Medical - PEF | Human Resources

MEDICAL INSURANCE COVERAGE

INSURANCE PLAN OPTIONS	Individual/ Family	Grade 9 & Below Salary Below $49,403	Grade 10 & Above Salary Above $49,403
EMPIRE PLAN (PPO) https://www.empireblue.com/	Individual	$60.07	$80.09
Family	$271.92	$323.33
EMBLEM HEALTH HIP PRIME (HMO) https://www.emblemhealth.com/	Individual	$138.50	$159.17
Family	$364.59	$418.72

Bi-Weekly Premiums

MY NYSHIP

INSURANCE PLAN OPTIONS Individual/
Family
Grade 9 & Below
Salary Below $49,403

Grade 10 & Above
Salary Above $49,403

EMPIRE PLAN (PPO)

https://www.empireblue.com/
Individual
$60.07 $80.09

Family $271.92 $323.33

EMBLEM HEALTH HIP PRIME (HMO)

https://www.emblemhealth.com/
Individual
$138.50 $159.17

Family $364.59 $418.72

ELIGIBILITY

Eligibility

You must work at least 50% effort and be scheduled to work for six consecutive bi-weekly pay periods.

→If your work week is 40 hours, you must work at least 20 hours per week to be eligible for benefits.

→If your work week is 37.5 hours, you must work at least 18.75 hours per week to be eligible for benefits.

Effective Date

APSU & PEF employees have a 28 day wait period from the date of appointment. Coverage is effective on the 29th day and you must enroll within 30 days of your appointment date. If you decline health insurance, you can still enroll in dental and vision benefits.

Cost

See chart above. Elect payroll deductions on a Pre-tax or After-tax basis when filling out the NYS Health Insurance Transaction Form (PS404).

SIGNING UP

New Employee

Submit the NYS Health Insurance Transaction Form (PS- 404) (and the PS-425 Domestic Partner Form if applicable) along with copies of the required proof(s) of eligibility to hrs_benefits@stonybrook.edu within 30 days of being appointed. If you delay in enrolling more than 30 days, you may be subject to a 5 pay period waiting period and your premiums will be deducted on an after tax basis.

Current Employee

To make a change to your current health insurance status visit Need to Make a Change below.

REQUIRED PROOF(S)

Documents & Proofs

For yourself, spouse, and any dependents you would like to enroll, copies of the following must be attached to the NYS Health Insurance Transaction Form (PS-404) and either brought to orientation or sent to hrs_benefits@stonybrook.edu. No substitutions will be allowed and the Department of Civil Service will not accept any enrollment applications without the required documents.

Documents and Proofs

Family Plan Coverage

Who can be covered?

Eligible Dependents:

⇒Spouse/Domestic Partner. For the required domestic partner documents & proofs go here.

⇒Child/Children up until the age of 26 years old (including step children, adopted children and/or children of your domestic partner). Your dependent may be eligible for the Young Adult Option Plan once they reach the maximum age of dependency (age 26).

⇒Disabled Child/Children may be covered beyond 26 years old subject to carrier approval. Additional PS451 - Statement of Disabilityrequired.

⇒Other dependent children may be covered. See NY Statement of Dependencefor additional information.

Young Adult Dependent Coverage

AGES 19 THROUGH 26

HEALTH INSURANCE

Effective January 1, 2011, the new Health Care Reform Act allows young adults ages 19 through 26 to be covered through a parent’s group health insurance policy regardless of their student status.

DENTAL/VISION

The Health Care Reform act only covers Health Insurance not Dental/Vision. In order to continue dental/vision benefits with your union you will need to provide proof of full-time student status for eligible dependents 19 – 25.

MAXIMUM AGE OF DEPENDENCY (AGE 26)

At the end of the month in which your child reaches age 26, they will no longer be dependents under your active employee health plan. Under the new Young Adult Dependent Option, eligible young adults may continue coverage once they reach the maximum age of dependency (age 26). For ore information, go to

Young Adult Dependent Option

NEED TO MAKE A CHANGE?

Option Period

Changes to your health insurance can be made during the Option Period (typically in November or December). Submit the NYS Health Insurance Transaction Form (PS- 404) along with copies of the required proof(s) of eligibility to hrs_benefits@stonybrook.edu during the Option Period.

With Qualifying Event

Or submit the NYS Health Insurance Transaction Form (PS- 404) along with copies of the required proof(s) of eligibility to hrs_benefits@stonybrook.edu within 30 days of experiencing a “qualified event” (i.e. birth of a child, marriage, divorce).

Qualifying Events

Without Qualifying Event

Additional changes may be made without a qualifying event; however, you will be subject to a 5 pay period wait plus after tax premium deductions. Submit the NYS Health Insurance Transaction Form (PS- 404) along with copies of the required proof(s) of eligibility to hrs_benefits@stonybrook.edu.

TRANSFERRING BARGAINING UNITS?

Waiting periods are usually eliminated if you are transferring within SBU so long as there is no break in service. For more information, visit Transferring Bargaining Units.

LEAVING STATE EMPLOYMENT?

COBRA

If you terminate your State employment, your health, dental and vision coverage will remain in effect for 28 days from the end of the pay period in which you leave and then COBRA continuation of benefits will be offered.

For questions, please contact hrs_benefits@stonybrook.edu.

IDENTIFICATION CARDS

When will my ID Card(s) arrive?

You will receive your identification card approximately 6 weeks after a Benefits staff member has processed your NYS Health Insurance Transaction Form.

Can I use my benefits before ID Cards arrive?

If you are enrolled in the Empire Plan, you may contact the Benefits Office at (631) 632-6180 and a staff member will be happy to provide you with the identification card number(s) and effective date. You may bring the card number(s) to the appropriate medical or hospital personnel as necessary.

If you are enrolled in an HMO, you must call the HMO for your card number. The telephone numbers of the individual HMOs are listed in the Summary of Benefits which can be found in your New Employee Orientation Packet or in the Benefits Summaries located on this webpage.

Lost ID Cards?

You can order new insurance cards at MYNYSHIP, a secure website for active, eligible New York State employees to access their health insurance enrollment information. For additional assistance registering, please refer to the MyNYSHIP Guideor call 631-632-6180.

PAYROLL DEDUCTION

When will deductions start?

Please allow two pay periods from the time that you submit your Health Insurance Transaction Form and required proof of eligibility to Benefits. If it has been more than two pay periods you may contact the Benefits Office at (631) 632-6180 and a staff member will be happy to assist you.

Deduction Amount is Wrong?

If the biweekly health insurance deduction on your paycheck is incorrect — e.g., individual coverage but you elected family coverage — or it changed and you did not request any changes — contact the Benefits Office immediately at (631) 632-6180 to speak with a staff member.

Deduction Missing?

If you do not see the health insurance deduction on your paycheck, please allow two pay periods from the time that you submit your Health Insurance Transaction Form and required proof of eligibility to the Benefits Section. If it has been more than two pay periods contact the Benefits Office immediately at (631) 632-6180 to speak with a staff member.