|
Your Benefits |
|
Employees:
Log on to your personalized Benefits information.
|
|
|
|
Dependents
Employees who are eligible for health insurance coverage under our BeneFlex and BasicCare programs can arrange for coverage for eligible dependents. You must be eligible for AND enroll in the plan(s) in order for your eligible dependent(s) to be covered.
Section 1: Eligible Dependents
Eligible dependents include:
- Your legal spouse or your registered domestic partner
- Your unmarried dependent children (by birth, legal adoption, legal guardianship) and/or your domestic partner's unmarried dependent children
Dependent children are eligible for coverage:
- Up to December 31st of the year in which the unmarried child reaches age 19
- Up to the end of the semester in which child reaches age 25 (must remain unmarried and a full-time student enrolled in an accredited institution of higher education)
- If they mentally or physically disabled and incapable of self support, provided that child was covered under an employer-sponsored medical plan prior to age 19, or age 25 (full-time student), and subject to satisfactory proof. There is no age limit.
You are required to submit proof of your relationship to the eligible dependents that you elect to cover under any of the health insurance plans.
Acceptable Documentation
We accept copies of the following documents (according to relationship):
Marriage Certificate
Domestic Partnership Statement & Affidavit
Birth Certificate (must list names of parents)
Legal Adoption Papers (final adoption papers, or confirmation of placement for adoption purposes)
Legal Guardianship Papers
Student Verification (of full-time student status for children ages 19-25)
We extend Domestic Partner coverage for both same and opposite gender domestic partners and their eligible children.
A Domestic Partnership is defined as:
- Two individuals of the same or opposite gender who live together in a long-term relationship of indefinite duration, with an exclusive, mutual commitment in which the Partners agree to be jointly responsible for each other's common welfare and to share financial obligations.
- The Partners may not be related by blood to a degree of closeness which would prohibit legal marriage in the state in which they legally reside if one was of the opposite gender.
To arrange for coverage under the health insurance plans (medical/ prescription, dental and vision) for your domestic partner (or your domestic partner's eligible dependent children), you must first:
- Register your partner with your employer by completing the "Statement of Domestic Partnership Affidavit" and submit it along with acceptable documentation to Benefit Services. Please note that the affidavit must be completed and signed by both you and your partner.
- You will have 31 days from the date your affidavit is approved to add your Domestic Partner and/or your Partner's eligible dependent child(ren) to your medical, dental and/or vision coverage. Please call Benefits Services for the procedures to add eligible dependents to coverage.
- If you do not enroll your registered domestic partner and/or your partner's eligible dependent children within this 31 day period, you must wait until the next announced Open Enrollment Period in order to add them to your plan unless you experience a qualifying change in family status.
Tax Implications of Domestic Partner Coverage
The Internal Revenue Service does not recognize the tax exemption of benefits extended to Domestic Partners. Therefore, you will be taxed on the dollar cost to cover your registered Domestic Partner and/or your Partner's eligible dependent children for benefits. This cost will be included as part of your gross income.
IRS regulations also affect coverage for your same-gender domestic partner and your partner’s eligible children in the following ways:
- Coverage is not available under the organization’s life insurance policy for dependents. (Note: you may name anyone as your beneficiary on your employer's life insurance plan covering you as an employee.)
- Coverage is not available for expenses incurred by your domestic partner and/or your partner's dependent children under the Flexible Spending Account (Health Care Reimbursement Account and the Dependent Care Reimbursement Account).
Before you request coverage, please be sure that you and partner read the Domestic Partner Summary & Affidavit that summarizes domestic benefit coverage, including its tax consequences.
Required Documentation
You and your domestic partner are required to sign a Statement of Domestic Partnership & Affidavit before coverage can begin. This completed form must be returned to Benefits Services.
Coverage for your unmarried dependent children is available under your employer's health insurance plans (medical, prescription, dental, and vision) in which you are enrolled.
For the definitions of eligible dependent children and criteria for maintaining enrollment under the plan, please see Section 1: Eligible Dependents.
Section 4.1: Dependent Children of Domestic Partners
Section 4.2: Dependent Children Age 19-25
Section 4.3: Disabled Children
Section 4.1: Dependent Children of Domestic Partners
Your domestic partner's unmarried dependent children who meet the definition of eligible dependents can be covered under the plan. Click here for additional information on adding your Domestic Partner's eligible dependent children under coverage, and the resulting tax implications.
Section 4.2: Dependent Child Reaching Age 19-25
Dependent children currently covered under the medical/prescription, dental and/or vision plans must be full-time students as of January 1st following the calendar year in which age 19 is attained. Full-time student status is required to continue coverage beyond age 19, through the end of the semester in which age 25 is attained.
If you have covered children who reach age 19 in the current calendar year:
- Remove child(ren) from coverage during Open Enrollment if they will not be full-time students as of the upcoming January 1st.
- If your child is no longer eligible because s/he is no longer a full-time student, you may consider continuation of coverage under COBRA, which is a federal law that allows you to continue coverage for dependents by paying the full premium (at our group rates) for up to 36 months. Contact Benefit Services at (212) 404-3787 for additional information and the appropriate forms.
If you have covered children who will be full-time students after age 19:
- You must provide verification of full-time student status to each health insurance plan, prior to the processing of any claims incurred after age 19. Verification of full-time student status is required once each year in order to continue coverage for children between the ages of 19 and 25.
- If your child's eligibility status changes during the year (he/she gets married, graduates from college, changes to part-time student status, etc.), you must remove him/her from coverage. As with other qualifying events that occur during the year, you are required to notify Human Resources within 31 days of the event. For more information, please see Section 6: Removing Dependents.
The procedures to verify full-time student status vary by each health plan, as described below:
- UnitedHealthcare PPO Basic and Plus Plans: Before the first claim is processed each calendar year, UnitedHealthcare requires documentation supporting your child's full-time student status.
- HMO Medical Plans (Aetna, Blue Cross, HIP): Every fall (usually in October), the HMO plans sends you a verification form to be completed.
- MetLife Dental PPO Basic and Plus Plans: On the claim form, you will need to check" yes" for full-time student status and supply the name of your employer your child attends.
Section 4.3: Disabled Children
Disabled children may be covered under our health insurance plans (medical/prescription, dental, vision) if they meet the definition of "disabled children". Disabled children are defined as children over age 19 who are mentally or physically disabled and incapable of self support. To arrange for coverage of an eligible disabled child:
- The child must have been disabled and covered by an employer-sponsored medical plan before reaching age 19, or if a full-time student, before age 25.
- To apply for coverage, you must complete a "Statement of Dependent Eligibility Beyond Limiting Age" form for the health insurance plan(s) under which you are requesting coverage for your disabled child. The form includes a physician or surgeon's statement that must be completed as part of the request.
- The request must be approved by the Insurance Company before benefits can be provided.
- Please note that each year, you may be required to provide requested proof that the child remains disabled, unmarried and still unable to support himself or herself.
For additional information or to obtain forms, please contact Benefit Services at (212) 404-3787, located at One Park Avenue (between 32nd & 33rd Streets), 16th floor, call us at (212) 404-3787, or email us at NYUbenefits@nyumc.org.
| Section 5: When You Can Enroll / Add Eligible Dependents |
Back to top |
Section 5.1: Your Initial Enrollment Period
Section 5.2: Qualifying Events (Changes in Family Status)
Section 5.3: Open Enrollment
To enroll or add dependents, please follow the guidelines under Section 7: Procedures to Add or Remove Dependents
Section 5.1: Your Initial Enrollment Period
- You must enroll for benefits within 30 days from the date you receive your initial notification if you are a new hire or a newly eligible faculty and staff member (as a result of a status change). You must also enroll your eligible dependents at the same time. If you do not enroll an eligible dependent, you will not be able to arrange for coverage for your dependent(s) unless you have a qualifying event (change in family status) or until the next Open Enrollment period.
- None of your eligible dependents will be covered if you do not enroll for benefits and you receive default coverage. If you do not enroll for benefits within the designated period, you will receive the "default coverage" for your job classification, which in all cases provides for individual coverage (employee only). You will not be able to arrange for coverage for your dependent(s) unless you have a qualifying event (change in family status) or until the next Open Enrollment period.
- No changes are allowed for the rest of the calendar year once you are enrolled for coverage (whether you actively enrolled for benefits or default coverage) UNLESS you experience a qualifying event (change in family status) that allows for a change under the plan.
Section 5.2: Qualifying Events (Changes in Family Status)
- "Qualifying events" are changes in family status that allow you to make certain kinds of changes (for example, adding eligible dependents) to your coverage under your employer’s plans.
- Changes must be made within 31 days of the qualifying event. If you do not request coverage for the eligible dependent(s) within 31 days of the change in family status event, you will have to wait until the next Open Enrollment Period before you may do so.
- Documentation supporting the occurrence and date of the qualifying event and documentation verifying each dependent’s relationship to you will be required.
- Family Status Changes that are considered qualifying events and allow you to add eligible dependents to your coverage include:
- Marriage
- Gain or loss of a domestic partner
- Legal separation or divorce
- Birth, adoption or legal guardianship of a child
- Changes in your (or your dependents') health care coverage due to changes in employment status
- Changes in student status (child age 19-25 becomes a full-time student)
- Death of a dependent
NOTE: The types of changes permitted as a result of a qualifying event will depend on the type of family status change and the provisions of each benefit plan
Section 5.3: Open Enrollment
- Open Enrollment is normally held once each calendar year (late
October/early November) and allows eligible faculty, physicians, and staff to
add any eligible dependent(s) to their coverage under the health insurance plans
in which the employee enrolls
- Changes made during an Open Enrollment Period will be effective on the following January 1st. Coverage for any dependent(s) added during an open enrollment period will go into effect the following January 1st.
- Documentation verifying each dependent's relationship to you will be required.
Section 6.1: Qualifying Events (Changes in Family Status)
Section 6.2: Open Enrollment
Section 6.3: Dependents Who No Longer Meet
Eligibility Criteria
To remove a dependent, please follow the guidelines under Section 7: Procedures to Add or Remove Dependents.
Section 6.1: Qualifying Events (Changes in Family Status)
- Qualifying events are changes in family status that allow you to make certain kinds of changes (for example, terminating currently covered dependents) to your coverage under your employer’s plans.
- Changes must be made within 31 days of the qualifying event. If you do not request removal of a dependent within 31 days of the change in family status event, you will have to wait until the next Open Enrollment Period before you may do so.
- You must remove from coverage any dependent once they no longer meet the definition of an eligible dependent under the plan.
- Documentation supporting the occurrence and date of a qualifying event will be required for certain types of changes (for example, divorce decree).
- Family Status Changes that are considered qualifying events and allow you to remove dependents from your coverage include:
- Marriage
- Gain or loss of a domestic partner
- Legal separation or divorce
- Birth, adoption or legal guardianship of a child
- Changes in your (or your dependents') health care coverage, due to changes in employment status
- Changes in student status (child age 19-25 no longer a full-time student)
- Death of a Dependent
NOTE: The types of changes permitted as a result of a qualifying event will depend on the type of family status change and the provisions of each benefit plan.
Section 6.2: Open Enrollment
- Open Enrollment is normally held once each calendar year (late October/early November) and allows eligible faculty, physicians, and staff to remove any eligible dependent(s) from coverage under the health insurance plans.
- Changes made during an Open Enrollment Period will be effective the following January 1st. Coverage for any dependent(s) removed from coverage during an open enrollment period will terminated as of the following January 1st.
Section 6.3: Dependents Who No Longer Meet Eligibility Criteria
Dependents enrolled for coverage under the health insurance plans MUST BE REMOVED from the plans when they no longer meet the definition of an eligible dependent under your employer's plans.
Examples of covered dependents who would no longer be considered eligible include:
- Spouse from whom you are legally separated or divorced
- Former stepchildren (children of a spouse from whom you are legally separated or divorced)
- Domestic Partner with whom you no longer have a partnership
- Dependent children of a Domestic Partner relationship with whom you no longer have a partnership
- Children who are married
- Children between 19 – 25 who are not full-time students (and do not qualify as disabled children under the plan)
- Disabled children who are no longer certified as disabled by the insurance company
You are required to notify the Benefit Services Department within 31 days of the change in a covered dependent's eligibility and complete any necessary benefit change forms to remove him/her from coverage. Documentation supporting the occurrence and date of the qualifying event is required for certain circumstances.
Required Documentation (depending on the relationship) include copies of:
Legal Separation Papers
Divorce Decree
Domestic Partnership Termination Statement
| Section 7: Procedures to Add or Remove Dependent(s) From Coverage |
Back to top |
Adding or removing a dependent from your health insurance plan(s) requires that you complete certain benefit forms. In most cases, documentation supporting the change in family status and/or verifying your relationship to each dependent will be required. Generally, you may add or remove a dependent from coverage:
Section 7.1: During a Qualifying Event or a Dependent’s
Change to Ineligible Status
Section 7.2: During Your Initial Enrollment Period
Section 7.1: During a Qualifying Event or a Dependent's Change to Ineligible Status
1. Complete the Qualifying Event Change Form.
- Complete your personal information in Section I of the form. Please note that if your marital status has changed, documentation will be required before our records can be updated.
- In Section II, indicate the type of change in family status for which you are requesting changes; the date of the qualifying event is also required.
- In Section II, please also indicate your selection for each benefit plan that is impacted by the current change in family status request. (Be sure that you understand the types of changes that are allowed for the type of qualifying event you have experienced; the back of the form provides this information.)
- Complete Section III to provide information on the dependent(s) that you are adding or removing from coverage. Your dependent's name, social security number and date of birth are required.
- Sign and date the completed form before returning it to Benefit Services. Review and follow any required steps under the next sections to ensure that your changes can be processed efficiently.
2. Attach a copy of any required documentation.
See Section 2: Proof of Relationship for acceptable documents according to relationship, for dependents that you are adding or removing to your coverage.
3. Additional Steps Necessary to Complete Request
- If you are waiving or terminating Medical coverage as a result of your qualifying change in family status, you must complete the Medical/Prescription Waiver Form. Please note that you may only waive medical coverage if you have medical coverage under another plan (for example, through a spouse).
- If you are enrolling for Medical coverage under one of the HMO Plans (and/or Dental coverage under the CIGNA DMO Plan), you must also complete the applicable enrollment form(s) for the plan.
Section 7.2: During Your Initial Enrollment Period and/or during an Open Enrollment Period:
To enroll you eligible dependent(s) when you elect benefit coverage during your initial enrollment period, you will need to follow the specific instructions for enrollment provided to you in your Benefits Enrollment Packet and/or your Annual Open Enrollment Packet.
Reminders about enrolling eligible dependents:- Proof of Relationship documentation is required for each dependent that you request coverage for under any of the health insurance plans. See Section 2: Proof of Relationship for acceptable documents.
- Your enrollment is not complete until Benefit Services is in receipt of all required forms [for example, the medical/prescription waiver form or your life insurance beneficiary designations, and any required proof of relationship documentation for eligible dependents you elect to cover and/or waive under your benefit plans].
For additional information, assistance, or to obtain any of the forms discussed in this section, please contact or visit the Benefits Services Department at:
Main office:
One Park Avenue (between 32nd & 33rd Streets), 16th Floor
Phone: (212) 404-3787
Fax: (212) 404-3900
Email: NYUbenefits@nyumc.org
Monday – Friday, 8am – 5:30pm
OnsiteHR office:
Greenberg Hall, SC-2
Wednesday, 8am – 4pm
(closed 11am-12pm)
|
|
|
