Home
Forms Library
Health Insurance Application Form - the United Nations

Health Insurance Application Form - the United Nations 2026

Health Insurance Application Form - the United Nations Preview on Page 1

See details

4.3 out of 5

49 votes

The document is a Medicare Part B Annual Premium Reimbursement Request form for ASHI participants, detailing the necessary information required for reimbursement claims, including personal details, proof of payment, and banking information for electronic fund transfers. It emphasizes the need for valid documentation and signatures to process the claim.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Health Insurance Application Form - the United Nations with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Health Insurance Application Form in the editor.
In Section 1, clearly print your full name, index number, mailing address, retiree number, personal email address, and telephone number. Ensure all information is accurate for processing.
Move to Section 2 to claim Part B premiums. Fill in your name, relationship to the participant, Medicare ID, coverage period (from and to), and the monthly premium paid. Remember to attach proof of payment.
If this is your first reimbursement claim, complete Section 3 with your bank information for EFT payment. Indicate if your banking details have changed and provide necessary details including bank name and account number.
Finally, sign and date the form at the bottom to confirm your understanding of ongoing Medicare payments.

Start using our platform today for free to streamline your Health Insurance Application process!

See more Health Insurance Application Form - the United Nations versions

We've got more versions of the Health Insurance Application Form - the United Nations form. Select the right Health Insurance Application Form - the United Nations version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.7 Satisfied (27 Votes)
2018	4.3 Satisfied (49 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is eligible for the UN Ashi?

[ ] Who qualifies for participation: In order to be eligible for after-service health insurance (ASHI), you must be a UN staff member who is at least 55 years of age, who is enrolled in a UN health insurance plan at the time of retirement, who has at least 5 (if employed before 1 July 1007 or 10 years (if employed

Who is eligible for the UN pension?

Eligibility. A UN pension is payable to a participant whose age on separation is the normal retirement age or more and whose contributory service was five years or longer.

How much is international health insurance per month?

To give you an idea of the range of costs, here are some examples of international health insurance plans and their approximate monthly premiums for a 35-year-old individual: Basic coverage plan with a $500 deductible: $150-$200/month. Comprehensive coverage plan with a $1,000 deductible: $250-$350/month.

What is the United Nations Agency for health?

World Health Organization (WHO)

Who is eligible for the United Nations membership?

The International Court of Justice (ICJ) ruled in 1948 that the finding that an applicant is a peace-loving state capable of carrying out the Charters obligations is the only permissible criterion for consideration, and that political interests should not have an effect on UN membership decisions.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Related forms

be ready to get more