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

Dependents are eligible if their relationship to the eligible participant is one of the following:

  1. A legally married husband or wife, but never an ex-spouse.
  2. A domestic partner at least 18 years of age, living together with the participant in a current continuous and committed relationship, although not related by blood to the participant in a manner that would bar marriage in New York State. More details concerning eligibility and tax consequences are available from your agency or the Office of Labor Relations Domestic Partnership Liaison Unit at 212-306-7605 (employees) or 212-513-0470 (retirees).
  3. Children under age 26 (whether married or unmarried), except as provided below (relating to adult children eligible for other health coverage). Effective July 1, 2011 the term "children" means the following:
    1. natural children;
    2. children for whom a court has accepted a consent to adopt and for the support of whom an employee or retiree has entered into an agreement;
    3. children required to be covered under a qualified medical child support order until the court order expires, at which time the child may continue to be eligible for coverage under (a) or (b) above;
    4. children for whom a court of law has named the employee or retiree as legal guardian;
    5. any other child who lives with an employee or retiree in a regular parent/child relationship and is the employee’s or retiree’s tax dependent. A child is the employee’s or retiree’s tax dependent if the employee or retiree claims the child on his/her income tax return as a dependent.

ENROLLMENT FORM (PDF)

HEALTH PLAN AND RATES

HEALTH BENEFITS 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 http://www1.nyc.gov/site/olr/health/healthhome.page

HEALTH BENEFITS BUY OUT WAIVER PROGRAM

The MSC Health Benefits Buy-Out Waiver Program allows eligible employees who have non-City group health benefits to waive their New York City health benefits in return for an annual cash incentive payment. For questions about the MSC Buy-Out Waiver Program, please call: (212) 306-7507.


About the Incentive Payment

This incentive payment is considered ordinary income and, therefore, is taxable to the recipient.

The annual amount of the incentive payment is:

Plan Year 2016

  • $3,000 to employees with family coverage who waive City health benefits
  • $1,500 to employees with individual coverage who waive City health benefits

For plan details, please visit: http://www1.nyc.gov/site/olr/health/active/health-active-fsa-programs.page

For enrollment forms, please visit: http://www1.nyc.gov/site/olr/fsa/fsa-forms-and-downloads.page

For the incentive payment buy-out form, visit: http://www1.nyc.gov/site/olr/fsa/fsa-msc-buy-out-waiver-home.page

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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

Use the links below to visit your health plan where you will be able to find an in-network doctor, urgent care center, lab or pharmacy.

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