The City University of New York
NYS HEALTH INSURANCE PROGRAMNYSHIP
Student Employee Health Plan (SEHP)
Office of Human Resources Management
University Benefits
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ELIGIBILITY
TO BE ELIGIBLE FOR NYSHIP BENEFITS YOU MUSTMEET ALL OF THE FOLLOWING CRITERIA:
Matriculate in a Doctoral Program at the CUNY Graduate Center or the Engineering Ph.D. Program at City College
Work in an eligible title (Graduate Assistant A, B, C, Adjunct Instructor, Adjunct Lecturer, Adjunct College Laboratory Technician And Non- Teaching Adjunct I, II)
Make a minimum $4,122 per year or $2,061 per semester
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ENROLLMENT
Complete the Health Benefits Enrollment Form (PS-404) and submit it along with supporting documentation to the NYSHIP
Coordinator at your college:
CUNY Graduate Center – Scott Voorhees - Office of Student Affairs, Room 7301.05
Phone number 212.817.7406
City College - Kim Ferguson - Office of Human ResourcesShepard Hall, Room 50 – (212) 650-7963
NOTE: Refer to the “SEPH Eligibility Requirements” sheet for list of required documentation:
www.cuny.edu/doctoralstudenthealthplan
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ENROLLMENT… (Cont’d)
YOU MAY ENROLL IN NYSHIP BENEFITS:
Within 45 days of your appointment - Late enrollments will be subject to a 30-day waiting period
Within 30 days of a qualifying event Within 30 days following involuntary loss of other
coverage .
During the Annual Open Enrollment Period – November 1st – November 30th
*Note: Employees of the CUNY Research Foundation are not eligible for these benefits.
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EFFECTIVE DATE OF COVERAGE
FOR NEWLY ELIGIBLE EMPLOYEES:
If you apply within 45 days of your date of appointment in a NYSHIP
eligible title, coverage for you and your eligible dependents will
generally be effective as of the date of your appointment.
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EFFECTIVE DATE OF COVERAGE
LATE ENROLLMENT:
If you apply for NYSHIP coverage more than 45 days after your date of
appointment in a NYSHIP eligible title, your medical coverage will begin 30 days from the date that your enrollment form is received by the NYSHIP Coordinator at
your college
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COVERAGE OUTSIDE OF THE USA
Services provided outside of the USA are treated as out-of-network services. You must complete a claim form to obtain reimbursement.
Download this claim form at:http://www.cs.state.ny.us/ebd/ebdonlinecenter/pof/images/OutOfStateForm.pdf
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INSURANCE CARDS
You should expect to receive your insurance card within 3-4 weeks following your enrollment.
You will receive 3 cards:
Medical/Hospitalization Dental Vision Care
Note: In case of an emergency, the carrier may use your SSN or NYSHIP card number to verify your coverage. Contact the University Benefits
Office at [email protected]
if you need to obtain your NYSHIP card number.
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ELIGIBLE DEPENDENTS
Spouse Domestic Partner Dependent Children - Up to age 26 (natural children,
adopted children, dependent step children). Disabled Dependents
Notes: Refer to the “SEHP Eligibility Requirements” on the
CUNY website for a list of required documentation.
www.cuny.edu/doctoralstudenthealthplan
[Note: Parents are not considered eligible dependents.]
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NYSHIP BENEFITS PROVIDERS
Medical Benefit – UnitedHealthCare Hospital Benefit - Empire BlueCross
BlueShield Dental Benefit – GHI Vision Care Benefit – EyeMed Prescription Drug Benefit -
UnitedHealthCare / Medco Health Solutions Mental Health/Substance Abuse Benefit -
UnitedHealthCare / OptumHealth
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NYSHIP BIWEEKLY PREMIUM RATES
[AS OF JANUARY 1, 2011]
INDIVIDUAL – $7.49 PER PAY PERIOD
FAMILY – $58.42 PER PAY PERIOD
Pre-tax bi-weekly health insurance premiums will be automatically deducted from your paycheck.
You may elect to have post-tax health insurance premium deduction by completing the appropriate section on the Health Benefits Enrollment Form
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CHANGES TO COVERAGE
You may make changes to your coverage:
Within 30 days of a Qualifying Event
During the Annual Open Enrollment Period
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QUALIFYING EVENTS
Marriage
Birth of a child
Becoming a child’s legal guardian, step-parent or adoptive parent
Arrival of an eligible dependent to the United States
Completion of the six month waiting period for attainment of Domestic Partner Status
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ANNUAL OPEN ENROLLMENT PERIOD
Generally held in November. For calendar year 2011 it is
November 1st - November 30th.
During the annual open enrollment period you may:
Enroll in health benefits or add eligible dependents without the 30-day waiting period for late enrollments
Change from individual to family coverage Change from family to individual coverage You may change from pre-tax to post tax status You may change from post-tax to pre-tax status
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TERMINATION OF COVERAGE
Coverage will cease when you no longer meet both of the requirements indicated below:
1. Matriculated in a Doctoral Program at the CUNY Graduate Center or in the Engineering Ph.D. Program at City College
2. Working in an eligible title (Graduate Assistant A, B, C, Adjunct Instructor, Adjunct Lecturer, Adjunct College Laboratory Technician And Non- Teaching Adjunct I, II)
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TERMINATION OF COVERAGE… (Cont’d)
Coverage will terminate when you cease working in a NYSHIP eligible title or when you graduate or take a leave from your doctoral program (whichever comes first).
Since you will have pre-paid for two pay periods of coverage, your coverage will end 28 days following the last date of the pay-period that your termination date falls within.
You must notify the University Benefits Office immediately once you no longer meet the eligibility requirements. Otherwise, it may result in unanticipated cost to you.
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CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT OF 1985 (COBRA)
NOTIFICATION
Under COBRA you and your dependents may continue group health coverage at a monthly premium of 102% of the group rate. The maximum period of coverage will vary depending on the reason for continuation.
The COBRA application process begins once the University Benefits Office is notified of your loss of eligibility. The NYS Department of Civil Service will send a COBRA package to your home address once the University Benefits Office has terminated your NYSHIP benefits.
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COBRA APPLICATION
Complete and return the COBRAenrollment application to the
addressindicated on the COBRA application
formon a timely basis
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COBRA MONTHLY PREMIUM RATES
[AS OF MARCH 2011]
INDIVIDUAL - $165.92
FAMILY - $617.41
You will receive a monthly bill from the NYS Department of Civil Service for your COBRA premium payments
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TO FIND A LIST OF PARTICIPATING PROVIDERS…
Medical - www.empireplanproviders.com
Dental - www.ghi.com
Vision Care - EyeMed 1-877-226-1412
General Information - 1-877-7-NYSHIP
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FILL OUT A NYSHIP TRANSFER FORM (NYSHIP001 TRF-UBO) IF YOU ARE:
Transferring to a new college
Changing title
Both transferring and changing title
DOWNLOAD THE FORM FROM:http://www.cuny.edu/administration/ohrm/university-benefits/
dshp.html
TRANSFERS
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ONLINE HOME ADDRESS CHANGE
To update your home address online:
Go directly to www.cs.state.ny.us/mynyship Choose a Civil Service ID and password You will receive an Activation Code in the mail
within 3 to 5 business days .
Once you receive your Activation Code, return to MyNYSHIP and log in with the Civil Service ID and password
Then go to Employee Self Service and update your home address
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If you are working at a CUNY Community College, contact the NYSHIP Coordinator at your college to
be transferred to the Graduate Center payroll.
CUNY Graduate Center – Scott Voorhees - Office of Student Affairs, Room 7301.05 - Phone number
212.817.7406
City College - Kim Ferguson - Office of Human Resources
Shepard Hall, Room 50 – (212) 650-7963
COMMUNITY COLLEGES
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PSC/CUNY WELFARE FUND ADJUNCT HEALTH INSURANCE
If you are eligible for NYSHIP coverage, you will no longer be eligible for adjunct health insurance through the PSC/CUNY Welfare Fund.
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SUMMER COVERAGE
Graduate Assistants - Coverage continues for all who remain on payroll and receive paychecks during the months of June, July and August.
Adjunct Instructor, Adjunct Lecturer, Adjunct College Laboratory Technician and Non- Teaching Adjunct I, II - Coverage continues if: a) you have or are expected to have a Fall 2011 appointment; and b) you prepay premiums to cover health insurance deductions for the summer months in which you are not expected to receive a paycheck.
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CONTACTS
CUNY Graduate Center – Scott Voorhees - Office of Student Affairs, Room 7301.05 - Phone number
212.817.7406
City College - Kim Ferguson - Office of Human Resources
Shepard Hall, Room 50 – (212) 650-7963
You may also contact the University Benefits Office at 212.794.5342
You may contact NYSHIP at 1-877-7-NYSHIP