New faculty and professional staff who are eligible have the opportunity to
participate in the New York State Health Insurance Program (NYSHIP) which is one
of the largest group health insurance programs in the United States. NYSHIP
provides valuable medical benefits for you and your eligible dependents through
two different options: The Empire Plan with some managed care features, or
health care from a participating Health Maintenance Organization (HMO). Both
options provide medical and surgical care, hospital expense benefits, mental
health and substance abuse benefits and prescription drug coverage. There are no
pre-existing condition exclusions.
AM I ELIGIBLE?
Full-time faculty and professional staff members are eligible for health
benefits if they are employed for at least three (3) months.
Part-time professional employees are eligible to receive benefits if they are
hired at a rate of $13,870 between July 2, 2010, and July 1, 2011, and be
appointed for at least three (3) months.
Part-time faculty members teaching two or more courses in
a semester are eligible for 13 payroll periods of coverage for each
semester worked. If teaching two or more courses in consecutive spring and
fall semesters, part-time faculty are eligible to receive benefits year round
with no breaks in coverage.
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, 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 42 days of appointment to avoid any extended
waiting period. Coverage will be effective on the
43rd day of employment.
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.
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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". For a list of qualifying events and more information about
the PTCP, view the
NYSHIP General Information Book for UUP Employees.
HEALTH INSURANCE PLAN CHOICES
EMPIRE PLAN
Membership in the New York State Empire Plan allows you to seek medical
services from any doctor, hospital, or health care provider that you wish.
Hospital and related benefit coverage is provided through Empire Blue Cross and
Blue Shield. Major medical/surgical benefits, provided by United HealthCare,
are available through participating and non-participating providers. Participating providers, which are paid directly by the
insurance company, have agreed to accept the negotiated usual, customary and
reasonable (UCR) fees as payment for services. You are responsible for a
co-payment: $20 for office visits, diagnostic/therapeutic services, and
rehabilitative care; $70 per emergency room visit. Fees for services received through non-participating
providers may be higher than the UCR rates and are subject to an annual
deductible. Once your annual deductible is met, reimbursement is 80% of
reasonable and customary expenses. Claims for services from providers who do
not participate in the plan are submitted using a claim form.
Empire Plan Participating Providers
Medco
Prescription Drug Plan 1-877-769-7447
Under the
Empire Plan Prescription Drug Program,
you can have your prescriptions filled at any network pharmacy or the mail
service pharmacy. This plan uses a flexible formulary and for up to a 30-day
supply of a covered drug, you pay a $5 copayment for Level 1 or generic
drugs, a $15 copayment for Level 2, preferred brand-name drugs and a $40
copayment for Level 3 or non-preferred brand-name drugs.
The network of participating pharmacies includes many of the major chains as
well as several independent pharmacies.
HEALTH MAINTENANCE ORGANIZATIONS
HMOs are managed health delivery systems organized to deliver health care
services in a specific geographic area. An HMO provides a predetermined set of
benefits through a network of selected physicians, laboratories and hospitals
for a prepaid premium. Except for emergency services, you and your enrolled
dependents must receive services from your primary care physician (which you
select at the time of enrollment) or at health centers or hospitals affiliated
with the HMO unless you have made other arrangements with your HMO. Medically
necessary visits to specialists are covered when authorized by your primary
care physician. If you select services outside your HMO network, payment for
these services will generally be your responsibility.
All HMOs charge a small co-payment for certain services, usually in the form of
a per-visit fee. HMOs have no annual deductibles and rarely, if ever, are claim
forms required. Member’s out-of-pocket costs are usually the lowest with this
type of plan.
Community Blue
Independent Health
HOW DO I ENROLL?
Please indicate your intention to participate or not to participate in a
health insurance plan on the Benefits Election Form. To enroll, you must complete the
Health Insurance Enrollment Form
(PS-404) online or provided in your orientation packet.
This form must be returned to the Employee Benefits Office, Cleveland Hall
410, within 42 days of
your appointment date to avoid any extended waiting period.
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