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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

Insurance Plans AETNA (Irrevocable) Life-Designation of Beneficiary Form

Irrevocable Designation of Beneficiary Aetna Life Insurance Company United Nations Group Contract Holder United Nations Group Contract(s) Number(s) GL-14008 / GC-14008 Name of Person Insured US Social Security Number (where applicable) Subject to the terms of the above numbered Group Contracts, I request that any sum becoming payable by reason of my death be payable to the following …

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

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)

Insurance Plans AETNA Life Evidence of Insurability Statement

United Nations DM.5 (10-02) PH Sign Req’d Page 1 of 4 Evidence of Insurability Statement Life Insurance Coverage Aetna Life Insurance Company United Nations Read This Instruction Page Carefully. Guidelines for Applicant You are required to provide an Evidence of Insurability Statement if one of the following applies: • You did not request coverage within the initial eligibility period for your …

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

Insurance Plans ASHI UN After service health insurance (2007)

United Nations ST/AI/2007/3 Secretariat 1 July 2007 07-43395 (E) 240707 *0743395* Administrative instruction After-service health insurance The Under-Secretary-General for Management, pursuant to section 4.2 of Secretary-General’s bulletin ST/SGB/1997/1 and for the purpose of implementing General Assembly resolution 61/264, hereby promulgates the following. Section 1 After-service health …

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

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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Insurance Plans MAIP-Continental Scale Annex A

Annex A Malicious Acts Insurance Policy (MAIP) Continental Scale The benefits payable hereunder in the event of permanent incapacity following an accident are payable in the following proportions of the limit of the Capital Sum Insured not exceeding US$500,000 for any one Insured Person: Description Percentage 1. Loss by severance of two limbs 100 2. Loss by severance of both hands or all fingers …

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 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)

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 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 …

Content Type: Document Document Type: Template

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