Medical Insurance: UN NY Aetna Medical Insurance

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Crisis Response
Financial Resources Management
Human Resources Management
Procurement
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Insurance Plans
Medical Insurance: UN NY Aetna Medical Insurance

Main navigation

Duties, Obligations and Privileges
- Standards of Conduct
  - UNDP Legal Framework for Addressing Non-Compliance with UN Standards of Conduct
- Harassment, Sexual Harassment, Discrimination, and Abuse of Authority
  - Harassment, Sexual Harassment, Discrimination, and Abuse of Authority
Classification of Posts
- Job Evaluation
Salaries and Related Allowances
Appointment and Promotion
Annual and Special Leave
Social Security
Travel and Removal Expenses
- Entitlement Travel
- Relocation Shipment
  - Relocation Shipment
Separation from Services
- Entitlements upon Separation
- Types of Separation
Disciplinary Measures and Appeals
- UNDP Legal Framework for Addressing Non-Compliance with UN Standards of Conduct
Non-Staff
Workforce Management
- Organizational Unit Restructuring
  - Organizational Unit Restructuring
- Performance Management
  - Performance Management and Development
  - Probation upon Appointment

Focal Point

Sarah Rose

Effective Date

29/04/2015

Planned Review Date

31/12/2024

Version

2.0

Latest updates

January 09, 2023 - The procedures have been updated to reflect UNDP's transition to its new cloud-based management platform Quantum in January 2023, replacing its previous ATLAS system.

December 01, 2015 - While the effective date remains the same, the content has been reviewed and edited without substantive changes in 2014 and 2015.

Relevant Regulations and Rules

Staff regulations and staff rules, including provisional staff rules, of the United Nations

This policy implements UN Staff Regulation 6.2 and Staff Rule 6.6

Policies

Main Policy

Medical Insurance: UN NY Aetna Medical Insurance

DOCX (159.36 KB)

View Download

Procedures

Main Procedures

1

Steps

Flowchart - Medical Insurance: UN NY Aetna Medical Insurance

Responsible Party

Template/Guideline

Flowchart - Medical Insurance: UN NY Aetna Medical Insurance

HR_Insurance Plans_Aetna NY Medical Insurance Flowchart

Download

Explanatory Notes

2

Steps

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

Steps

Enrollment of staff:

The completed application for enrolment form is certified and submitted to 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

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

4

Steps

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

Steps

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

HR Administrator,

UN Insurance Unit

Template/Guideline

Explanatory Notes

6

Steps

Issue ID card:

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

Responsible Party

Insurance Company

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

Steps

Claims:

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

Steps

Verification and reimbursement of claims:

Insurance carrier reimburses staff member directly

Responsible Party

Insurance Company

Template/Guideline

P-2 Form Designation of Beneficiaries

HR_Insurance Plans_Designation, Change or Revocation of Beneficiary Form P-2

Download

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

Steps

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,

Insurance Company

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.

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