Health insurance

(1)     At the 12th session (April 1952: CO-ORDINATION/R.124) CCAQ, having been consulted by TAB, recommended that medical and hospitalization expenses of fellows and scholars should be covered to the extent of $ 1,000 through compulsory insurance under a joint policy; WHO undertook to work out a scheme.

(2)     At the 13th session (September 1952: CO-ORDINATION/R.132, para. 56), after considering the information compiled by UN on the health insurance plans available to staff of the various organizations, the Committee urged the desirability of a single plan to cover staff of organizations established in the same place.

(3)     At the 14th session (April 1953: CO-ORDINATION/R.142, paras. 68-76) the Committee reviewed progress made towards bringing all staff at a particular duty station under the same health insurance scheme. It agreed to make the information available to the Pension Board which, at its third session, had adopted a resolution on standardization of provisions for sick leave and health insurance.

(4)     Also at the 14th session (April 1953: CO-ORDINATION/R.142, paras. 100-107) the Committee agreed, as regards health insurance for fellows and experts, that:

  1. the provision of health insurance for fellows was not intended to cover death and disability. The enquiries by WHO concerning global coverage not having resulted in satisfactory offers from insurance companies, the Committee decided to recommend to TAB that in this case the risk be self-insured through the Special Account. If this proposal were agreed by TAB, it would be necessary to assure common standards of benefits. The Committee believed that the limitations set forth in paragraph 103 of the report might suitably apply, with the exception perhaps of the $ 20 limitation;

  2. the assumption of responsibility for health insurance for experts by participating organizations should not lead to the abandonment of existing satisfactory arrangements for recipient government responsibility. The Committee recommended that TAB should obtain a blanket insurance policy on a contributory basis covering all experts for reasonable medical bills. In the meantime, agencies should undertake to meet new costs, either through self-insurance or through commercial policies of their own. To avoid too great variations in the details of the coverage provided by agencies due to the absence of a common insurance plan, the Committee thought it useful for the organizations to note the conditions and limitations for reimbursement which UN applied in the case of its experts and which were stated in detail in para. 103 of CO-ORDINATION/R.142.

(5)     At the first part of the 21st session (April 1960: CO-ORDINATION/R.325, paras. 70-71) the Committee examined a compendium of health insurance plans in the various organizations. It expressed continued interest in the objective of an overall plan to cover all staff, and WHO, which had adopted such a plan for its own staff, undertook to report on the question by 1963. Each organization which amended its own scheme would send the amendments to WHO.

(6)     At the 23rd session (March 1962: CO-ORDINATION/R.391, paras. 83-85) CCAQ agreed that organizations should arrange for health insurance, on a shared-cost basis, for dependants accompanying experts at field locations.

(7)     The Committee heard an interim report from WHO on its experience with its world-wide health insurance scheme. It agreed that any organization might develop a similar scheme, but should not make major departures from the WHO plan, so as not to prejudice the possibility of an eventual common scheme.

(8)     At its 24th session (March 1963: CO-ORDINATION/R.430, para. 57) CCAQ reiterated the desirability of extending to dependants both adequate medical insurance coverage on a shared-cost basis and an entitlement to paid travel out of an area for emergency medical reasons. Such provisions should obtain generally and are not to be linked to any restricted list of areas.

(9)     In October 1965 a CCAQ Working Party discussed the problem of health insurance for conference languages staff (see CO-ORDINATION/CC/SO/136). Organizations which made no provision for such insurance agreed that they would give sympathetic consideration to the question of providing some form of protection for conference staff who were not covered, or were insufficiently covered, by other arrangements, against the risk of heavy expenses arising out of a serious illness or operation or injury occurring during periods of employment. The 27th session of CCAQ (March 1966: CO-ORDINATION/R.532, para. 69) agreed that caution would be needed in applying this undertaking; organizations could not, for example, accept liability for expenses attributable to pre-existing conditions.

(10)     In 1969 CCAQ requested its secretariat to make a comparative study of health insurance plans of organizations. Pressure of other work delayed the work, but a draft was circulated in 1972. A similar study was given to the Special Committee for the Salary Review in 1971 (A/AC.150/CRP.78). At a special session in July 1972, dealing mainly with Special Committee matters, CCAQ agreed (CO-ORDINATION/R.947, paras. 13-15) that the development of a single world-wide inter-organization scheme was not practicable, but that agreed guidelines might be formulated on certain points if time permitted.

(11)     At its 50th session (Part II) (February-March 1979: ACC/1979/R.2 (Part II), para. 19) CCAQ endorsed the intention of its Working Party on Compensation for Service-Incurred Injury, Illness or Death to prepare, through a sub-group established for the purpose, a common response to the Joint Inspection Unit's Note on the Health Insurance Schemes in the United Nations System (JIU/NOTE/77/2).

(12)     At its 55th session (March 1983: ACC/1983/9, paras. 51-52) CCAQ agreed on the position it would take when ICSC considered a request of the General Assembly that it "examine the need for raising the ratio of contributions by organizations of the United Nations common system for health insurance of staff members and the question of applying appropriate retroactivity" (Resolution 37/126, 37th session of the General Assembly, 1982). CCAQ agreed to indicate that it did not believe it was desirable to try to force a common standard on all organizations. At its 17th session (March 1983) ICSC reviewed the question and agreed that, taking into account the divergent views expressed, it could make no progress in the matter (ICSC/17/R.28, paras. 138-147).

(13)     At its 59th session (July 1983: ACC/1983/18, paras. 45-50) CCAQ was informed, at the same time as ICSC, that UN would be making proposals to the General Assembly to modify the ratio of contributions to the health insurance schemes of the UN from the current 50/50 to an arrangement whereby the organization would contribute two-thirds towards the cost of health insurance and the staff members one-third. CCAQ confirmed its decision of the previous session that this matter was not a suitable one for treatment on a common system basis.

(14)     At its 18th session (July 1983) ICSC decided to investigate another possible cost-sharing formula based on applying a ceiling of staff contributions corresponding to the average of the staff contributions to health insurance expressed as a proportion of net remuneration and weighted by the number of staff members at the seven headquarters duty stations. Such an alternative formula would be applied from 1 January 1984 wherever appropriate, after action by legislative bodies (9th annual report, A/38/30, paras. 99-107).

(15)     As a result of resolution 38/235 adopted by the General Assembly at its 38th (1983) session, CCAQ agreed at its 60th session (March 1984: ACC/1984/9, paras. 88-91) to oppose basing a possible common health care scheme on that of the comparator country, such schemes having to respond to each organization's needs and to circumstances in various duty stations. It would also not be appropriate to attempt to arrive at a fixed formula for the determination of a maximum rate of share to be borne by the organizations and the staff.

(16)     At its 62nd session (March 1985: ACC/1985/6, paras. 68-74), CCAQ agreed to inform the Commission that in practically all organizations, participation in a health insurance scheme was mandatory. (By resolution 38/235, the General Assembly had requested the Commission to study the question of mandatory participation.) The Committee considered that contributions to a mutual insurance scheme should be paid without a ceiling.

(17)     At its 63rd session (July 1985: ACC/1985/14, paras. 54-57), CCAQ agreed that it would be desirable to attempt to harmonize the eligibility criteria for after-service health insurance coverage. UN informed the Committee that studies had been initiated with a view to providing after-service coverage to those who were covered in active service by the non-contributory scheme in appendix E of the UN Staff Rules and who had no after-service coverage. The Committee also expressed the view that the definition of "mandatory" participation in health insurance needed further study.

(18)     At its 66th session (March 1987: ACC/1987/4, para. 46) CCAQ concluded that the definition of the term "mandatory" was a matter for each organization to determine.

(19)     At its 70th session (March 1989) the attention of CCAQ(FB) was drawn to the cost of organizations' contributions to health insurance schemes for staff members, which were escalating fast and could be expected to continue to do so. It agreed that the evolution of such costs would call for continuing scrutiny by financial management, and asked its secretariat to collect relevant data (ACC/1989/7, para. 49).

(20)     At its 71st, 72nd and 73rd sessions (September 1989 and March and September 1990) CCAQ(FB) provisionally reviewed data collected from the organizations, and at its 74th session (March 1991) it expressed satisfaction with the format finally agreed for the tables. In its view the information could be of use to financial managers as well as those responsible for administering health insurance schemes. It agreed that the tables should be periodically updated so that the evolution of costs might be followed (ACC/1991/6, paras. 59, 60; see also ACC/1989/15, paras. 56, 57; ACC/1990/5, paras. 37-40; ACC/1990/12, paras. 39-41).

(21)     At its 78th session (March 1993: ACC/1993/6, paras. 80-82) CCAQ noted documents before ICSC and CCAQ(FB) and decided that before any productive review of the cost-sharing arrangements for health insurance, it would be necessary to examine the impact of health insurance premia on the calculation of the post adjustment, an analysis of the benefits which pertain to different health insurance schemes, along with the costs of individual plans, the impact of local requirements on individual plans and the different populations in the coverage. ICSC decided not to take any action at the time but to review the question later as a non-priority issue (ICSC/37/R.18, para. 190).

(22)     At its 80th session (February 1994: ACC/1994/4, paras. 112-113) CCAQ gave preliminary consideration to a proposal for obtaining a global common system voluntary group insurance for long-term care, at the request of UNIDO, FAFICS and AFICS(NY). Recognizing that the issue was one that would gain in importance over time, CCAQ requested its secretariat to pursue the matter. At its 81st session (June 1994: ACC/1994/14, paras. 165-167) CCAQ considered a follow-up which did not involve a cost to the organizations and agreed that the issue should be pursued with some urgency. AFICS(NY) continued to support the introduction of a compulsory system and emphasized that the need for long-term care had arisen due to changes in the medical environment.

(23)     At its 80th session (February-March 1994), CCAQ(FB) reviewed the information contained in its biennial report on the cost of health insurance, and decided to complement the existing tables with information on after-service health insurance, cost-containment measures and services responsible for health insurance (ACC/1994/5, para. 33).

(24)     At its 81st session (August-September 1994), CCAQ(FB) examined the regular biennial report on the cost of health insurance and concluded that information on after-service health insurance and cost-containment measures could usefully form part of the standard package in the future. Noting the uneven quality of information provided, it requested its secretariat to make proposals for improvements in the tables at its first session in 1996 (ACC/1994/15, para. 33).

(23)     At its 82nd session (April 1995: ACC/1995/5, paras. 142-147) CCAQ considered the extent to which organizations had a responsibility towards insuring against long-term care costs, through arrangements which would supplement current health care schemes. As international employers bore a special responsibility to their expatriate staff, who were normally ineligible for social protection schemes provided by their home country and might also be deprived of the safety net of close kin, it was important to pursue the matter in depth and with urgency. The Committee endorsed a proposal to set up a small inter-sessional task force, which would include health insurance and actuarial specialists.

(24)     At its 83rd session (August-September 1995), CCAQ(FB) was apprised of a decision by CCAQ(PER) to establish a small task force to look into the extent to which organizations have a responsibility towards ensuring against long-term costs. While generally supporting the idea of such a study, CCAQ(FB) believed that the costs of such care could not be financed from Organizations' budgets which were being substantially cut back in many cases (ACC/1885/20, paras. 47-49).

(25)     At its 85th session (July 1996: ACC/1996/14, paras. 63-70) CCAQ examined a review of matters relating to the introduction of affordable long-term care insurance for UN common system staff, retirees and their dependents as well as the findings of a small inter-sessional task force. A report prepared by a UK-based firm of underwriters provided insight into the possibility of using a commercial company to insure all or part of long-term care costs. The task force, in addition to making suggestions as to eligibility and procedures, noted that such schemes were more effective if they were compulsory and had concluded that a viable alternative would be for the Pension Fund to collect contributions into a separate long-term care fund on which the health insurance administrations or some separate body would draw to meet costs of actual cases. Such procedures would not involve a direct contribution to the scheme by Member States, rather each organization would bear the costs of the overhead in administering claims. CCAQ considered that a compulsory scheme should be further explored but some organizations felt that would require financial support from Member States and attention should be given to the option of a voluntary scheme. Various issues were identified for further study and review by CCAQ in 1997.

(26)     At its 87th session (July 1997: ACC/1997/13, paras. 21 & 57-64) CCAQ decided to move forward with the development of a long-term care insurance scheme, starting with a commercially-based scheme and leaving open the option of later becoming self-insured. The inclusion of a small compulsory element would help to keep the premiums at a reasonable level and ensure the scheme's viability. The Committee was concerned at the way the costs of the compulsory element would be met, perhaps by linking them to the costs of health insurance, especially in those organizations where health insurance in an organization's health insurance scheme was mandatory. The secretariat was requested to pursue the question with the insurance company that had developed the proposal based on an element of mandatory coverage.

(27)     At its third high level meeting (February 1998: ACC/1998/CCAQ-HL/9, para. 16) CCAQ-HL noted that CCAQ(FB) would be pursuing the accounting for and funding of after-service medical benefits.

(28)     At its 88th session (April 1998: ACC/1998/5, paras. 22-23) CCAQ received a briefing on a submission drawn up to introduce long-term care insurance across the common system and agreed to consult with senior management, legal counsels and staff representatives at the headquarters' levels to review the contents and questions raised, on the basis of the recommendations put forward, and to provide the secretariat with an analysis of the process and time-frame required for consideration of the scheme in each organization.

(29)     At its 89th session (July 1998: ACC/1998/9, paras. 36-37) CCAQ was provided with information on the status of the consultation process on the proposal to introduce long-term care insurance in the common system and noted that the process would require more time for completion. It requested its secretariat to help resolve concerns raised regarding the mandatory nature of the scheme, cost-sharing and other aspects of the proposal.

(30)     At its 89th session (February 1999: ACC/1999/6, para. 53) CCAQ(FB) considered two documents that comprise its biennial report on health insurance, one giving the major trends and current position and the other a more detailed reference document for the use of insurance units. Participants agreed that these were useful resource documents but that the Committee should review the matter again, including the content and frequency of the report, before the due date of the next report. The United Nations raised the issue of varying practices with respect to the basis on which the contributions of retirees to the cost of After-Service Health Insurance (ASHI) were assessed and suggested that the Committee discuss this issue further at the next session.

(31)     At its 90th session (April 1999: ACC/1999/5, paras. 29-30)) CCAQ was informed of a number of developments in respect of the introduction of long-term care insurance in organizations, including a change in the nomenclature from what had formally been called "mandatory" and "voluntary" elements which had been renamed "core" and "additional" premium arrangements. Meetings had taken place between the insurers and those organizations which had expressed willingness to move forward with the introduction of the insurance. As a result UPU, IAEA and UNIDO had expressed their intention to introduce long-term care insurance with effect from 1 July 1999 on the basis of the scheme developed by the insurers as part of their health insurance arrangements. The ITU was actively reviewing entering the scheme as of the same date subject to further discussions in the context of its health insurance scheme jointly shared with ILO. The Inter-American Development Bank and the World Tourism Organization would probably also introduce the scheme. Following consultations with staff, the United Nations, UNDP and UNICEF had concluded that while a UN group long-term care insurance plan would be an important benefit for staff and retirees, the proposed plan did not meet all the needs of UN staff and retirees. Interest in the scheme had also been expressed by the Coordinated Organizations and CERN.

(32)     CCAQ after reviewing this information reaffirmed the importance of long-term care insurance arrangements and noted that organizations which were proposing to move forward in July 1999 were accommodating long-term care insurance under their current health insurance schemes, including the cost-sharing provisions of those schemes. Being aware that there remained some concern for the level of the premiums which would apply to retirees CCAQ requested those individual organizations pursuing the consultative process as agreed at its 89th session to make maximum benefit of the work already undertaken by the insurers ensuring at the same time that the integrity of their detailed proposals was respected.

(33)     At its 90th session (August-September 1999: ACC/1999/14, paras. 23-24) CCAQ(FB) was briefed by the United Nations on the recommendations by the ACABQ that the long term implications and impact of the growth to the cost of ASHI benefits and the method of valuation of the liability relating to those benefits should be addressed on a system-wide basis, along with practical indications on how the United Nations Secretariat proposed to address the issue. Following an exchange of views on this matter, the Committee agreed to establish a working group and suggested that the United Nations should act as the lead agency. The United Nations indicated that it would not be possible to commence such a review until the end of the year 2000. The Committee agreed that it would reconsider this question at its next session.

(34)     At its 91st session (August-September 2000: ACC/2000/6, paras. 12-13), the Committee was informed that the United Nations, following up on the briefing at the last session on the long term implications and impact of the growth to the cost of ASHI benefits, had hired, in conjunction with the New York-based Funds and Programmes, a consulting actuary who would shortly begin to review the issue with a view to identifying possible options. Inputs from other organizations would be welcomed but it was suggested that this should take place after an initial report was presented to the Committee at its next session.

(35)     At its 5th high-level meeting (October 2000: ACC/2000/CCAQ-HL/6, para. 18) CCAQ-HL took note of the considerations and concerns contained in a note prepared by the secretariat on improving and harmonizing medical insurance coverage for locally recruited staff (ACC/2000/CCAQ-HL/5) and was informed of the measures being taken, or planned, to help alleviate hardships to staff insured under the Medical Insurance Plan (MIP), including the invocation of the exceptional hardship provisions in preference to an overall increase in the ceiling. In this context, the Committee was conscious of the need to ensure utmost confidentiality in such cases and hence to reduce access to information about such cases to the minimum. It noted the intention of some organizations to look into the possibility of purchasing medications in bulk for the treatment of staff members and their dependants living with HIV/AIDS.

(36)     The Committee decided, as a short-term measure, to invite organizations to: (a) review the insurance scheme reimbursement ceilings applicable to all staff of the organization to ensure that there were no discriminatory practices by virtue of the place where a staff member was located; (b) ensure the utmost confidentiality in the screening, approval and payment of health insurance claims along the lines suggested by the Interagency Advisory Group on Aids (IAAG); (c) ensure that such arrangements were included in coordinated programmes for the training of administrative staff and to institute such training programmes if they did not already exist; (d) review contractual practices in respect of staff hired on repeated short-term contracts especially with regards to the applicability of staff health provisions to those staff; and (e) take such other measures as were required to assist staff in respect of time lags for reimbursement of claims, staff members' contributions to insurance schemes and drawing up lists of approved care providers at the local level. The Committee decided further, in looking towards a longer term solution, to invite its secretariat to investigate the extent to which greater commonality in approach might be introduced into the provision of health insurance for the United Nations systems staff members and their dependants and report back thereon as soon as possible.

(37)     At its April 2002 meeting (CEB/2002/HLCM/8, paras. 22-23) the HR Network, further to a request of ACC at its spring 2000 session that proposals be presented "for improving and harmonizing medical insurance coverage for national staff within the United Nations system," examined a study aimed at assisting in developing an appropriate response to this request in order to provide input to HLCM for its consideration of the matter.

(38)     Specifically, the HR Network: (a) recalled that this item had been raised as a result of perceived discrimination linked to variations in insurance schemes and coverage for national staff within the UN system regarding expenses of national staff members in need of medical care for the treatment of HIV/AIDS; (b) noted that a number of agencies were taking steps to streamline contractual arrangements and insurance ceilings, which often were the source of the perceived discrimination; c) agreed that the paper was a good starting point and set the stage for discussion of the issue, especially in view of the fact that the question of health insurance had been the subject of many reviews and discussions since the creation of the UN and the specialized agencies; (d) considered that the establishment of a single world-wide Health Insurance Scheme (HIS) for all UN system staff was no longer a desirable or practicable objective as: (i) there were good reasons for the existence of several schemes, to accommodate different organizational needs and medical and legal environments; (ii) none the less, the existence of 19 schemes in the system, with significant differences between them regarding benefits, contributions and administration, was not desirable on grounds of equity and cost-effectiveness; and (iii) all schemes should therefore provide staff members and their dependants with a comparable level of protection, regardless of their category, level and duty station.

(39)     The HR Network noted that the HLCM had requested the budget and finance network to undertake an analysis of all the dimensions of the problems associated with funding after-service health care and noted further that (a) good health insurance coverage was a significant element of conditions of service in the recruitment and retention of a high quality workforce, (b) the increased cost of health insurance coverage was a world-wide phenomenon due to demographic evolutions (i.e. aging workforce) and scientific advances and (c) the increased costs of health care due to the impact of stress in certain workplace situations was now well documented and so to a certain extent should be viewed as a necessary cost of doing business.

(40)     The Network agreed that in order to reduce the perception of inequity and to achieve greater cost effectiveness, while at the same time not lowering the levels of benefits now available under the best schemes, it would be desirable to work towards greater commonality and improvements in the following areas: (a) funding arrangements, (b) level of contributions, (c) level of benefits, (d) reimbursement ceilings, (e) long term care, (f) availability and criteria for after service coverage, (g) arrangements upon transfer to another UN common system organization (and therefore insurer), (h) pooling resources for risk coverage (particularly for smaller organizations), and (i) pooling resources for the administration of claims. It agreed that, in the event that HLCM decided to pursue this work, the HR Network stood ready to provide advice and assistance on the terms of reference, including its objectives and parameters.

(41)     At its October 2002 session (CEB/2002/5, paras. 39-40) HLCM, seeking greater commonality of health insurance arrangements, considered that the provision of adequate health insurance coverage was a system-wide issue which had implications for a number of HR policies inter alia in respect of mobility. HLCM decided: (a) to invite the HR Network to make recommendations for those areas in which a more coherent approach might be feasible; (b) to consider and make recommendations to HLCM on long term care insurance provisions; and (c) to request organizations based in New York as a matter of urgency to review greater commonality in health insurance approaches, including the provisions of the MIP. The MIP applies to local staff members and retirees throughout the world and is administered by the United Nations, UNDP, UNICEF and UNHCR. The Van Breda Plan is a commercial scheme administered by Van Breda of Antwerp, Belgium, for staff and retirees away from Headquarters, New York. The policy holder is the UN. The Geneva Plan is an in-house health insurance programme for staff and retirees administered by the United Nations Office at Geneva (UNOG). The Aetna and Blue Cross medical insurance programmes and the Cigna dental programme are commercial plans intended primarily for staff and retirees based in the United States. The policy holder is the United Nations.

(42)     At its March 2003 meeting (CEB/2003/HLCM/12, paras. 17-18) the HR Network, recalling that it had concluded at its meeting in April 2002 that the establishment of a single worldwide health insurance scheme was neither desirable nor possible, noted that a working group of those organizations using the MIP was carrying out a comprehensive review of the MIP upon completion of its 15 years of operation and that some organizations were considering outsourcing its administration. It agreed that, once the findings of this working group were available, it would consider at its next meeting constituting an inter-agency task force to analyse the main discrepancies existing between the various schemes and propose strategies and practical measures which could be undertaken to achieve a more coherent approach and encouraged organizations in the meantime vigorously to pursue solutions at the field level on health insurance arrangements for their contingent work force. It also requested the CEB secretariat to obtain information from each organization on the level of coverage of long term care provided for under their current health insurance schemes and to report thereon to the next meeting.

(43) At its July 2003 meeting (CEB/2003/HLCM/20, paras. 16-18) the HR Network took note of an oral report on the progress of the MIP working group. Specifically, the Network noted that: (a) during the first six months of 2003 the existing reimbursement methodology had been modified to allow for a significantly higher level of reimbursement before reaching the maximum annual entitlement provided for under the plan; (b) in recognition of issues with respect to the manner in which the contribution of retirees under the MIP were assessed, the MIP Working Group had studied alternative approaches to bring the current methodology in line with the manner in which retirees' contributions were assessed under other United Nations plans and would soon recommend a solution. The Network agreed that the CEB secretariat should update and expand upon previous CCAQ/FB studies on health insurance arrangements to include issues reviewed by the MIP working group, provisions covering dental, mental health and long term care and organizations' health insurance for their contingent workforce.

(44)     At its 7th session (March 2004: CEB/2004/3, para. 48) HLCM agreed to a proposal by the FB Network for the creation of a joint FB/HR Working Group on the issue of long term care, as this was an important HR issue that might have financial implications.

(45)     At its July 2004 meeting (CEB/2004/HLCM/25, para. 22) the HR Network supported the proposal to create a joint FB/HR working group and agreed that the Network representation on the group should include senior level HR experts and that, ideally, there should be one HR representative from an organization that was insured by a private company and one from a self-insured organization.

(46)     At its September 2004 video-conference (CEB/2004/HLCM/28, paras. 6-7) the FB Network noted that HLCM, at its seventh session, had agreed to the proposal by the Network for the creation of a joint FB/HR Working Group on the issue of long term care and noted that organizations were asked to consult internally on who would represent them on a working group to be set up on this issue by the CEB secretariat.

(47)     At the same video-conference (ibid. Para. 8) the FB Network noted that the UN Secretariat would be releasing a paper in early January 2005 for consideration at the resumed session of the UN General Assembly, on After-Service Health Insurance (ASHI) liabilities, which would include an annex with information on each organization's policy and procedures with regard to the recognition and funding of its respective ASHI liabilities. The Network agreed that there was a need to establish a single definition from a social policy perspective of what was the desirable level of health care for UN system staff (both during and after service) so that benefits were sustainable over time from a financial perspective.

(48) At its fifth session (CEB/2006/HLCM/6, para.61), in response to the report on ASHI, the Chairman of the FB Network asked the United Nations for an update on after service health insurance.  The United Nations would provide this feedback through their website.
(49) At its eleventh session (CEB/2006/HLCM/12, paras.61-63), the HR Network requested that the CEB Secretariat facilitate a joint HR and FB Network working group on long-term care.

(50) During the HR Network’s videoconference in May 2006 (CEB/2006/HLCM/13, paras.7-8), it was noted that few health insurance plans provided for long term care, which was prohibitively expensive for retired employees.  The HR Director announced a renewed effort to develop a long term care plan.  The ILO would convene a working group with UNESCO and IAEA. 

(51) At its meeting in July 2006 (CEB/2006/HLCM/17, paras.45-47), the HR Network noted that the working group on long-term care had been established and was soon to commence its work.  The coordinating agency was ILO.  In addition to ILO, the UN, UNESCO, IAEA, UNFPA, FAO, and UNWTO agreed to participate in the working group.

(52) Since its meeting of March 2006, the HR Network had established two working groups on long-term care and appendix D. At its sixth session of August 2006 (CEB/2006/HLCM/34, paras.98-101), the FB Network acknowledged the enormous financial implications on these two subjects and agreed that it would be appropriate to consult the HR Network from the beginning of the working groups’ activity. The FB Network therefore agreed to consult internally with their respective HR Offices on this issue, and nominate a representative from Finance/Budget Offices in the established working groups.  

(53) With due consideration of the fact that organizations are in different positions with respect to the funding of their ASHI liabilities, including some that have a full funding of such liabilities, and that the issue of ASHI is of extreme importance for both its major financial implications, and its relevance as an entitlement of UN staff, HLCM recommended at its 13th session (CEB/2007/3, paras. 128-131) that a joint Working Group of the FB and the HR Networks be established to guide the discussion on the subject in a coordinated manner.

(54) At the same session, HLCM further recognizing the validity of the reasons that may have induced some member organizations to withdraw from the MAIP common programme, agreed that it would be desirable and in line with the current efforts towards increased harmonization and coherence, to establish a Working Group of interested organizations to discuss the possibility – should the presence of a strong business case be demonstrated - of stipulating a single, system-wide policy as of the next insurance cycle.

(55) At its seventh session (CEB/2007/HLCM/FB/10 23, paras. 124-128), the FB Network members stressed the need for a higher uniformity to be pursued across the system in the treatment of ASHI, particularly in relation to mechanisms used to fund the accrued liabilities and to deliver the health-related services to employees. This subject would be further taken up and discussed at the next FB Network meeting.

(56) The HR Network agreed, at its fifteenth session (CEB/2008/HLCM/HR/17, paras. 88-89) that a joint working group with the FB Network should be formed to explore the opportunity of developing a common approach to providing Long Term Care insurance coverage as part of the overall social insurance.

(57) At the ninth session of the FB Network (CEB/2008/HLCM/FB/18, paras. 125-128), the following organizations declared their interest in participating in the working group on Long Term Care, and would nominate representatives from their respective financial offices: UN (Vera Rajic and Patrick Goergen), ILO (Clifford Kunstler, current Chair of the WG, who combines both HR and FB profiles), UNWTO. The HR Network would review and finalize the Terms of Reference for this Working Group.

(58) At its twelfth session (CEB/2010/HLCM/FB/9, paras.23-25), the FB Network approved the recommendation to halt participation of the FB Network in the joint HR/FB Working Group on Long Term Care and to inform the HR Network accordingly. Recommended the HR Network to explore options of the long term care benefits offered by the private sector in view of the advantages of economies of scale presented by the UN system. 

(59) At its twenty second session (CEB/2011/HLCM/HR/19, paras. 26-30), the HR Network agreed that the budget endorsements for UN Cares will be conducted via email.

(60) At its seventeenth session in Turin (CEB/2011/HLCM/FB/21, paras.50-53), the FB Network acknowledged the importance of harmonization of ASHI practices requested to revisit the subject in its next meetings.

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