PSCCUNY WELFARE FUND

1 / 31
About This Presentation
Title:

PSCCUNY WELFARE FUND

Description:

Eligible for basic health coverage under the NYC Health Benefits Program ... Persons with : HIP-POS, Aetna QPOS, Aetna HMO, CIGNA or GHI-HMO will be ... – PowerPoint PPT presentation

Number of Views:235
Avg rating:3.0/5.0
Slides: 32
Provided by: media176

less

Transcript and Presenter's Notes

Title: PSCCUNY WELFARE FUND


1
PSC-CUNY WELFARE FUND
A Program of Supplemental Health Benefits
provided through negotiated employer contributions
2
Eligibility for Benefits
  • Employee of the City University of New York
  • Eligible for basic health coverage under the
    NYC Health Benefits Program
  • Full-time Instructional Staff with appointment 6
    mos.
  • Working in a covered title (next page)
  • Paid from tax-levy funds
  • Working 20 hours per week

3
Covered Titles
  • Instructional Staff
  • College Laboratory Technicians
  • Higher Education Officer series
  • Full-time Faculty titles
  • Continuing Education Teachers
  • Classified Managerial Staff
  • Administrative Superintendent (BG)
  • Assistant College Security Director
  • Chief Administrative Supt. (BG)
  • Chief Administrative Supt. of Campus (BG)
  • College Security Director
  • Computer Operations Manager
  • Computer Systems Manager
  • Deputy University Security Director
  • University Associate Chief Engineer
  • University Chief Architect
  • University Chief Engineer
  • University Security Director

4
Enrollment Process
  • Complete the PSC-CUNY Welfare Fund Enrollment
    Form which is available from the Human Resources
    / Personnel Office
  • Submit acceptable documentation to support the
    eligibility status of dependents spouse and
    children

5
Effective Date of Coverage
  • PSC-CUNY Welfare Fund benefits begin on the
    1st day of the month following appointment date
    or on the first day of the month, if
    that is the hire date, provided that the
    Enrollment Form and all supporting documentation
    is received within 31 days.
  • If the Human Resources Department does not
    receive the required forms within 31 days the
    appointment date, benefits may be delayed or
    lost.

6
Basic and Contributory Plans
  • Basic
  • Prescription Rx
  • Long-Term Disability
  • Dental
  • Extended Medical
  • Death
  • Vision
  • Hearing Aid
  • Contributory
  • Optional LTD Rider
  • Catastrophic Medical
  • Life Insurance
  • Long-Term Care

7
Prescription Drug
  • The Medco program applies to all Plan
    participants except those who have basic health
    insurance through HIP-POS, Aetna QPOS, Aetna
    HMO, CIGNA or GHI-HMO and elect the carrier
    rider.
  • Prescriptions may be filled through the Medco
  • Mail order or through an extensive network of
    participating Retail pharmacies
  • Injectable and Chemotherapy medication is under
    PICA,
  • a separate, City-administered program with its
    own Card.

8
Prescription Drug
  • Medco Mail Order Service
  • Maintenance Drugs up to 100-day supply of
    medication
  • Generic Drugs 20 coinsurance with a 5.00
    minimum
  • Preferred Brand-name Drugs 20 coinsurance
    with a 30.00 minimum
  • Other Brand-name Drugs 20 coinsurance with a
    60.00 minimum
  • _________________________
  • whichever is greater
  • list is available from Medco

9
Prescription Drug
  • Medco Retail Pharmacy Program
  • Acute Care Drugs up to 30-day supply of
    medication
  • Generic Drugs 20 coinsurance with a 5.00
    minimum
  • Preferred Brand-name Drugs 20 coinsurance
    with a 15.00 minimum
  • Other Brand-name Drugs 20 coinsurance with a
    30.00 minimum
  • Mail Order is encouraged. If a retail pharmacy is
    used past a 2nd refill, the coinsurance
    increases to 35
  • ____________________
  • whichever is greater
  • list is available from Medco

10
Prescription Drug
  • Medco Non-participating Pharmacies
  • Persons who use drug stores not in the Medco
    Network
  • must pay the full cost of a prescription
  • must complete a direct reimbursement claim form
    and submit to Medco
  • will be reimbursed for a portion of the cost

11
Prescription Drug
  • Rx Stipend Program Non-Medco
  • Some basic health insurance includes Drug Benefit
    Rider
  • The PSC-CUNY Welfare Fund provides a stipend to
    offset the cost of the Rider.
  • Persons with HIP-POS, Aetna QPOS, Aetna HMO,
    CIGNA or GHI-HMO will be automatically enrolled
    by the Fund Office if yes is checked on ERB.

12
Long-Term Disability
Standard Life Insurance Co.
  • Coverage after completing one year of service
  • Begins 1st of month following six consecutive
    months of total disability
  • Pays 50 of the pre-disability salary with a
    minimum of 1,250 monthly and a maximum of 2,500
    monthly
  • Benefits continue to the earlier of five years or
    age 65

13
Dental Option A
  • Guardian Life Insurance Co.
  • Preferred Provider Organization-PPO Network
  • Participating panel, but may use any dentist
  • No deductible, annual or lifetime maximum payment
  • Dental Schedule
  • each dental service has a scheduled fee
  • Participating Dentists Charge Reduced Fees
  • Best Reimbursement is for Preventive work
  • Child Orthodontia

14
Dental Option B
  • Delta Care USA
  • Provides an HMO Panel of Dentists
  • Reverse Reimbursement Schedule
  • Tells how much you Pay, not what you get back
  • Cost predictability, if care is used
  • Low out-of pocket. Most preventive services free
  • Adult and Child Orthodontia

15
Extended Medical
  • ASO PSC-CUNY Program
  • Deductible
  • For those who purchase the Optional Rider through
    GHI basic. the deductible is 1,000 for
    individual plan and 2,000 for a family plan
  • For those who do not purchase the Optional Rider,
    the deductible is 4,000 for an individual plan
    and 8,000 for a family plan
  • Coinsurance
  • After deductible is met, Welfare Fund Extended
    Medical pays 60 of RC not paid by basic GHI
  • After coinsurance outlays exceed 3,000 for
    individual or 6,000 for family in a calendar
    year, Welfare Fund Extended Medical will pay
    100 of R C not paid by GHI

16
Death Benefit
  • Limited to Active Employees
  • Designated beneficiary listed on the Green

    Card is entitled to 2,500

17
Optical
General Vision and Davis Vision
  • Benefits available once every 24 months
  • Plan includes eye exam, frame and most lenses
  • General Vision Services (GVS)
  • Davis Vision
  • Direct reimbursement Plan
  • Up to 100 for prescription glasses purchased
    through a non-participating provider

18
Optical
General Vision and Davis Vision
  • "Off Year" benefit for dependent children who
    have a prescription change in the year following
    the use of the benefit.
  • No charge if GVS is notified at the time of
    service.
  • Percentage discount if Davis Vision is notified
    at the time of service.

19
Hearing Aid
  • Benefits available once every 36 months
  • Direct reimbursement of up to 500
  • Special Program with the Speech Hearing Center
    of Brooklyn College
  • General Hearing Services affiliated with GVS

20
Contributory Plans
  • Optional Member Pays
  • Enhanced Long Term Disability
  • Catastrophic Major Medical
  • Term Life Insurance
  • Long Term Care Insurance

21
Enhanced Disability Benefit
Optional
  • Standard Life Insurance Co.
  • 60-Day Window after hire. Otherwise requires
    physical.
  • Disability pay increases from 50 to 60 of the
    pre-disability salary.
  • Minimum pay increases from 1,250 to 1,500
    monthly and maximum increases from 2,500 to
    6,000 monthly
  • Benefits continue to age 65
  • If you are a member of TIAA, TRS, ERS or BOERS
    Contributions to a TIAA account equal to 10 of
    pre-disability salary (Minimum of 100 monthly)

22
Catastrophic Major Medical
Optional
  • Marsh Affinity via US Life Insurance Co.
  • Supplement to basic health policy.
  • 10,000 deductible
  • Premium based upon age at time of enrollment
  • Plan pays up to 2 million for up to ten years
    for covered services (medical, surgical
    convalescence)

23
Life Insurance
Optional
  • New York State United Teachers (NYSUT)
  • Term life insurance provided by the NYSUT Trust
    Fund.
  • New Full-time employees receive one-year 25,000
    term life insurance policy at no cost, with an
    option to renew. Must be new NYSUT member.
  • Spouses or domestic partners can be covered
  • Employees under age 65 may apply for added
    coverage up to 1,000,000. Physical exam may be
    required
  • Policy is portable

24
Long-Term Care
Optional
  • John Hancock Life Insurance Co.
  • Provides benefits to those unable to care for
    themselves because of chronic illness or severe
    physical impairment.
  • Dependents can also be covered
  • Eligibility Actives and retirees. Premium
    increases with age of initial enrollment
  • Return of Premium provision
  • Policy is portable

25
Long-Term Care
Optional
  • Other Carriers
  • The John Hancock Program is negotiated and
    monitored by the PSC-CUNY Welfare Fund
  • There are two other programs available, and all
    are payable via payroll deductions
  • A Group Long Term Care Insurance Program (offered
    by the City of New York)
  • New York State United Teachers Long Term Care
    Program (offered by the NYSUT Trust Fund)

26
How to Contact Your Fund
  • By Phone (212)254-5230 or Fax (212)354-5363
  • By Website PSCCUNYWF.org
  • Website Provides linkages to benefit carriers
  • Website provides Summary Plan Description
  • Website provides Downloadable Forms
  • Website provides linkages to Employer basic
    carriers

27
A Few Points for New Employees to Remember
  • Decisions you make now are important. Be certain
    you are well-informed
  • Some decisions are easier to change than others.
    For example a Pension decision is for the
    duration of employment, Health Insurance can be
    changed during an annual re-opener.
  • Some Decisions if made sooner- lower periodic
    payments e.g. LTC which stays at a constant
    premium based upon age at enrollment

28
continued..
  • Some optional programs adjust premium with age
    For example, optional life insurance goes up by
    five-year increments as the insured ages
  • Some optional programs adjust premium with age
    and salary For example, the Optional LTD
    program
  • You will need to decide on a Dental Program
    either Guardian or Delta. This option can be
    changed once each year during the same time as
    the City-wide Re-opener. With Delta, you must
    also select a provider.

29
VERY IMPORTANT Guaranteed Issue
  • Some optional programs only offer that additional
    coverage without evidence of individual
    insurability for a limited time. The
    time window is
  • Long-Term Care 60 days from DOH
  • Enhanced Disability 60 Days from 1st DOH
    Anniversary
  • DOH Date of Hire

30
Also remember
  • Changes to GHI Optional Rider (which can reduce
    the Extended Medical deductible) CAN ONLY BE MADE
    DURING THE CITIWIDE ANNUAL RE-OPENER.
  • AND Finally
  • Be aware of COBRA It has 2 Parts your Fund and
    the basic City (CUNY) coverage. If you are
    COBRA-eligible and want both the basic and the
    Welfare Fund benefits, you must enroll in both!
  • When you leave or RETIRE, let everyone know where
    you are. You may be entitled to benefits or have
    opportunities where we need to notify you!

31
We are here for Assistance Advocacy
PSCCUNYWF.org (212) 354-5230
61 Broadway 15th Floor NY,NY 10006
Write a Comment
User Comments (0)