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

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Decline Individual Coverage for Medical Insurance Plan or Medical Benefits Plan for Bank/Bank Couple


In cases of marriage or domestic partnership between members of the World Bank Group staff, the couple cannot be covered both as staff and as eligible family members under the other staff member’s Medical Insurance Plan (MIP).

Bank couples can elect one of the following options:

  • Two individual plans:

o  For Headquarters (HQ) staff, two separate MIPs

o  For country office (CO) staff, two separate Medical Benefits Plans (MBPs)

o  One MIP and one MBP.

  • Two individual plans with eligible family members:

o  One staff member + some or all eligible family members in one plan

o  Other staff member + other eligible family member in the other plan.

  • One plan with all eligible family members for medical plans—this includes spouse/domestic partner and dependent children.

In order to be covered under one MIP/MBP, one of the staff needs to decline the individual coverage and assume coverage as an eligible family member for medical plans.




Action by Staff



Submit the completed form to HR Operations for processing.


Action by HR


Send an email to the staff member confirming enrollment and/or change.


Check the enrollment status on myHR Self-Service.


Enrollment/change in coverage is effective from the first of the month following the receipt of the request.