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MIP GMC Henner Refund Claim Form

Page 1 MIP - REFUND CLAIM FORM How to complete and send the claim 1. Make sure to complete each item on the form to avoid a delay in the payment of your claim. 2. Make sure to sign the claim. If you are a minor/under age: have a parent or a guardian sign for you. If you are unable to complete/sign: a) have your spouse or an adult family member sign for you; or b) a UNDP officer but only if there …

Content Type: Document Document Type: Template Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: Medical Insurance: Medical Insurance Plan (MIP)

Insurance Plans Security Clearance Request Form

SECURITY CLEARANCE REQUEST (SECURITY CLEARANCE IS REQUIRED FOR ALL COUNTRIES IN PHASE I OR ABOVE) To be completed by Traveller and sent to Benefits and Entitlements Services​​​​​​​​​​​​ (for forwarding to Designated Official of UNDP Country Office) Indicate whether you are an UNDP FORMCHECKBOX Staff Member or FORMCHECKBOX Consultant 1. Name ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ …

Content Type: Document Document Type: Template Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: Malicious Acts Insurance Policy (MAIP)

Insurance Plans Designation Change or Revocation of Beneficiary Form P-2

UNITED NATIONS DESIGNATION, CHANGE, OR REVOCATION OF BENEFICIARY To be completed by STAFF MEMBER and submitted to HUMAN RESOURCES OFFICER I, ( First, Middle, Maiden, Surname)       INDEX NO.       born on (Day, Month, Year)       Organization/Department/Division/Office       Duty Station       hereby designate the person or persons named below as my beneficiary or beneficiaries under Staff Rules …

Content Type: Document Document Type: Template

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Content Type: Document Document Type: Visual Guide Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: Medical Insurance : UN Worldwide Medical Insurance Plan

Claim for Compensation under Appendix D to the Staff Rules

UNITED NATIONS NATIONS UNIES PROCEDURE FOR SUBMISSION OF COMPENSATION CLAIMS 1. When a staff member sustains an injury or suffers an illness which he or she considers to be attributable to the performance of official duties and wishes to claim compensation (reimbursement of medical expenses, etc.), the staff member should observe the following procedure: (a) Report the accident as soon as …

Content Type: Document Document Type: Template Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Compensation Policy: Compensation for Death, Injury or Illness – Appendix D

Content Type: Document Document Type: Visual Guide Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Compensation Policy: Compensation for Death, Injury or Illness – Appendix D

Application For After Service Health Insurance (ASHI) and Pension Fund Deduction of Premiums

Application For After Service Health Insurance and Pension Fund Deduction of Premiums United Nations Insurance and Disbursement Service, FF-300, 304 East 45th St. New York, NY 10017 ( Tel: (212) 963-5813 ( Email: ashi@un.org Applicant Information (Print all information clearly.) ( PLEASE COMPLETE AND SIGN BOTH SIDES OF THIS FORM) Name ( LAST, First )       Retiree Number       Home Address       …

Content Type: Document Document Type: Template Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: After-Service Health Insurance: ASHI UN

MIP Application/Request for Change Form

DUTY STATION (COUNTRY/CITY): UNDP MEDICAL INSURANCE PLAN (MIP) Application/Request for Change DATE OF ENROLMENT: SUBSCRIBER INFORMATION: Active staff member Participating survivor (after service) Retiree (after service) Appendix D Beneficiary (after service) Abolition of post Cigna ID number (if any): 1. LAST NAME 2. FIRST NAME 3. DATE OF BIRTH (D/M/Y) 4. SEX 5. INDEX NO (if active) or Pension No …

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Content Type: Document Document Type: Visual Guide Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: Medical insurance: UN NY Empire Blue Cross PPO Medical Insurance

Content Type: Document Document Type: Visual Guide Policy Area: Human Resources Management Policy Chapter: Social Security Policy Sub-Chapter: Insurance Plans Policy: Medical Insurance: UN NY Aetna Medical Insurance