• Eligibility

As a member of the Instructional Staff of The City University of New York, you are eligible for health coverage under the City of New York’s Health Benefits Program (NYCHBP) and for benefits provided by the Professional Staff Congress/CUNY (PSC-CUNY) Welfare Fund, if you work at least 20 hours per week, and your appointment is expected to last for more than six months.

• Eligible Dependents

You may also enroll your dependents if their relationship to you is one of the following:

a. A legally married husband or wife. (An ex-spouse is not eligible for coverage under the NYCHBP regardless of the provisions of any legal settlement).

b. A domestic partner, (i.e., a person, at least eighteen years of age, living together with you in a current continuous and committed relationship, and not related by blood to you in a manner that would bar marriage in the State of New York, and who, together with you, has registered as your domestic partner with the City of New York and has not terminated the domestic partnership.) There are tax consequences, credit and collection implications, debt obligations, and legal consequences of your domestic partnership registration and health benefits enrollment. Please consult your tax and legal advisors.

c. Unmarried children under age 19. The term “children” for purposes of this and the following source of definitions, include: natural children; children for whom a court has accepted a consent to adopt and for the support of whom you have entered into an agreement; children for whom a court of law has made you legally responsible for support and maintenance; and children who live with you in a regular parent/child relationship and are supported by you.

d. Unmarried dependent children age 19 to 23 who are full-time students at an accredited degree-granting educational institution.

e. Unmarried children who cannot support themselves because of a disability, including mental illness, developmental disability, mental retardation, or physical handicap, so long as their disability occurred while the dependent was covered by the City.

• Enrollment

  To enroll you must obtain an Employee Health Benefits Application (Form ERB) at your College Human Resources Office. The form must be filed within 31 days of your appointment date. If you do not file the form within 31 days of your appointment date, the start of your coverage will be delayed and you may be subject to a loss of benefits. You are required to provide acceptable documentation to support the eligibility status of all persons to be covered by the NYCHBP, which may include a birth certificate, marriage certificate, divorce papers, domestic partner registration forms, etc.

Note: You and your dependents cannot be covered by two health contracts for which the City pays or to which the City contributes.

• Effective Dates of Coverage

Coverage begins on your appointment date, provided your College Human Resources Office has received your Employee Health Benefits Application (Form ERB) within 31 days of that date. Coverage for eligible dependents listed on your Application will begin on the date that you become covered. Dependents acquired after you submit your Application will be covered from the date of marriage, domestic partnership, birth or adoption, provided that you submit the required notification and documentation within 31 days of the event.

• Basic Health Plans

As an eligible participant of the NYCHBP, you may choose from several health plans. These plans provide basic coverage, which may or may not require additional premiums from you. You may obtain additional benefits by paying an additional premium through payroll deductions on a pre-tax basis. The health plans presently available to you are:

1. AETNA U.S. HEALTHCARE HMO
2. AETNA U.S. HEALTHCARE QPOS
3. CIGNA HEALTHCARE
4. EMPIRE HMO NEW YORK
5. EMPIRE HEALTHCARE NJ HMO
6. EMPIRE EPO
7. GHI-CBP/EBCBS8. GHI HMO
9. GHI TYPE C/EBCBS (Current Members Only)
10. HIP PRIME HMO
11. HIP PRIME POS (Formerly HIP Choice)
12. METROPLUS
13. HEALTHNET (Formerly PHS)
14. VYTRA HEALTH PLANS

• Health Plan Models

Most, but not all, of the health plans available to you provide the following care, with various limitations according to the particular plan:

Health Maintenance Organizations (HMO)
A prepaid medical group practice plan that provides a comprehensive predetermined medical care benefits package. The following services are provided from participating providers only:

Outpatient Care/Office Visits
Specialist Care
Outpatient Diagnostic Tests (X-rays, labs, etc.)
Inpatient Hospital Care
Maternity Care (Mother and newborn)
Emergency Room Care
Mental Health Inpatient Care
Mental Health Outpatient Care
Substance Abuse/Chemical
Dependency Inpatient Care
Prescription Drug Coverage

Preferred Provider Organization (PPO)
A managed care plan that contracts with employers, insurance companies or other third party administrators to provide comprehensive medical service. Providers exchange discounted services for increased volume and prompt payment. Participants’ out-of-pocket costs are usually lower than a fee-for-service plan.

Exclusive Provider Organization (EPO)
A more rigid type of PPO closely related to an HMO. Provides benefits or levels of benefits only if care is rendered by institutional and professional providers within a specified network (with some exceptions for emergency and out-of-area services).

Point-of-Service (POS)
A type of managed care plan that allows members to choose at the point where care begins to receive services from a participating or nonparticipating provider, usually with a financial disincentive for going outside the network. The following services are provided both in-and out-of-network for the EPO, PPO & POS:

Physician’s Visit
Outpatient Diagnostic Tests (X-rays, labs, etc.)
Inpatient Hospital Care
Maternity Care (Mother and newborn)
Emergency Room Care
Prescription Drug Coverage
Mental Health Inpatient Care
Mental Health Outpatient Care
Substance Abuse/Chemical
Dependency Inpatient Care
Substance Abuse/Chemical
Dependency Outpatient Care

All have deductibles and or maximum out-of-pocket ceilings.

• Health Plan Models

To select a health plan that best meets your needs, you should consider the following factors:

1. Coverage: Some plans provide preventive services; others do not. Some cover routine care; others do not.

2. Choice of Doctor: Some plans provide partial reimbursement when nonparticipating providers are used. Other plans only pay for or allow the use of participating providers.

3. Convenience of Access: Certain plans may have participating providers or centers that are more convenient to either your home or workplace. You should consider the location of physicians’ offices and hospital affiliations before selecting a health plan.

4. Cost: Some plans require payroll deductions for basic coverage. The cost of Optional Riders also differs. Some plans require a co payment for each routine doctor visit. Some plans require the payment of a yearly deductible and coinsurance before the plans will reimburse you for the use of
non-participating providers. If a plan does not cover certain types of services that you expect to use, you must also consider the out-of-pocket cost of these services.

To obtain further information on benefits, participating doctors, office locations, and costs, please refer to the New York City Health Benefits Summary Program Description (SPD).

• Medical Spending Conversion (MSC)

  MSC is comprised of two distinct programs:

  A. The Premium Conversion Program

  All employees who have payroll deductions for health benefits are automatically enrolled in the Premium Conversion Program. The Premium Conversion Program allows for payments of health plan deductions on a pre-tax basis, thus reducing the amount of gross salary on which Federal Income and Social Security (FICA) taxes are calculated. The overall reduction in gross salary is shown on the Form W-2 at the end of the year, but no change is reflected in the gross salary amount on your biweekly paycheck. You may decline enrollment in the Premium Conversion Plan when you first become eligible for health plan coverage or during the Open Enrollment Period. To do so, you must complete an MSC Form and submit it together with the health Benefits Application to your College Human Resources Office.

  B. The Health Benefits Buy-Out Waiver Program.

  The Health Benefits Buy-Out Waiver Program allows you, if you are eligible for NYCHBP health benefits, to waive City health benefits and receive a cash incentive payment, provided that you are covered under a spouse’s or domestic partner’s health plan or through another employer that is not a City agency. The annual incentive payment of $500 for individual coverage, or $1000 for family coverage, is taxable to you, the employee.

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• Eligibility

  You are eligible for benefits provided by the PSC-CUNY Welfare Fund if you are a member of the City University of New York Instructional staff, with an appointment expected to last for more than six months and you are paid from tax-levy funds* and work at least 20 hours per week; and you are eligible for health coverage under the City of New York’s Health Benefits Program (NYCHBP). To obtain more detailed information, please refer to the Summary Plan Description (SPD) for active members of the PSC/CUNY Welfare Fund.

  *Continuing Education Teachers and a number of classified staff managerial titles are also eligible for benefits. The managerial titles are: Administrative Superintendent of Campus Buildings and Grounds; Computer Operations Manager (CUNY); Computer Systems Manager (CUNY); Management Intern; Chief Administrative Superintendent of Campus Buildings and Grounds; University Chief Architect; and University Chief Engineer.

• Eligible Dependents

  You may also enroll your dependents if their relationship to you is one of the following:

  a. A legally married husband or wife. (An ex-spouse is not eligible for coverage under the NYCHBP regardless of the provisions of any legal settlement).

  b. A domestic partner, (i.e., a person, at least eighteen years of age, living together with you in a current continuous and committed relationship, and not related by blood to you in a manner that would bar marriage in the State of New York, and who, together with you, has registered as your domestic partner with the City of New York and has not terminated the domestic partnership.) There are tax consequences, credit and collection implications, debt obligations, and legal consequences of your domestic partnership registration and health benefits enrollment. Please consult your tax and legal advisors.

  c. Unmarried children under age 19. The term “children” for purposes of this and the following source of definitions, include: natural children; children for whom a court has accepted a consent to adopt and for the support of whom you have entered into an agreement; children for whom a court of law has made you legally responsible for support and maintenance; and children who live with you in a regular parent/child relationship and are supported by you.

  d. Unmarried dependent children age 19 to 23 who are full-time students at an accredited degree-granting educational institution.

e. Unmarried children who cannot support themselves because of a disability, including mental illness, developmental disability, mental retardation, or physical handicap, so long as their disability occurred while the dependent was covered by the City.

• Enrollment

To enroll, you must obtain a PSC-CUNY Data Sheet at your College Human Resources Office. The form must be filed within 31 days of your appointment date. If you do not file the form within 31 days of your appointment date, the start of your coverage will be delayed and you may be subject to a loss of benefits. You are required to provide acceptable documentation to support the eligibility status of all persons to be covered by the PSC-CUNY WELFARE FUND, which may include a birth certificate, marriage certificate, divorce papers, domestic partner registration form, etc.

• Prescription Drug Plan

The plan covers most drugs that legally require a prescription and have Federal Drug Administration (FDA) approval for treatment of the specified condition. Enrollment under this plan is automatic when you apply for health benefits.

1. GHI/CBP, Empire EPO, Empire HMO, Healthnet and Vytra HealthCare

a. National Prescription Administrators (NPA) Generic Reimbursement Plan Card and Central Fill Mail Order Plan. Co payment: $5 or 20%, whichever is greater.

2. HIP PRIME HMO and HIP PRIME POS

a. HIP drug rider.

3. All Other Health Plans.

a. Drug riders are provided through the carriers.

4. Psychotropic, Injectable, Chemotherapy and Asthma (PICA) Prescription Drug Program. The PICA program provides drugs in certain categories to you and your eligible dependents. GHI, Blue Choice, Vitra, or Healthnet members access this benefit through their NPA card. If your primary health coverage is HIP, Aetna, or CIGNA you will have an “NPA PICA” card, which you will use only to access PICA drugs. PICA covers medications in four specific drug categories:

Psychotropic

Antidepressants.
Antipsychotics.

Injectable

Most medications administered by injection (not in the doctor’s office) except for diabetes medications, which continue to be covered by your health plan.

Chemotherapy

Medications used to treat cancer.
Medications used to treat the side effects of chemotherapy.

Asthma

Inhalers.
Most medications used to treat asthma.

• Dental Plan

  The plan is designed to provide you with comprehensive dental care service while reducing or eliminating your out-of-pocket expense. There is no annual deductible when you use a participating dentist.

  1. Dental Reimbursement Plan $100/individual and $200/family deductible for non-participating providers $1,750 lifetime maximum to each of your eligible family members for Orthodontics Reimbursement as per a schedule of fees.

2. Participating Dentist. Self-Insured Dental Services (SIDS). No deductible. $1,750 lifetime maximum for Orthodontics Co-payment for certain procedures.

• Optical Plan

Benefit is available once every 24 months to you and your dependents based on the basic City health plan in which you are enrolled. If your carrier does not have the benefit, the Fund provides the benefit.

1. Direct Reimbursement Plan $100 maximum reimbursement for prescription glasses purchased through a non-participating provider.

2. Davis Vision Plan includes eye examination and prescription glasses. Other options are available at your expense, co-payment of $25 for contact lenses.

3. General Vision Services (GVS) Plan includes eye examination and prescription glasses. Other options are available at your expense.

• Hearing Aid Benefit

Benefit is available once every 36 months based on the City health plan in which you are enrolled. If your carrier does not have the benefit, the Fund provides the benefit.

1. Direct Reimbursement $500 maximum

2. Brooklyn College-participating outlet

• Group Life & Accidental Death & Dismemberment Insurance (For you)

Eligibility

If you are actively at work full-time, you are eligible for PSC-CUNY Welfare Fund benefits for Group Life & Accidental Death & Dismemberment Insurance through Teachers Insurance and Annuity Association of America - College Retirement Equities Fund (TIAA-CREF).

1. Basic Group Life
The amount of insurance coverage is determined by your age as of your enrollment date. Coverage decreases as your age increases. The maximum coverage is $50,000 for age 40 or less and the minimum coverage is $5,000 for age 65 and over. The full cost of the coverage is paid by the PSC-CUNY Welfare Fund and includes an equal amount of Accidental Death and Dismemberment (AD&D) insurance.

2. Optional Group Life
You can increase your insurance coverage by choosing additional amounts of life insurance and paying low group life rates through payroll deductions. The increased coverage also provides an equal amount of Accidental Death and Dismemberment insurance.

Enrollment and Effective Date
You must complete an application and an authorization for payroll deduction card. If you enroll before or within 60 days of your date of hire medical evidence of good health will not be required.

To be eligible you must be actively-at-work on the date of enrollment eligibility. If you elect the optional coverage within the 60-day enrollment period, coverage goes into effect on the date you elect the coverage.

If you elect coverage after the 60-day enrollment period, coverage will go into effect on the date TIAA approves your written evidence submitted on the “Employee Statement of Health Form.”

LIVING CHOICES: An accelerated death benefit from TIAA is a provision of this Group Life Insurance. This allows an employee who is terminally ill (life expectancy of 12 months or less as certified by a physician) the opportunity to collect all or part of his/her life insurance at a time when he/she needs it most. It is paid in a lump sum, without fees, in amounts up to 100% of the policy.

Conversion

Any or all, basic group or optional group life insurance coverage may be converted to an individual policy at termination of employment or retirement.

• Group Total Disability Insurance (For you)

Total Disability or Totally Disabled is …

1. For the elimination period and for the next 24 months, being completely unable, due to sickness, bodily injury or pregnancy, to perform the material and substantial duties of your normal occupation: and

2. After those 24 months, being unable, due to sickness, bodily injury or pregnancy, to perform the material and substantial duties of any occupation for which you are reasonably qualified by education, training or experience. You must be under the regular care of a Physician, other than yourself.

Eligibility

As an actively-at-work, full-time permanent employee of CUNY, you are eligible for PSC-CUNY Welfare Fund benefits, and for basic disability coverage, at no cost, after completing one year of service. You may also elect to pay for additional disability coverage.

Enrollment and Effective Date

You must complete an application and an authorization for payroll deduction card. If you enroll before or within 60 days of your date of hire medical evidence of good health will not be required.

To be eligible you must be actively-at-work on the date of enrollment eligibility. If you elect the optional coverage within the 60-day enrollment period, coverage goes into effect on the date you elect the coverage.

If you elect coverage after the 60-day enrollment period, coverage will go into effect on the date TIAA approves your written evidence submitted on the “Employee Statement of Health Form.”

Elimination Period

You must be on disability for a continuous period of six (6) months before the basic long-term disability program pays benefits. Note: The monthly income benefit provided by this plan subtracts (offsets) any employer-provided benefits, such as Social Security, Workers’ Compensation, sick leave or other retirement or disability benefits, from your monthly disability check and may be subject to Federal, State and local taxes.

1. Basic Disability Coverage
The basic disability coverage pays 50% of the pre-disability salary with a minimum of $1,250/month and a maximum of $2,500/month before offsets. This basic monthly income benefit begins on the first of the month following six consecutive months of total disability. If you continue to receive sick leave payments which equal the monthly wage past six consecutive months of total disability, benefits will begin on the first day of the month after the month in which the last sick leave payment equal to the monthly wage base is paid. Benefits continue to the earlier of five years or age 65 if you become disabled at age 60 or less, four and- a-half years if you become disabled between age 60 and 65, to age 70 if you are 65 but less than 681/2, and one year if you are 681/2 or older.

2. Optional Disability Coverage
The basic disability coverage is provided for a maximum of five years. If you need further protection, you may elect to pay an additional premium through payroll deductions for the optional Long-Term Disability insurance, which provides the following:

a. Increased Monthly Benefit Benefits increase from 50% of the monthly salary to 60%. The minimum benefit is $1,500 and the maximum is $5,000 before offsets.

b. The Annuity Premium Benefit Contributions to your TIAA-CREF pension accumulation-equal to 10% of your monthly pre-disability salary-continue during disability. If you are a member of NYCERS or NYCTRS, a TIAA-CREF retirement fund is set up for you. This benefit is in addition to the monthly income cash benefit.

c. A Longer Benefit Payment Period Benefits are extended to age 65. If disability occurs after age 60, the duration of benefits will continue as under the Basic plan.

d. Minimum Benefit Payment The optional plan offers a minimum TIAA benefit of $100 a month, even if your disability income from other sources equals or exceeds your monthly calculated income benefit.

Restrictions

If you become disabled during your first year of coverage due to a pre-existing condition, the disability is not covered by the Plan. After your insurance has been in effect for a full year, you are covered for any disability, including one resulting from a pre-existing condition.

Conversion

Both Basic Disability and Optional Disability Insurance terminates at termination of your employment or at your retirement.

• Major Medical Supplements

  CIGNA Major Medical Supplement to GHI/CBP Coverage

  The CIGNA Major Medical Supplement is designed to provide additional protection against the extraordinary cost of a serious or long-term illness not covered by your GHI/CBP allowances.

  Eligibility

  You and your dependents are eligible for this coverage if you are:

  a) An active full-time member of the City University Instructional staff and

  b) Covered by the GHI/CBP Plan or

  c) A retiree and Medicare is not your (or your dependent’s) primary coverage.

  Enrollment

  If eligible, you and your dependents will automatically be enrolled in the CIGNA Major Medical coverage.

  Deductible

  The deductible is $500 for an individual plan and $1,000 for a family plan for those who purchase the Optional Rider through GHI; $2,000 for an individual plan and $4,000 for a family plan for those who do not purchase the Optional Rider. Benefits will be paid for up to 80% of the remaining covered expenses. Once the total out-of-pocket expenses reach $3,000 for an individual or $4,000 for a family, benefits will be paid for up to 100% of the remaining covered expenses.

• Long Term Care Plans

  These plans provide services ranging from nursing home care to custodial care at home, including help with daily activities such as eating and dressing, to professional attention, such as skilled nursing care. They also include services offered through adult day health care programs and other community agencies. The plans are designed to help you safeguard financial assets and plan for the future by providing financial protection against the devastating cost of long term care.

  Long Term Care provides benefits when you are unable to care for yourself because of a chronic illness, severe physical impairment or disease that lasts a long time, the normal aging process, or because of a cognitive impairment, such as Alzheimer’s disease or senile dementia, which requires constant supervision.

  Eligibility

  As a full time member or a retired member of the Instructional staff you may enroll in a LTC plan. Your spouse or domestic partner, parents and parents-in law may also be covered whether or not you enroll.

  Enrollment

  In order to qualify for coverage, each applicant must complete a medical questionnaire.
  You may enroll in one of the following contributory plans:

  1. CNA Group Long-Term Care Insurance Program (offered by the City of New York). You may pay for these premiums through payroll deductions.

  2. John Hancock Mutual Life Insurance Company (offered by the PSC-CUNY Welfare Fund). You may pay for these premiums through payroll deductions

  3. New York State United Teachers’ Long Term Care Program. You may pay for these premiums through payroll deductions if you are a member of the PSC-CUNY union.

  4. TIAA-CREF. You must pay for these premiums through direct pay.

  Premium

  Premiums are determined by the age at initial enrollment and the benefit level you choose.

• Catastrophe Major Medical Insurance Plan (Marsh Affinity) $2,000,000

  The Catastrophe Major Medical Insurance Plan has been designed to supplement your basic policy and help pick up eligible expenses not covered by the various NYCHBP, any other major medical, and hospitalization plans. These plans may provide adequate health insurance protection, but may limit benefits on a yearly basis and may limit benefits again as to covered charges.

  Eligibility

  You, your spouse or domestic partner, and dependent children from birth to 21 years of age (27 if attending school full time), are eligible, provided you and your eligible dependents are covered under a basic health plan.

  Deductible

  There is a $10,000 deductible (or the amount paid by your basic health insurance if higher). When insured, usual and customary eligible expenses count toward your deductible in full. Even those eligible expenses paid for by your basic health insurance policy as well as those paid out of your own pocket count toward meeting your deductible.

  Enrollment

  To enroll yourself and your dependents, complete the application form, and return to Seabury-Smith.

  Effective Date

  As long as each person applying meets eligibility requirements, pays the premium, and has not during the five (5) years immediately prior to completing the application been treated for, or diagnosed as having, heart disease, kidney disease, internal cancer, any immune disorder, AIDS or AIDS-Related Complex (ARC), diabetes, neurological disease, mental or nervous dysfunction, alcohol or drug dependency, coverage will be effective the 15th of the month following receipt and acceptance of the written application and applicable premium, through payroll deduction, or direct payment.

  Premium

  The premium for this plan is based upon your age at enrollment and may be paid through payroll deductions.

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Flexible Spending Accounts are available for two types of expense, health and dependent care. They are funded through pre-tax payroll deductions, thereby reducing your taxable income. The Health Care Flexible Spending Account (HCFSA) helps you pay for health-related expenses not paid by your health, dental or vision insurance. The Dependent Care Assistance Program (DeCAP) Spending Account provides the opportunity for you to use tax-free dollars to pay for the expenses to care for your children or other dependents while you and your spouse work (or go to school full-time). For the HCFSA you must provide documentation that the service was not covered through another source, i.e., Explanation of Benefits (E.O.B.) from the plan.

• Eligibility

  You are eligible to participate in the HCFSA and DeCAP programs if you are eligible for health coverage under the NYCHBP.

  Enrollment

  To participate in either or both spending account programs, you must complete and return an Enrollment/Change Form.

  Effective Date of Coverage

  The period of coverage for these spending account programs is the tax or calendar year. For the Plan Year, the period of coverage is from January 1st through December 31st. Newly eligible employees may participate as soon as they become eligible for health benefits. To participate, you must submit an Enrollment/Change Form within thirty (30) days of becoming eligible for these spending account programs. Contributions will be prorated over the remaining pay periods. Enrollment is not automatic from year to year. You must re-enroll each year during the annual enrollment period. Elections will be effective January 1st or the date of your first deduction if you become eligible after the beginning of the Plan Year.

  Forfeiture Rules

  Federal regulations require that you use the entire amount in each of your accounts by the end of each Plan Year (December 31st). You have until February 28th (for HCFSA) and January 31st (for DeCAP) of the next year to submit any claims incurred during the prior Plan Year in which you were a participant. If you do not use the entire amount you
  allocate to each of your accounts, you forfeit the unused balance. This is often referred to as the “Use It or Lose It” rule. Note: You should also be aware that if you participate in both spending account programs, the amount you allocate to one account cannot be transferred to the other.

  Coordination of Benefits (COB)

  You may be covered by two or more group health benefit plans, which may provide similar benefits. Should you have services covered by more than one plan, your plan through the NYCHBP will coordinate benefit payments with the other plan. One plan will pay its full benefit as a primary insurer, and the other plan will pay secondary benefits. This prevents duplicate payments and overpayments. In no event shall payments exceed 100% of a charge. The NYCHBP follows certain rules, which have been established to determine which plan is primary; these rules apply whether or not you make a claim under both plans.

  Rules of Coordination

  The rules for determining primary and secondary benefits are as follows:

  1. The plan covering you as an employee is primary before a plan covering you as a dependent.

  2. When two plans cover the same child as a dependent, the child’s coverage will be as follows:

  • The plan of the parent whose birthday falls earlier in the year provides primary coverage.

  • If both parents have the same birthday, the plan, which has been in effect the longest is primary.

  • If the other plan has a gender rule (stating that the plan covering a dependent of a male employee is primary before a plan covering a dependent of a female employee), the rule of the other plan will determine which plan will cover the child.

  3. If no other criteria apply, the plan covering you the longest is primary. However, the plan covering you as a laid-off or retired employee, or as a dependent of such a person, is secondary, and the plan covering you as an active employee, or as a dependent of such a person, is primary, as long as the other plan has a COB provision similar to this one.

• Special Rules for Dependents of Separated or Divorced Parents

  If two or more plans cover a dependent child of divorced or separated parents, benefits are to be determined in the following order:

  1. The plan of the parent who has custody of the child is primary.

  2. If the parent with custody of a dependent child remarries, that parent’s plan is primary. The stepparent’s plan is secondary and the plan covering the parent without custody is tertiary (third).

  3. If the specific decree of the court states one parent is responsible for the health care of the child, the benefits of that parent’s plan are determined first. You must provide the appropriate plan with a copy of the portion of the court order showing responsibility for health care expenses of the child.

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• Coverage terminates:

  •For you and your covered dependents, when you stop receiving a paycheck, except when you are eligible for:

  a) Special Leave of Absence Coverage (SLOAC) as a result of your temporary disability or illness; or

  b) Family and Medical Leave Act (FMLA) which entitles you to twelve (12) weeks of leave in a 12-month period to care for a dependent child, a covered family member, a domestic partner, a child of a domestic partner and/or for your own serious illness.

  • For a spouse, when divorced from you or a retiree.

  • For a domestic partner, when partnership terminates.

  • For a child, upon marriage or reaching an ineligible age, except for unmarried dependent full-time students who are covered on most plans up to age 23 or 25.

  • For all dependents, unless otherwise eligible, when you die.

• HIPAA

  The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that the plan administrator issue certificates of group health plan coverage to employees upon termination of employment which results in the termination of group health coverage. Beginning June 1, 1997, and thereafter, each individual, upon termination, will receive a certificate of creditable coverage from the plan administrator. This certificate provides the necessary information to certify coverage that will be credited against any pre-existing condition exclusion period provided under a new health plan.

• COBRA Continuation of Benefits

  The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that the City offer employees, retirees and their families the opportunity to continue group health and/or welfare fund coverage in certain instances where the coverage would otherwise terminate.
  The monthly premium will be 102% of the group rate (or 150% of the group rate for the 19th through 29th months in cases of total disability). All group health benefits, including Optional Riders and Welfare Fund health benefits, are available.
  The maximum period of coverage is 18, 29, or 36 months depending on the reason for continuation.

  Eligibility

  If you are not eligible for Medicare
  You are eligible for continuation under COBRA if your health and welfare fund coverage is terminated due to a reduction in hours of employment or termination of employment (for reasons other than gross misconduct). Termination of employment includes unpaid leave of absence of any kind.

  If you are Medicare eligible
  If you have lost coverage because of termination of employment or reduction in your hours you are eligible under the City’s Medicare-supplemental plans for up to 18 months after the qualifying event, or—in the case of loss of coverage for all other reasons—up to 36 months. (Medicare eligible family members are also included).

  Spouses/Domestic Partners Not Eligible for Medicare
  Spouses/Domestic Partners of employees or retirees have the right to choose continuation of coverage if they lose coverage for any of the following reasons:
  

  1. Your death as an employee or retiree;

  2. Termination of your employment (for reasons other than gross misconduct);

  3. Loss of health coverage due to a reduction in your hours of employment;

  4. Divorce from you as an employee or a retiree;

  5. Termination of domestic partnership with you as an employee or a retiree;

  6. Your retirement, when you are not eligible for retiree health insurance.
  

  Dependent Children not Eligible for Medicare
  Dependent children of employees or retirees have the right to continue coverage if coverage is lost for any of the following reasons:

  1. Death of a covered parent;

  2. The termination of a covered parent’s employment (for reasons other than gross misconduct);

  3. Loss of health coverage due to the covered parent’s reduction in hours of employment;

  4. The dependent ceases to be a “dependent child” under the terms of the NYCHBP; or

  5. Retirement of the covered parent.

  Note: Individuals covered under another group plan are not eligible for COBRA continuation of benefits unless the other group plan contains a pre-existing condition exclusion. However, these individuals may be able to purchase certain welfare fund benefits.

  Periods of Continuation
  Continuation of coverage for the former employee, retiree, family, or individual dependent as a result of termination of employment (for reasons other than gross misconduct), reduction of work schedule, or loss of welfare fund benefits due to retirement is available for a maximum period of 18 months. This period will be measured from the date of loss of coverage.
  If you are totally disabled on the date of termination from employment or reduction of hours, continuation of coverage for you and your eligible dependents may be extended from 18 to 29 months. The monthly premium for the 19th through 29th month will be 150% of the group rate. To qualify for 29 months of COBRA continuation of coverage, Social Security must determine that you are totally disabled. If Social Security later determines that you are no longer totally disabled, COBRA continuation of coverage may terminate before the end of the 29th month.
  Continuation of coverage for your spouse/domestic partner or dependents as a result of your death, divorce, domestic partnership termination, or loss of coverage due to medicare-eligibility, or loss of dependent child status, is available for a maximum of 36 months.
  Continuation of coverage can never exceed 36 months in total, regardless of the number of events, which relate to a loss in coverage. Coverage during the continuation period will terminate if the enrolled fails to make timely premium payments or becomes enrolled in another group health plan (unless the new plan contains a pre-existing condition exclusion).

  Notification Responsibilities
  Under the law, you or a family member have the responsibility of notifying the College Payroll or Human Resources Office and the applicable welfare fund within 60 days of your death, divorce, domestic partnership termination, or your change of address, or of a child’s losing dependent status. Retirees and/or family members must notify the NYCHBP and the applicable welfare fund within 60 days in the case of death of the retiree or the occurrence of any of the events mentioned above. If you are totally disabled (as determined by Social Security) on the date of termination of employment or reduction of hours, you must notify your health plan of the disability. The notice must be provided within 60 days of Social Security’s determination and before the end of the 18-month continuation period. If Social Security subsequently determines that you are no longer disabled, you must also notify the health plan of this. This notice must be provided within 30 days from Social Security’s final determination. When the qualifying event (such as your death, termination of employment, or reduction in hours) occurs, you or your family will receive a COBRA information packet from the College describing continuation overage options.

  Election of COBRA Continuation
  To elect COBRA continuation of health coverage, the eligible person must complete a “COBRA - Continuation of Coverage Application.” Employees and/or eligible family members can obtain application forms from the College Human Resources Office. As a retiree, your eligible family members can obtain application forms by contacting the NYCHBP and the Welfare Fund.
  Eligible persons electing COBRA continuation coverage must do so within 60 days of the date on which they receive notification of their rights, and must pay the initial premium within 45 days of their election. Premium payments will be made on a monthly basis. Payments after the initial payment will have a 30-day grace period.

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New York State law mandates participation in a retirement system. As a new staff member you have 30 days from your appointment date to choose a retirement program, and the choice is irrevocable. If no choice is filed within 30 days, the law mandates that you be assigned to The Teachers’ Retirement System of the City of New York.
You may choose between The Teachers’ Retirement System of the City of New York (TRS) , or the Optional Retirement Program (ORP) presently administered by Teachers Insurance and Annuity Association of America - College Retirement Equities Fund (TIAA-CREF).
If you are already a member of the TRS, the Board of Education Retirement System (BOERS) or the New York City Employees’ Retirement System (ERS), you may remain in that program. If you were recently appointed to an Instructional staff title and were previously a member of BOERS or ERS and you wish to remain a member, you must file an application for Transfer Contributor status within
30 days of your appointment.
New Instructional staff who are members of ERS and are on a leave of absence from a civil service position must remain in ERS until they have relinquished their leave, generally upon attainment of 13.3b status in the Instructional staff position. Once this status is attained, you have sixty (60) days to elect to remain in ERS, transfer to TRS or elect membership in the ORP.
If you are retired and receiving a pension from New York State or any of its political subdivisions, you may obtain approval to work without affecting your pension, but you cannot participate in our pension
program. You must file for a waiver under sections 211 and/or 212 of the Retirement and Social Security Law. Please note that there are earnings limitations under these circumstances. Consult your College Human Resources Office for further information.
If you are a substitute Instructional staff member, you are eligible to participate in the ORP (TIAA-CREF) only, due to vesting requirements.

• The Teachers' Retirement System of the City of New York (TRS):

  Type of Plan – Defined Benefit Plan:
  Benefits are based on age, final average salary (FAS) and years of service credit.

  Vesting Five (5) years

  Retirement Eligibility If you are an inservice member who is at least age 55
  and has completed at least five years of membership service, you would be eligible to receive immediate payment of a retirement allowance. A member who separates from service before age 55
  with at least five years of membership service would be eligible to receive a retirement allowance upon reaching age 55. If you are a Tier I, as described below, you may retire before age 55 if you have 30 years or more of service credit but you will receive an actuarially reduced benefit. If you are a Tier II, III or IV member as described below, and you retire before age 62 with less than 30 years of service credit, you will receive an actuarially reduced benefit.

  Contribution Rates In general, you qualify for Tier I status if you last joined TRS before July 1, 1973; for Tier II if you last joined after June 30, 1973 and before July 27, 1976; for Tier III if you joined after July 26, 1976 and before September 1, 1983; for Tier IV if you last joined after August 31, 1983. Contributions for Tier I and II are based on factors such as your age and credited prior service. If you are a Tier III or IV member with less than 10 years of membership or credited service, you must contribute 3% of your gross pay to TRS’ Qualified Pension Plan (QPP) until you have attained at least 10 years of membership or credited service. [Please note that on October 1, 2000 the Benefit Enhancement Law (Chapter 126 of the Laws of 2000) was passed that provided for the stopping of member contributions after 10 years of membership or credited service. For members not covered by a collective bargaining agreement, implementation of this provision was also October 1, 2000. For members covered by a collective bargaining agreement, the implementation date is contingent upon the ratification of a new collective bargaining agreement. However, the implementation will be retroactive to October 1, 2000.]

  Retirement Allowance If you are a Tier I member who has served at least three years in the position from which you are retiring, your FAS would generally be the actual gross salary earnable during the 12 months prior to your retirement. If you are a Tier II or III/IV member, your Final Average Salary (FAS) is generally the average of your highest three consecutive salaries. Calculation methods are as follows:

  For eligible Tier I Plan A members: 50% of your FAS for your first 20 years of qualifying service, provided you meet your minimum accumulation; 1.2% of your FAS for each additional year of credited service rendered before July 1, 1970 but prior to your 20-year date; 1.7% % of your FAS for each additional year of credited service; an amount based on any ITHP accumulations in excess of those required to fund the full benefit; and an amount based on any Annuity Savings Fund (ASF) balance that is in excess of the minimum accumulation.
  For eligible Tier I Plan B members: 1.2% of your FAS for each year of credited service rendered prior to July 1, 1970; 1.53% of your FAS for each year of credited service rendered after June 30, 1970; and an annuity based on the balance of your ASF and ITHP as of your retirement date. For eligible Tier II Plan C members: 50% of your FAS for your first 20 years of credited service, provided you meet your minimum accumulation; 1.7% of your FAS for each year of credited service; an amount based on any ITHP accumulations in excess of those required to fund the full benefit; and an amount based on your ASF balance that is in excess of the minimum accumulation.
  For eligible Tier II Plan D members: 1.2% of your FAS for each year of credited service rendered before July 1, 1970; 1.53% of your FAS for each year of credited service rendered after June 30, 1970; an amount based on your ITHP; and ASF balances.
  For Tier III/IV members, the calculation method are as follows: 1 2/3% multiplied
  by years of service credit for members with fewer than 20 years of service credit; or 2% of FAS multiplied by years of service credit for members with 20-29 years of service credit; or 60% of FAS for Tier III members with 30 years or more of service credit; or 60% of FAS for first 30 years of service credit + 11/2% of FAS multiplied by years of service credit exceeding 30 years for Tier IV members.

  Tax-Deferred Annuity (TDA) TRS’ Tax  Deferred Annuity (TDA) Program is an optional Section 403(b) investment program that provides you with a convenient and flexible way to accumulate personal investments for your retirement. You may designate a contribution rate (within Internal Revenue Service limits) and make changes to that amount at any time during the year. You may invest your TDA funds in any combination of
  three investment programs and may change your investment elections on a quarterly basis during the designated filing periods. You may enroll in ONE tax deferred annuity program only.

  Disability Benefits You are eligible to retire with disability benefits if you have 10 or more years of service credit and are physically or mentally incapable of performing work duties. However, there is no minimum service requirement if you are disabled as a natural and proximate result of an accident that was sustained in the performance of duties in active service and that was not caused by your negligence. You must file the applicable disability retirement application: a “Tier I Ordinary Disability Retirement Application (code OD1), a “Tier II Ordinary Disability Retirement Application” (code OD2), a “Tier III Ordinary Disability Retirement Application” (code OD3), a “Tier I Accident Disability Retirement Application (code AD1), a “Tier II Accident Disability Retirement Application” (code AD2), a “Tier III Accident Disability Retirement Application” (code AD3) or a “Tier IV
  Disability Retirement Application”
  (code OD4).

  Death Benefit If a Tier I in-service member dies before becoming eligible for retirement, the death benefit would equal the member’s Annuity Savings Fund (ASF) balance, ITHP balance, and an amount based on their salary and years of service credit. If the member is eligible for a service retirement at the time of death, or dies within the first 30 days after retiring, the death benefit would be the greater of the amount previously mentioned or a benefit based on the reserves that would have been payable under Option I modified had the member retired on the day before s(he) died. If a Tier II, III, or IV member dies while in service and is credited with at least one year of service since last joining TRS, the member’s designated beneficiary can apply to receive Ordinary Death Benefits. The death benefit would equal the balance in the member’s ASF (for Tier II members) or MCAF and ASAF (for III and IV members), plus the amount of either Death Benefit #1 or Death Benefit #2 as applicable.

  Portability As a TRS member you may transfer your membership to any eligible New York State or New York City public retirement system. Tier I/II members who separate from service may elect to withdraw their ASF funds. Tier III/IV members who separate from service with fewer than 10 years of service credit may elect to withdraw their MCAF and ASAF funds. In either case, doing so would terminate their TRS membership.

  Loans If you are a Tier I/II member, you become eligible for a Qualified Pension Plan (QPP) loan after three years of membership. If you are a Tier III/IV member, you may qualify for a QPP loan
  after one year of membership. All members enrolled in the TDA Program become eligible for a TDA loan after one year of participation.

  Retiree Health Benefits You are eligible for health coverage and you may enroll in the NYCHBP when you retire if you meet all of the following criteria:

  a. You have, at the time of retirement, the appropriate years of credited service as a member of a retirement or pension system maintained by the City of New York (this requirement does not apply if you retire because of accidental disability); and

  b. You have been employed by the City immediately prior to retirement, as a member of such system, and have worked regularly for at least 20 hours per week; and

c. You receive a pension check from a New York City retirement system.

Please verify your eligibility for health insurance as a retiree with your College Human Resources Office.

• The Optional Retirement Program (ORP)
  Teachers Insurance and Annuity Association
  - College Retirement Equities Fund (TIAA-CREF) is the Funding Vehicle for the ORP.

  Type of Plan - Defined Contribution Plan:
  Benefits are based on the amounts contributed by the employer and the employee and the investment experience.

  Vesting Vesting occurs after the completion of the first 366 days of continuous employment as an Instructional staff member. Once vested, retroactive contributions from the date of appointment as an Instructional staff member will be made. Vesting and participation will be immediate if an employee has a preexisting open TIAA-CREF Retirement Annuity (RA) contract.

  Retirement Age Minimum: None to collect retirement income. However a minimum retirement age may affect eligibility for other benefits. Note that if you separate from service and begin retirement income, Section 150 of the Civil Service Law of New York does not allow you to participate in the retirement plan if you are subsequently re-hired. Moreover, you are able to work (rehired after retirement) and earn a salary if you have a 211 or 212 waiver.

  Contribution Rates Tier 1 (appointed before June 30, 1973) and Tier II (appointed between July 1, 1973 and July 26, 1976) members: You are required to contribute 1.5% of your NET pay to your account at TIAA-CREF. CUNY contributes an amount equal to 10.5% of your salary for the first $16,500 earned per year, plus an amount equal to 13.5% of your salary earned in excess of $16,500 per year. Tier III (appointed between July 27, 1976 and August 31, 1983): and Tier IV (appointed between September 1, 1983 and July 16, 1992) members: You are required to contribute 1.5% of your GROSS pay to your account at TIAA-CREF. CUNY contributes an amount equal to 10.5% of your salary for the first $16,500 earned per year, plus an amount equal to 13.5% of your salary earned in excess of $16,500 per year. Tier V (appointed after July 16, 1992) members: You are required to contribute 3% of your GROSS pay to your account at TIAA-CREF. CUNY contributes an amount equal to 8% of your yearly salary to this account. Once you have reached 7 years of employment as an Instructional Staff Member, CUNY will contribute an amount equal to 10% of your yearly salary thereafter. Earnings in an adjunct/ hourly Instructional staff position held
  by a full-time Instructional staff member, who is a member of TIAA-CREF, are pensionable.

  Tier Reinstatement You may be eligible for Tier reinstatement if you have had prior service with the University. At the time of your reappointment, please provide your Human Resources Office with information regarding your prior membership in TIAA-CREF through your CUNY service so that a determination can be made regarding your Tier level.

  Retirement Allowance Retirement benefits are based on your annuity accumulations, age at retirement, and the income option you select.

  Tax-Deferred Annuity You may participate in a tax-deferred annuity program, which allows you to set aside pre-tax dollars subject to IRS limits. Those with 15+ years of service with CUNY may be eligible for catch-up contributions not to exceed a $15,000 lifetime maximum. Community College employees are also eligible to enroll in the City’s 401(k) plan. However, the above mentioned 15-year catch-up is not available to 401(k) plan participants. Effective January 1, 2002, those age 50
  and over may be eligible to make additional pre-tax contributions. You may be limited in enrolling with more than ONE 403(b) Funding Vehicle at a time for your tax deferred annuity program. For more information, please contact your College Human Resources Office. Disability Benefits Member may choose to retire and begin annuity income, or can elect to receive distributions from an array of alternate payment options, at any time. Disability income will be offset by these payments (see Disabi