UNICEF Manuals: Policies and Procedures. Chapter 11: Insurance and Compensation. Book I: Human Resources Manual

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1 UNICEF Manuals: Policies and Procedures Main Page Search About and Help Intranet home Book I: Human Resources Manual e-handbook Flag: Chapter 11: Insurance and Compensation Section 2: Medical, Hospital & Dental Insurance Plans Date: 01/05/1997 Ref: CF/MN/P.01/11 Chapter 11: Insurance and Compensation SECTION 2: MEDICAL, HOSPITAL & DENTAL INSURANCE PLANS General All staff are eligible and some are required to enrol in health insurance coverage, depending upon the type and duration of their appointment Staff Members under 100 Series. Staff members administered under the 100 Series of the UN Staff Rules holding appointments of three months or longer (except locally-recruited staff at designated duty stations) are eligible to enrol in one of the health insurance plans. Although these staff are not required to carry health insurance, they are encouraged to do so Locally-recruited staff administered under the 100 Series of the UN Staff Rules at designated duty stations and with an appointment of three months or longer, are automatically covered under a UN common system self-insurance plan called MIP and are not eligible for enrolment in any other medical or dental insurance plan Staff Members under 200 Series. Staff members administered under the 200 Series of the Staff Rules and holding appointments of one month or longer are required to carry health insurance coverage (see Staff Rule 206.4) Staff Married to Another Staff Member. In the case of a staff member married to another staff member, the insurance coverage, whether at the two-person or family level, must be carried by the higher-salaried staff member. It should also be noted that if one spouse retires from service with the organization before the other spouse, the spouse who remains in active service must become the subscriber even if the retired spouse had been the subscriber up to the date of retirement and is eligible for after-service health insurance (ASHI) benefits following separation from service Children. Except for the Geneva Plan, children may be covered up to the end of the year in which they reach age 25 provided they are unemployed and unmarried Under the Geneva Plan, children may be covered up to age 30 provided they are in full-time attendance at school or not in full-time regular employment (i.e., they work fewer than 30 hours per week) Disabled or Handicapped Children. Except for the Geneva Plan, disabled or handicapped children over age 25 may be eligible for continued coverage under the plans.

2 Proof of disability must be submitted within 31 days after the child reaches age 25 and is subject to approval by: a) the insurance company in all cases except staff covered under MIP; or b) the UN Medical Director in the case of staff covered under MIP The following criteria must be met in order to consider the child disabled or handicapped: a) the child is incapable of self-sustaining employment because of a mental or physical handicap; b) the child became so incapable prior to age 25; and c) the child remains chiefly dependent on the staff member for support and maintenance Under the Geneva Plan, coverage may continue for children aged 18 or over who are considered disabled within the meaning of the UN Staff Rules and Regulations Secondary Dependants. Except for the Geneva Plan, no coverage is available for secondary dependants under any of the UN medical or dental insurance plans. However, staff posted in NY may take out private coverage directly with HIP/HMO for secondary dependants, provided: a) the secondary dependant has lived in the staff member s household for a minimum of six months before submitting application; b) the secondary dependant furnishes an affidavit that he/she is dependent upon the staff member and is not employed; c) the secondary dependant is not in the United States on a visitor s visa; d) the staff member applying for secondary dependent coverage must have an account with the United Nations Federal Credit Union (UNFCU) for the processing of payment of premiums; e) the secondary dependent must remain in the plan for a minimum of one year; and f) changes may be made only once per year Under the Geneva Plan, a father, mother, brother or sister who is a secondary dependant within the meaning of the UN Staff Rules, may be covered for only basic benefits. For complete details on the exclusions and limitations, please refer to the Statutes and Internal Rules of the UN Staff Mutual Insurance Society against Sickness and Accident (see Annex 11). Premiums The medical and dental insurance plans administered by the UN as described below are available at a premium cost to staff members, a portion of which is paid by UNICEF in the form of a subsidy. All premiums and subsidies are paid through automatic payroll deductions. Annexes contain the schedules of premiums and staff contributions for all medical and dental insurance plans. Enrolment All staff members should complete enrolment procedures within 31 days of the date of eligibility (e.g., upon initial appointment of required minimum duration or upon transfer to another duty station). Failure to do so will result in the following: a) staff member governed under the 100 Series of the UN Staff Rules and not covered under MIP must wait until the Annual Health Insurance Campaign 1 (the campaign is generally set for the first week of June each year; a UN circular announcing the campaign and outlining the procedures for enrolment in the various insurance plans is distributed to all staff yearly; the effective date of coverage applied for during the campaign is the first day of the

3 following month); b) staff member governed under the 100 Series of the UN Staff Rules and covered under MIP: i) will automatically be enrolled for individual coverage only; and ii) will not be able to subsequently enter his/her dependants nor be eligible at a later date for after-service coverage; and c) staff member governed under the 200 Series of the UN Staff Rules with a contract of one month or longer: i) will automatically be enrolled in a medical plan for individual coverage only; and ii) will be able to enrol his/her dependants only during staff member s annual enrolment opportunity, which is on the anniversary date of his/her appointment (e.g., if employed 15 June, the next enrolment opportunity would be on 15 June of the following year) All staff eligible for coverage under the Geneva Plan must wait until the Annual Health Insurance Campaign in Geneva. The campaign is generally held during the month of May of each year Change in Family Status. All requests for changes in coverage (e.g., marriage or birth/adoption of children) must be submitted within 31 days of the change in family status, or in the case of the Geneva Plan, within 31 days of the arrival of the family member(s) at the duty station. Failure to request the change in coverage will result in the following: a) staff member governed under the 100 Series of the UN Staff Rules and not covered by MIP, must wait until the next Annual Health Insurance Campaign; b) staff member governed under the 100 Series of the UN Staff Rules and covered by MIP, will not be able to subsequently enrol his/her dependants nor be eligible at a later date for after-service coverage; and c) staff member governed under the 200 Series of the UN Staff Rules, must wait until his/her next annual enrolment opportunity. Identification Cards Subscribers to all plans, except the Geneva plan and MIP, will be provided with an identification card from the insurance company. In the case of the Geneva Plan, the member will receive a copy of the processed application form indicating his/her insurance identification number. Separation from Service Upon separation from service, staff members may be eligible for After-Service Health Insurance (ASHI) coverage (see Section 5 of this Chapter). However, in all cases, coverage in the UN plans ceases as follows: a) NY Plans: Coverage continues through the last day of the month in which the staff member is separated; b) Van Breda Plan: Coverage continues for one month following the date of separation; c) MIP: Coverage continues through the last day of the month in which the staff member is separated, except in the case of separation for disciplinary reasons, when coverage ceases immediately; and d) Geneva Plan: Coverage normally ceases at the end of the month in which the staff member is separated. However, upon application, coverage may be retained for up to: i) three months for staff who participated in the plan for less than three years; and

4 ii) six months for staff who participated in the plan for three years or longer. Special Leave Without Pay For periods of special leave without pay (SLWOP) for a partial month, a full month s premium will be deducted, and coverage under the insurance plans will not be interrupted. During periods of SLWOP for one month or longer, the organization will not subsidize insurance premiums. Continued participation is optional with full payments (subsidy plus staff member s own contribution) to be made by the staff member. Such payments are to be made in advance on a quarterly basis Insurance Coverage Maintained. Staff members who wish to continue coverage should make arrangements as follows: a) international and local staff stationed in NY should contact the UN Insurance Section to arrange for payment of the premium as follows: Insurance Section Office of Programme Planning, Budget and Accounts Room S-2765 United Nations New York, NY b) international staff stationed outside NY should forward to the Finance Officer, Finance Section, DFAM NY a cheque made payable to UNICEF for the full amount of the premium due; and c) local staff stationed outside NY should arrange payment through their local Operations/Finance Officer Insurance Coverage Dropped. If a staff member decides not to retain insurance coverage while on SLWOP, no action is required upon commencement of the special leave Re-Enrolment upon Return to Duty. Upon return from SLWOP, regardless of whether or not the staff member retained or dropped coverage during the period of special leave, he/she must re-enrol in the insurance coverage within 31 days of return to active status. Failure to do so will result in the following: a) staff administered under the 100 Series of the UN Staff Rules and not covered under MIP, loss of coverage until the next insurance campaign; b) staff administered under the 100 Series of the UN Staff Rules and covered under MIP, loss of coverage for family members who may not subsequently re-enter the plan nor be eligible at a later date for after-service health coverage; and c) staff administered under the 200 Series of the UN Staff Rules, loss of coverage for family members until their next anniversary date. Coordination of Benefits Coordination of insurance benefits will apply, as appropriate, for all UN insurance plans (i.e., if a staff member is entitled to reimbursement by another insurer, reimbursement under Aetna, Blue Cross, GHI, Van Breda, the Geneva plan and MIP will be based on the difference between the costs actually incurred and reimbursement from the other insurer). Cancellation of Coverage Except in the case of MIP and staff administered under the 200 Series of the UN Staff Rules, coverage in any of the plans may be cancelled by the staff member at any time. However, re-enrolment will be possible only during the subscriber s annual enrolment opportunity as defined in paragraphs and In the case of the Geneva Plan, the UN Staff Mutual Insurance Society will require the staff member to provide a detailed explanation for review by the Executive Secretary of the Society as to why he/she cancelled coverage and is re-applying. The Executive Secretary will then decide whether the staff member may re-enrol.

5 Cessation of Coverage of Family Members. Changes in the staff member s family, which result in a family member ceasing to be eligible, e.g., a spouse upon divorce or a child reaching the age of 25 years, marrying or taking up full-time employment should be immediately notified as follows: a) international and local staff stationed in NY, to the UN Insurance Section; b) international staff stationed outside NY, to the Personnel Officer in PSS, DHR responsible for the duty station; and c) local staff stationed outside NY, to the local Personnel/Operations Officer Staff members who wish to discontinue coverage of a family member for any other reason may do so at any time, although this is strongly discouraged. The responsibility for initiating the resulting change in coverage (e.g., from "staff member and spouse" to staff member only" or from "family" to "staff member and spouse") rests with the staff member. It is in the interest of staff members to provide this notification promptly whenever changes in coverage occur in order to benefit from any reduction in premium contribution which may result. Any such changes will be implemented on the first of the month following receipt of notification. No retroactive adjustments can be made as a result of failure to provide timely notification of any change. AETNA Open Choice Plan Aetna Open Choice Plan (Aetna) is available to all UNICEF staff members posted in NY and internationally-recruited staff members serving outside NY The Aetna plan offers worldwide coverage for hospitalization and surgical, medical and prescription drug expenses. Under this plan, medically necessary treatment for a covered illness or injury may be obtained at a hospital or from a physician of one s own choosing, whether an in-network or non-network provider Aetna is a dual-track plan that offers all the benefits of the traditional Aetna indemnity plan plus the option of a preferred provider organization (PPO) network of physicians and other medical providers nationwide. This means that participants can choose, if they wish, to go to a doctor who is in-network and pay only $10 per visit or treatment without any further need to file a claim with Aetna. Alternatively, participants may opt to receive treatment from any physician not in the network and be reimbursed by Aetna in the usual way, subject to the annual deductible and the normal co-insurance Under the non-network (traditional) track of the new Aetna plan, when a participant has met the annual deductible of $125 per individual and $3785 per family and a further $1,000 per covered individual in co-insurance (20 per cent of $5,000) of recognized expenses), Aetna will reimburse all further claims incurred in the year, subject to the provision that they be "reasonable and customary", at 100 per cent. The deductible and co-insurance requirement must be met each calendar year When a participant is treated by a network physician, paying the fixed $10 co-payment for each visit, it is important to note that those $10 amounts do not count toward meeting the $1,000 out of pocket expense limit referred to above. This is so because, under the in-network track of the plan, medical expenses are already considered to have been paid at 100 per cent to the network provider after the participant has met the fixed $10 co-payment There is no mandatory pre-certification requirement for non-emergency hospital admissions There is no lifetime reimbursement limit under the Aetna plan Subscribers to the Aetna plan may also take advantage of the Aetna Pharmacy Management (APM) prescription drug programme. Coverage Please refer to Annex 11 which contains a summary of the benefits under this plan.

6 Identification Cards, Provider Directory and Plan Description Every participant in the Aetna plan receives an identification card (two copies). The Aetna card is valid for both hospital and medical services as well as for the discount prescription drug plan. Enclosed in the envelope containing the Aetna identification card will be a pre-addressed postcard to be completed and returned to Aetna requesting the provider directory and the Aetna plan description book. The directory may also be consulted on the Internet (see Annex 11). Only by returning the postcard to Aetna, indicating their place of residence on the card, will subscribers receive the provider directory and plan description book When using the services of a participating provider or the APM discount prescription drug programme, no claim is filed for reimbursement of charges made by non-participating providers should be submitted to the Aetna claims office (see Annex 11) on the relevant claim form (see Exhibit 11) for reimbursement of prescription drugs not obtained through APM will be reimbursed through the submission of the standard claim form (see Exhibit 11) to the Aetna claims office (see Annex 11) Procedures for submission of a claim are shown on the claim form. Forms are available from PSS, DHR, the local Personnel/Operations Officer or directly from Aetna Subscribers should note that claims for reimbursement must be submitted to Aetna no later than two years from the date on which the medical expense was incurred. received by Aetna later than two years after the date on which the expense was incurred will not be eligible for reimbursement. Grievance Procedure If Aetna denies a claim in whole or in part, the subscriber will receive a written notice from Aetna. This notice will explain the reason for the denial and the appeal procedure. The request for review must be submitted in writing within 60 days of receipt of the notice. The subscriber should include the reasons for requesting the review and submit the request directly to Aetna. Aetna will review the claim and notify the subscriber of its final decision normally within 60 days of receipt of the request. If special circumstances require an extension of time, notification will be given to that effect. Blue Cross/BlueChoice Preferred Provider Organization (PPO) Plan The Blue Cross/BlueChoice Preferred Provider Organization (PPO) plan is available to all UNICEF staff members stationed in NY and internationally-recruited staff serving outside NY The services of non-participating physicians may be utilized anywhere in the world All non-emergency hospital admissions must be pre-certified through the Blue Cross Utilization Management Program There is no lifetime reimbursement limit under the Blue Cross/BlueChoice PPO plan Subscribers to Blue Cross/BlueChoice PPO may take advantage of a facility known as Personal Health Adviser, a toll-free, 24-hour health information service providing access to registered nurses and an audio health library comprising over 400 health care topics Subscribers to the Blue Cross/BlueChoice PPO plan may also take advantage of the Empire Pharmacy Management (EPM) discount prescription drug programme. Coverage Please refer to Annex 11 which contains a summary of benefits under this plan. Identification Cards, Provider Directory and Plan Description Book Subscribers to the BlueChoice plan receive two sets of identification cards (two cards in each set), one

7 card evidencing membership in the plan itself and the other for the discount prescription drug plan. Enclosed in the envelope containing the BlueChoice identification cards will be a pre-addressed postcard for return to Blue Cross to be completed with the name and home address of each subscriber. Only by returning the postcard to Blue Cross will subscribers receive the BlueChoice directory and benefits handbook When using the services of a participating provider or the EPM discount prescription drug programme, no claim is filed for reimbursement of charges made by non-participating providers should be submitted to the Empire Blue Cross and Blue Shield claims office (see Annex 11) on the relevant medical insurance claim form (see Exhibit 11) for reimbursement of prescription drugs not obtained through EPM will be reimbursed through the submission of an EPM Prescription Claim Form (see Exhibit 11) to the Empire Blue Cross and Blue Shield claims office (see Annex 11) Procedures for submission of a claim are shown on the claim form. Forms are available from PSS, DHR, the local Personnel/Operations Officer or directly from Empire Blue Cross and Blue Shield Subscribers should note that claims for reimbursement must be submitted to Blue Cross no later than two years from the date on which the medical expense was incurred. received by Blue Cross later than two years after the date on which the expense was incurred will not be eligible for reimbursement. Grievance Procedure If Empire Blue Cross and Blue Shield denies a claim in whole or in part, the subscriber has the right to appeal the decision. Blue Cross will send written notice of the reason for the denial. The subscriber then has 60 days to submit a written request for review. Blue Cross will send a written decision with an explanation within 60 days of receiving the appeal. If special circumstances require more time, Blue Cross can extend the review period up to 120 days from the date the appeal was received. For a review of a hospital or medical claim, the subscriber should write directly to Empire Blue Cross and Blue Shield (see Annex 11). Health Insurance Plan/Health Maintenance Organization (HIP/HMO) Health Insurance Plan of Greater New York/Health Maintenance Organization (HIP/HMO) is a prepaid medical insurance plan available only to staff members stationed in NY The HIP/HMO plan follows the concept of total prepaid group practice hospital and medical care, i.e., there is no out of pocket cost to the staff member for covered services at numerous participating medical groups in the Greater New York area, including New Jersey and certain areas in Florida. HIP/HMO participants may select a physician at a HIP medical centre or from a listing of neighbourhood affiliated physicians for primary care services. The affiliated physician is visited in his/her private office. Specialty care is given in a HIP medical centre based on the referral of the selected affiliated physician. To select a neighbourhood affiliated physician, the HIP participant should contact HIP/HMO (see Annex 11) Prepaid hospital services are covered in full when hospitalization is authorized by an HIP/HMO physician. In-hospital physician s services are also covered in full when rendered by an HIP/HMO physician Medical appliances are covered in full and prescription drugs are covered, with a $5.00 co-payment, when prescribed by HIP/HMO physicians and obtained through HIP/HMO participating pharmacies The costs of necessary emergency treatment obtained outside the covered area are included in the plan coverage There is no ceiling on the use of authorized services, no deductibles to cover and no insurance forms to complete.

8 Benefits Please refer to Annex 11 which contains a summary of the benefits under this plan No medical bills are rendered and no claim forms are required except for care for emergency services rendered outside the covered areas or the United States. In such emergencies, staff members will be required to pay the bills and then forward them directly to HIP/HMO for reimbursement (see Annex 11). Kaiser/Health Maintenance Organization The Kaiser Foundation Health Plan of the Northeast/Health Maintenance Organization is a prepaid medical insurance plan available only to staff members stationed in NY The Kaiser Foundation Health Plan is an HMO, providing all medical-related services at any one of four health centre locations, accessible to staff members residing in northern Bronx, Westchester County and southern Connecticut as well as hospitalization when authorized by a Kaiser physician. Participants will also have the option of continuing to receive care at a Kaiser medical centre or from any of more than 90 physicians associated with the Katonah Medical Associates or Physician s Choice, two multi-specialty medical groups serving Westchester and Connecticut, respectively. Kaiser health centres accommodate not only physicians offices but also laboratory, X-ray, pharmacy and mental health services Prepaid hospital services are covered in full when hospitalization is authorized by a Kaiser/HMO physician. In-hospital physician s services are also covered in full when provided by or authorized by a Kaiser/HMO physician Medical appliances are covered in full and prescription drugs are covered, with a $3.00 co-payment, when prescribed by Kaiser/HMO physicians and obtained at Kaiser/HMO pharmacies The costs of necessary emergency treatment obtained outside the covered area are included in the plan coverage There is no ceiling on the use of authorized services, no deductibles to cover and no insurance forms to complete. Coverage Please refer to Annex 11 which contains a summary of the benefits under this plan No medical bills are rendered and no claim forms are required, except for care for emergency services rendered outside the covered area or the United States. In such emergencies, staff members will be required to pay the bills and then forward them directly to Kaiser/HMO for reimbursement. GHI Preferred Dental Insurance Plan The Group Health Incorporated (GHI) Preferred Dental plan is available separately or in conjunction with any of the NY insurance plans for staff holding appointments of six months or longer and, at a separate premium cost payable by the staff member and UNICEF GHI does not apply to subscribers under the Van Breda Plan, the Geneva Plan or MIP, as these plans already include dental coverage GHI provides a fixed schedule of benefits and provides dental coverage for all dental services rendered anywhere in the world.

9 In the greater NY area, as well as other parts of the United States, participating clinics and dentists are available whose prepaid charges are confined to the GHI schedule of benefits. A complete directory listing of participating providers is available for consultation in PSS, DHR The GHI Identification Card, which is provided to enrolled staff members, should be shown to the GHI participating dentist before services are rendered Charges of non-participating dentists may exceed the allowances provided under the schedule of benefits. In such cases any extra cost will be at the staff member s expense The maximum benefit under the plan is $2,000 per annum for each insured family member. Coverage Please refer to Annex 11 which contains a summary of the benefits under this plan. Provider Directories A complete directory listing of GHI participating dental providers in the greater NY metropolitan area is available for consultation in PSS, DHR When the services of a non-participating dentist are utilized, a claim form (see Exhibit 11) should be filled out and signed by the staff member; the dentist should also complete and sign his/her portion of the form. The completed claim form should then be mailed to GHI (see Annex 11). Claim forms are available from PSS, DHR the local Personnel/Operations Officer or directly from GHI. Grievance Procedure If a subscriber disagrees with the disposition of a claim by GHI, a review may be requested. Such request must be made in writing to GHI (Attention: Appeals) within 60 days of notification. The subscriber s GHI certificate number and the claim number concerned, as well as any pertinent information regarding the disputed claim, should be included in the request for review. Upon receipt of the request for review, the claim will then be reconsidered, taking into account such additional information as may have been provided by the subscriber. Upon completion of this review, the subscriber will receive written notification of the decision, of this review, the subscriber will receive written notification of the decision, explaining the upholding or modification of the original disposition of the claim. World Access World Access (formerly known as Access America) is a facility available to Aetna and Blue Cross/BlueChoice subscribers. The $0.25 per month per subscriber cost of the World Access facility is built into the premium schedule for Aetna and Blue Cross/BlueChoice World Access provides an international travellers 24-hour hotline assistance programme for obtaining medical care abroad, or within the United States, when at least 100 miles from one s normal place of residence. Participants who call the hotline numbers (see Annex 11) will, where possible, be provided with referrals from a worldwide network of physicians, dentists, hospitals, pharmacies and other medical facilities. In addition, in most cases, World Access will settle the costs of emergency foreign hospital admission and treatment. If the emergency hospitalization occurs in the United States and the hospital does not accept the Aetna or the Blue Cross/BlueChoice identification cards, World Access will also settle the related costs directly with the hospital and then claim reimbursement directly from Aetna or Blue Cross as the case may be. In the case of hospitalization, World Access medical staff will contact the insured patient s local physician in order to monitor the case and services being received. In the event of an emergency hospitalization in the circumstances described above, it is important that World Access be contacted upon admission to the hospital or, at the latest, before discharge. Any hospital bill paid by the participant must be sent to Aetna for reimbursement or Blue Cross, as World Access does not reimburse participants directly When contacting World Access, the subscriber must identify himself/herself as a UN participant and state the World Access identification number for the UN, which is:

10 a) 2065; and b) his/her Aetna or Blue Cross/BlueChoice subscriber identification number, which is: 8-{UN index number}-00. Van Breda Medical, Hospital and Dental Insurance The Van Breda plan is available to all staff members except those stationed in the United States, and locally-recruited staff stationed in Beirut, Mexico City and Santiago where MIP is not in effect. However, staff members who have eligible dependents residing in the United States are encouraged to enrol in either the Aetna or Blue Cross/BlueChoice plans and GHI Dental plan The Van Breda plan provides coverage for hospital, medical, and dental services rendered anywhere in the world Coverage under the Van Breda base component in respect of medical treatment, prescribed by qualified physicians, is limited to 80 per cent of the costs incurred, including physician s fees. Under the major medical component, 80 per cent of the remaining unpaid costs is paid, subject to a deductible of $200 per participant and $600 per family Hospital charges and services are covered in full except that reimbursement is limited for a hospital room in: a) Europe and North America to $600 per day; b) Israel, to $700 per day at: i) 100 per cent in respect of the daily semi-private room rate; and ii) 70 per cent in respect of the daily private room rate Thus, if an insured family member chooses a hospital in North America or Israel at which the daily semi-private room rate exceeds $600/700, the cost of the daily room rate above $600/700 will be borne by the subscriber. However, the $600 per day limitation will not apply to semi-private hospital accommodation in three specific circumstances: a) in connection with medical evacuation to any hospital in the United States authorized by the UN Medical Director. 2 (see Chapter 12, Section 6 of this Manual); b) in cases of bona fide medical emergency arising while in the United States; and c) in situations where the necessary medical treatment can only be provided at a hospital in the United States where the daily semi-private room rate exceeds $600. In such cases confirmation must be obtained from Van Breda prior to the hospital admission The cost of dental treatment is reimbursable at the rate of 80 per cent up to a maximum of $750 per insured family member per calendar year The Van Breda insurance plan covers reimbursement up to a maximum of $250,000 per insured family member per calendar year. Coverage Please refer to Annex 11 which contains a summary of the benefits under this plan for reimbursement should be submitted directly to Van Breda on a Van Breda claim form (see Exhibit 11). Procedures for submission of claims are indicated on the back of the claim form. A supply of the

11 forms is available from PSS, DHR, the local Personnel/Operations Officer, UNICEF Supply Division in Copenhagen or directly from Van Breda (see Annex 11). Geneva Plan All staff in Geneva, regardless of the duration of their appointment, are eligible to enrol in the Geneva Plan. However, for appointments of under six months, some exclusions and limitations apply as provided in Annex V of the Statutes and Internal Rules of the UN Staff Mutual Insurance Society against Sickness and Accident (see Annex 11) who has been affiliated under the provisions of Annex V of the Internal Rules for an uninterrupted period of six months may become a member in the same way as other staff members The Geneva Plan reimburses, within the limits laid down in the Society s Internal Rules, the expenses incurred by its members for hospital, medical and dental services anywhere in the world. Coverage and limitations under the Plan are provided in the Society s Statutes and Internal Rules which are distributed to all members and can be obtained from the local Operations Unit in Geneva If a member decides to obtain medical care away from the duty station where medical costs are higher than in Geneva, reimbursement shall not exceed the cost of equivalent treatment provided in Geneva A provisional and annual deductible of 100 Swiss Francs per insured person and with a ceiling of 200 Swiss Francs per family will be applied to the first reimbursement. After application of the annual deductible, medical and dental costs are normally reimbursed at 80 per cent and hospital costs at 100 per cent There is no lifetime reimbursement limit for regular benefits. However, there is lifetime reimbursement limit of Swiss Francs 35,000 per person for supplementary benefits. Benefits Please refer to Annex 11 which contains the Statutes and Internal Rules of the Geneva UN Mutual Insurance Society Against Sickness and Accident for refunds must be made on a special form (see Exhibit 11) and submitted to the Finance Service of the UN Office at Geneva. Claim forms can be obtained from the local Operations Unit in Geneva. Medical Insurance Plan (MIP) PLEASE NOTE PARAS HAVE BEEN CANCELLED National Insurance Plans Some countries may offer national insurance plans to cover medical, hospital, and dental care, and in some cases, pension benefits. In such instances, where the national health insurance plan offers comparable and adequate coverage, the UN organizations at the duty station may jointly present to their relevant Headquarters a request that participation in MIP be waived for the entire duty station If the Head of Office wishes to obtain approval for local staff to participate in a national insurance plan, the following information should be provided to the Personnel Officer in PSS, DHR in charge of the duty station: a) complete information on the insurance plan; b) text of the national insurance legislation; and

12 c) overview of costs for staff members and UNICEF Locally-recruited staff members in duty stations which elect coverage under a national health insurance scheme rather than under MIP, are not entitled to compensation under Appendix D to the UN Staff Rules, as similar compensation is provided under the national scheme (see Article 1(b) of Appendix D) If a UNICEF office participates in a national insurance plan, all locally-recruited staff members in the duty station must be covered by the same plan. Where a waiver of participation in MIP for the entire duty station has been approved on the basis of coverage provided by a national health insurance plan (see paragraph ), individuals who are excluded from the governmental coverage (e.g., because they are not nationals of the country), will be permitted to enrol in MIP. All staff members are required to authorize UNICEF in writing to deduct their contribution to the plan from their salary payments in the currency of the duty station. Coverage National health insurance plans normally provide coverage for medical/hospital expenses only in the home country. Therefore, when a staff member from such a country travels abroad at the organization s expense, UNICEF will arrange for, and absorb the cost of, private health insurance coverage for the duration of the travel. The local Personnel/Operations Officer should make arrangements for such coverage prior to the departure of the staff member on travel and charge the cost to travel expenses. For RAM Use Only: Document Verification The UNICEF Intranet is intended for the exclusive use of UNICEF staff.