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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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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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MIP Cigna Refund Claim Form

5. 90 .3 41 in vc _E N (0 11 5) Cigna International Health Services BVBA • Plantin en Moretuslei 299 • 2140 Antwerpen • Belgium • RPR Antwerpen • VAT BE 0414 783 183 • FSMA 13799 A-R / D M Y D M Y D M Y D M Y D M Y D M Y D M Y Name plan member Personal reference n° Organisation Address Telephone Email Patient Name Date of birth Gender M F Relationship Plan member Spouse/Partner Child Other, …

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 MIP

Insurance Plans Aetna Life Application For Group Life Insurance

United Nations DM.7 (10-02) 1 Application For Group Life Insurance Aetna Life Insurance Company United Nations (Please read Eligibility Requirements on reverse side before completing this form.) Applicant Information (Print all information clearly.) Name (LAST) First Payroll Index Number Sex M F Home Address Birthdate (Day/Month/Year) Organization Duty Station Room Number Office Telephone Number …

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

Pre-Award Negotiations Strategy

Pre-Award Negotiations Strategy Substantive Pre-Award Negotiations Title of the Procurement process Name of the recommended Offeror Subjects of negotiations (list the areas to be negotiated) Objectives of the negotiations (what does the negotiation seek to achieve) Justification for initiating the negotiation: · Why must negotiations be done for this procurement process? · Identify aspects of the …

Content Type: Document Document Type: Template

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MIP : Medical Insurance Plan Rules

UNDP MIP Rules Effective 1 January 2016 ADMINISTRATION UNIT Distribution of work Processing of claim Final approval of claim MEDICAL ADVISORY BOARD Processing of prior agreement (if applicable) within 2 working days MAILROOM Transmission of claim to the Administration Unit IT SYSTEM Explanation of benefits & bank transfer issuing Office of Human Resources Bureau of Management Document Name …

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MIP List of Reimbursable and Non-reimbursable Drug Medicines

Presentation UNDP MIP Drugs and medications: What is reimbursable as of November 1st, 2006 In order to clarify the rules for drug and medication reimbursement, this table introduces the classes of medications that may or may not be reimbursed according to the MIP rules. General comments As the "Over-the-counter" concept may vary from one country to another, all drugs must be prescribed by a …

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 MIP