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Open
Choice PPO
Global Benefits
Eligibility and Enrolment
UN will automatically establish AGB services for the staff and retired staff who meet the general requirements noted in Paragraph 4 of the present Circular. More specifically, UN will identify eligibility for AGB based on the insurance participation and duty station for active staff, and on the insurance participation and mailing address for retired staff. Those determinations will be made using the information that is presently recorded in the relevant personnel system: IMIS for UN, Atlas for UNDP, SAP for UNICEF.
This is an enrollment process that does not require any action on the part of the staff members or retired staff members involved.
Dependents enrolled under the Aetna health insurance of the eligible staff member or retired staff member will also be included automatically.
Staff members and retired staff members who do not meet the eligibility criteria for AGB are not eligible for the new services. Members who are not eligible for AGB services retain their present Aetna services.
Note that for participants in the Headquarters Aetna health insurance programme, eligibility for AGB depends on the duty station of the staff member or the mailing address of the retired staff member. The residence of family members covered as dependents has no bearing on eligibility for AGB.
All AGB programme correspondence (I.D. cards, explanations of benefits, reimbursement checks, and any other materials) will continue to be sent to the mailing address on record for you in the personnel system.
Description of Services Provided by Aetna Global Benefits (AGB)
1. An International Service Center, in Tampa Florida. The International Service Center is organized specifically to provide member service for Aetna-insured individuals who live outside the U.S. The International Service Center staff is knowledgeable of international health care, is multilingual and multinational, and represents on-site fluency in 12 languages - including all 6 of the UN working languages. Aetna's regular service center will continue to serve U.S.-based UN staff and retired staff.
2. Toll-free telephone access to member service, 7 days a week 24 hours a day, 365 days a year.
3. Admission to international hospitals on a direct-pay basis, with which AGB has negotiated such arrangements. AGB's current list contains more than 600 hospitals internationally and more hospitals are continually added. When a hospital has accepted a direct-pay arrangement with AGB, it means that you need not make an up-front deposit upon admission, and that you will not be required to settle your bill upon discharge, except for the deductible and any coinsurance that you may be required to pay. For physicians' services, you will still have to settle your bill locally, as at present, and then remit the bills to AGB for reimbursement. [NOTE: If you do not wish to use an AGB-contracted provider, you may always seek medical services from another facility or medical professional of your choice - or, depending on circumstances, necessity. If the particular provider of medical services is not one of the AGB-contracted providers, direct-pay assistance may not be available.
4. Expedited reimbursements for international claims. The International Service Center has maintained a performance level of 80% of all international claims processed in 14 days or less. Note this statistic does not count mail time to and from the Service Center.
5. Reimbursement available in a variety of international currencies.
6. Accessibility. The AGB International Service Center can be reached in any of the following ways
How to File AGB Claims and Obtain Reimbursement
1. If the provider of your services is a direct-pay provider, the provider will normally file the claim on your behalf, directly with AGB. It may be helpful to bring a completed AGB "Medical Benefits Request" - i.e., Claim Form - to your appointment, if that is possible for you. If so, be sure to sign the Assignment of Benefits section on the Form (this signature permits AGB to send reimbursement to the provider and is integral to the direct-billing agreement). Note that the hospital or physician may have their own claim forms they prefer to use, and AGB accepts such forms. If there are questions, the provider may contact AGB directly.
2. You can initiate a direct pay claim if you prefer. To do so, go to the AGB website, click on "Find a Physician or Hospital" then click on "International Direct Pay Hospitals", and then on "Submit a Request". Follow the directions to fill out and submit the web-based form. Alternatively, you may call the International Service Center. Following this step, AGB will then contact the direct pay provider.
3. When you are submitting a claim yourself, a completed Claim Form should accompany each submission. It is essential that you include the providers' itemized bills or receipts that include the diagnosis (nature of illness or reason for treatment), the procedures or services performed, the dates of service, and the amounts charged. Paid receipts alone, if they do not include the essential information stated above, are not sufficient.
4. Claims may be submitted to AGB by Mail, Overnight Delivery Service, or FAX, at the addresses given above. An AGB Claim Form is downloadable at the AGB website www.aetna.com/agb, at the UN Insurance intranet website and at www.un.org/insurance. AGB advises that FAX is a faster submission method, and results in faster overall turn-around time and claim reimbursement. If you choose to submit claims by FAX, please take care to (1) ensure your itemized bills and provider receipts are copied onto letter-sized paper and that the copies are legible, (2) write your AGB I.D. number on each page that you fax (Note that when your "I.D. Number" is requested it ALWAYS means the I.D. number that is shown on your AGB I.D. card immediately above your name), and (3) include a cover page that gives the date, total number of pages in your FAX, and your personal contact information - telephone, FAX, and mail address.
5. You may inquire into the status of any claim by sending an email to the AGB International Service Center at agbservice@aetna.com. You may also check claim status online by using Aetna Navigator. To register for Aetna Navigator, simply click on the "Navigator" link that is found at the AGB website, and follow the step-by-step instructions to register.
6. AGB standard reimbursement is in U.S. Dollars. Reimbursement in a non-U.S. currency can be made at your request, provided (1) the currency in which you request reimbursement is on AGB's list of approximately 100 non-U.S. currencies, (2) reimbursement can be made via wire transfer to the bank that you specify on the AGB Benefits Request Form, and (3) your bank's wire charges are your responsibility if you choose this mode of reimbursement. For more information, contact the International Service Center.
7. Please remember that the UN medical programmes require that the insurance company must receive all claims for reimbursement of covered medical services no later than 2 years after the date of the service.
Informed Health Line (IHL)
Informed Health Line is included within the overall AGB service package provided for eligible UN staff, retired staff, and their covered dependents.
IHL offers 24-hour, toll-free telephone access to general health information provided by qualified, U.S.-based professionals. This information might assist you, for example, to better understand a particular medical condition, or the kinds of treatment that may normally be prescribed for a particular medical condition. In turn this knowledge can prepare you to comply more effectively with the physician's instructions and help your care be as effective as possible. Note that IHL is designed to provide you general information, intended only to help you be a more knowledgeable patient; IHL does not provide medical advice, for which you must rely on the medical professional of your choice.
Some examples of IHL services include:
IHL is located at the International Service Center in Tampa, and can be reached using the same telephone numbers.
Using the AGB Website
AGB maintains a website at www.aetna.com/agb that provides access to information and functions provided by AGB. In order to use these features, you must first register at the AGB website.
To register for the AGB website, go to the website address given above, and click on "Members". Then, using your member I.D. number (the number found on the front of your AGB I.D. card immediately above your name) follow the step-by-step instructions to register. If you have questions please contact the AGB International Service Center for assistance.
Please note that Aetna offers a second website, called Aetna Navigator. There is a link on the AGB website to Aetna Navigator. If you also register for Aetna Navigator, you will then need only use your Navigator user ID and password in order to access either of these two websites.
To register for Aetna Navigator, go to www.aetna.com/index.htm , and on the right-hand side of the page, click on "Log In" for Navigator and follow the registration steps. You can also click on the Navigator link at the AGB website, and follow the step-by-step instructions there.
It is recommended, if you have access to the internet, that you register at both the Aetna Navigator and AGB websites as soon as you can after 1 October 2005. This will afford you access to all the resources Aetna provides at both websites. For example: · Among the many other functions contained within Aetna Navigator, you may inquire into the status of your AGB claims. · A complete, current list of worldwide providers with which Aetna has negotiated direct-pay agreements can be found at the AGB website. This list is continually updated with new additions as they are negotiated.
If you have internet access, you may consult the information on these websites at any time, from your home or office. Using the internet allows much faster and generally more convenient access to the information and services.
If you do not have internet access, you will still be able to obtain equivalent information and services by calling the AGB International Service Center for assistance.