Skip to Main Navigation

Human Resources


CONTACT

The World Bank
1818 H Street N.W.
Washington, DC 20433

Stay Connected

HR Forms for Medical Insurance for HQ (MIP)

  
  •  

Cigna Dental Claim Form (HQ) – US Claims

  •  

Cigna Dental Claim Form (HQ) – International Claims

  •  

F00018 Retiree Medical Insurance Plan (RMIP): Non-U.S. National Health Plan (NHP) Transmittal Form (HQ)

  •  

F00023 Retiree MIP Direct Deposit of Medical Insurance Claim Payments (HQ)

  •  

F00032 Retiree MIP Medicare Reimbursements (HQ)

  •  

F00996 Request For Movement Between Domestic and International Administrators For MIP (HQ)

  •  

F01997 Enrollment and Payroll Deduction Authorization To Change MIP Enrollment (Bank/Bank Couple) (HQ)

  •  

F200021 U.S. National Health Plan (Medicare) Transmittal Form (HQ)

  •  
F200037 Life Event Reporting - HQ 
 
  •  

Form - 892 - MIP: Aetna Claim for Reimbursement of Medical and Hospital Expenses (HQ)

  •  

Form - Aetna Handicapped Child Attending Physician's Statement (HQ)

  •  

Form - Aetna Request for Continuation of Medical Coverage for Handicapped Child (HQ)

  •  

Form - MIP - Evidence of Insurability Statement Medical Coverage Late Enrollment - For Sponsored Plan Only (HQ)

  •  

Form - MIP Cigna Claim for Reimbursement of Medical and Dental Expenses (HQ)

  •  

Form - Medical Insurance Plan: Cigna International Estimate of Hospitalization Costs (HQ)

  •  

G00063 Medical Insurance Plan (MIP) A Guide to Preventative Care (HQ)

  •  

G00064 Aetna Active Staff MIP Comparison Benefit Grid (HQ)

  •  

G00066 Aetna Active Staff MIP Option A Summary (HQ)

  •  

G00067 Aetna Active Staff MIP Option B Summary (HQ)

  •  

G00068 Aetna Active Staff MIP Option C Summary (HQ)

  •  

G00069 Cigna International Option Active Staff MIP AI Summary (HQ)

  •  

G00070 Cigna International Option Active Staff MIP BI Summary (HQ

  •  

G00071 MIP Premium Schedule, Active and Retiree Plans (HQ)

  •  

G00074 Aetna Retiree MIP Plan 1 Summary (HQ)

  •  

G00075 International Option (Cigna) Retiree MIP Plan 1 (HQ)

  •  

G00076 Aetna Retiree MIP Plan 2 Summary (HQ)

  •  

G00077 International Option (Cigna) Retiree MIP Plan 2 (HQ)

  •  

G00080 Aetna Sponsored Parent Plan Summary (HQ)

  •  

G00081 MIP International Administrator Option Detailed Provisions (HQ)

  •  

Guide - MIP Summary Plan Description (HQ)

  •  

MIP EyeMed Reimbursement of Vision Expenses - HQ (CO, HQ)

  •  

MIP EyeMed Reimbursement of Vision Expenses - HQ Non-U.S. (HQ)

  •  

Summary of Benefits for Employee Group Waiver Program (EGWP) (HQ)