1. The City University of New York NYS HEALTH INSURANCE PROGRAM NYSHIP Student Employee Health Plan (SEHP) Office of Human Resources Management University Benefits

2. Updated 12/10/09The University Benefits Office2 ELIGIBILITY TO BE ELIGIBLE FOR NYSHIP BENEFITS YOU MUST MEET ALL OF THE FOLLOWING CRITERIA: Enrolled in a Doctoral Program at the CUNY Graduate Center or the Engineering Ph.D. Program at City College AND Appointed to an eligible title at a Senior College (Graduate Assistant A, B, C, Adjunct Instructor, Adjunct Lecturer, Adjunct College Laboratory Technician And Non- Teaching Adjunct I, II) AND Make a minimum $4,122 per year or $2,061 per semester

3. Updated 12/10/09The University Benefits Office3 ENROLLMENT Complete the Health Benefits Enrollment Form (PS-404G) and submit it along with supporting documentation to: For students at the CUNY Graduate Center: Scott Voorhees – Office of Student Affairs, Room 7301 Phone number 212.817.7406 For students at City College: Kim Ferguson - Benefit Officer, Shepard Hall Room 50 Phone number 212.650.7963 NOTE: Refer to the “SEPH Eligibility Requirements” sheet for list of required documentation: www.cuny.edu/doctoralstudenthealthplan

4. Updated 12/10/09The University Benefits Office4 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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7. Updated 12/10/09The University Benefits Office7 EFFECTIVE DATE OF COVERAGE Coverage for you and your eligible dependents will be effective on the date of your appointment Note: 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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9. Updated 12/10/09The University Benefits Office9 INSURANCE CARDS You should expect to receive your insurance card within 3-4 weeks following your enrollment You will receive 3 cards separately by mail:  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 212-794-5342 if you need to obtain your NYSHIP card number.

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12. Updated 12/10/09The University Benefits Office12 ELIGIBLE DEPENDENTS Spouse Domestic Partner Dependent Children - Up to age 19 (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 [Parents are not considered eligible dependents]

13. Updated 12/10/09The University Benefits Office13 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

14. Updated 12/10/09The University Benefits Office14 NYSHIP BIWEEKLY PREMIUM RATES [AS OF JANUARY 2010] INDIVIDUAL - $6.32 PER PAY PERIOD FAMILY - $47.36 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

15. Updated 12/10/09The University Benefits Office15 CHANGES TO COVERAGE You may make changes to your coverage:  Within 30 days of a Qualifying Event  During the Annual Open Enrollment Period

16. Updated 12/10/09The University Benefits Office16 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

17. Updated 12/10/09The University Benefits Office17 ANNUAL OPEN ENROLLMENT PERIOD Generally held in November. For calendar year 2009 it is November 1st - November 30th. During the annual open enrollment period you may:  Enroll in health benefits  Change from individual to family coverage  Change from family to individual coverage  Add eligible dependents without 30-day waiting period

18. Updated 12/10/09The University Benefits Office18 CHANGES TO TAX STATUS FOR PREMIUM DEDUCTION OPTION TRANSFER PERIOD Generally held in November For calendar year 2009 it is November 1 st - November 30 th You may change from pre-tax to post tax status You may change from post-tax to pre-tax status

19. Updated 12/10/09The University Benefits Office19 TERMINATION OF COVERAGE Coverage will cease when you no longer meet both of the requirements indicated below: 1. Enrolled in a Doctoral Program at the CUNY Graduate Center or in the Engineering Ph.D. Program at City College AND 2. Appointed in an eligible title (Graduate Assistant A, B, C, Adjunct Instructor, Adjunct Lecturer, Adjunct College Laboratory Technician And Non- Teaching Adjunct I, II)

20. Updated 12/10/09The University Benefits Office20 TERMINATION OF COVERAGE… ( Cont’d) Coverage will terminate two pay periods following your graduation, leave from the doctoral program or appointment end date, which ever comes first. 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.

21. Updated 12/10/09The University Benefits Office21 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.

22. Updated 12/10/09The University Benefits Office22 COBRA APPLICATION Complete and return the COBRA enrollment application to the address indicated on the COBRA application form on a timely basis NOTE: Effective January 2010 dependent child coverage is extended through age 29

23. Updated 12/10/09The University Benefits Office23 COBRA MONTHLY PREMIUM RATES [AS OF OCTOBER 2009] INDIVIDUAL - $120.43 FAMILY - $514.59  You will receive a monthly bill from the NYS Department of Civil Service for your COBRA premium payments  You may be eligible for The American Recovery and Reinvestment Act of 2009 – The ARRA provides for COBRA premium assistance for you and your covered dependents who have a continuation of coverage election opportunity related to an involuntary termination of employment that occurred during the period September 1, 2008 through February 28, 2010

24. Updated 12/10/09The University Benefits Office24 DEPENDENT CHILD ELIGIBILITY A recently enacted NYS Law has extended dependent child eligibility through age 29 Coverage for young adults dependents will be “COBRA-like”:  Charged at the Full Share Individual Rate  Each dependent will enroll in their own individual policy

25. Updated 12/10/09The University Benefits Office25 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

26. Updated 12/10/09The University Benefits Office26 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

27. Updated 12/10/09The University Benefits Office27 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

28. Updated 12/10/09The University Benefits Office28 If you are working at a CUNY Community College, contact the Student Affairs Office at the Graduate Center to be transferred to the Graduate Center payroll COMMUNITY COLLEGES

29. Updated 12/10/09The University Benefits Office29 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

30. Updated 12/10/09The University Benefits Office30 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 2010 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

31. Updated 12/10/09The University Benefits Office31 CONTACTS Scott Voorhees – Office of Student Affairs, Room 7301, Phone number 212.817.7406 Kim Ferguson – City College Benefit Officer, Shepard Hall Room 50, Phone number 212.650.7963 You may also contact the University Benefits Office at 212.794.5342 or UniversityBenefits.NYSHIP@MAIL.CUNY.EDU You may contact NYSHIP at 1-877-7-NYHSIP