Human Resources

Health Benefits

When can I make changes to my Health Insurance Plan?
Changes can be made to your Health Insurance Plan within 31 days of a qualifying event (i.e. marriage, birth of a baby, death of spouse, or divorce).

Until what age is my dependent child covered under my health plan?
Unmarried dependent children between 19 and 23 who are full-time students at an accredited degree-granting educational institution. The student must be covered as a dependent through the City program and must receive at least 50 percent of his/her support from the employee or retiree. Coverage terminates when the student graduates or ceases to be a full-time student or on December 31 of the year of the student’s 23rd birthday, whichever is earlier.

What is the difference between HMO, EPO and POS?

HMO - Health Maintenance Organization (HMO) plans provide managed, pre-paid hospital and medical services to its members. An HMO member chooses a Primary Care Physician (PCP) from within the HMO network, and the PCP manages all medical services, provides referrals, and is responsible for non-emergency admissions. Individuals and/or families who choose to join an HMO can receive health care at little or no out-of-pocket cost, provided they use the HMO’s doctors and facilities and there are usually no deductibles to meet or claim forms to file. There is no out-of-network coverage.

PPO - Participating Provider Organization (PPO)/Indemnity plans offer the freedom to use either a network provider or an out-of-network provider for medical and hospital care. Participating Provider Organization (PPO)/Indemnity plans contract with health care providers who agree to accept a negotiated lower payment from the health plan, with co-payments from you, as payment in full for medical services. When you use a non-participating provider, the subscriber is subject to deductibles and/or coinsurance.

EPO - Exclusive Provider Organization (EPO) plans offer a higher level of choice and flexibility than many other managed care plans. Members can see any provider in the EPO network, which contains family and general practitioners as well as specialists in all areas of medicine. There is no need to choose a primary care physician and no referrals are necessary to see a specialist. There is no out-of-network coverage.

POS - Point-of-Service (POS) plans offer the freedom to use either a network provider or an out of-network provider for medical and hospital care. If you use a network provider, health care delivery resembles that of a traditional HMO, with prepaid comprehensive coverage and little out-of-pocket costs for services. When you use an out-of-network provider, health care delivery will have less comprehensive coverage and is subject to deductibles and/or coinsurance.

How do I enroll for Health Insurance Benefits?
To enroll you must obtain and file a Health Benefits Application Form at Human Resources – Shuster Hall - 230.

When does my coverage become effective?
Coverage becomes effective the date of hire for full-time instructional staff and civil service appointees, provided they have filed their enrollment application within 31 days of date of hire. For Provisional employees and College Assistants (working 20hrs/wk) coverage begins on the first day of the pay period following completion of ninety days of continuous employment.

What is PICA?
The Pica Program is a separate prescription drug benefit that covers medications in two specific drug categories (Injectables and Chemotherapy). PICA coverage is available with all plans offered by the NYCHBP.

What is the Health Care Flexible Spending Account Program? (HCFSA)
HCFSA is funded through pre-tax payroll deductions, thereby reducing your taxable income. HCFSA helps pay for eligible out-of-pocket medical expenses.

What is the Buy-Out-Waiver Program?
The Buy-Out-Waiver Program enables eligible employees who have non-City group health benefits to waive their City health benefits in return for an annual cash incentive payment ($500.00 for individual coverage, $500.00 for Domestic Partners, $1,000.00 for family coverage). Once you enroll in the Buy-Out-Waiver Program, you are enrolled until you notify Human Resources that you wish to withdraw from the program (i.e. in order to enroll in NYC Health Benefits Program). Those who waive or cancel City health plan coverage and subsequently wish to enroll or reinstate benefits will not have coverage until the beginning of the first payroll period 90 days after the submission of a Health Benefits Application, unless the participant has lost other group coverage.

Who is eligible for Cobra?
Employees whose health and/or welfare fund coverage are terminated due to a reduction in hours of employment or termination of employment (including unpaid leaves of absence of any kind) are eligible for the continuation of their coverage under COBRA, provided they are not covered under another group plan.

When does my health coverage end once I am terminated?
All benefits terminate on the last day you are on payroll.

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Last modified: Oct 13, 2011

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