Step

Flowchart

Responsible Party

Template/Guideline

Explanatory Notes

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 a staff member or eligible family members is/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 enrolment campaign. See  https://www.un.org/insurance/content/un-wwp for more information
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

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

Template/Guideline

Explanatory Notes

Entitlements Services Unit  in BES/GSSC in Copenhagen 

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

Step

Enrollment of staff: 

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

Responsible Party

UN Health and Life Insurance Unit

Template/Guideline

Explanatory Notes

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 Health and Life Insurance Unit

Template/Guideline

Explanatory Notes

Step

Issue ID card: 

Electronic ID cards are available in the staff member’s personal web page. If requested
Identity cards are issued to the staff member and eligible dependent(s)

Responsible Party

Staff member,

Template/Guideline

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 information.

Step

Claims: 

Insurance claims are submitted through Online Claiming tool or, 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 one 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; or by email: hlis@un.org.

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

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.