Health Care, Prescription Drugs, Coordination of Benefits FAQs

Full-time employees make contributions for health care coverage through convenient payroll deductions.

Each fall, during the designated Open Enrollment Period, you will have an opportunity to make changes to your health care coverage and add or drop dependents. Changes made during Open Enrollment become effective on January 1 of the following year.

Changes remain in effect for the entire year, unless you experience a qualifying life event that permits you to change your coverage.

This is your share of the cost of coverage under a health plan. NYU requires a contribution for the cost of health care for most employees. Contact the NYU Benefits Office to determine what your contribution to the plan will be in the current plan year.

A copayment is a flat dollar amount that you pay for specific services each time you use them, such as office visits. Copayments are not part of the annual deductible (if your plan has one), and are not applied to any out-of-pocket maximum. Each NYU health care plan has a schedule of benefits, with specified copayments for covered services.

Yes, when you are eligible for coverage under a NYU medical or dental plan, you may elect to cover your eligible spouse, or registered domestic partner, and/or eligible children. (See also, "Dependent Coverage".)

Generally, you become eligible to enroll for coverage during the NYU initial enrollment period. This period is from your date of hire until 31 days following your date of hire. If you do not enroll during this period, you will have to wait until the next Open Enrollment Period.

A qualifying life event is a change in your personal life that may impact your eligibility or your dependents' eligibility for benefits. If you are eligible to make changes, you must make the change within 30 days of the date of your qualifying life event. After the 30-day deadline, you will have to wait until the next Open Enrollment Period to make further changes.

Any changes made must be consistent with the qualifying event experienced. Some changes, e.g., birth, marriage, and divorce, may require proof of the qualifying event.

Examples of qualifying life events are: birth or adoption of a child; marriage; establishing a domestic partnership; divorce; ending a domestic partnership; disability; death; spouse/domestic partner gains or loses coverage; move to an area where current coverage is not available; and retirement.

In-network doctors and hospitals have a negotiated fee agreement with your insurance plan. Each of the plan providers offered by NYU has an extensive roster of in-network providers who are board-certified and rigorously screened.

The out-of-pocket maximum limits the amount you might be expected to pay for medical services each calendar year. This means that once your expenses reach a certain amount after you pay your deductible, covered services will be paid in full by your Plan, at the Reasonable and Customary rate. Out-of-pocket maximums do not apply to services with copays.

The NYU Point-of-Service (POS) Value and POS Advantage plans cover services rendered by both in-network and out-of-network providers and have a different out-of-pocket maximum for each type of service. The Aetna and Oxford HMO Plans cover in-network services only. All other plans have an out-of-pocket maximum for covered services.

If you are enrolled in one of the NYU Point-of-Service Plans, you may choose to use an out-of-network provider and still have a portion of the cost of those services covered by your plan. Note that the fees they charge are not limited by a contracted fee agreement. If you go out of network, any amounts your provider charges that are above Reasonable & Customary rates, are your responsibility and are not credited to your out-of-pocket maximum. (See also, "Explanation of Reasonable & Customary".)

The Aetna and Oxford HMO Plans cover in-network services only.

The annual deductible is an amount you must pay before your Plan will pay any benefits. Your annual deductible does not apply to services with copayments, but amounts that you pay toward your annual deductible are credited to your out-of-pocket maximum.

If you are enrolled in one of the NYU Point-of-Service Plans, and you go out of network, any amounts your provider charges that are above Reasonable & Customary rates are your responsibility and are not credited to your annual deductible. (See also, "Explanation of Reasonable & Customary".)

Coinsurance is the percentage of the cost for covered services that are your responsibility. After your deductible limit has been reached, the Plan will pay a stated percentage, based on Reasonable & Customary rates, and you pay the other percentage. Coinsurance is applied to your out-of-pocket maximum.