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1
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Step
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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Step
Enrollment:
An Application for ASHI Form must be completed and submitted together with supporting documents in respect of staff member’s application for After-Service Health Insurance (ASHI) coverage, including his/her eligible family members, where relevant
In cases in which eligibility for ASHI coverage accrues as a result of the death of a staff member, the surviving spouse and/or eligible dependent children must apply for ASHI coverage within the three months following the date of death of the staff member
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Responsible Party
Staff member,
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Template/Guideline
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Explanatory Notes
Administrative Instruction ST/AI/394 dated 9 May 1994 sets out the established policy in regard to the provision of the After-Service Health Insurance (ASHI) coverage under specified conditions
Administrative instruction ST/AI/2007/3 dated 1 July 2007 sets out the change in conditions for eligibility and cost of participating in a UN ASHI plan for staff recruited on or after 1 July 2007
Staff members who become eligible after an event that gives rise to an entitlement for coverage for ASHI must be informed of the procedures for enrollment. Education of staff about the provisions under the insurance plan and distribution of materials by the person most familiar with the scheme, are absolutely necessary.
If an office administers personnel on behalf of another agency, the same rules and procedures for UNDP staff must be followed
At the time of retirement, a staff member may switch from the insurance plan that he/she had on an in-service basis to a health insurance plan that is more appropriate following separation from service, under certain conditions. For example, a staff member who, while in active service, participated in a Headquarters health insurance plan, may switch to a non-United States-based plan if he/she will reside outside the United States following separation from service, provided that covered dependants will also reside outside the United States.
After-Service Health Insurance participants who change their country of primary residence following separation may also transfer from one insurance plan to another if a different plan is more appropriate to the new country of residence. In such cases, the change in plan will become effective on the first day of the month following receipt of written notification regarding the change in country of residence or as soon thereafter as is practical. With respect to health insurance plans available to after-service participants who reside in the United States, transfer from one plan to another may be made subject to the condition that there must be two years' coverage under any such plan before a change can be made. . For more information, visit https://www.un.org/insurance
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3
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Step
Enrollment:
Staff members separating from service at Headquarters may submit the relevant application forms directly to the Health and Life Insurance Section, Office of Programme Planning, Budget and Accounts, 304 East 45th Street, 3rd Floor, Room FF-300.
Staff members at other duty stations who apply for ASHI coverage under a plan administered at Headquarters must submit the relevant application forms through their administrative office, not directly to the UN Health and Life Insurance Unit at Headquarters.
Staff members separating from service at other duty stations who wish to apply for After-Service Health insurance coverage under a plan that is not administered at Headquarters should contact the local human resources office or the office administering their in-service health insurance coverage.
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Responsible Party
OHR Copenhagen,
UN Health and Life Insurance Unit,
BES-GSSC
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Template/Guideline
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Explanatory Notes
The administration of this category of employees is centralized in the Benefits & Entitlements Services Unit in BES-GSSC in Copenhagen
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4
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Step
Enrollment:
Data on enrolment form is verified and validated and any change in coverage is processed into Quantum promptly.
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Responsible Party
OHR Copenhagen,
BES-GSSC
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Template/Guideline
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Explanatory Notes
It is the responsibility of the staff member to ensure the correct mailing address is submitted. Incomplete or incorrect mailing addresses in Quantum will result in misdirected mail or failure to receive important documentation.
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5
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Step
Enrollment:
Staff member records in Quantum are validated, contributions are computed and coverage is activated.
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Responsible Party
UN Health and Life Insurance Unit
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Template/Guideline
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Explanatory Notes
The UN Health and Insurance Unit administers the workflow of enrolment and reporting directly with the Insurance Carrier on behalf of UNDP
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6
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Step
Payment of contributions to the cost of After-Service Health Insurance coverage:
Staff member must include the authorization permitting UNJSPF to effect monthly deduction from the periodic pension benefit as an integral application component for after-service coverage
In the case of ASHI subscribers who:
- elect to defer pension payments or
- receive monthly pension benefit payments that are insufficient to meet the cost of the participant’s monthly health insurance coverage;
- or where automatic deductions from periodic pension payments payable from the UNJSPF or Appendix D are not available, payment of the requisite contribution must be made in advance of the period of coverage under the applicable health insurance plan on a quarterly, semi-annual, or annual basis.
After-Service Health Insurance participants whose premium contributions are payable on the basis of an invoice, rather than through the automatic pension deduction mechanism, must remit full payment of the amount billed by the due date indicated on the invoice.
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Responsible Party
Staff member
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Template/Guideline
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Explanatory Notes
Subscribers covered under the ASHI will have their contributions deducted on a monthly basis from their periodic pension and/or Appendix D benefit.
Contributions must be made in a currency acceptable to the Organization for the purposes of the insurance plan chosen. In the case of health insurance plans administered at Headquarters, the only currency acceptable is the United States dollar.
Failure to remit the premium in full by the date indicated will result in suspension of insurance coverage, without further notice. Insurance coverage may be reinstated provided that the full required premium payment is remitted within three months of the date of suspension of coverage, along with payment for any subsequent period that may have become due. Failure to reinstate coverage by the latter date will result in termination of eligibility to participate in the ASHI programme.
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7
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Step
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.
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Responsible Party
Staff member
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Template/Guideline
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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 under 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.
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8
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Step
Reimbursement of claims:
Insurance carrier reimburses staff member directly
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Responsible Party
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Template/Guideline
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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
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9
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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 a written notice explaining the reason for the denial and the appeal procedure.
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Responsible Party
Staff member
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Template/Guideline
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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 claim office of the respective 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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