FAQs
On this page, you will find various FAQs related to enrollment to and maintenance of your health insurance and life insurance plan/s.
Eligibility and Enrollment
My duty station is not in New York. Can I enroll in a US-based plan?
Yes, staff members and retirees who are considering coverage for family members residing in the United States of America or who intend to seek medical care in the United States on a regular basis are reminded that they should consider enrolling in a United States-based plan during the Annual Enrollment Campaign in June.
My duty station is New York. Can I enroll in the UN Worldwide Plan?
No, the United Nations health insurance programme requires that staff members, retirees or covered dependants residing in the United States enroll in a United States-based plan.
Can my eligible dependants enroll in a different plan?
No, it is not possible to cover staff members or retirees in one health insurance plan and cover their eligible dependants in another. It is also not possible to cover dependants only, nor is it possible to combine two medical plans.
Can I enroll in the HIP plan?
No, effective 1 July 2013, the HIP Health Plan of New York was closed to new subscribers (i.e., staff members or retirees). Subscribers who are currently covered may remain in the plan, and any changes related to eligible household members will be accepted. However, a current subscriber who transfers to another United States-based plan during the annual enrollment campaign will not be allowed to return to the HIP plan in future annual enrollment campaigns.
What changes can I make during the annual enrollment campaign?
- enroll or terminate enrollment in the United Nations Headquarters-administered insurance programme
- change to another plan
- add or terminate coverage for eligible dependants
As a retiree, when can I make changes to my health insurance plan(s)?
Individuals enrolled in United Nations Headquarters-administered After Service Health Insurance may make a change between either United States-based plan once every two years only, in accordance with section 8.2 of administrative instruction ST/AI/2007/3, on After Service Health Insurance
Are additional actions required if I switch coverage between the Aetna and Anthem Blue Cross plans?
Plan participants who switch coverage between the Aetna and Anthem Blue Cross plans and who have met the annual deductible or any portion thereof under either of those plans during the first six months of the year may, under certain conditions, be credited with such deductible payment(s) under the new plan for the second six months of the year. The deductible credit will not occur automatically and can be implemented only if the plan participant:
- Formally requests the deductible credit on the special form designed for that purpose
- Attaches the original explanations of benefits attesting to the level of deductibles met for the calendar year by the plan participant and/or each eligible covered dependant.
To receive the credit, participants must submit the completed form to the Section (not to Aetna or Anthem Blue Cross) by email to hlis@un.org, together with the relevant explanations of benefits, no later than 31st August.
What is the minimum contract duration for enrollment in a UNHQ-administered plan?
Staff members holding temporary appointments with one or more extensions that, when taken cumulatively, will amount to three months or more of continuous service can enroll themselves and eligible family members from the beginning of the contract that will meet the three-month minimum threshold.
I am new to Insurance plans and I am feeling rather lost and overwhelmed. Is there a guideline to help me with selecting the right policy?
You can find all relevant information on this page. In addition, the HLIS’ benefits assistants can provide additional guidance if needed. They can be reached via hlis@un.org.
As a new staff member, do I have to sign up or take any actions to claim coverage with CIGNA?
Once you have enrolled under a Cigna administered plan, you will receive a welcome email with your reference number. This number allows you to log into Cigna's website. On the member pages, you can submit claims. A plastic membership card for you and all enrolled family members will be sent to you or your Duty Station.
Before we enroll, is there a way to see if a particular provider is in-network with Aetna or Anthem Blue Cross?
The provider should be able to confirm if they are in the Aetna or Anthem Blue Cross network. Additionally, you may find information on the carrier website.
Once you make changes in ESS, how do you know that they have been processed?
You will receive an enrollment confirmation with the respective information.
Coverage outside the Duty Station
Some airlines announced that travel might be allowed for passengers from certain destination with high infection rate of COVID 19 only with PCR Test. In this case, will Cigna cover the cost of the test or will it be claimed as travel expenses?
In this case, the test would not be covered under UN WWP or UN MIP since not medically necessary.
What happens with personal international travel if I am a MIP member? Does the insurance cover only duty- related travel?
Only the portion of the costs that would, at reasonable and customary level, be charged for similar service in the duty station will be reimbursed.
The UN Worldwide plan is not covering the US. What needs to be done, if I or my family come to the US for a 3-4 weeks’ vacation? Do I need to buy another insurance for the US for those 3-4 weeks?
UN WWP participants are only adequately covered for emergency care in the US. Only in case the treatment follows a medical emergency in the USA, the MMBP will reimburse an additional 80% of the participant’s 20% share. In case of medical emergencies, no deductible will apply. However, the participant’s total out-of-pocket cost (the 20% share) is 2,200 USD, or 6,600 USD for the family, before the MMBP kicks in.
I am considering working from home for a few weeks from another country - does this impact my insurance entitlements and benefits if, for example, an accident happens? Do I need prior approval?
Benefits under the plan did not change. The customer service numbers for each plan are still accessible and prior approval is still being processed for all plans.
If I am going to telecommute from Europe or other places outside of the US, can I switch to Cigna?
The current policy requires that staff members duty stationed in the US have to enroll in US-based plans so you cannot enroll in the UN Worldwide plan if your duty station is New York. Special considerations are being given during the duration of the COVID-19 pandemic for staff members duty stationed in New York that cannot come to the United States because of COVID- 19 travel restrictions.
I have half of my family located in the USA and others located outside the USA, which plan is suitable for me?
Both Aetna and Anthem Blue Cross have international coverage. The UN Worldwide Plan administered by Cigna is not configured to provide adequate coverage in the USA.
Will the open enrollment period be extended for staff currently telecommuting from outside the US because of the pandemic until after their return to the duty station (NY)?
The open enrollment period will not be extended for staff currently commuting outside of the USA. However, they can contact their Executive Office to determine if they fall under the pandemic related exceptions.
With the current situation, many of us are in other states than the original duty stations. Does Aetna cover for providers and services rendered in any of the 50 US states or perhaps even outside of the country?
Aetna covers providers and services rendered in other states and internationally.
Does the Aetna plan provide worldwide coverage, and may I consult out-of-network providers?
Yes, the Aetna plan covers out of network providers. In addition, the plan does cover you around the world.
Does Aetna cover hospitalization in the Dominican Republic?
Yes, hospitalizations abroad (including DR) are covered.
Does Anthem Blue Cross cover medical expenses in all US States and Internationally?
In the United States, medical expenses outside of Anthem’s 28 county service area in NY are covered under Blue Card PPO and outside the United States, medical expenses are covered under Blue Cross Blue Shield Global Core.
For New York based staff who are telecommuting from abroad during this time, are there any negative consequences, limits on access to services, etc.?
No, the UN Benefits Plan is not impacted.
Does Anthem cover hospitalization in the Dominican Republic?
Yes. Please contact BlueCross BlueShield Global Core. The contact information for the UN specific number for Global Core is toll-free: 1 (855) 327-1444.
I am covered under Anthem Blue Cross. If my family received medical treatment outside the US, to whom I should send my medical bills?
Please contact the BlueCross BlueShield Global Core. The contact information for the UN-specific number for Global Core is toll-free: 1 (855) 327-1444.
Does Cigna also cover dental services in all 50 states?
Yes, the Cigna Dental plan reimburses services received in all 50 states.
Coverage and Benefits
What are the effective commencement and termination dates of my health insurance coverage?
Provided that enrollment is completed within the prescribed 31-day time frame, coverage for a staff member newly enrolled in a health insurance plan begins on the first day of a qualifying contract or the first day of the following month. When a contract terminates before the last day of a month, coverage will remain in place until the last day of that month.
When can I expect my ID card?
Cards are shipped by the third-party administrators to subscribers’ mailing addresses on average 10 business days after the upload of the Insurance Eligibility file which is transmitted to the Insurance carriers, start of month and mid-month. Please allow for 1 month upon enrollment.
Can I make changes to my insurance coverage between annual enrollment campaigns?
Only if at least one of the following qualifying events occurs and enrollment is completed within 31 days of such an occurrence:
- Appointment or re-appointment
- Transfer or assignment to a new duty station
- Return from SLWOP
- Marriage or divorce of staff member
- Marriage or full-time employment of covered child
- Birth, legal adoption, or death
- Presentation of proof of loss of employment and loss of coverage by the staff member under a spouse’s health insurance plan
Does the UN provide health insurance coverage for short-term staff (less than 3-month contract)?
Staff members holding temporary appointments of less than three months are eligible to enroll in the United Nations short-term medical insurance plan insured by Cigna on an individual basis only, based on availability. Information regarding the insurance programme for temporary appointments of less than three months can be obtained from the Health and Life Insurance Section. Staff members enrolled in the short-term medical insurance plan will be required to transfer to one of the regular medical insurance plans upon extension of their temporary appointment beyond three months.
How can I keep my MIP coverage after separation from the UN and who should I reach out to for this matter?
You cannot. The UN health insurance plans are only for active staff, former staff under specific conditions, and their eligible dependants.
Is there a way to purchase supplementary insurance for the UN Worldwide plan, to cover any gap in service? UNSMIS/UNIQA in Geneva offer a complementary insurance option.
Cigna does not currently offer a supplementary cover for UN WWP or UN MIP.
Are we covered by Cigna in case of COVID-19 related illness?
Yes. Covid-19 is covered like any other illness under the UN WWP and UN MIP. UN has decided to cover medically necessary diagnostic testing of Covid-19 at 100% during the pandemic.
Would ABA therapy sessions (autism) be considered a mental health service or a paramedical fee?
ABA therapy will be covered under a separate benefit. Individual sessions, being 1 on 1 sessions between the patient and therapist will be covered. Prior approval must be requested.
If I would like to test myself and my family members for Covid-19, is it reimbursable by Cigna?
Both UN WWP and UN MIP cover medically necessary, diagnostic testing for Covid-19. UN has decided to waive any cost-sharing for Covid-19 testing during the pandemic.
What would be the additional cost of having dental coverage in the US if I decide on the Anthem Blue Cross PPO Policy?
An explanation on how to calculate premium contributions can be found in the footnote of Annex 1 on Page 20 of ST/IC/2020/13.
Why doesn’t the dental insurance cover all forms of teeth ailments?
Dental plans, unlike medical ones, are discounted plans, that cover preventive care and basic procedures such as treatment for gum disease, extractions, fillings, and root canals. Coverage is limited because of the low premiums paid for dental insurance. Not all ailments are covered; however, preventive, and basic care are covered.
I have Aetna medical insurance, and the Cigna Dental add on. My spouse has his own medical insurance from his work, but no dental insurance. Can we add the Cigna Dental coverage for him without adding medical coverage through the UN?
Yes, you may.
If I'm already on Anthem Blue Cross but have decided to start fertility treatments, what are my options for switching plans mid-year? Are there any plans on adding fertility coverage to Anthem Blue Cross in the future? Fertility treatments are not usually something done by choice and are very costly. Often, women don't have the luxury to wait 8 months or even 2 or 3 months until a new insurance cycle to switch plans.
Coverage related to fertility treatments under the Anthem Blue Cross plan will not be changed during this renewal cycle. You may change your plan during the annual enrollment campaign.
Why is the UN not negotiating the rule that if we are admitted to a hospital which is in network, we will be covered 100 percent? We should not have to sign any form regarding out-of-pocket payments for any affiliates working with that hospital but not being in-network.
The Insurance industry in the US can only request, but not mandate all medical providers to be in-network providers. UNHQ does not negotiate with providers but uses the network of its Third-Party Administrators (TPAs). TPAs usually negotiate with these out-of-network providers and reimburse at reasonable and customary rates. However, it is within the law to require plan members to sign these forms when seeking medical services within the US.
Has COVID-19 affected the Aetna health insurance, as well as the Hartford Life Insurance? If so, in which way(s)?
Medical benefits and coverage under Aetna and life insurance have not changed since COVID-19. Teleconsultations were added to Aetna medical benefits since the pandemic.
Does the Aetna insurance plan cover fertility treatments such has egg freezing or IVF?
Yes, Aetna covers fertility treatment and IVF.
What is the rationale for not reimbursing parts of ambulance costs on the basis that the service provider is out- of-network? When one calls 911 in a medical emergency, it is unreasonable to ask the dispatcher for an in-network EMS.
We consider all emergency ambulance transports as in-network, regardless of the network status of the ambulance company.
If I am enrolled in the Aetna PPO and want to receive IVF treatments outside of the US, will Aetna cover these costs? What is the process for approval?
The United Nations' plan does allow infertility services outside of the US.
What is the coverage for fertility drugs under the Aetna plan? Fertility meds are considered specialty drugs and may or may not be covered. One round of IVF can cost up to USD15,000 just for the drugs.
Artificial insemination is limited to six treatments per lifetime; advanced reproductive technology is limited to $25,000 per lifetime for medical expenses and $10,000 per lifetime for pharmacy expenses, including specialty medications covered by the plan.
I have Anthem Blue Cross coverage which does not cover mental health residential programs other than for addiction. Does the Aetna plan cover those? If so, what are the criteria?
Residential Treatment programs are covered like any other expense but must meet clinical guidelines. Please refer to the Aetna website for our clinical policy bulletins.
For treatment by a psychologist or psychiatric nurse practitioner, what is covered by Aetna?
This treatment is covered like any other medical service. Please refer to the Aetna website for our clinical policy bulletins.
Does Aetna cover egg freezing?
Egg freezing is covered as part of a treatment plan under the Advanced Reproductive Technology subject to the lifetime maximum of $25,000.
Does the Anthem Blue Cross insurance plan cover fertility treatments such has egg freezing or IVF?
Anthem Blue Cross does not cover fertility treatments and IVF.
Does Empire Blue Cross cover COVID-19 tests outside the US?
Yes.
The changes for 2020 include reduction of out-of-network physical therapy and certified social worker reimbursement rates – What is the amount of these changes?
The out-of-network reimbursement for Physical Therapy is changing to 200% of Medicare and the out-of-network reimbursement for Certified Social Worker is changing to 225% of Medicare.
Does Anthem Blue Cross cover non-US non-emergency health service (e.g., annual health check)? I understand that Aetna does not.
Yes, please refer to the UN Circular for Specific Benefits.
For treatment by a psychologist or psychiatric nurse practitioner, what does Anthem Blue Cross cover?
The UN Plan covers both In and out-of-network Benefits for these services. Please review the UN Circular for specific provider qualifications.
What are the new rates for Anthem Blue Cross out-of-pocket reimbursements for physical therapy and clinical social work referenced in point 4(b) of ST/IC/2020/13?
The out-of-network reimbursement for Physical Therapy is changing to 200% of Medicare and the out-of-network reimbursement for Certified Social Worker is changing to 225% of Medicare.
Kindly elaborate on any pre-approval in case we need to work from abroad, including Covid-19 testing.
The UN Plan requirements for pre-approval are the same. COVID-19 testing would not require prior authorization.
I have not been successful in finding an in-network mental health provider (psychiatry) for my child covered under Anthem Blue Cross in New York. There simply aren't any outside of medical residents working in hospital clinics. However, out-of-network providers charge vastly more than the maximum allowed by Anthem Blue Cross ($400 vs. $250 maximum allowed per consultation). This means that even with insurance, I have to pay $200 out-of-pocket per visit. Why do Anthem Blue Cross maximums not correspond with the reality of psychiatric service provider costs in NYC?
Out-of-network maximum allowable amounts are based on a percentage of the National Medicare Rate. The rates are not based on the charges a provider bills. Please contact Anthem Customer Service to locate INN providers.
For vision-care under Anthem Blue Cross, where can we go to find further information? I understand that it's managed by a different company, but the information on Anthem's main portal is very limited.
Please contact Anthem Blue View Vision via 1 (866) 723-0515.
Why are you not allowing us to use other online pharmacies - for example CVS? Why are we forced to use only one? They will soon increase prices.
Ingenio-Rx RX is the Pharmacy for Home Delivery. As of 7th January 2020, UN members with medical coverage through Anthem BCBS can also opt out of home delivery and get a 90-day supply from a CVS Pharmacy.
Does Blue Cross cover non-US non-emergency health service (e.g., annual health check)? I understand that the Aetna plan does not.
Yes. Please refer to the UN Circular for specific benefits.
Why is the UN not negotiating the rule that if we are admitted to a hospital which is in-network, we will be covered 100 percent? We should not have to sign any form regarding out-of-pocket payments for any affiliates working with that hospital but not being in-network.
You can refuse to sign the paperwork and ask for only in-network providers. Hospitals do staff their facilities with some out-of-network Providers. Please call Anthem's Customer Service with any specific examples and discuss your options.
Does my dental entitlement accumulate/roll-over if I don't use it for one year?
No, our dental benefits do not roll-over if not used. The maximum resets each year on the 1st of July.
Claims
Are there time limits for filing claims?
Plan participants should note that claims for reimbursement of medical services under the Aetna and Anthem Blue Cross plans and the UN Worldwide Plan must be received by the administrators of the plans no later than two years from the date on which the medical expense was incurred. Claims for reimbursement of dental services under the US Cigna Dental plan must be received no later than one year from the date on which the dental expense was incurred.
How can I dispute my claims?
In the case of disputed claims, the staff member must exhaust the multilevel appeal process with the Third-Party Administrator before requesting assistance from HLIS. The process is indicated in the explanation of benefits or denial letter mailed to the participant member by the Third-Party Administrator and the applicable benefits booklet.
How can I raise a complaint against Cigna? Are there any oversight mechanism? How can I submit issues to Cigna?
Members can submit a complaint to Cigna via the member pages, by email or phone. Cigna will then revert within 3 working days to that complaint.
May I please ask about the time limit to submit medical claims? Is it within one or two years?
For UN WWP, the claim submission deadline is 2 years. For UN MIP, it is 1 year. This is to be counted as of date of service.
Many of us have been suffering because of Cigna's lack of will to pay required medical treatment. How can the UN find a solution for this matter?
Please inform Cigna about the claim that was not reimbursed and obtain clarification on the reason for keeping the claim pending, or not reimbursing it. You will then receive a clear update on why the claim could not (yet) be reimbursed. The contact details are on your insurance card.
Dependants and Beneficiaries
Can I enroll secondary dependants (parents or siblings)?
No, “Eligible family members” do not include secondary dependants, family members of temporary staff members with appointments of less than three months or family members of occasional workers. The term “eligible family members” refers to a recognized spouse and one or more dependent children.
What are eligible dependants?
The United Nations health insurance programme recognizes only one eligible spouse for coverage. A dependent child is one who meets the definition according to staff rules and is considered to be a household member in the organization’s ERP system (Umoja, Quantum, SAP, oneUNOPS, etc.).
What is the maximum age for a child to be covered?
A child is eligible to be covered under the programme until the end of the calendar year in which he or she attains the age of 25, provided that he or she is not married or employed full time. Children with disabilities may be eligible for continued coverage beyond the age of 25 provided that they are certified disabled by the Division of Health-Care Management and Occupational Safety and Health, if the parent is an active staff member, or by the United Nations Joint Staff Pension Fund, if the parent is a retiree.
Who is included in a "family"? Who can I include in my plan?
You can find specific details on eligible dependants in the information circular ST IC 2020 which is uploaded on the Policy Documents Page of this website.
I am a P3, have Cigna Insurance for myself and want to include my wife. How much would the monthly premium increase for this situation, will it be 1.5, 2 time or else?
You can find specific details on premiums on the Health Plan Pages of this website. We also have a simulator available under the Reference Material Pages.
My daughter will turn 21 on coming August, will she be covered after that age?
Yes, she is eligible to be covered under the programme until the end of the calendar year in which she attains the age of 25, provided that she is not married or full-time employed.
My children and I have Cigna MDI and my children are living in the US. Can I change their medical insurance to be different from mine? If yes, which medical insurance is the best to use in the US?
No, all eligible dependants need to be enrolled in the staff member’s health plans.
If I want to replace one of my dependent children with a newborn child, what is the process? Can I assign more than 6 kids as beneficiaries?
You will have to terminate insurance for one child in June 2020 and enroll the newborn child before in June or within 31 days after the birth of your child. There is no limit in the number of dependent children.
Can I enroll former dependants (now over 25) in Cigna and pay by myself?
No, this is not possible.
Does my son, currently studying in the US and 23 years of age, also qualify to be covered by Cigna? My duty station is Kenya.
The sole exception to the measures in the US arises in the case of a dependent child who attends school or university in the United States and is required by the educational institution to enroll in its health insurance plan. In such a case, the student’s health insurance plan at the school or university will be primary and the UN Worldwide Plan will be secondary.
As a single employee, is there an option to have secondary dependants (in this case, parents) insured too, by adding a premium?
No, only primary dependants (eligible spouses and children) can join the plan. Secondary dependants, such as parents and siblings are not allowed to enroll in a UN HQ administered health insurance plan.
When my adult son is no longer eligible to be covered at the end of December (he turns 25 this year), will the premium deducted from my pay be adjusted automatically?
Your adult son will be removed from the plan at the end of the year he becomes 25. However, your premium will only be adjusted if there is a difference in coverage level.
I have Cigna dental insurance for my family. My daughter turns 25 in July. Until when is she covered? Do I have to do anything, or will she automatically be removed at the appropriate time?
Your daughter will be covered until the end of the year (31st December 2020). The HLIS will remove her from your coverage.
Is there any difference in my and my spouse’s coverage under the same plan? Are there different limits and thresholds?
No, there is no difference in coverage between the staff member and spouse enrolled under the same plan.
My spouse is currently insured by his employer. Given the situation, we do not know what will happen with his job. Can I add him to my plan at a later date, or would I have to do it during the annual enrollment campaign only?
You need to enroll your spouse during the annual campaign. The policy will not allow enrollment at a later date.
Is my spouse covered under my insurance when I retire? Is there a minimum eligibility requirement?
Your spouse can be covered under your insurance when you retire if the eligibility criteria are satisfied.
My family moved back to our home country due to COVID-19 issues in New York and may not return until Feb 2021. Can I stop the insurance coverage for them now and if so, will I be able to reinitiate when they return in Feb 2021?
Your family can be dropped from coverage during the annual enrollment campaign. However, if dropped, they cannot be enrolled until the next annual enrollment campaign in June 2021.
I'm expecting a baby later this year. Will I be able to add my new baby and my husband to my plan?
You can add your baby within 31 days of your baby's birth. There is no qualifying event to add your husband when your baby is born. Your husband can only be added during the annual enrollment campaign, or within 31 days of marriage.
My dependants are studying outside the NY metro area, will there be any issues on coverage with Anthem and Cigna?
Dependants outside of the NY Metro Area are covered by the Anthem Blue Cross and Cigna Dental plans.
UN agencies allow for secondary dependants to be covered under the UN health insurance plans whereas this option is not available for the UNS. The SG is trying to bring consistency to UN agencies. Is consistency across insurance plans part of the reform?
The UN HQ administered plans do not allow the coverage of secondary dependants under UNHQ plans.
Can my spouse, who is my dependant and enrolled in the UN insurance with Anthem Blue Cross, apply for Medicare as a green card holder upon filing joint UN tax return for the past five years?
Your spouse can apply at the local Social Security Administration office for Medicare Part B. Only they can determine if your spouse is eligible.
My husband retires on 28th August this year and he will not have after service insurance from his employer after that. Can I add him to my plan then?
Please review the eligibility criteria as well as a list of qualifying events on the Active Staff Toolkit Page of this website.
If I have plans of getting married, will my stepchild be covered? What would be the conditions under which my partner and my future stepchild could be covered?
Please review the eligibility criteria reflected in ST/IC/2020/13 on pages 7 – 9.
Is there an option for family members no longer eligible as dependants (over 25) to still have coverage under Anthem Blue Cross and/or Cigna?
Only in cases of children certified as disabled by either the UN Medical Department or the UNJSPF.
My son (currently 18 years old) will attend a university abroad. My experience during Home Leave was that Anthem Blue Cross was difficult to use, and I did not get any partial reimbursement. If the university offers a student health insurance, I might cover him under such an option. Could I remove him from the UN insurance in September? Is this considered a qualifying event?
No, you would have to drop him during the annual enrollment campaign.
My son is currently covered by his father's health insurance. If he loses his job in the future, will I be able to enroll my son outside the annual campaign period?
No. Please refer to pages 9 and 10 of the ST/IC/2020/13.
I am covered under the Aetna health insurance plan and my premium is very high for just me and my daughter. How many more eligible family members I can enroll in the same plan while maintaining the current premium amount?
You are currently paying premiums for two participants and cannot add another eligible family member for the same rate. If you add another participant, you will be charged the family premium under the Aetna plan.
Telehealth
During the pandemic, does Anthem Blue Cross continue to cover telephone and telehealth visits with my current doctors (even if they are not part of LiveHealth Online)? Is there an end date for this?
Due to the ongoing pandemic, Anthem Blue Cross has extended the provisions of telephonic consultations through 30th September 2020.
During the pandemic, does Anthem Blue Cross continue to cover telephone and telehealth visits with my current doctors (even if they are not part of LiveHealth Online)? Is there an end date for this?
Due to the ongoing pandemic, Anthem Blue Cross has extended the provisions of telephonic consultations through 30th September 2020.
What doctors are available in the On-Line Insurance telehealth services?
For Live Health On-Line it would be any doctor listed when you log onto Live Health On- Line.
What kind of video consultations are available with Aetna?
Behavioral Health video consults and telemedicine consults are available. In addition, you can use Teladoc Aetna’s telemedicine provider for video consultations.
Is the telehealth service connected to my doctor? Will they have access to my medical history?
If you use our Teladoc services, they will ask if you want to have your visit shared with your doctor and will then ask for your primary care physician's information. They will not have your entire medical history upfront.
I enrolled in Teladoc and was then subsequently targeted by Teladoc with Facebook personalized ads using the insurance information provided through my plan. I contacted Teladoc and they did not even dispute it and fully acknowledged that this is standard practice to encourage use of their service. Needless to say that I immediately terminated the Teladoc service.
In December 2017, Facebook was used to communicate directly with UN Aetna plan participants about your eligibility to use Teladoc as part of your health plan benefits. At that time, it was an additional touch point to ensure that members knew how we could help them during the flu epidemic.
I have tried to use the Aetna telehealth options but there are very little providers available. Are the medical practitioners on Aetna’s regular website available for telehealth services?
The United Nations uses Teladoc as our primary Telehealth provider.
Is Telehealth only offered for general consultation or also for medical specialists?
Telehealth gives you access to both General Practitioners and Specialists. Your first consultation will always be with a GP who may refer you to a (Telehealth) Specialist. Your first Telehealth consultation will always be with a GP who can then refer you to a Specialist (in or out of Telehealth) if needed.
Cost Containment
Why should I make every effort to select in-network providers?
Out-of-network providers charge higher costs and expose the patient to financial risk, since the plans will cap reimbursements based on a reasonable and customary rate and not the actual provider’s charges.
How are benefits coordinated if I am covered by two or more plans?
The United Nations health insurance programme does not reimburse the cost of services that have been or are expected to be reimbursed under another insurance, social security, or similar arrangement. For those participants covered by two or more plans, the United Nations health insurance programme coordinates benefits to ensure that the participant receives as much coverage as possible, but not in excess of expenses incurred. Plan participants covered under the United Nations health insurance programme are expected to advise the third-party administrators when a claim can also be made against another insurer.
How can I help fighting fraud, waste, and abuse?
Plan participants are strongly encouraged to review their explanation of benefits or claim statement carefully to ensure that only services received from their provider are billed. Furthermore, it is the responsibility of the plan participants to report any questionable charges to the third-party administrators so that they can be investigated.
Please advise if any changes are foreseen in the yearly insured value and yearly premium rates?
You can find specific details on benefits as well as premiums on the Health Plans Pages of this website.
Can someone explain to me how the rates keep going up and up, year after year, while benefits are decreasing? I switched from Aetna to Anthem Blue Cross last year in order to save some money on health insurance, and this year we are hit with a 9% increase.
Increases in premiums are a direct result of increased utilization. Premiums will increase after a period of increased utilization. Benefits are decreased or adjusted to lower the premium increase that would have been implemented.
Is it correct that my monthly premium for Anthem Blue Cross PPO (for staff member and spouse) is $1,787.53 while Aetna is $2,407.11? Right now, I only pay for the staff member and spouse under Cigna Worldwide which only comes to $305 per month. Please clarify.
The Premiums and contribution rates for the three plans are reflected in ST/IC/2020/13 on pages 20 and 21.
What does the UN Insurance department do to audit claim fraud?
The insurance carriers are responsible for conducting monitoring and compliance exercises to highlight potential fraud. Those who engage in fraud will be reported to the authorities within the United Nations and the country in which the fraud occurred for appropriate action, such as non-payment of suspected fraudulent claims, suspension of any subsidy, termination of coverage, criminal investigation, and other administrative actions, including termination of employment, for any staff member involved.
Did the premium rate increase for the TPAs or did the administrative fee increase? If the insurances are self-funded, and TPAs are only paid the administrative fees, why did the premiums increase?
Premium rates reflect the cost of claims which accounts for 96 – 97 percent of the total cost of US-based plans, and the cost of administrative fees which makes up 3 - 4 percent of the cost. Whereas total premiums increased by between 6 – 9 percent, the administrative fees for US plans increased by between 1 – 2 percent.
Why is the premium increasing every year? My health insurance premiums increased with no change in health, thus leaving my salary decreased every year.
Premiums increase after utilization increases so increases in premiums are a direct result of increased utilization.
Please advise if any changes are foreseen in the yearly coverage value and yearly premium rates?
Yes, changes are foreseen to both premium rates and benefits and can be found in the information circular ST IC 2020/13.
I heard that there is a GA mandate of 50% cost sharing each whereas this is not the case as evident in the salary slip. It states that the UN share is less than the employee share.
The 50% cost sharing is based on the total premium for all active staff. If you earn more, you contribute more than 50%. If you earn less, you contribute less than 50%.
Life Insurance Programme
What is the effective date of my life insurance coverage?
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 The Hartford
Is there a term insurance scheme for life insurance?
There is only one UN Group Life Insurance Plan. Kindly refer to ST/IC/2002/63 and ST/IC/2006/21.
How can we get a copy of the "fine print" terms and conditions for the life insurance coverage prior to adhering to the plan?
The documents containing information related to the UN Group Life Insurance Plan are ST/AI/2002/6, ST/IC/2002/63, ST/AI/2002/63/Amend.1 and ST/IC/2006/21.
Do you issue Life Insurance certificates?
Yes, the HLIS issues Life Insurance Certification for After Service Life Insurance participants (retired staff members).
Do you have self-service to login and see all the information on my life insurance?
It is not possible to login to self-service and see life insurance information.
Health Insurance Programme
General
Does UNHQ offer insured health insurance plans?
All health plans administered by United Nations Headquarters, other than the HIP Health Plan of New York, are self-funded health benefit plans.
What cost does the insurance premium cover?
The yearly contributions paid by the participants and the portion of the premium paid by participating United Nations entities are used to cover claim costs plus a fixed administrative fee per primary subscriber (i.e., staff member or retiree).
Who decided on the cost-sharing arrangement?
The cost-sharing ratios are set by the General Assembly.
Are premiums pro-rated?
Neither the portions of the monthly premium of plan participants nor those of the organizations are prorated. The full monthly premium amount will be collected regardless of the date on which coverage begins within a month.
What is meant by “experience-rated’ health insurance plans?
Each year’s premiums are based on the cost of medical or dental treatment received by United Nations participants in prior years, plus the expected effect of higher utilization and medical inflation, plus the appropriate allowance for administrative expenses for the new plan year.
Can I receive rebates if my consumption is less than my premium?
No, each plan in the United Nations Headquarters health insurance programme provides protection against the high cost of health care, whether it involves preventive care, management of chronic conditions, serious illness, or injury. Premiums collected are pooled together, from which the claims are paid. To ensure the viability and affordability of the plans, subscribers are expected to participate and contribute to the plan through the regular payment of premiums, regardless of their current health condition and need for coverage. Strict rules for enrollment in, and termination from, the plan have been put in place to prevent abuse and participation on an “as needed” basis only.
My Umoja doesn’t provide the SS info. Is there another way?
Please contact the Health & Life Insurance Section via hlis@un.org.
Is the deadline to make changes 31 days or 30 days?
Yes, the deadline to make changes is 31 days after the qualifying event.
I reviewed the step-by-step pdf for switching insurance companies on UMOJA. If I follow those steps, am I done with the process or do I need to reach out to my present (until end of the month) insurance company to inform them?
After completing the steps in Umoja and receiving the enrollment confirmation, the process is complete. You are not required to inform the insurance company.
Could you please explain the differences between US based plans?
Please refer to the Health Plan Page on our website for a definition of US-based plans.
The premium costs for health insurance plans in USA are very high. While the same plans are offered at substantively lesser price for other specialized UN agencies like WHO, World Bank. Please explain why the UNS can't negotiate to offer competitive pricing.
The premiums we pay are directly related our plan design and the utilization of all members in the plan. The UN plan is robust, and utilization is high.
What are the contact details for the HLIS during this COVID phase? What is the best way to reach you since the offices are closed?
The HLIS moved to a service-oriented architecture prior to the COVID-19 phase and can be contacted via hlis@un.org.
What is the cost difference between the Aetna PPO and Anthem Blue Cross PPO?
Please refer to the Health Plans Pages of the HLIS website for an elaborate comparison.
Please define the range of a "plan year".
The Plan Year is from 1st July to 30th June of each year.
Right now, I am using Anthem Blue. For my wife, my daughter and myself, we pay $993 monthly. If I switch to Aetna, how much would the monthly payment be?
Please review the premiums and contribution rates located in ST/IC/2020/13 on page 20.
Annual Enrollment Campaign
As a subscriber to Anthem Blue Cross and Cigna, do I need to do anything with respect to the annual enrollment campaign?
Current subscribers do not have to do anything if they do not plan to switch plans or change the dependants covered under their policy.
As an Anthem Blue Cross and Cigna subscriber, do I need to do anything with respect to the annual enrollment campaign?
Current Anthem Blue Cross and Cigna subscribers do not need to do anything during the annual campaign unless they wish to switch from Anthem Blue Cross and/or Cigna Dental.
Aetna
For treatment by a psychologist or psychiatric nurse practitioner, what does Aetna cover?
The Aetna Medical plan covers medically necessary services/visits to psychologist and a nurse practitioner in accordance with Aetna Clinical Policies. Please refer to the Aetna website for our clinical policy bulletins.
Does Aetna have an HSA account?
Currently, we do not offer an HSA account with a United Nations plan.
I tried to register for the united healthcare app but couldn't. Where can I find the ID number and group number? Are these the same as for Aetna?
The Aetna ID is only for the Aetna programs.
Anthem Blue Cross
Anthem Blue Cross is offering discounts on plans - has this been explored by the Insurance section to get discounted rates for UN plans?
The UN plans are self-insured. What is referenced on the Anthem website is regarding fully insured plans.
Does Anthem have an HSA account?
No. The UN does not have an HSA plan.
UN WWP
Why should I not seek care in the US when covered under the UN Worldwide Plan?
The plan does not offer adequate medical protection owing to the annual reimbursement limit of $250,000 and the high cost of medical care in the United States. In addition, you will be responsible for the first $5,000 per person or $15,000 per family every year before the plan begins to pay for medical services received in the United States. Furthermore, expenses incurred in the United States will not be subject to the Major Medical Benefits Plan.
How is a regional rate group determined?
Three regional premium rate groups have been established to enable the determination of premiums that are broadly commensurate with the expected overall level of claims for the locations included within each rate group. The applicable rate group is based on the staff member’s duty station regardless of whether the covered family members are residing in the same duty station or if care is sought primarily outside the duty station. For retirees, the applicable rate group is based on the retiree’s mailing address.
Why is the annual insured value in the UN Worldwide Plan capped at 250,000 USD per year? What am I supposed to do in unfortunate serious incidents where the costs may exceed that amount?
Financial hardship may apply in the event of serious illness.
What is the deductible for Worldwide insurance used in the US?
Under UN WWP, a deductible of 5,000 USD per insured person or 15,000 USD per family per calendar year applies for care in the USA.
Could you provide more information on new autism and ABA coverage?
Applied Behavioral Analysis (ABA) is a type of therapy that can improve social, communication, and learning skills through positive reinforcement. Effective 1 July 2020, individual ABA sessions (1 on 1 sessions between the patient and the therapist) for patients with autism spectrum disorder will be covered under the UN WWP.
MIP
Could you explain, in a simpler manner, what stop loss is?
‘Out-of-pocket maximum’ refers to the total sum of co-payments paid by all family members in a calendar year. Once the out-of-pocket maximum for covered treatments and services has reached the stop loss limit, the MIP will start reimbursing an additional 80% of the out-of-pocket expenses. This is what is called the ‘stop loss clause’.
Is there any change for MIP in relation to autism/ABA? Or is it only available in the UN Worldwide plan?
For UN MIP, ABA is currently not covered.
ASHI & ASLI
Is enrollment in ASHI automatic?
Staff members are reminded that, among the eligibility requirements for After Service Health Insurance coverage, the applicant must be enrolled in a United Nations scheme at the time of separation from service. Enrollment in the After Service Health Insurance programme is not automatic. Application for enrollment must be made within 31 days before or 31 days after the date of separation.
Is enrollment in Medicare Part B required?
Since 1st January 2011, United Nations Headquarters has required all former staff members and dependants (including surviving dependants and eligible dependent children) who are enrolled as participants in After Service Health Insurance and who qualify for participation in Medicare Part B, to enroll in the United States Medicare Part B programme.
Can I stay in ASHI when re-employed by the United Nations?
No, a post-retirement appointee who returns to service and re-enters the Pension Fund as a contributing participant, or a surviving dependant (spouse and/or child) who enters the Pension Fund as a contributing participant, must discontinue his or her After Service Health Insurance coverage and enroll in the health plan as an active staff member.
How can I change my address?
You can change your address by sending an email to ashi@un.org. Please be sure to include your index and/or retiree number.
My husband is an ASHI member, while I am an active staff member. Can I be included in my husband's coverage? Currently, we have separate medical insurances.
To be enrolled under your husband’s ASHI plan, you should have been added to his plan when he retired.
As a retired staff member with US-based insurance, can I change to a different insurance if I move to a different country?
A retired staff member with ASHI coverage can change coverage upon moving to a different country. This information is reflected in ST/AI/2007/3.
If me and my partner both work at UNHQ and one of us retires more than five years earlier than the other. Can the retiree be enrolled in the ASHI insurance scheme or instead become a dependant on the medical insurance plan of the partner that still remains active staff?
Coverage will depend on the ASHI eligibility criteria that is available on the Retirees Toolkit Page of this Website.
If I, as a NY-based staff member, retire, does Anthem Blue Cross continue to cover my medical insurance upon return to my home countries?
This is a UN question regarding what coverage the UN provides to NY based staff members and retirees after they return to their home countries.
If I am enrolled in the Anthem Blue Cross plan when I retire and have to enroll in Medicare at age 65, while maintaining Anthem Blue Cross through ASHI, can I go to a provider that does not take Medicare and use my Anthem Blue Cross ASHI benefits for that provider?
Yes, but you may incur additional out-of-pocket costs if the provider is not In Anthem’s network as well.
SLWOP
I am on leave without pay and would like to add a dependant during this campaign. I intend to return from leave soon. What do I have to do?
Please make your changes by sending an applicaton form to hlis@un.org.
What actions do I need to take to retain coverage during SLWOP?
HLIS must be informed directly by the staff member in writing of his or her intention at least 31 days in advance of the commencement of the special leave. At that time, HLIS will require evidence of approval of the special leave, together with payment covering the full amount of the cost of the coverage(s) retained (i.e., both the staff member’s contribution and the Organization’s share, given that no subsidy is payable during such leave).
What actions do I need to take upon return to work following SLWOP?
Upon return to duty following special leave without pay, Umoja automatically reinstates coverage for United Nations staff members under the health insurance plan and coverage type in which he or she was insured before taking the special leave without pay. In case the United Nations staff member returning from special leave without pay wishes to drop insurance coverage, he or she can request withdrawal from the plan within 31 days of the return from special leave without pay. Failure to withdraw within 31 days of the return from special leave without pay will result in the staff member being unable to withdraw until the next annual enrollment campaign.
Can I change between health insurance plans while on SLWOP?
Staff members may be allowed to transfer to a health insurance plan that is more appropriate to where they will reside during the period of special leave, provided that such leave is at least six months in duration. However, staff members enrolled in the UN Worldwide Plan before taking special leave and planning to reside in the United States during the period of special leave may enroll in the Aetna or Anthem Blue Cross and Cigna Dental plans.