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Health
Insurance and Prescription Drugs |
New Graduate Assistants who are eligible have the opportunity to participate in
the Student Employee Health Plan (SEHP) through the New York State Health
Insurance Program (NYSHIP) which is one of the largest group health insurance
programs in the United States. The Student Employee Health Plan provides
valuable medical benefits for you and your eligible dependents. It provides
medical and surgical care, hospital expense benefits, mental health and
substance abuse benefits, prescription drug coverage, dental and vision care.
There are no pre-existing condition exclusions.
AM I ELIGIBLE?
Graduate student employees eligible for an employer contribution under the
NYSHIP SEHP are those who work at least one-half an assistantship and are
employed at a stipend that would yield a total compensation of $4,422 or more
for the contract year.
Employees who work at least one-half an assistantship but are hired mid-year,
will be eligible if they earn a stipend that would yield a total compensation
equal to $4,422 or more when annualized.
A graduate student employee (and his/her dependents) currently enrolled in
NYSHIP’s Empire Plan or a NYSHIP HMO as an employee of New York State, a
Participating Employer or a Participating Agency is also eligible for coverage
under the NYSHIP SEHP.
ARE MY DEPENDENTS ELIGIBLE FOR COVERAGE?
You may enroll for either individual or family coverage.
Eligible dependents include a spouse or domestic partner and children under the
age of 26.
If you wish to carry family coverage, copies of the following
documents are needed to support your dependent’s eligibility:
marriage certificate for a spouse, proof of current financial
interdependence if married for more than one year, and proof of
residency and financial interdependence for a domestic
partnership. Copies of birth certificate(s) and social security
card(s) will also be required prior to enrolling all dependents.
WHEN WILL MY COVERAGE BE EFFECTIVE?
If you wish to enroll for
health insurance/prescription coverage, you must select a plan
within the first 45 days of appointment to avoid any extended
waiting period. Coverage will be effective on the
date of application.
WHAT IS THE COST OF COVERAGE?
New York State pays a significant portion of the premium for
yourself and your dependents. You pay the balance which is
deducted from your paycheck on a biweekly basis. There are two
types of coverage that you may purchase: individual or family.
2013 Health Insurance Biweekly Rates
Individual Coverage - $10.18
Family Coverage - $69.95
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One of the decisions you will need to make when enrolling for
health insurance is whether or not to participate in the
Pre-Tax Contribution Program (PTCP). Under PTCP, your health insurance premiums are
deducted from your pay before taxes are taken out. This lowers your taxable
income and gives you more spendable income. Under Internal Revenue Rules
(IRS), if you participate in PTCP, you cannot change your health insurance
deduction once the amount is set for the tax year unless you have a
"qualifying event".
HEALTH INSURANCE PLAN SUMMARY
HOSPITAL BENEFITS PROGRAM
Administered by Empire BlueCross BlueShield – Provides coverage for
inpatient and outpatient services provided by a hospital or birthing center
and for hospice care. Also provides inpatient Benefits Management Program
services for pre-admission certification of scheduled hospital admissions or
within 48 hours after an emergency or urgent admission. Services are
available through participating and non-participating providers. For
inpatient services there is a $200 copayment per admission. If you use a
network provider, the Plan will pay 100% of allowable amount after you pay
the copayment. If you use a non-network provider, the Plan will pay 80% of
allowable amount after you pay the copayment. You are responsible for the
balance.
For outpatient services, you are subject to a copayment of $15 per visit if
you use a network provider. Using a non-network provider will require you to
meet an annual deductible of $100 per covered individual. The Plan would
then pay 80% of allowable expenses. You are responsible for the balance.
Emergency Room care is subject to a $25 copayment per visit. The copayment
is waived if you are admitted.
MEDICAL/SURGICAL BENEFITS PROGRAM
Administered by United HealthCare – Provides coverage for medical services,
such as office visits, surgery and diagnostic testing. Coverage for
chiropractic care and physical therapy is provided through the Managed
Physical Medicine Program. Home care services provided in lieu of
hospitalization and diabetic supplies provided by the Home Care Advocacy
Program. Benefits Management Program services for Prospective Procedure
Review of Magnetic Resonance Imaging (MRI). Some covered services from a
network provider are paid-in-full and others are subject to a copayment of
$10 per visit. You have network coverage for up to 15 visits per person per
calendar year. If you use a non-network provider, there is an annual
deductible of $100 per covered individual and then the Plan pays 80% of
allowable expenses for covered services. You are responsible for the
balance.
MANAGED MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAM
Administered by OptumHealth – Provides coverage for inpatient and outpatient
mental health and outpatient substance abuse services. If you use a Network
provider, there is a copayment of $200 per person per admission. The Plan
will then pay 100% of the network allowance.
If you use a non-network provider, the copayment is $200 per person per
admission. The Plan pays 80% after you pay the copayment. You pay the
remaining balance.
HOW DO I FIND A PARTICIPATING PROVIDER?
Go to
Empire Plan participating providers or call 1-877-7-NYSHIP
(1-877-769-7447)
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PRESCRIPTION DRUG PROGRAM
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Administered jointly by Medco and United Health Care – provides coverage
for prescription drugs, oral contraceptives and diaphragms.
You have the following copayment for drugs purchased from a participating
pharmacy; Generic Drug $5, Preferred Brand-Name Drug $15, Non-Preferred
Brand-Name Drug $40.
Prescription drug coverage is included in the combined $1,250,000 annual
benefit maximum.
HOW DO I FIND A PARTICIPATING PHARMACY?
To locate a participating pharmacy go to
Medco or call 1-877-769-7447
HOW DO I ENROLL?
Please indicate your intention to participate or not to
participate in the Student Employee Health Plan on the Benefits
Election form. To enroll, please complete the
Health Insurance Enrollment Form (PS404G)
online or provided in your orientation packet and return it to the
Employee Benefits Office, Cleveland Hall 410, within 45 days of
your appointment date to avoid any extended waiting period.
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