Frequently Asked Questions

Active staff, Retirees and Survivors

For new subscribers, cards are shipped by the insurance carriers to subscribers’ mailing addresses 10 business days after the upload of the Insurance Eligibility file which is transmitted to the Insurance carriers, mid month and end of month.  Please allow 3 – 4 weeks upon enrolment.

To obtain a replacement card you must contact member services of the applicable insurance carrier (Aetna, CIGNA, Empire).                   

For details regarding contacting your insurance carrier, please visit either their page on this website or the current Information Circular.

IMPORTANT: There are no cards for subscribers of the UN short term.

 

For Aetna, Empire, and CIGNA Dental subscribers please access insurance carrier's website to register and print or request a card. Your ID numbers are as follows:

IMPORTANT: (If your index number is less than 6 digits add zeros in front of your index to make up the 6 digits)

Aetna: ID number: 000 + staff member’s six digit index #

BlueCross: Please refer to the full announcement explaining the new ID structure

CIGNA Dental:  R + staff member’s 8 digit index # (Please refer to full announcement explaining the new ID structure)

 

Group Policy # are as follows:

Aetna:           014008-12-008 (UN Staff)

                     014008-14-008 (UNDP Staff)

                     014008-15-008 (UNICEF Staff)

 

Aetna Global:  620538-12-001 (UN Staff)

                      620538-12-001 (UNDP Staff)

                       620538-12-001 (UNICEF Staff)

 

BlueCross:       374610 - A (UN Staff)

                        374610 - G (UNDP Staff)

                        374610 - I (UNICEF Staff)

 

CIGNA:      3211508 (ALL staff members)

  • Claims for reimbursement must always be submitted directly to the insurance carrier no later than two years from the date the medical expense was incurred.
  • If a claim is denied in whole or in part, the subscriber has the right to appeal the decision by submitting a written request for review by the insurance carrier 
  • In the event of a claim dispute the resolution of such dispute is guided by the terms and conditions of the policy contract in question and the final decision rests with the insurance carrier and not the United Nations.
  • For a more detailed description of plans including exclusions and limitations please see the Member Plan Descriptions set out on the Plans page of this website.
  • For UNDP and UNICEF staff members, please forward your change of address request to your personnel office and ensure that both home and mailing addresses reflect your new address.
  • For UN staff members, please update your mailing address in Umoja.  Please ensure that your information is added in the appropriate field.  If your mailing address includes an apartment number, please add it to the second address line.
  • For retirees, please send an email to ashi@un.org. Please be sure to include your index and/or retiree number.

ActiveHealth

ActiveHealth Management Nurse Care Program helps people with long-term medical conditions reach their best health. It provides information and coaching by registered nurses. Members tell us that one of the most valuable parts of the program is working with a nurse one-on-one over the phone. Members also receive helpful information in the mail.

Studies show that when patients receive the correct treatments and avoid care errors, hospitalization, surgeries, and attending procedures and treatments are reduced.

Recommendations from Active Health doctors and nurses, and based on established clinical data based on Care Engine data and patient PHR input. Your doctor may or may not have the same level of information; therefore you are advised to consult further with your doctor.

Active Health professionals provide recommendation to you and your treating physician. They do not write prescriptions.

Active Health’s physician specialty areas include cardiology, Internal Medications, Family Practice, Emergency Medicine, Nephrology, GI, Pediatrics and Geriatrics. (Care considerations consults are conducted with Harvard and Columbia medicine Specialist).

Yes, all UNHQ enrollees have access to the active health program.

The HLIC (Health & Life Insurance Committee) which is comprised of both management and staff representatives took part in the decision-making process.

Yes, you can call active health and provide information for input to your PHR.

The program is available to Aetna and BC members who travel outside the US, but not who reside outside of North America.

Absolutely. We encourage you to talk with your doctor about the program and to share this Q&A. If you doctor has any questions, we would be happy to speak with him or her about the program.

No, only your doctor can decide what treatment is right for you. Your nurse is an additional resource who can help you work more effectively with your doctor. Some of our members say it is helpful to talk with their ActiveHealth Disease Management nurse right before or after their doctor visits.

ActiveHealth’s services are included with your medical plan. Based on the information we received from your medical plan, it looks like you might have or be at risk for a long-term health condition and could benefit from working with an ActiveHealth Management nurse.

If we identify a possible opportunity to improve the quality of the healthcare you receive, the information may be shared with your doctor. ActiveHealth understands and respects the privacy of personal health information. Our programmes are secure and confidential, in full compliance with federal and state laws. Your health information cannot be used to affect your employment in any way.

No. This program is offered as part of your medical benefits and comes at no extra cost to you.

Health plans and employers buy ActiveHealth’s services for their members and employees. They want their members and employees to be as healthy as possible, and they recognize that better healthcare means lower healthcare costs for everyone over the long term.

The program is voluntary and you can choose to decline participation any time. However, many people have found the program beneficial, and we hope you will give it a try.

No, the ActiveHealth Management Nurse Care program has no effect on what is – or is not – covered under your medical plan. It is an added service to help you reach your best health.

Your nurse will schedule a call with you about four times a year, or more frequently depending on your individual needs.

It only takes about 10 to 15 minutes to get started. Your nurse is flexible and will work with your schedule.

The Claims file is transmitted by Electronic File Transfer. 

PHR data is accessible to the individual member; parents have access to dependents children’s PHR if they are less than 18 years old. Members may provide temporary or ongoing access to treating physicians. The data is protected on a secure server which has not been breach during its 10 years history.

The insurance carrier has no access to the Active Health recommendations and processes claims in accordance to provision of the medical plan as outlined in the Headquarters circular.

Participation is anticipated to result in healthier staff members. This will, in turn, result in a decrease in claims and eventually in premium cost.

The RN’s come to ActiveHealth with 5 to 10 years of clinical experience all licensed in the state of Virginia. Many also hold licenses in DC, New Jersey, Pennsylvania and other states.

ActiveHealth is a company focused on healthcare quality. We help doctors and patients in many different ways, including providing personalized information that can help patients receive better quality healthcare. Our nurses also coach patients over the telephone.

Retirees and Survivors

Both increases are separated due to our new system implementation.

In prior years, any necessary increase related to the COLA was applied together with the July ASHI rate increase.  However, due to the system changes at the Pension Fund and UN Secretariat, this is no longer possible.

This increase is different.  It is based solely on the COLA that just took effect.  

Please note that none of the NY-administered insurance plans, Aetna, Empire, HIP, UN WWP, nor UN MIP, provide long-term care insurance or long-term care services.  Individuals must make their own arrangements for finding and/or financing such care and services as the plans do not contain such benefits.

In cases of change of country of residence, the two year wait period does not apply. You may request to switch to the UN Worldwide Plan in writing when leaving the US for a long period of time. Please note that you will need to provide an overseas address.

 

If one spouse retires from service with the Organization before the other spouse, the spouse remaining in active service must become the subscriber. This applies even if the retired spouse had been the subscriber up to the date of retirement and is otherwise eligible for after-service health insurance coverage following separation from service. If both staff members have separated from service and if each individually is eligible for after-service health insurance coverage, the cost of the contribution towards the after-service health insurance coverage must be borne by the former staff member with the higher pension.

You may elect to change plans at retirement or remain in your present plan.  You will be required to remain in the chosen plan at retirement for a minimum of 2 years before you are allowed to change plans. You may request this change by sending a written request to the Insurance Service. Do not send notice to the Pension Fund.  If you are retiring in the United States or you have covered dependants in the United States, you cannot enroll in the Van Breda plan.  The Van Breda plan is for staff members who are residing outside of the US and do not have dependants living in the US.  US-based retiring staff members or those with US-based dependants must elect a US-based Insurance plan.

You must provide written notice to the Insurance Service with request for any changes.  Information relating to insurance should not be sent to the Pension Fund.  However, change of address request must be sent to both the Insurance Service and the Pension Fund, since these two systems are not electronically linked in any way.  Any request for changes must be made by the primary insured and not any other person, unless we are provided with a Power of Attorney authorization to do so.

The following briefly summarizes ASHI eligibility requirements for retiring staff members and their eligible dependants. For more exhaustive information, please refer to ST/AI/2007/3.

Retiring Staff:

  • Must be a staff member of the UN, UNICEF, UNDP, UNOPS, UNFPA, UN WOMEN. Staff members retiring from the liaison offices of some UN System organizations who were covered through the Direct Billing Programme are also eligible for ASHI coverage. 
  • Must be at least 55 years old or over;
  • Must be enrolled in a UN Health Insurance plan at the time of retirement;
  • Must elect to receive a monthly pension benefit. The pension may be deferred up to full retirement age, but withdrawal settlements make a retiring staff member ineligible for ASHI.
  • Must have at least 10 years of health insurance participation under an eligible contract for subsidized ASHI participation. If less than 10 years of health insurance participation but more than 5 years of health insurance participation under an eligible contract and the staff member was hired before 1 July 2007, the staff member is eligible for unsubsidized ASHI participation until the 10 year requirement is met. For those hired on or after 1 July 2007, the eligibility requirement is 10 years under an eligible contract for ASHI participation and for subsidy. This means that they cannot continue their insurance coverage under ASHI unless they have accumulated 10 years of insurance participation at the time of retirement while employed under an eligible contract;
  • Staff members and dependants granted a disability benefit by the UNJSPF (age and participation requirements are waived in these cases).

Dependants covered at the time of the staff member’s retirement are eligible to continue their coverage provided:

  • The staff member applies for them when applying for ASHI;
  • Dependant children have not reached age 25 at the time of retirement, except in case of disability 
  • That they have been covered for at least five years (or two years if they were covered by a government or private insurance) in the case of a staff members hired on or after 1 July 2007 (please see ST/AI/2007/3 for more details) except of course newly acquired dependants. 
  • If a dependant child is disabled and 25 or older, the disability must be certified by the Pension Fund.
  • Surviving spouses and dependants of active or retired staff members are also eligible provided they were covered under the staff member’s policy at the time of his/her death.The application time limit for Surviving spouses and children of staff members who die in service is of ninety (90) days following the staff member’s passing.

Important Consideration: Please note that in accordance with the ASHI AI and Section 7.3 of ST/AI/2001/2 the participatory years under the limited duration appointment are not included in the calculation of eligibility as the rules state enrolment in a United Nations contributory health insurance plan by a staff member under an ALD appointment shall not be counted for the purpose of determining eligibility for coverage under the United Nations after-service health insurance programme.

Retirees and Survivors, ASHI

The Health and Life Insurance section maintains the rate scales utilized for the calculation of ASHI contributions.  The ASHI rate scales utilize the fully unreduced pension and/or Appendix D monthly value as defined in ST/AI/2007/3 section 3.  When reviewing the PDF document please note that you must first find your insurance plan.  Once you have located the page that contains your insurance plan, you must find the Pension Range row that includes your total monthly benefit.  Once you have located that row, please go across to find your coverage level (Subscriber Only, Subscriber Plus One, etc.).  The number where your Pension Range row and Contribution column of your coverage level meets will correspond to the monthly ASHI premium.

Note: ASHI Rates for Cigna International is based on the country associated with the subscriber's mailing address and are grouped into rate groups 1, 2, and 3 as defined below per ST/IC/2017/18.  

  • Rate group 1 includes all locations outside the United States of America other than those listed under rate groups 2 and 3.
  • Rate group 2 includes Chile and Mexico.
  • Rate group 3 includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom of Great Britain and Northern Ireland. 

The Health and Life Insurance section maintains the rate scales utilized for the calculation of ASHI contributions.  The ASHI rate scales utilize the fully unreduced pension and/or Appendix D monthly value as defined in ST/AI/2007/3 section 3.  When reviewing the PDF document please note that you must first find your insurance plan.  Once you have located the page that contains your insurance plan, you must find the Pension Range row that includes your total monthly benefit.  Once you have located that row, please go across to find your coverage level (Subscriber Only, Subscriber Plus One, etc.).  The number where your Pension Range row and Contribution column of your coverage level meets will correspond to the monthly ASHI premium.

Note: ASHI Rates for Cigna International is based on the country associated with the subscriber's mailing address and are grouped into rate groups 1, 2, and 3 as defined below per ST/IC/2018/15.  

  • Rate group 1 includes all locations outside the United States of America other than those listed under rate groups 2 and 3.
  • Rate group 2 includes Chile and Mexico.
  • Rate group 3 includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom of Great Britain and Northern Ireland. 

The Health and Life Insurance section maintains the rate scales utilized for the calculation of ASHI contributions.  The ASHI rate scales utilize the fully unreduced pension and/or Appendix D monthly value as defined in ST/AI/2007/3 section 3.  When reviewing the PDF document please note that you must first find your insurance plan.  Once you have located the page that contains your insurance plan, you must find the Pension Range row that includes your total monthly benefit.  Once you have located that row, please go across to find your coverage level (Subscriber Only, Subscriber Plus One, etc.).  The number where your Pension Range row and Contribution column of your coverage level meets will correspond to the monthly ASHI premium.

Note: ASHI Rates for Cigna International is based on the country associated with the subscriber's mailing address and are grouped into rate groups 1, 2, and 3 as defined below per ST/IC/2019/xx.  

  • Rate group 1 includes all locations outside the United States of America other than those listed under rate groups 2 and 3.
  • Rate group 2 includes Chile and Mexico.
  • Rate group 3 includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom of Great Britain and Northern Ireland. 

The Health and Life Insurance section maintains the rate scales utilized for the calculation of ASHI contributions.  The ASHI rate scales utilize the fully unreduced pension and/or Appendix D monthly value as defined in ST/AI/2007/3 section 3.  When reviewing the PDF document please note that you must first find your insurance plan.  Once you have located the page that contains your insurance plan, you must find the Pension Range row that includes your total monthly benefit.  Once you have located that row, please go across to find your coverage level (Subscriber Only, Subscriber Plus One, etc.).  The number where your Pension Range row and Contribution column of your coverage level meets will correspond to the monthly ASHI premium.

Note: ASHI Rates for Cigna International is based on the country associated with the subscriber's mailing address and are grouped into rate groups 1, 2, and 3 as defined below per ST/IC/2019/xx.  

  • Rate group 1 includes all locations outside the United States of America other than those listed under rate groups 2 and 3.
  • Rate group 2 includes Chile and Mexico.
  • Rate group 3 includes Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom of Great Britain and Northern Ireland. 

ASHI, Retirees and Survivors

This is a PDF copy of the PowerPoint document, which provides an overview of the content presented.

This is the presentation, that the Health and Life Insurance section will present at the upcoming May 2018 Pre-Retirement Session in New York.

Medicare, National Programs

If you plan to be away from the US for a prolonged period of time, you are still responsible for ensuring that Medicare payments are made in a timely manner. In the event the SSA terminates your coverage due to non-payment, your claims will be adjudicated as if you had Medicare and you will therefore be responsible for 80% of your claims. No exceptions will be granted by the UN for a retiree's failure to pay their Medicare premiums. 

Active staff, Retirees and Survivors, Medical Insurance, New to the UN

Please visit the New to the UN page for health and life insurance coverage options offered by the United Nations. Additionally, you may find Navigating the Healthcare System in the US, a handbook prepared by the United Nations Medical Services Division, to be a great resource to guide you on how the health care system works in the US.

Active staff, Life Events

Loss of coverage under a spouse's health insurance plan owing to the spouse's loss of employment beyond his or her control is considered to constitute a qualifying event for the purpose of enrolment in a United Nations health insurance plan, provided that the staff member holds a qualifying contract with the United Nations.

Application for enrolment in a United Nations health insurance plan under these circumstances must be made within 31 days of the qualifying event. The staff member will need to submit a health insurance application form. In addition, application for coverage must be accompanied by an official letter from the spouse's employer, certifying the termination of employment and its effective date. 

Adding a new dependant

The following are the various events to enrol dependants for coverage within 31 days of such event:

  • New Birth – copy of modified Personnel Action Form (PAF) required
  • Adoption - copy of modified Personnel Action Form (PAF) required
  • New marriage - copy of modified Personnel Action Form (PAF) required
  • When enrolling a new born the effective date of Coverage is always the new born’s date of birth.  (DOB)

Cessation of coverage

Coverage ceases automatically following a separation from service. For re-instatement staff members must re-apply within 31 days of being re-appointed by submitting an application and PA to Insurance. Coverage may also cease for staff members transferring to another pay rolling duty station or department and re-application may be necessary for coverage to be reinstated.

Note: Voluntary termination of medical and/or dental coverage can only be requested during the Annual Enrolment Campaign period.

 

Active staff

Insurance coverage is terminated automatically but is not automatically restored, for staff members:

  • whose contracts expire or who are separated from service; or
  • who transfer between Organisations e.g., UN, UNDP, UNICEF; or
  • who are reappointed following any break in employment or change in employment contract series; or
  • who transfer to a different payrolling office.

Most individuals whose contracts end do in fact leave the United Nations common system. However, many insured staff members transfer between e.g., the United Nations, United Nations Development Programme or United Nations Children's Fund; these staff members must reapply for health insurance coverage as soon as a personnel action has been generated by their employing organisation. Such reapplication for health insurance coverage must be made within 31 days of the effective date of the transfer. Strict attention to this requirement is necessary to ensure continuity of health insurance coverage because, as noted, separation from an organisation results in the automatic termination of insurance coverage at the end of the month. Staff members who transfer between organisations should also ensure that the receiving organisation establishes the staff member's household members and mailing address in its database so that coverage can be reinstated under the receiving organisation.

Staff members should also be aware that if there is a separation from service, no matter how short, insurance coverage will be terminated. Therefore, upon any reappointment, the staff member must reapply in order to reinstate health and/or life insurance coverage.   

Finally, whenever a staff member's transfer involves a change in payrolling office, the insurance at the former office ceases, and insurance at the receiving office must be established. This is not automatic and requires an application. 

Active staff, Retirees and Survivors, New to the UN

Health Insurance 

  • ​​Active staff:
    • New Hire/Re-hire: Provided that the application is made within the prescribed 31-day time frame, coverage for a staff member newly enrolled in a health insurance plan commences either on the first day of a qualifying contract (minimum of 3 months for medical and dental insurance) or on the first day of the following month.
    • Annual Enrolment Campaign: coverage commences 1 July.
    • Change in payrolling office/agency: coverage commences either on the first day of a qualifying contract (minimum of 3 months for medical and dental insurance) or on the first day of the month following a qualifying contract.
    • New dependant: coverage commences on the first day the dependant becomes eligible (for example on the day a child is born or adopted, on the marriage date for a spouse).
  • Retirees: after-service coverage commences on the first day of the month following retirement.

Kindly note that although effective on the afore-mentioned dates, it may take 3-4 weeks for the coverage to be reflected under the Insurance provider database and insurance cards to be mailed.  Staff members and retirees may therefore be requested to pay expenses upfront and should seek reimbursement through the insurance provider once the insurance cards are received.

Life Insurance

  • Initial Appointment: coverage commences on the first day of the month during which the application is submitted
  • Evidence of Insurability required: coverage commences on the approval date by Aetna

Note:

  • If a contract terminates before the last day of a month, coverage will remain in place until the end of that month. For example, if the contract terminates on 15 December 2013, the coverage will end on 31 December 2013.

New to the UN

Welcome to the United Nations! Please visit the New to the UN page for more information and resources about your options.

National Programs, Medicare

Yes you are eligible to enrol in Medicare Part B even though you did not contribute to Social Security.  You do not need to enrol in Part A since it will be an additional cost to you.  However, you need to enrol in Part B as the United Nations has made the enrolment in part B a requirement for all eligible ASHI participants and their dependents as of 1 January 2011. 

The UN will adjudicate your claims as if you had Medicare Part B. In other words, when Aetna, Blue Cross, or HIP receives a claim from one of your physicians, they will only pay the balance of the claim as if you had enrolled in Medicare part B.  You will be responsible for 80% of your claims.

You should re-enrol as soon as possible because your claims will be adjudicated as if you had Medicare Part B as your primary coverage. The UN will not pay any additional penalties incurred during the period when the Medicare Part B coverage was dropped.

For those already enrolled in Medicare Part B prior to 1 January 2011, please remain in the plan.  The UN will reimburse you for your Medicare Part B premiums.

Yes. The penalty is of 10% for every year for which you were eligible for Medicare and did not apply. If you are 65 or over at 1 January 2011 and did not apply for Medicare prior to that date, the UN will pay the applicable penalty if you join during your Medicare enrolment eligibility period. If however you only become eligible for Medicare after 1 January 2011 and choose not to enrol, then you will be responsible to pay the penalty and the UN will only reimburse you the premium amount before any penalty is applied by the US Social Security Administration.

Since our US based insurance plans (Aetna, Blue Cross, and HIP) cover prescription drugs, there is no need to apply for Medicare D. Moreover, the United Nations receives a drug subsidy from the US Government for each UN retiree enrolled in Medicare Part A or Part B or both, and not enrolled in Part D. We therefore require our ASHI participants not to enrol in Medicare Part D.

Your spouse does need to apply as soon as he/she is eligible. The premium will be reimbursed by the UN by reducing the monthly ASHI contribution. Any amounts in excess will be accumulated and paid out in lump sums to the ASHI participant. Please note that the ASHI Unit will need to receive a duly filled Medicare Part B Reimbursement Request Form and the required attachments before refunding premiums.

Medicare Advantage Plan and MediGap are supplemental coverages that are offered to eligible members at an additional cost. You do not need to enrol in these supplemental insurances since our US based insurance plans will reimburse what Medicare A and B do not cover under what is determined to be reasonable and customary, and covered under UN plans.

If you are entitled to US Social Security payments, you will be automatically enrolled as you approach age 65 and should receive a card in the mail. If however you are not entitled to Social Security or if you declined to enrol when you reached age 65, but need to enrol in Medicare Part B, you may do so by contacting your local Social Security Administration office.  You can locate your local office by going to the Social Security Administration website, www.socialsecurity.gov. 

You are eligible for free Medicare Part A (hospitalization) if you contributed to Social Security for 40 quarters (ten years) and will be automatically enrolled in Medicare when you turn 65.

You are eligible for Medicare Part B (doctors visits from age 65), if you have lawfully resided in the United States for a minimum of 5 years, including periods under a G-4 visa.

  • Example: You retire at age 62 after being on a G4 visa at UNHQ and apply for a permanent resident status (Green card). You are eligible to apply for Medicare three years later at age 65, although you would have only been a permanent resident for about 3 years.  You do not need to receive US Social Security payments to be eligible for Medicare Part B.

Even though most individuals become eligible for Medicare Part B upon attainment of age 65, there is an exception to the age requirement if Social Security has declared you disabled.

If you did not contribute to Social Security, you do not need to enrol in Part A since it will be an additional cost to you.  However, you need to enrol in Part B as the United Nations has made the enrolment in Part B a requirement for all eligible ASHI participants and their dependents as of 1 January 2011.

People who live in US Territories such as Puerto Rico are eligible.

Please submit a copy of your Medicare card to ensure that we coordinate your benefits with the insurance carriers.  Also send the Medicare Part B Reimbursement form along with a letter or notice from the Social Security Administration (SSA) indicating your Medicare premium amount.

You are not required to enrol at the moment and the United Nations will therefore not reimburse the Medicare premium if you do decide to enrol. Please contact us to discuss the particulars of your situation upon your return to the US.

The UN insurance plan (Aetna, Blue Cross, or HIP) will pay up to the remaining 20% as applicable and if the services are covered.

The UN insurance plans (Aetna, Blue Cross, or HIP) will cover the yearly Medicare deductible each year. It is best for your provider to claim the deductible with your insurance carrier as opposed to paying out of pocket and filing a claim yourself with your carrier as it may be difficult or impossible to recover this money.

Beginning 2016, the reimbursements for Medicare Part B premiums will be made directly to your bank account on a monthly basis on the last working day of the month.

Please note that the UN Health and Life Insurance Section will need to receive a duly filled Medicare Part B Reimbursement form along with a copy of the letter/notice from SSA indicating premium amount before refunding any premiums. If you are submitting for the first time, you must also submit a copy of your Medicare card. This request only needs to be submitted once a year, unless there is a change in your monthly Medicare Part B premium.

You may contact Social Security and request a “Social Security Benefit Verification” document.  You may request this document online at www.socialsecurity.gov, by calling 800-772-1213, or by visiting your local Social Security office.

The Medicare Part B premiums are only reimbursed to ASHI participants. As soon as your ASHI coverage is terminated, so does the reimbursement. You may drop your Medicare coverage and re-enrol when the active insurance coverage ceases. However, everything has to be done in a timely fashion so as not to have a gap in your Medicare coverage when you re-join ASHI. If you decide not to drop the Medicare coverage for the period of the post-retirement appointment, please note that the UN will not reimburse the premiums during that period.

Your claims will be adjudicated as if your had Medicare.  You will be responsible for 80% of your claims.  It is important to re-enrol in Medicare as soon as possible if they allow you or at the very least, during the following Medicare general enrolment period which is held from January to March every year.

If you do not receive a social security check, you will be billed by Medicare for Medicare Part B premiums once every quarter. However, you may contact the SSA at the number provided at the back of your quarterly invoice to sign up for monthly direct payments. By so doing, the premium will be deducted from your bank account monthly. 

The itemized bill or claim can be submitted directly to Aetna or Blue Cross. Providers who have opted out of Medicare should include that information with the claim. If neither Aetna nor Blue Cross has a record that the provider has opted out of Medicare, the claim may be pending for a Medicare EOB/Copy of Medicare Opt-Out Letter.

Doctors who opt out of Medicare are provided with a Medicare Opt-Out Letter. Most providers who opt out of Medicare are updated in Aetna and Blue Cross's Provider Databases already. However, if the insurance carrier does not have record that the provider opted out of Medicare, the provider could include that information with the claims that are submitted. (i.e. copy of the Medicare Opt-Out Letter). 

Please visit www.medicare.gov. This is the most accurate resource in determining whether a Doctor is in Medicare. Please note that there are three categories of doctors in relation to Medicare:

  • Participating doctors are those who accept the set Medicare assignment (maximum amount a doctor can charge for a specific service).
  • Non-participating doctors are allowed to go above the Medicare assignment, up to a federal maximum of an additional 15% (for NY, the maximum is 5%)
  • Opt-out doctors are those doctors who have fully opted out of Medicare. This means that if you go to such a doctor, Medicare will not cover your claim and you are advised to follow your normal claim process. Please note that opt-out doctors may still be within your medical insurance plan’s network.

Additionally, please note that being enrolled in Medicare Part B does not restrict your choice of doctors under a UN plan and you will still be reimbursed as before if the doctor has “opted-out” of Medicare.  Your claims have to be accompanied by a letter from your doctor indicating he/she has opted out of Medicare before sending claims to insurance carrier.

No it does not.  If you are enrolled under the UN Cigna dental plan, the Medicare Part B enrolment/eligibility has no impact on your Cigna coverage.

The date your Medicare Part B coverage becomes effective will be the first day when your UN insurance becomes secondary when you visit a doctor who has not “opted-out of Medicare”.

If you are a retired staff member, Medicare is primary for your spouse and the UN insurance (Aetna, Blue Cross, and HIP) is secondary. However, the UN insurance remains primary for you as a subscriber. If you are an active staff member, the UN insurance is always primary and Medicare secondary, even if you or your spouse have Medicare Part B.  Your spouse has the choice to keep or drop his/her Medicare insurance, note that the premiums will not be reimbursed under an active plan.

If your physician is not a Medicare provider, you can still remain with this doctor. Your physician’s billing procedures will not change. In other words, if:

  • the doctor is an in-network doctor, you will only have to pay your co-pay of either $15.00 or $20.00;
  • the doctor is an out-of-network doctor; you will be responsible for the applicable deductibles and co-insurance.

For UN members that have Medicare and go to providers that accept Medicare, claims are automatically processed by Medicare and UN insurance (Aetna, Blue Cross, or HIP) as it is the provider’s responsibility to submit claims to Medicare

Once you enrol in Medicare Part B and you provide your Medicare details to the UN via the Medicare Part B Premium Reimbursement form, we will update our system with your information and pass it to the applicable insurance (Aetna, Blue Cross, or HIP) for future processing.   

For UN members that elect to go to providers that do not accept Medicare, it is the member’s responsibility to adhere to the standard claims processes currently in place.

If the medical service that you are planning to receive is not covered by Medicare, your secondary insurance plan (hence the UN plan) will pay for it, as long as the service is included into the secondary plan’s reimbursable items.

You maintain your full right to choose the doctor of your choice.  The quality of medical service from doctors rather depends on each individual provider and quality of his/her skills. Evaluating your medical providers should always take place regardless of the type of insurance you have. There is also a large variation in quality of hospitals.

Medical Insurance, New to the UN

The plans offer similar coverage.  However, the plan comparison highlights the few differences. In addition, the plans have different cost.