Office of Human Resources Management University Benefits

1. The City University of New YorkNYS HEALTH INSURANCE PROGRAMNYSHIPStudent Employee Health Plan (SEHP) Office of Human Resources Management University Benefits

2. ELIGIBILITY TO BE ELIGIBLE FOR NYSHIP BENEFITS YOU MUST MEET 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 The University Benefits Office

3. 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 Resources Shepard Hall, Room 50 – (212) 650-7963 NOTE: Refer to the “SEPH Eligibility Requirements” sheet for list of required documentation: www.cuny.edu/doctoralstudenthealthplan The University Benefits Office

4. 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. The University Benefits Office

5. The University Benefits Office

6. The University Benefits Office

7. 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. EFFECTIVE DATE OF COVERAGE The University Benefits Office

8. 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 The University Benefits Office

9. 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 The University Benefits Office

10. The University Benefits Office

11. 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 UniversityBenefits.NYSHIP@mail.cuny.edu if you need to obtain your NYSHIP card number. The University Benefits Office

12. The University Benefits Office

13. The University Benefits Office

14. 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.] The University Benefits Office

15. 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 The University Benefits Office

16. 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 The University Benefits Office

17. CHANGES TO COVERAGE • You may make changes to your coverage: • Within 30 days of a Qualifying Event • During the Annual Open Enrollment Period The University Benefits Office

18. 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 The University Benefits Office

19. 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 The University Benefits Office

20. 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) The University Benefits Office

21. 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. The University Benefits Office

22. 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. The University Benefits Office

23. COBRA APPLICATION Complete and return the COBRA enrollment application to the address indicated on the COBRA application form on a timely basis The University Benefits Office

24. 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 The University Benefits Office

25. 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 The University Benefits Office

26. TRANSFERS 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 The University Benefits Office

27. 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 The University Benefits Office

28. 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 212.817.7406City College - Kim Ferguson - Office of Human ResourcesShepard Hall, Room 50 – (212) 650-7963 COMMUNITY COLLEGES The University Benefits Office

29. 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. The University Benefits Office

30. 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. The University Benefits Office

31. 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 ResourcesShepard 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 The University Benefits Office