Staff Handbook

Medical Plan Options

Choosing a Plan

Full-time regular employees get free health care coverage for themselves after three months of employment. You must enroll at a New Employee Orientation, where you will also have the opportunity to enroll eligible family members or registered domestic partners at little or no cost. You may choose between the NYU Point-of-Service Plan and one of three Health Maintenance Organizations (HMOs). You may not waive coverage.

Whom You May Insure Under the NYU Point-of-Service Plan or in an HMO

You may choose to insure:

• Individual—Yourself only
• Two Person—Yourself plus one (spouse or registered domestic partner or dependent child);* or
• Family—Yourself plus two or more (spouse or registered domestic partner and dependent child(ren),* or two or more dependent children). This is called the family plan.

*Dependent children are eligible for coverage up to the end of the calendar year in which they reach age 19 or dependent unmarried children up to the end of the calendar year in which they reach age 25 while a full-time student at an accredited educational institution. You may also cover unmarried dependent children who become totally disabled before age 19 without regard to age. Contact the Benefits Office for more information.

Proof of Relationship

You are required to provide proof of your relationship to your dependents if you elect to cover them on an NYU medical or dental plan. This may include a copy of one of the following:

• Marriage certificate
• NYU Domestic Partner registration affidavit
• Birth certificate that shows the names of both the parent and the child
• Final adoption papers; or
• Documentation substantiating placement for adoption

Special Note Regarding Coverage for Registered Same-Sex Domestic Partners and their Children

Because the Internal Revenue Service does not recognize the tax exemption of benefits extended to domestic partners, adding your registered domestic partner and his or her children to your medical or dental plan may result in additional costs for you. For more information, please refer to the publication Summary of University Policy on Domestic Partner Benefits Coverage. Contact the Benefits Office for more information regarding possible tax consequences of registering your domestic partner and his or her children on your medical or dental plan.

Enrollment and Effective Date

1. You become eligible under the NYU Medical Plan options on the day after you complete three months of regular NYU employment. If you are not actively working on the date your coverage becomes effective, your coverage will not take effect until you return to work for one day.
2. Review your enrollment kit. Further details are available in the specific HMO or POS plan kits available from the Benefits Office.

Changing Your Health Care Coverage

Annual Open Enrollment

Each fall during the designated open enrollment period, you have the opportunity to make the following changes in your healthcare coverage, to become effective the following January

• Switch coverage to or from the NYU Point-of-Service Plan (United Healthcare) or one of the Health Maintenance Organizations (HMOs) available through NYU
• Change from one HMO to another HMO
• Add or drop your eligible dependents from your medical or dental coverage

Changes will remain in effect until the next open enrollment period, unless you have a qualifying status change that permits you to change your coverage. Qualifying status changes include events such as marriage, registration of a domestic partner, and the birth or adoption of a child. For a complete list, see What is a Qualifying Status Change.

Enrolling New Dependents

To ensure coverage, new dependents must be enrolled in the NYU medical plans within 31 days of marriage or registration of a domestic partner and their children, birth, or adoption. Coverage will be effective as of the date of the event. See Proof of Relationship.

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The NYU Point-of-Service Plan (United Health Care)

The NYU Point-of-Service Plan is administered by United HealthCare. The Point-of-Service Plan allows you to seek treatment from a United HealthCare network provider, or to go out-of-network to the provider of your choice. In this way, the Point-of-Service plan acts like two plans in one: An HMO with a traditional indemnity plan included in it. Under the plan, you have access to quality health care, lower out-of-pocket costs, and, most importantly, choice. Each time you need care, you choose whether you receive it from a provider who is part of the network (in-network provider) or from a provider outside the network (out-of-network provider). If you enroll in the NYU Point-of-Service Plan, you and each of your covered family members must select a Primary Care Physician (PCP) from the United HealthCare provider network. Having a designated PCP is a required step to accessing in-network benefits. If you choose, you can also see any provider who is not part of the United HealthCare network. You must submit claims for these services to the plan and they will be covered under the out-of-network part of the plan.

Summary of In-Network and Out-of-Network Benefits

The chart below compares the benefits you receive when you seek care from a United Healthcare
network provider, and when you go outside the network.

* You pay $5 when you receive care from an NYU Medical Center doctor who is part of the United HealthCare network. You pay $10 when you receive care from any other provider in the United HealthCare network.

**Claim forms can be downloaded or picked up at the NYU Benefits Office.

Retail Prescription Drug Program

If you choose to enroll in the NYU Point-of-Service Plan, you pay less for retail prescription drugs when you use a participating Caremark CareSelect retail pharmacy, regardless of whether an in-network or out-of-network doctor prescribes the medication for you. You need to present your Caremark prescription ID card at a participating pharmacy to receive plan benefits.

Mail-Order Prescription Drug Program

You pay less for maintenance medication when you fill your prescription through the Caremark Mail-Order Prescription Drug Program. Maintenance medications are those typically prescribed for long-term illnesses, like diabetes or arthritis. For the latest Caremark prescription drug co-pays, consult the Health Plan Comparison Chart found in your new hire or open enrollment kit.

Health Maintenance Organizations (HMOs)

You may choose to join one of the three Health Maintenance Organizations (HMOs) offered instead of the NYU Point-of-Service Plan, if an HMO offered by the University services your residential area. HMOs provide pre-paid coverage for treatment of illness, injury, and maternity care, as well as for preventive care, health education, and other programs. The three HMOs offered to you at the time of publication are Aetna U.S. Healthcare, Oxford Health Plans, and HIP.

What is an HMO?

• HMOs provide care only through their affiliated doctors and institutions, except in an emergency.
• All medical services provided by the HMO are included in the monthly premium, which is paid in part by NYU. There are usually no claim forms, no annual deductibles, and, depending on the HMO, either no charge or a minimal charge per service or visit.

Highlights of HMO Coverage

Services offered by HMOs vary by organization. However, most HMOs provide the services listed below:

• Office visits to physicians
• Prescription drug plan
• Hospital care
• Laboratory and x-ray services
• Mammography
• Surgery and related services
• Regular physical examinations
• Prenatal and post-natal care
• Well-baby care
• Eye examinations
• Diagnostic tests
• Health education

In addition, most HMOs cover the following services on a more limited basis:

• Home health care as prescribed by a physician
• Convalescent facility care
• Hospice care
• Birthing center care
• Inpatient and outpatient psychiatric care
• Inpatient and outpatient treatment for alcoholism or drug abuse

For more details, request an HMO enrollment kit from the NYU Benefits Office. If you have specific questions about an HMO’s coverage and important exclusions from coverage, request a copy of the Group Member Service Agreement from the HMO, or from the NYU Benefits Office.

Eye Care Plan of America

Whether you elect the NYU Point of Service Plan or an HMO, you can take advantage of The Eye Care Plan of America Optical Discount Plan, which offers discounts on a wide array of eyecare needs, including frames, lenses, contacts and eye care accessories (such as contact lens solution and non-prescription sunglasses). To get your discount, just show your discount card to any Eye Care Plan of America (ECPA) provider. For more information, call ECPA at (800) 221-3272, or visit their Web site at www.ecpa.com.

For More Information

To learn more about any medical plan options, request a Summary Plan Description (SPD), or speak with a Benefits Specialist, call the Benefits Office at (212) 998-1270.

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