manager.
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