PSCCUNY WELFARE FUND

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PSC-CUNY WELFARE FUND
A Program of Supplemental Health Benefits
provided through negotiated employer contributions
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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

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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

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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

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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.

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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

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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.

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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

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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

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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

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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.

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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

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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

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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

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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

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Death Benefit

• Limited to Active Employees
• Designated beneficiary listed on the Green
  
  Card is entitled to 2,500

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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

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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.

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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

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Contributory Plans

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

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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)

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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)

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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

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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

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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)

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How to Contact Your Fund

• By Phone [phone] or Fax [phone]
• 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

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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

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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.

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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

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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!

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We are here for Assistance Advocacy
PSCCUNYWF.org [phone]
61 Broadway 15th Floor NY,NY 10006