Health Benefits and Eligibility

Health Benefits are provided through the City of New York Health Benefits Program (NYCHBP). You are eligible for enrollment if you work on a regular schedule at least 20 hours per week, and your appointment is expected to last for more than six months.

EFFECTIVE DATES OF COVERAGE

The effective date of coverage is based on your type of appointment.

Full-time instructional members, employees appointed from Civil Service lists, exempt employees, and those non-competitive employees for whom there is an experience or education requirement, coverage begins on their appointment date, provided your health Benefits Applications has been received by the Personnel Office within 31 days of that date.

For provisional employees, temporary employees, and those non-competitive employees for whom there is no experience or education requirement for employment, coverage begins on the first day of the pay period following the completion of 90 days, provided your health Benefits Applications has been received by the Personnel Office within 31 days of that date.

ELIGIBLE DEPENDENTS

  1. A legally married husband or wife, but never an ex-spouse.
  2. A domestic partner provided supported documentation is provided to Office of Personnel. Please refer to the Information packet for CUNY Employees and Retirees with a Domestic Partner (PDF).
  3. Unmarried children under age 19. Coverage will terminate for children reaching 19 at the end of the payroll period during which the age of 19 was attained.
  4. Unmarried dependent children between 19 and 23 who are full-time students at an accredited degree-granting educational institution. Coverage terminates when the student graduates or ceases to be a bull-time student or on December 31 of the year of the student’s 23rd birthday, whichever is earlier.

ENROLLMENT FORM (PDF)

HEALTH PLAN AND RATES

SUMMARY PLAN DESCRIPTION (PDF)
(For detailed information about plan models, special rules, eligibility, dependent coverage, qualifying events, buy-out waiver, termination and reinstatement of benefits and transfer period, please download or read the Summary Plan Description) or contact Ysabel Macea, Benefits Officer, at 718 281-5027 or e-mail at Ymacea@qcc.cuny.edu. You can also visit the New York City Health Plan Program at www.nyc.gov/html/olr

HEALTH BENEFITS BUY OUT WAIVER PROGRAM

If you choose not to join a health insurance program, you must complete a waiver form. Under certain conditions you may be eligible to a cash incentive payment when you waive health benefits. If you have City coverage thorough another agency the incentive does not apply. The incentive for individual coverage is $500 per year and $1,000 per year for family coverage, paid in two installments. Proof of health care coverage and family status are required.

For plan details, please visit:
www.nyc.gov/html/olr/html/flex_spending/msc_health_plan_details.shtml

For enrollment forms, please visit:

http://www.nyc.gov/html/olr/downloads/pdf/fsa/2011_MSCBOfrm.pdf

http://www.nyc.gov/html/olr/downloads/pdf/healthb/erbapp.pdf

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BASIC HEALTH PLAN MODELS

Eligible employees may choose from several health plans.
There is no cost for basic coverage under DC37 Med-Team, GHI-CBP/Empire Blue Cross BlueShield, and HIP HMO. Other plans require a payroll or pension deduction. You may purchase additional benefits through Optional Riders at a cost. The health plan models available to you as an active employee are:

Health Maintenance Organizations (HMO)

A system of healthcare that provides managed, pre-paid hospital and medical services to its members. An HMO member chooses a Primary Care Physician (PCP) from within the HMO network. The PCP manages all medical services, provides referrals and is responsible for non-emergency admissions. Members are subject to a co-payment. There are usually no deductibles to meet or claim forms to file. If a physician outside of the health plan is used without a referral from the PCP, the member is responsible for all bills incurred. HMO Health Plans presently offered are Aetna HMO, CIGNA Healthcare, GHI HMO, Empire HMO New York, Healthnet, HIP Prime HMO, and Vytra Health Plans.

The following services are provided from participating providers only:

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Preferred Provider Organization (PPO)

Offers the freedom to use either a network provider or an out-of-network provider for
medical and hospital care. Participating plans contract with health care providers who
agree to accept a negotiated lower payment for the health plan, with co-payments from the member as payment in full for medical services. When using non-participating providers, the member is subject to deductibles and/or coinsurance. PPO Health Plans presently offered is the Group Health Incorporated-Comprehensive Benefits Plan/Empire Blue Cross Blue Shield (GHI-CBP/EBCBS). GHI-CBP/Empire BlueCross members may receive additional benefits by purchasing the optional riders indicated below. If you opt to enroll in the riders, you must purchase both.:

 

  1. Outpatient mental health and inpatient chemical dependency treatment – provides additional outpatient psychiatric and inpatient chemical dependency treatment services.
  2. Enhanced NYC non-participating provider reimbursement schedule – provides increased reimbursement, for certain services, of the basic GHI’s non-participating provider fee schedule.

Exclusive Provider Organization (EPO)

Offers a higher level of choice and flexibility than many other managed care plans.
Members can see any EPO network provider. There is no need to choose a PCP and no
referrals are necessary to see a specialist. There are no claim forms to file and members
will never have to pay more than the co-payment for covered services. There is no out-of network coverage. The EPO Health Plan presently offered is the Empire EPO.

Point-of-Service (POS)

Offers the freedom to use either a network or an out-of-network provider for medical and hospital care. When using network providers, health care delivery resembles that of a traditional HMO. When using out-of-network providers, healthcare delivery resembles that of a traditional indemnity plan, subject to deductibles and/or coinsurance. POS Health Plans presently offered are Aetna QPOS, and HIP Prime POS.

The following services are provided both in-and out-of-network for the PPO, EPO & POS:

  • Physician’s Office Visits Prescription Drug Coverage (Optional Rider)
  • Outpatient Diagnostic Tests (X-rays, labs, etc.)
  • Mental Health (Inpatient/Outpatient Care)
  • Inpatient Hospital Care (Includes Maternity Care)
  • Substance Abuse (Inpatient/Outpatient Care)
  • Maternity Care (Mother and Newborn)
  • Chemical Dependency (Inpatient/Outpatient Care)
  • Emergency Room Care.

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HEALTH PLANS CONTACT INFORMATION

Aetna HMO 1 800 445-8742 Health Plan offered by NYCHBP www.aetna.com

Cigna Healthcare 1 800 832-3211 Health Plan offered by NYCHBP www.cigna.com

Empire BCBS 1 800 433-9592 For GHI-CBP Members Only www.empireblue.com/nyc

Empire EPO & Empire HMO 1 800 767-8672 Health Plan offered by NYCHBP www.empireblue.com/nyc

GHI HMO 1 877 244-4466 Health Plan offered by NYCHBP www.ghi.com

Group Health Incorporated
(GHI/CBP) 1 212 501-4444 Health Plan offered by NYCHBP www.ghi.com

Healthnet 1 800 441-5741 Health Plan offered by NYCHBP www.healthnet.com

HIP Prime POS & HIP Prime HMO
1 800 HIP-TALK
1 800 447-6929 Health Plan offered by NYCHBP www.hipusa.com

Vytra Health Plan 1 800 448-2527 Health Plan offered by NYCHBP www.vytra.com

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