PSC-CUNY WELFARE FUND

A Program of Supplemental Health Benefits

provided through negotiated employer contributions

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

Covered Titles

Instructional Staff

College Laboratory TechniciansHigher Education Officer seriesFull-time Faculty titlesContinuing Education Teachers

Classified Managerial Staff

Administrative Superintendent (B&G)Assistant College Security DirectorChief Administrative Supt. (B&G)Chief Administrative Supt. of Campus (B&G)College Security DirectorComputer Operations ManagerComputer Systems ManagerDeputy University Security DirectorUniversity Associate Chief EngineerUniversity Chief ArchitectUniversity Chief EngineerUniversity Security Director

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]

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.

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

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.

Prescription Drug

Medco Mail Order Service

Maintenance Drugs : up to 100-day supply of medication

Generic Drugs : 20%* coinsurance with a $5.00 minimumPreferred** Brand-name Drugs : 20%* coinsurance with a $30.00 minimumOther Brand-name Drugs : 20%* coinsurance with a $60.00 minimum_________________________* whichever is greater** list is available from Medco

Prescription Drug

Medco Retail Pharmacy Program

Acute Care Drugs : up to 30-day supply of medication

Generic Drugs : 20%* coinsurance with a $5.00 minimumPreferred** Brand-name Drugs : 20%* coinsurance with a $15.00 minimumOther 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

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

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.

Long-Term Disability

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

Standard Life Insurance Co.

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

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

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 R&C 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

Death Benefit

Limited to Active Employees Designated beneficiary [listed on the

Green Card] is entitled to $2,500

Optical

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

General Vision and Davis Vision

Optical

"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.

General Vision and Davis Vision

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]

Contributory Plans

Optional = [Member Pays]

o Enhanced Long Term Disabilityo Catastrophic Major Medicalo Term Life Insurance o Long Term Care Insurance

Enhanced Disability Benefit

Standard Life Insurance Co.o 60-Day Window after hire. Otherwise requires physical.o Disability pay increases from 50% to 60% of the pre-

disability salary.o Minimum pay increases from $1,250 to $1,500 monthly and

maximum increases from $2,500 to $6,000 monthlyo Benefits continue to age 65o 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)

Optional

Catastrophic Major Medical

Marsh Affinity [via US Life Insurance Co.]

o Supplement to basic health policy. o $10,000 deductibleo Premium based upon age at time of enrollmento Plan pays up to $2 million for up to ten years for

covered services (medical, surgical & convalescence)

Optional

Life Insurance

New York State United Teachers (NYSUT)

o Term life insurance provided by the NYSUT Trust Fund.o 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.

o Spouses or domestic partners can be coveredo Employees under age 65 may apply for added coverage

up to $1,000,000. Physical exam may be requiredo Policy is portable

Optional

Long-Term Care

John Hancock Life Insurance Co.o Provides benefits to those unable to care for

themselves because of chronic illness or severe physical impairment.

o Dependents can also be coveredo Eligibility – Actives and retirees. Premium

increases with age of initial enrollment o Return of Premium provisiono Policy is portable

Optional

Long-Term Care

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)

Optional

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

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 ]

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.

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

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!

We are here for Assistance & Advocacy

PSCCUNYWF.org (212) 354-5230

61 Broadway 15th Floor NY,NY 10006