There is something striking about the September 4 letter from the FAFICS President to association heads that I came across on the AFICS/NY website today.
The questions that UN retirees raised in their letters last month to the FAFICS President went beyond the mechanics of individual health insurance claims. We asked about cost containment, independent auditing, the basis for the premium increases, and the late communication of the changes. (See link to my "Reality Check" post below).
The President’s letter to the association heads focuses primarily on what retirees should do when they have a problem with a claim or an unanswered inquiry. That’s useful information. But it raises an important question:
Why is it that when we asked questions about how the health insurance system itself operates, who oversees it, how costs are controlled, whether decisions are independently scrutinized, and whether retirees have an effective voice in those decisions, we get an answer primarily about how to navigate the claims process?
Still, it’s a useful topic and I’m taking the opportunity to provide some detailed information about the process, as the FAFICS President outlines, add some information about resources that may be of assistance to UN retirees, and highlight some gaps that may need to be addressed.
According to the September 4 letter, the official pathway is:
1. Take a rejected claim or unanswered inquiry to your plan's claims administrator.
2. If the problem remains unresolved, take it to the health-insurance unit of your former organization.
3. If it still isn't resolved, take it to your local AFICS association, which can then escalate generic, system-wide issues to FAFICS.
The President’s letter notes: “We cannot take up individual cases across our 65 Associations, but every case you share sharpens our advocacy. You and your members are not facing this alone. I invite every Association to send us your generic questions and concerns at any time.”
Here are the official steps regarding claims:
1. Start with the claims administrator
The UN's current retiree guidance directs participants to the relevant third-party administrator for questions about claim processes, ID cards and related matters. For UN Headquarters-administered plans, the administrator contact is specific to each plan: Here's the information as per the HLIS ASHI website:
https://www.un.org/insurance/content/retirees
The important thing to understand is that the claims administrator is an administrator, not an independent advocate for the retiree. If your claim is denied, you are using the plan's own claims and appeals machinery to challenge that decision.
2. Then comes HLIS
If the issue cannot be resolved with the claims administrator, FAFICS directs retirees to the health-insurance unit of their former organization. For UN Headquarters retirees, that means the Health and Life Insurance Section, HLIS. The current HLIS retiree contacts are:
917-367-9727
HLIS also provides client service at its New York office during designated hours. HLIS handles questions concerning enrollment, maintenance and changes to UNHQ-administered health-insurance plans and provides policy or technical support. But it is part of the UN administrative structure. It is not an independent advocate whose role is to represent the retiree against that structure.
AFICS associations
The FAFICS president then directs UN retirees to their local AFICS association when a problem remains unresolved. Remember, however, that the vast majority of UN retirees worldwide are not members of an AFICS association.
I just saw that the AFICS/NY After-Service Health Insurance page on its website, for example, states: “AFICS/NY helps you navigate After-Service Health Insurance (ASHI) and Dental Insurance (ADI) with confidence. From policy updates to enrollment guidance, we provide the information and advocacy you need to manage your benefits clearly and effectively.”
The general telephone number and email address for AFICS/NY are:
212-963-2943
At the end of the health insurance page,“Still have questions” leads to a “contact us” link. I can’t say what happens after a UN retiree contacts AFICS/NY or any other local AFICS association seeking advocacy on after-service life insurance. It likely depends on the association, its resources and its willingness and ability to intervene.
https://www.aficsny.org/services-ashi-medicare
Here’s the list of local AFICS associations with contact info posted on the FAFICS website:
https://fafics.org/member-associations/list/
A simple test
I suggest a simple test for UN retirees who need assistance: reach out and see what happens. In the case of AFICS/NY, and indeed any of the FAFICS member associations, retirees should be able to find out not only what information is available, but what the association is prepared and able to do when an individual needs help resolving an after-service health insurance problem. This seems particularly reasonable given that FAFICS and its member associations present themselves as representing UN retirees generally, not only those who pay membership dues. If that is the claim, then retirees, members or not, should be able to expect meaningful assistance when they need it.
4. What about the UN Ombudsman?
There may be another possible resource, for guidance, not advocacy: the UN Ombudsman and Mediation Services. The Ombudsman serves current and former employees of the UN Secretariat, including retirees, and provides confidential assistance in exploring options and navigating difficult situations.
Contact:
unoms@un.org
917-367-5731
But it is important not to misunderstand its role. The Ombudsman is not a health-insurance appeals body and does not decide claims. Its role is to help people understand their options and navigate difficult situations. It may nevertheless be useful when someone feels stuck and needs help figuring out how to proceed.
5. Independent resources
For retirees in the United States, independent organizations can sometimes help with aspects of health-insurance problems, particularly Medicare.
The Medicare Rights Center provides assistance with Medicare benefits, denials and appeals and operates a national helpline at 800-333-4114.
In New York City, HIICAP, the Health Insurance Information, Counseling and Assistance Program, provides free Medicare counseling through NYC Aging at 212-244-6469.
These resources are obviously limited to Medicare-related issues. Retirees elsewhere may want to investigate comparable independent health-insurance or patient-advocacy services in their own countries.
So where is the gap?
Official pathway:
Claims administrator → former organization/HLIS → local AFICS → FAFICS for generic, system-wide issues
There are two gaps we need to recognize:
It's important to note that none of the above is the same as having an independent advocate whose job is to take up an individual retiree's case. Second, the claims pathway does nothing to answer the broader questions retirees raised about cost containment, independent oversight, auditing, transparency and decision-making.
What might we eventually need? If these gaps persist, there are several possibilities we may eventually need to consider.
First, FAFICS by UN retirees, and UN staff unions by staff, could be pressed to establish a clearer and more accessible mechanism for individual health-insurance advocacy, rather than leaving retirees (and staff) to navigate the system largely on their own.
Second, the UN could be asked to establish an independent health-insurance ombudsman or participant advocate with a genuine mandate to assist retirees (and staff) with individual cases while also identifying recurring systemic problems.
Third, if neither approach proves possible, retirees (and staff) may eventually need to consider whether another mechanism for independent representation is necessary.
Those are possibilities, not a call to action today. For now, I think it is useful simply to be encouraged that our collective action can have an impact; understand what the system says you should do; what each entity can actually do; and where the gaps are. I'm putting these issues out there for comment and discussion, with a view to possible future action. I welcome your thoughts and perspectives.
https://unpension.blogspot.com/2026/08/a-reality-check-on-fafics-un-retirees.html
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