Version July 2018
UN MIP
BENEFITS DESCRIPTION
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.2/25
CONTENT
This doc ument contains a general des c ription of t he medic al cover provided by UN through its
Medical Insurance Plan (MIP) for local staff outside the U.S.A. Should you have any questions
about an item that is not listed below or need additional information, please contact Cigna or consult
your personal webpages at www.cignahealthbenefits.com.
Our services ..................................................................................................................... 3
Your coverage.................................................................................................................. 7
1. In general ........................................................................................................................6
2. Summary of benefits ...................................................................................................... 10
2.1. In the hospital ............................................................................................... 10
2.2. Ambulance and transportation expenses ......................................................... 11
2.3. A he Geea Paciie ........................................................................... 12
2.4. A he eciai ........................................................................................... 13
2.5. A he iceed aified heah cae ide (he ha dc) ..................... 14
2.6. A he icia .......................................................................................... 16
2.7. A he dei ................................................................................................ 17
2.8. A he haaci ........................................................................................ 17
2.9. A he eciaied ie ffice ................................................................... 18
2.10. In the laborato ry/medical ima ging facility .......................................................... 19
2.11. Pregnancy and childbirth............................................................................... 19
3. Special situations ........................................................................................................... 21
3.1. Countries wit h inadequate medical facilities ............................................................. 21
3.2. Official Duty Travel (DT) ......................................................................................... 22
3.3. Medical Evacuation Travel (MET) ........................................................................... 22
3.4. Stop Loss Clause and Out-of-pocket maximum ....................................................... 23
3.5. Hardship provision ................................................................................................. 23
4. Exclusions..................................................................................................................... 24
5. Access to forms ............................................................................................................. 25
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
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UN Med ic al Ins ur anc e Plan p.3/25
OUR SERVICES
24/7 Availability
You can reach us anytime, anywhere in your preferred language. If you want to know how to
submit a claim or have any other questions, or in case of emergency, you can contact us by
phone, email, fax or post. Our contact details are mentioned on your membership card and on
your personal webpages.
Tip: Keep your membership card in your wallet or purse so you have our contact information
at hand in case of emergency!
Our contact details
You can reach us 24 hours a day, 7 days a week, 365 days a year. In case of emergency or if you
simply have a question, you can contact our multilingual staff in several ways. Our contact details
are mentioned on your membership card and on your personal webpages.
Your
region
Europe, CIS, Middle
East and Algeria, Egypt,
Libya, Morocco, Tunisia
and Western Sahara
Sub-Saharan Africa i.e. all
Africa except for Algeria,
Egypt, Libya, Morocco,
Tunisia and Western
Sahara
Asia-Pacific
Latin America and the
Caribbean
Cigna
office
Belgium
Kenya
Malaysia
USA, Florida
www.cignahealthbenefits.com
un.mip@cigna.com
+32 3 217 65 72
+32 3 217 65 72
+60 3 2032 53 33
+1 305 908 91 70
Cigna
P.O. Box 69
2140 Antwerpen
Belgium
Cigna - United Nations Gigiri
complex
Commercial Operations unit
P.O. Box 14678-00100
Nairobi
Kenya
Cigna
P.O. Box 10612
50718 Kuala Lumpur
Malaysia
Cigna
P.O. Box 451989
Sunrise, Florida 33345
USA
Cigna
Plantin Moretuslei 299
2140 Antwerpen
Belgium
Cigna
Park Office Suites
1
st
floor, Suite 7
Parklands Road
Nairobi
Kenya
Cigna
3B-15-3A, Block3B,
Plaza Sentral -
Jalan Stesen Sentral
5
50470 Kuala Lumpur
Malaysia
Cigna
151 Sawgrass
Corporate Parkway
Suite 300
USA
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Toll-free numbers
Wherever feasible, you can call us for free through a toll-free number. You can consult the list of
available toll-free numbers on your personal webpages. If there is no toll-free number available for
the country of your duty station, you can use the dedicated phone numbers of our offices listed
above. They are also mentioned on your membership card.
Your personal webpages Access to online information and services
All information regarding your plan is gathered on your personal webpages. Basically, everything
you need to know is easily available in one place that is accessible at any time from anywhere in
the world. Here you can also access our online services: you can search our worldwide health
care provider network for a particular provider, download fillable forms and consult your
settlement details.
Tip: We master all major languages in-house, so there is no need for you to translate any of
the documents you wish to send us.
Access to quality health care at preferential rates
Wherever you are, you have access to our worldwide network of health care providers. We make
sure you benefit from health care services at preferential rates. To find a health care provider that
best suits your needs, search our provider list by location, type of facility and/or specialty on your
personal webpages.
Free choice of health care provider
You have free choice of health care provider worldwide. However, if you seek medical treatment
outside the country of your duty station, reimbursement will be limited to the reasonable and
customary expenses level applicable to the country of your duty station.
Consulting a health care provider from our network is beneficial to you as we have negotiated
advantageous rates with most of our health care providers. This will also have a positive impact
on your patient share (co-payment).
Let us pay your medical bills
By simply showing your membership card prior to and upon admission to a hospital in our network
you do not have to advance your medical expenses first and submit a claim for reimbursement
afterwards. You will only have to pay your patient share (co-payment).
Prior approval: no surprises by notifying us in advance
For all non-emergency hospitalisations , MRIs, PET scans, CT scans, and major dental treatment
you must request prior approval by our Medical consultant. By contacting us before a planned
admission, you will benefit from our direct payment service and pre-negotiated prices. This means
a lower patient share (co-payment) and no unpleasant surprises when you receive your medical
bill.
Information on serious illnesses and possibility to contact our Medical
consultant
We help raise awareness about the risk of developing serious or chronic diseases like diabetes,
cardiovascular disorders or cancer. If you would like personal advice, feel free to contact our
Medical consultant through your personal webpages.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.5/25
Swift processing of your medical claims
As we have claims processing offices in four time zones (Antwerp, Nairobi, Miami and Kuala
Lumpur), we can quickly process your claims and handle your queries. Thanks to our high-quality
services, we have a customer satisfaction rate of 98%.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
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UN Med ic al Ins ur anc e Plan p.6/25
YOUR COVERAGE
1. In general
Benefits
Description
Aim
The UN Medical Insurance Plan (MIP) is a health insurance
scheme provided to locally-recruited active and former staff
members (and their eligible family members) serving or
residing at designated duty stations away from the
headquarters.
Overall maximum
The overall m aximum equals 6 times the MIP Reference
Salary per individual person (not per family) in a single
calendar year.
The MIP Reference Salaries are updated on a yearly basis.
Eligibility
Automatic enrolment for:
- Staff members holding appointment of three (3) months
or more
Optional enrolment for:
- Eligible family members of staff members
- After-service health insurance (ASHI) protection for
eligible former staff members and their eligible family
members
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UN Med ic al Ins ur anc e Plan p.7/25
Reasonable and customary
Reasonable and customary expenses refer to the prevailing
pattern of charges for professional and other health services
provided at the duty station where the service is provided
(aff ebe d ai). Thi aie eice
provided ihi he c f he aff ebe d
station.
For services provided outside the country of the staff
ebe d ai, only the prevailing pattern of
charges for the services provided within the country of
the staff member's duty station is accepted.
Exception only in case of:
- emergency during official travel (DT);
- approved medical evacuation travel (MET);
- services provided in countries with inadequate medical
facilities.
In these cases reimbursement is considered up to the limits
of the country where care is provided or up to the limits of
the country for which Cigna has granted its prior approval.
To avoid unpleasant surprises it is hence recommended to
request Ciga approval beforehand.
See also 3.1. Countries with inadequate medical facilities and
0
Official Duty Travel (DT) and 3.3 Medical Evacuation Travel
(MET).
Currency of reimbursement
By default, claims will be reimbursed in the currency of the
MIP aicia salary/pension.
Validity of prescriptions
One year
For continuous medication, the physician has to indicate that
the drug is required for a longer period, and specify that
period.
Claim submission deadline
All claims must reach Cigna within 12 months after the date
when the expenses were incurred.
Outpatient treatment/outpatient
surgery/day case
Treatment given on an outpatient basis, where the date of
admission is the same as the date of discharge.
Inpatient treatment/hospitalisation
Treatment given on an inpat ient basis, where t he date of
admission differs from the date of discharge (minimum one
overnight stay).
Insurance year
An insurance year is equal to a calendar year.
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UN Med ic al Ins ur anc e Plan p.8/25
Prior approval
Prior approval from Cigna Medical consultant is required
for all non-emergency hospitalisations and for the following
services:
MRIs, PET scans, CT scans;
major dental treatment;
sub-acute and long-term acute care admissions;
inpatient rehabilitation;
residential treatment;
transplants;
mental health treatment and substance abuse
rehabilitation.
Prior approval means that reimbursement is guaranteed
only in cases where Ciga Medical consultant grants his
explicit approval for the treatment, on the basis of the
medical justification, as well as a cost estimate provided by
the MIP participant at least one week before the planned
admission. In case of medical emergency, approval can be
obtained post factum, on the basis of the same medical
criteria.
Coordination of benefits
The MIP does not reimburse c osts for medical services that
have been or are expected to be reimbursed under another
insurance, social security or similar arrangement (whether
government-run or private).
The MIP participant is therefore requested to claim under
that applicable arrangement first and then to submit a claim
under the MIP in case of any non-reimbursed amount.
Claims for such non-reimbursed amount will not be
reimbursed at 100% but will be processed and reimbursed
according to the conditions set out by the plan.
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Appeal process
First-level appeal
Review of a benefit determination needs to be requested
from Cigna through the regular communication channels
(see Our contact details) within 60 days following receipt of
the corresponding settlement note. Plan members are
encouraged to submit any additional information that can
support their appeal.
Cigna will review and make a decision within 60 days
following receipt of the appeal request, except if special
circumstances require an extension of time.
The review is based on the foll owing parameters:
- applicable plan design or contract language;
- claims and utilisation management guidelines
and policies;
- relevant medical and dental records;
In case the appeal is denied, Cigna will send the Plan
member a written notice that includes all specific reasons for
the denial.
Second-level appeal: external review
If the claim dispute remains open after the first-level appeal
and the value of the disputed claim is at least 500 USD, a
review by an external arbitrator may be requested within 60
days following receipt of the denial of the first-level appeal.
The ex ternal review will be performed by an independent
medical ee deigaed jil b Ciga Medical
consultant and the Pla ebe aedig hicia. The
decision made by this arbitrator shall be considered final and
shall be binding on both parties to the dispute.
Each party shall pay its own medical doctor. The cost of
arbitration and fees payable to the medical arbitrator shall be
borne half by the plan member and half by the plan except
where the arbitrator settles the dispute in favour of the Plan
member, in which case the fees will be payable solely by the
plan.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.10/25
2. Summary of benefits
For elements that are not listed below, we kindly refer you to the UN MIP List of reimbursable and
non-reimbursable items.
2.1. In the hospital
GENERA L RUL E
Insurance coverage is valid within the country of your duty station. While you may
decide to seek medical care outside the country of your duty station, reimbursement
will be limited to the reasonable and customary expenses level applicable to the country
of your duty station.
You are cove red for a ll genera lly a ccepted medical and surgical proce dure s ( up to the
limits of reasonable and customary expenses), including the latest medical
technologies.
The UN MIP offers a free choice of physician and care provider. You are therefore
entitled to be treated by the physician of your choice and in the medical facility of your
choice.
Item
Remarks
Prior approval from Cignas Medical consultant is required for all non-emergency
hospitalisations. Notification of such hospitalisations should be given at least 1 week
prior to the admission date.
Bed and board
Private room: 70% of the rate for a private
room rate OR 100% of the rate for a semi-
private room (whichever is higher)
Semi-private room: 100%
General ward: 100%
ICU: 100%
Dc fee during a hospitalisation (i.e.
including an overnight stay)
100%
Outpatient consultations in hospital
80%
Other hospital expenses
100%
Emergencies
100%
Extra bed for accompanying adult for
enrolled children under 13
80%
Personal expenses
Not covered
Home for the elderly/nursing home
Not covered
Spa cures
Not covered
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UN Med ic al Ins ur anc e Plan p.11/25
Item
Remarks
Drug and alcohol abuse
Inpatient: see Hospitalisation
Maximum 90 days per person per calendar year,
provided it is carried out at facility certified for
detoxification and rehab.
Outpatient:
80% up to limit for psychotherapy, which is equal to
1 month MIP Reference Salary per calendar year
(per patient).
Outpatient surgery
Dc fee: 100%
Other hospital expenses: 100%
Outpatient chemotherapy, radiotherapy,
100%
Outpatient haemodialysis
80%
Second surgical opinion
80%
2.2. Ambulance and transportation expenses
GENERA L RUL E
All treatments and medicines must be prescribed by a qualified and registered medical
doctor.
Item
Remarks
General transportation costs
Not covered
Ambulance - ground
80%
Transportation from the place where you fell ill or
got injured by an accident to the nearest hospital.
Ambulance air
Not covered
For provisions for medical evacuations, see the
administrative instructions ST/AI/2000/10 and the
information circular ST/IC/2000/ 70 on medical
evacuation.
Evacuation
Not covered
- For provisions for medical evacuations, see
adiiaie ici ST/AI/2000/10 ad
he ifai cica ST/IC/2000/70
medical evacuation:
- Active staff: via HR in duty station
- Retired staff: not foreseen
Repatriation of deceased person
Not covered
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UN Med ic al Ins ur anc e Plan p.12/25
2.3. At the General Practitioners
GENERA L RUL E
All treatments and medicines must be prescribed by a qualified and registered medical
doctor.
Item
Remarks
Consultation
80%
Annual subscription fees
Not covered
Routine examinations for children until 19
years old
Well-child care
100%
New-born: 1 routine examination at birth, in
the hospital
0- 1 year old: 6 routine visits per year
1-2 years old: 2 routine visits per year
3-19 years old: 1 routine visit per year
Routine physical examinations for adults
For children up to 19 years old: see Well-child care
For adults from 20 years old: 80% with a maximum of
1 exam per person per calendar year:
Blood analysis:
o Haematology;
o Sedimentation rate;
o Blood sugar;
o Creatinine, urea;
o SGPT, SGOT, Gamma GT,
bilirubin;
o Cholesterol Tot al, LDL, HDL,
triglyceride.
Urine analysis:
o Microscopic evaluation;
o Glucose;
o Albumin.
o Stool/faecal analysis: occult blood.
o Hepatitis B: once a year from 21
years old.
Chest x-rays:
o Once every two years.
o Once every year if a smoker or 45
years of age or older
Static and exercise electro cardiogram (ECG):
o Once every two years;
o Once every year if 45 years of age or
older.
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UN Med ic al Ins ur anc e Plan p.13/25
Item
Remarks
Colonoscopy:
o Women between the ages of 50 and
75: once every 5 to 10 years;
o Men between the ages of 45 and 75:
once every 5 to 10 years.
For women:
o Pap smear: once a year;
o Mammography: once a year if 40
years of age or older;
o Bone Mineral Density (BMD) test:
once a year if 60 years of age or
older.
For men:
o Urological examination: once every 2
years if 55 years of age or older;
o Prostate specific antigen (PSA): once
a year if 50 years of age or older;
o Abdominal ultrasound for aortic
aneurysm: once a year if 60 years of
age or older.
HIV test & counselling
100%
2 voluntary blood tests per year without prescription
Vaccinations/preventive
medication/immunisations
For adults: 100% for immunisations for adults that are
recommended by the local health authorities and/or
the World Health Organization
Immunisations for official duty travel (DT) should be
claimed under the funding source covering your travel
expenses and not claimed under the MIP.
For children (well-child care): the MIP covers
immunisations as determined by the local health
authorities and/or the World Health Organization.
Seasonal flu vaccination
100%
2.4. At the specialists
GENERA L RUL E
All treatments and medicines must be prescribed by a qualified and registered medical
doctor.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
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UN Med ic al Ins ur anc e Plan p.14/25
Item
Remarks
Consultation
80%
Routine examination for women (children
smear, mammography, gynaecology)
80%
1 PAP smear and 1 mammography per calendar year
Routine urological examination for men
(PSA-test)
80%
1 PSA-test per calendar year
2.5. At the licensed qualified health care providers (other than
doctor)
GENERA L RUL E
A doctors prescription is required for care given by a person holding a paramedical
degree (e.g. nurse, physiotherapist).
Renewal of the prescription is required for treatments taking longer than 3 months, unless
indicated otherwise in the remarks.
Item
Remarks
Psychiatrist - psychotherapy
80% up to he eiae f e h MIP
Reference Salary per calendar year (per patient)
Physiotherapy
80%, only if the treatment aims at improving or
restoring bodily functions
Not covered in case the treatment is provided
preventively
If the duration of the treatment exceeds 6 months,
the attending physician must reassess the treatment
and issue a new prescription.
Treatments requiring more than 60 sessions per
calendar year are subject to i aa b Ciga
Medical consultant.
Osteopathic treatment
80%, only if the treatment aims at improving or
restoring bodily functions
Not covered in case the treatment is provided
preventively
Chiropractic treatment
80%, only in case of treatment of chronic pain
syndrome AND provided that:
- the treatment is recognised as valid by the
competent health authorities of the country, AND
- the treatment is provided by a qualified medical
doctor or a licensed chiropractor
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
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UN Med ic al Ins ur anc e Plan p.15/25
Item
Remarks
Acupuncture
80%, only if:
- the treatment is recognised as valid by the
competent health authorities of the country, AND
- the treatment is provided by a qualified medical
doctor or a licensed chiropractor
Private home duty nurse
80%, only if these are medical acts (wound dressing,
injections, etc.) and if they are provided by a qualified
nurse
Home health care
80%, only if prescribed as medically necessary and as
an alternative to either hospitalisation or a stay in a
skilled nursing facility
Alternative medicine
- In general: not covered but there are exceptions:
- Chinese medicine is accepted for staff members
assigned to a duty station located in China.
- Ayurveda is accepted for staff members assigned
to a duty station located in India provided the
treatment is given in India.
- Some treatments are covered at 80% (see List of
reimbursable and non-reimbursable items), under
the following conditions:
the patient suffers from a medical condition
that requires treatment, AND
the treatment is recognised as valid by the
competent health authorities of the country,
AND
the treatment is given by a qualified medical
doctor.
Speech therapy
80%, only if the treatment aims at improving or
restoring speech functions
Not covered in case the treatment is given
preventively
Homeopathy
80%, under the following conditions:
the patient suffers from a medical condition
that requires treatment, AND
the treatment is recognised as valid by the
competent health authorities of the country,
AND
the treatment is provided by a qualified
medical doctor.
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UN Med ic al Ins ur anc e Plan p.16/25
2.6. At the opticians
GENERA L RUL E
See the General rule for care given at the general Practitioners (2.3.), unless indicated
otherwise in the remarks.
Item
Remarks
Eye test to determine dioptre by
ophthalmologist
80% up to 100 USD in a period of 12 months
Lenses
80% up to 75 USD/lens; maximum 2 lenses in a
period of 12 months (the date of the 1
st
purchase
determines the start of the 12-month period)
A waiting period of 12 months applies from the
enrolment into the MIP.
Frames
80% up to 50 USD per frame; maximum 1 frame in a
period of 24 months (the date of the 1
st
purchase
determines the start of the 24-month period)
A waiting period of 12 months applies from the
enrolment into the MIP.
Contact lenses
See Lenses
Fluid for contact lenses
Not covered
Disposable lenses
80% up to 150 USD per period of 12 months (the date
of the purchase of the first pair of lenses determines
the start of the 12-month period)
A waiting period of 12 months applies from the
enrolment into the MIP.
Prescription sunglasses with dioptre
See Lenses and Frames above
Lasik/keratotomy and other procedures to
change the dioptre
80% up to 150 USD per eye
Prior approval is required.
A waiting period of 12 months applies from the
enrolment into the MIP.
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UN Med ic al Ins ur anc e Plan p.17/25
2.7. At the dentists
GENERA L RUL E
All dental treatments, including dental surgery, are covered and reimbursed as Ordinary
dental care.
Item
Remarks
Ordinary dental care
80% up to 50% of the MIP Reference Salary per
person per calendar year
Major dental treatment (e.g. prosthesis,
bidge, ia)
80% bec he ii f Odia dea cae
Prior approval is required. Please provide us with the
following documents:
treatment plan;
OPG (panoramic x-ray of the mouth) taken
before the treatment.
An OPG taken after the treatment may also be
required..
Orthodontics (e.g. braces, dento-facial
orthodontics)
80% bec he ii f Ordinary dental care, only
if the treatment was started before the age of 15
Maximum treatment period: 4 years
Dental surgery
80% subject to the limit f Odia dea cae
Some oral surgery procedures are not subject to the
ceiling for dental care (see List of reimbursable and
non-reimbursable items)
Dental care after an accident
80% up to one time the MIP Reference Salary per
person per calendar year
2.8. At the pharmacists
GENERA L RUL E
All medicines must be prescribed by a qualified and registered medical doctor.
Item
Remarks
General
80%, only if the medicines are prescribed, medically
necessary and contain pharmaceutical components to
treat a specified diagnosis.
Medication for emergency care and for
use in hospital
100%
Contraceptive devices and medication
80%
Condoms are not reimbursable.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
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UN Med ic al Ins ur anc e Plan p.18/25
Item
Remarks
Vitamins
- Multivitamins: not covered
- Specific vitamins/minerals: not covered,
unless when the vitamin/mineral in question is
taken to cure an existing deficit.
Please send the results of the relevant
laboratory test so that our Medical consultant
can ascertain whether this is the case.
2.9. At the specialised suppliers office
GENERA L RUL E
The services listed below are normally reimbursable at 80% provided they are prescribed
by the attending physician as medically necessary.
Item
Remarks
Orthopaedic devices
80% for rental
(Purchase is acceptable if it turns out to be cheaper
than rental or if the equipment cannot be rented.)
Hearing aids
80% up to 300 USD per apparatus, including the
related examinations and batteries
Maximum of 1 apparatus per period of 36 months
Batteries for hearing aids
See Hearing aids
Adaptation to the aie
accommodation (shower, elevator,
lavatory, etc.)
Not covered
Orthopaedic shoes/insoles
80%
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UN Med ic al Ins ur anc e Plan p.19/25
2.10. In the laboratory/medical imaging facility
GENERA L RUL E
In general, tests and medical imaging are done on an outpatient basis. Test and imaging
carried out during a hospitalisation are covered at 100% (see Hospitalisation).
Item
Remarks
Diagnostic medical imaging
Outpatient: 80%
Inpatient: 100%
MRI, PET scan, CT scan
Outpatient: 80 %
Inpatient: 100 %
Prior approval is required.
Lab tests
Outpatient: 80%
Inpatient: 100%
2.11. Pregnancy and childbirth
GENERA L RUL E
Outpatient care given during pregnancy and at childbirth is reimbursable at 80%.
Inpatient care given during pregnancy and at childbirth is reimbursable at 100%.
Item
Remarks
Delivery in hospital
See Hospitalisation
Outpatient delivery
See Outpatient surgery
Home delivery
80%
Visits by a licensed midwife
80%
Pre- and postnatal exercises
80%
Sterilisation
see Outpatient surgery
Reversal of sterilisation
Not covered
Hormonal treatment to stimulate fertility
80%, only if meant to stimulate natural fertility
IVF (in-vitro fertilisation)
Not covered
ICSI (intra-cellular sperm injection)
Not covered
AI (artificial insemination)
Not covered
MESA (microchirurgical epididymal
sperm-aspiration)
Not covered
TESE (testicular s perm -extraction)
Not covered
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.20/25
Item
Remarks
Cryopreservation
Not covered
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.21/25
3. Special situations
3.1. Countries with inadequate medical facilities
For each country with inadequate medical facilities, the UN MIP has established a regional area
of care, i.e. a specific neighbouring country or region designated by the UN, where staff members
can seek medical treatment without requesting approval for a medical evacuation. Medical
expenses incurred in such areas will be reimbursed up to the limits of reasonable and customary
expenses of the country where the treatment or service is provided.
For medical evacuations, the current procedures remain in place.
Duty station
Regional area of care
Afghanistan
Pakistan and India
Bhutan
India
Burundi
Rwanda, Uganda and Kenya (only when services
are not available in Uganda)
Cambodia
Thailand
Expenses incurred at the Bumrungrad Hospital will
be strictly reimbursed on the basis of reasonable
and customary limits applicable in Thailand. Please
note that MIP participants will be responsible for all
charges exceeding the reasonable and customary
limits applicable in Thailand.
Central African Republic
Cameroon
Comoros
Mayotte, Réunion and Mauritius
Democratic Republic of Congo
Burundi, Rwanda and Uganda (for staff members
and their family members located near the Eastern
borders of Congo)
East Timor
Australia (Darwin)
Eritrea
Sudan, Egypt (only when services are not available
in Sudan)
Guinea Bissau
Senegal
Haiti
Dominican Republic
Iraq
Jordan and Lebanon
Kosovo
Albania, Bosnia, Croatia, Macedonia, Montenegro,
Serbia, Slovenia
Laos
Thailand
Expenses incurred at the Bumrungrad Hospital will
be strictly reimbursed on the basis of reasonable
and customary limits applicable in Thailand. Please
note that MIP participants will be responsible for all
charges exceeding the reasonable and customary
limits applicable in Thailand.
Lesotho
South Africa
Liberia
Ghana
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.22/25
Libya
Tunisia (for staff wit h duty s tation Libya but
physically located in Tunisia, it is also Tunisia)
Mali
Senegal
Myanmar
Thailand
Expenses incurred at the Bumrungrad Hospital will
be strictly reimbursed on the basis of reasonable
and customary limits applicable in Thailand. Please
note that MIP participants will be responsible for all
charges exceeding the reasonable and customary
limits applicable in Thailand.
Sierra Leone
Ghana
Serbia
Macedonia, Montenegro, Bosnia, Serbia, Slovenia,
Albania, Croatia
(for staff with duty station Serbia but physically
located in Kosovo)
Somalia
Kenya
South Sudan
Uganda, Kenya and Sudan
Sentence removed
Sudan
Egypt
Swaziland
South Africa
Syria
Lebanon and Jordan (only when services not
available in Lebanon)
Tanz ania (Arus ha only)
Kenya (Nairobi)
Turkmenist an
India
Zimbabwe
South Africa
This list will be reviewed on a yearly basis.
3.2. Official Duty Travel (DT)
Expenses for emergency treatment will be reimbursed according to the pattern of charges for
professional and other health services prevailing in the country where the expenses are incurred.
Expenses for non-emergency treatments will be reimbursed according to the pattern prevailing in
he c f he aff ebe d ai. DT is not available for retirees/ASHI participants.
3.3. Medical Evacuation Travel (MET)
Expenses will be reimbursed according to the pattern of charges for professional and other health
services prevailing in the country where MET is authorised. The medical expenses incurred during
MET will be reimbursed according to the conditions set out by the plan for the type of care that has
been approved. MET is not available for retirees/ASHI participants.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.23/25
In case you chose to be evacuated to another country than the country that is authorised, the
expenses will be reimbursed according to the pattern of charges prevailing in t he country where
MET is authorised.
3.4. Stop Loss Clause and Out-of-pocket maximum
O-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 defined below, the MIP will start reimbursing an additional 80% of the out-of-pocket expenses.
This is what is called the cae.
The stop loss limits are:
- Active staff: 50% of he aff ebe monthly net base salary (i.e. gross salary minus staff
assessment)
- Retired staff: 50% of the remuneration used for the calculation of he eied aff ebe
contribution (i.e. 25% of the monthly net base salary at the date of separation adjusted by t he
global cost-of-living increases declared by the UNJSPF)
The s t op los s c lause will not apply until the total amount of non-reimbursed medical and hospital
expenses incurred by the MIP participant and enrolled family members (for reasonable and
customary care) have exceeded the stop loss limits mentioned above in a single calendar year.
The following items do not count towards the out -of-pocket maximum:
non-reimbursed portion of dental care, outpatient mental and nervous care, eyeglasses and
hearing aids;
non-recognised medical and hospital expenses (for example, the difference between semi-
private and private accommodation in the hospital does not count towards the out-of-pocket
maximum).
3.5. Hardship provision
The max imum amount of reimbursement of medical expenses per individual person (not per family)
in a single calendar year is established at 6 times the MIP Reference Salary.
The MIP Reference Salary is updated on a yearly basis.
MIP participants are expected to meet these expenses after this limit has been reached.
In the event of major medical expenses, MIP participants may be faced with expenses that
considerably exceed the normal limits payable under the MIP, so much so that they may experienc e
undue financial hardship. Under such very exceptional circumstances, amounts in excess of the
regular limit of 6 times the MIP Reference Salary may be reimbursed.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.24/25
Such cases will be examined together by Cigna and UN Insurance and Disbursement Service.
Please note that such cases will not be considered as hardship until the total amount of non-
reimbursed medical and hospital expenses incurred by the MIP participant and enrolled family
members (for reasonable and customary care) have exceeded the stop loss limits mentioned under
3.4.
4. Exclusions
The c overage shall, amongst other items, not extend to:
- Insured participants who are mobilised or who volunteer for military service in time of war;
- Injuries resulting from motor-ve hi c le ra c i ng or dangerous c om pe t i t ions in res pec t of whi c h bet ti ng
is allowed (normal sports competitions are covered);
- The consequences of insurrec tions or riot s if, by taking part, the plan member has broken the
applicable laws; and the consequences of brawls, except in cases of self-defence;
- Spa cures, rejuvenation cures or cosmetic treatment (reconstructive surgery is covered where it
is necessary as a result of an accident for which coverage is provided);
- The direc t or indirec t res ults of explosions , heat release or irradiation produc ed by trans mutation
of the atomic nucleus or by radioactivity or resulting from radiation produced by the artificial
acceleration of nuclear particles;
- Expenses for, or in connection with, travel or transportation, whether by ambulance or otherwise,
except that charges for professional ambulance service used to transport the insured participant
between the place where he or she is injured by an accident or stricken by disease and the first
hospital where treatment is given will not be excluded;
- Expenses that are not deemed to be reasonable and customary. The determination of the
reasonable and customary charge for each service is made by Cigna, based on the prevailing
charges for the service at the place where treatment is rendered and considering the complexity
of the treatment, including related services or supplies. Fees for treatments, supplies or services
that are determined by Cigna to be excessive compared with prevailing fee levels will be
reimbursed up to the reasonable and customary level for the geographical area in which such
medical services are received;
- Medical care that is not medically necessary or medical care that is not medically recognized as
a treatment for the diagnosis provided;
- Products, the effectiveness of which has not been sufficiently proved scientifically and which are
not generally medically recognized in the medical world, are not covered under the health plan.
One example of this exclusion is products containing glucosamine or chondroitin sulphate;
- Elective surgery that is not resulting from an accident, illness or maternity;
- Alternative medicine; see 2.5 for detailed information.
- Food and dietary products;
- Fertility/infertility treatment.
Ple as e n o t e that t he ins u r a n c e c o n t r ac t is t he o n ly a ut hentic tex t .
Cigna July 2018
UN Med ic al Ins ur anc e Plan p.25/25
This is a non-limitative list. In case the treatment you are considering is not listed here nor in the
List of reimbursable and non-reimbursable items, we advise you to contact us to request prior
approval.
5. Access to forms
On your personal webpages you can download the claim form and the cost estimate form. You can
access your personal webpages as follows:
- Go to www.cigna healthbenefits.com and click Pa ember
- Fill in your personal reference number and password. You can find your personal reference
number on your membership card (414/xxxxx).
