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Group Health Insurance Options and Information

NYS:  The Empire Plan/United Health Care
The Empire Plan provides coverage for hospitalization through Blue Cross and combined medical, surgical and major medical coverage through United Health Care.  There is a co-payment for each outpatient visit to a hospital, with the exception of visits for chemotherapy, radiation therapy, physical therapy or kidney dialysis.

The plan features a network of participating providers, which can be found at http://www.provider.uhc.com/empire  (hospitals, physicians, laboratories, chiropractors and other specialists and establishments). Services rendered by these providers will be paid in full with the exception of a co-payment for office visits, lab tests, x-rays and outpatient surgeries. You pay nothing out of pocket for all other services; the insurance carrier pays the provider directly. Claims for services by providers who do not participate in the Empire Plan must be submitted on a major medical claim form. Once a deductible amount is met, major medical will pay 80% of reasonable and customary charges. After deductible and coinsurance limits have been met, the plan pays 100% of covered expenses.

HMO Health Plans
Health Maintenance organizations (HMO's) maintain their own health care centers and employ their own physicians and other health professionals. HMO's differ from conventional medical plans in that they provide medical services rather than reimbursing their members for the cost of services received elsewhere.

HMO's provide a wide range of health services from office visits to complex medical treatment and hospitalization for a fixed, prepaid payment, which you share by payroll deductions with the State.

Under an HMO you choose your own primary care physician from a list of local physicians. In most cases, the designated physician in their office will provide your medical care. If you need a diagnosis or treatment that is not available from your primary care physician, they will arrange for you to see a specialist.

Services received by your primary care physician, or by a specialist when referred by your primary care physician, are paid in full except for a minimal per office visit charge. There are no claim forms to be filed and your physician's office staff completes all administrative details. All referrals and hospital admissions must be authorized in advance by your primary care physician. Non-emergency care received without authorization is not covered and payment will be your responsibility. Emergency care of a life threatening nature is covered in full providing upon arrival at an emergency room your HMO is notified.

Eligibility
The following employees are eligible for health insurance coverage for themselves and their eligible dependents at the group rate:

  • Full-time faculty and professional staff
  • Part-time faculty who teach at least two courses per semester
  • Part-time professional staff who earn at least $13,337 per year between 7/2/09 - 7/1/10; $13,870 or more between 7/2/10 and 7/1/11.  (Excluding those employees deemed to be casual persuiant to resolution of IP Charge U-5724.)

Effective Date of Coverage
For eligible faculty and professional staff, providing you apply for coverage within the first 30 days of employment, coverage will become effective on the 43rd day of employment.

Cost of Coverage
The State pays 90% of your health insurance premium and 75% of the premium for your eligible dependents. You may elect to have your bi-weekly health insurance premium deducted from your pay on a pre-tax basis. Effective January of each year, your bi-weekly premium cost is subject to change.

Sick Leave Exchange Program
Eligible professional employees who have at least 15 days accumulated sick leave may exchange three days of sick leave accruals that would normally be earned for a maximum $300 reduction in health insurance premiums for the year. Election of the sick leave exchange program is made in November of each year.

Health Option Program
Eligible classified employees who have at least 15 days accumulated sick leave may exchange three days of sick leave accruals that would normally be earned for a maximum $310.44 reduction in health insurance premiums for the year.  Election of the Health Option Program is made in November of each year.

How to Enroll
To apply for enrollment in either the Sick Leave Exchange Program or the Health Option Program, you must complete a health insurance enrollment form, and an HMO application, if necessary, available in the Human Resources Office.

Change of Plan Option or Coverage
There is an annual transfer period (usually in November of each year) during which time you can change you health insurance option and coverage for eligible dependents.

Retirement Coverage
If you meet specific criteria, you will be eligible to continue your health insurance in retirement. In general, you must have complete ten (10) years of service to the College, be a member of a state administered retirement system and be enrolled in one of the health insurance programs at the time of retirement.

Prescription Drug Program 
The Empire Plan Prescription Drug Program includes:

  • Open formualry
  • Depending on your group, up to a 30 day supply of a covered drug from a participating retail pharmacy or through Medco by Mail, you will pay a $5 copayment for generic drugs, $15 copayment for brand-name drugs that have no generic equivalent and $30 or $40 copayment for non-preferred brand name drug.  For all groups, when you fill a prescription for a brand-name drug that has a generic equivalent you pay your brand-name copayment plus the difference in cost between the brand-name drug and its generic equivalent. 
  • Depending on your group, the cost for a 31 to 90 day supply of a covered drug through a  participating retail pharmacy  is a $10 copayment for generic drugs, $30 copayment for brand-name drugs that have no generic equivalent and $60 to $70 copayment for non-preferred brand-name drugs.
  • Depending on your group, the cost for a 31 to 90 day supply of a covered drug through Medco by Mail is a $5 copayment for generic drugs, $20 copayment for preferred brand-name drugs that have no generic equivalent and a $55 to $65 copayment for a non-preffered brand-name drugs.
  • You may fill your prescription through the mail service pharmacy.  A pharmacist is on call 24 hours a day for urgent questions on your prescriptions.
  • If you use a non-participating pharmacy, you will pay the full cost and then submit a claim for partial reimbursement.
  • Prior authorization is required for certain drugs.
  • Drug Utilization Review (DUR) when you use your card. 

Dental Insurance
There is no premium cost to employees for coverage and there are no co-pay or deductible requirements. Payments under this plan are made according to a schedule of allowances. If you use a participating dentist you should have no additional expenses for services other than those outlined in the plan. For the most part, participating dentists limit their fees to the plan's payment schedule. However, there are minor exceptions. Should you elect a non-participating dentist, the plan will pay up to the maximum allowance in its payment schedule. You will be responsible for any costs over and above this allowance.

Part-time or temporary employees whose employment is expected to last less than six (6) months are not eligible for enrollment in this plan.

Vision Care
Once every 24 months, through one of the Plan's providers, eligible employees and their dependents are entitled to an eye examination, one pair of glasses (lenses and frames). The benefit may also be applies towards contact lenses instead.

Should you elect a non-participating optometrist, the plan will pay up to the maximum allowance in its payment schedule. You will be responsible for any costs over and above this allowance.

Part-time or temporary employees whose employment is expected to last less than six (6) months are not eligible for enrollment in this plan.

Detailed information concerning the health insurance programs is available from the Human Resources Office or NYS OnLine at www.state.ny.us/ebd/index.html.


Unemployment Insurance

Unemployment insurance is temporary income for eligible workers who become unemployed through no fault of their own and who are ready, willing, able to work and have sufficient weeks and wages in covered employment. In New York State, the money for unemployment insurance benefits comes from taxes paid by employers. No deductions are ever made from a worker's paycheck for it. It is the Department of Labor that determines whether an unemployed worker qualifies for unemployment insurance.

Federal and New York State laws prohibit discrimination with respect to race, creed, color, national origin, sex, age or marital status. Your claim for unemployment insurance benefits will be evaluated and an eligibility determination will be made without regard to any of these factors.

Further information is available from the Human Resources Office or directly from the NYS Department of Labor @ www.labor.state.ny.us


Life Insurance

Group life insurance programs are available through your bargaining unit membership, or by specific policy arrangements sponsored by your union. Premiums can be paid through payroll deduction. In addition, faculty and professional staff are eligible for term life insurance programs as individuals through TIAA-CREF or other insurance carriers.

Disability Insurance

Upon completion of one (1) year of full-time service with the College, faculty and professional staff employees will automatically be enrolled in a group long-term disability plan offered through The Standard Insurance Company. Part-time faculty and staff who are eligible for benefits are also enrolled after one year of service.

The objective of this plan is to ensure that a substantial portion of your income will be protected in the event of a catastophic illness or injury of long-term duration.  There is no cost to employees who are enrolled in this plan.

The plan provides for an income of 60% of your basic monthly salary, to a maximum of $7,500 per month, and also contributes a monthly premium to your retirement account while disabled. Benefits begin following six (6) months of total disability.

Additional plan and benefit payout information is contained in the pamphlet Group Disability Insurance Program for Professional Staff and is available in the Benefits Office of Human Resouces.  Please contact Grace Bonnell, Benefits Manager,at (914) 251-6091 to request a copy of this pamphlet.



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