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1
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Steps
Flowchart
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Responsible Party
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Template/Guideline
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Explanatory Notes
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2
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Steps
Application for ASHI:
Complete form and submit within 30 days of separation from service
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Responsible Party
Former Staff Member
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Template/Guideline
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Explanatory Notes
The education of staff about MIP ASHI and the distribution of materials are absolutely necessary
Refer to MIP 7.2 for eligibility conditions
If an office administers personnel on behalf of another agency for MIP purposes, the same rules and procedures for UNDP staff must be followed
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3
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Steps
Application for ASHI in case of death of a former staff member:
Surviving spouse (if any) or the eldest eligible child completes the MIP Application/Request for Change Form and submits within 30 days of the death of the former staff member
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Responsible Party
Surviving Spouse,
Dependent,
HR Administrator
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Template/Guideline
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Explanatory Notes
If an insured former staff member dies, the surviving spouse (if any) or the eldest eligible child becomes eligible to assume the role of the subscriber and to continue to pay contributions in accordance with the appropriate category of coverage
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4
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Steps
Enrollment:
After validation of eligibility and approval of application, the applicant is notified
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Responsible Party
HR Administrator
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Template/Guideline
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Explanatory Notes
When potential after-service participants elect not to enroll in the after-service coverage when they first become eligible, neither they nor their eligible family members will be permitted to enroll in MIP at a later date. If the potential after-service participant elects not to have after-service coverage, a signed note stating this decision must be put into the staff member’s file at the time of separation.
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5
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Steps
Calculation of contributions:
ASHI contributions are calculated based on category of coverage as laid down in MIP Rule 7.4. and ASHI subscriber is informed of the amount of contribution and method of payment
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Responsible Party
HR Administrator,
Finance Officer
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Template/Guideline
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Explanatory Notes
Contact MIP_ASHI
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6
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Steps
Eligibility Data:
Reviews and validates eligibility data in the system and transmits file to claims administrative company
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Responsible Party
MIP HR Technical Support
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Template/Guideline
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Explanatory Notes
A technical interface uploads enrollment and eligibility data from Quantum and the claims administration company (TPA)
In addition to ensuring the correct calculation of ASHI contributions, the data entry process is also critical for reporting purposes and for timely and accurate payments of MIP reimbursement claims
A technical interface uploads enrollment and eligibility data from Quantum and the claims administration company (TPA)
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7
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Steps
ID Cards:
Uploads eligibility data, updates ID cards and communicates exceptions, if any, to HR Technical Support
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Responsible Party
Claims Administration Company (TPA)
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Template/Guideline
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Explanatory Notes
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8
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Steps
Managing eligibility data in Global Payroll:
Data on enrollment form is verified and validated and any change in coverage is processed into Quantum promptly
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Responsible Party
HR Administrator
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Template/Guideline
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Explanatory Notes
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9
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Steps
Claims:
MIP Claims are submitted through online claiming tool available in personal web page of the plan member, or, in a sealed envelope containing the MIP Refund Claim form and supporting documents, directly to the company that administers MIP claims, following the instructions on the claim form.
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Responsible Party
ASHI Subscriber
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Template/Guideline
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Explanatory Notes
Effective January 2004, UNDP outsourced the administration of MIP claims to an independent administration brokerage company (TPA). The company is responsible for administering MIP claims and for ensuring compliance by subscribers with the MIP rules and avoiding unreasonable or abusive use of the Plan.
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10
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Steps
Reimbursement of claims:
Claims are verified and processed as follows:
If the claim fully meets requirements, a payment instruction is sent to the MIP HR Technical Support and a Statement of Benefits is sent to the staff member
If the claim does not meet requirements, a notification and/or request for further information/ documentation is sent to the staff member
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Responsible Party
Claims Administration Company
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Template/Guideline
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Explanatory Notes
Payment of claims is made through an interface between the claims administration company and Quantum. Payment that goes through this interface will not indicate the nature of the medical services provided.
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". Patient confidentiality will be protected.
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11
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Steps
Payments:
The payment instruction file received from the MIP administration company is uploaded into system and an instruction is sent to CO to effect payment
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Responsible Party
MIP HR Technical Support
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Template/Guideline
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Explanatory Notes
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12
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Steps
Payments:
Vouchers are uploaded, payments are processed through accounts payable, and ASHI subscriber member is notified
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Responsible Party
Finance Officer
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Template/Guideline
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Explanatory Notes
In order to effect prompt and timely payment, the ASHI subscriber must be properly set up as a vendor in Quantum
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13
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Steps
Change of residence:
When there is a change of country of residence, the following actions are taken:
Claims administration company and the appropriate UNDP office in the new country of residence are informed in writing and a completed MIP Application/ Request for Change form is completed
Data is updated in Quantum to reflect changes
ASHI contributions appropriate to new country residence are calculated and collected
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Responsible Party
ASHI Subscriber,
HR Administrator
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Template/Guideline
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Explanatory Notes
ASHI Subscriber/ HR Administrators in UNDP Offices of old and new countries of residence
If there is no UNDP Office in the new country of residence, the subscriber will be administered by the UNDP Office that is closest to the new country of residence. Participation in the after-service coverage will continue, provided the subscriber pays a contribution appropriate for the new country of residence.
The contribution will be in the currency of the new country of residence. The UNDP office will take steps to see that the insured persons were up-to-date in their contributions for after-service coverage in their previous country of residence.
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