Health Plans: Before you Choose, Know

Jan 16, 2002 3:44 PM

Questions & Answers

Q: May I change my coverage?
A: You may transfer from one plan to another during the transfer period (usually in October). The coverage under the new plan becomes effective the first pay period in January. If you move out of the area covered by an HMO or a POS plan, you may transfer immediately to another plan.Q: How do I change my coverage?
A: Ask your school secretary for an ERB form. Complete and return it to her/him.Q: What is an optional rider and how do I get one?
A: The city offers an optional rider for GHI-CBP that provides additional benefits at an additional cost; a description of its benefits is included in the city’s booklet.
To apply for a rider, obtain and complete an ERB form and return it to your school secretary. You may select a rider only during your initial enrollment or during a transfer period.
Some HMOs offer a rider which may provide benefits such as prescription drug coverage. UFT Welfare Fund members do not need these riders.Q: How do I add a new family member?
A: Ask your payroll secretary for an ERB form. Complete and return it to her/him not more than 31 days after that individual has joined your family. If the form is submitted after 31 days, the family member cannot be added until the next transfer period.

Q: What if both spouses or domestic partners work for New York City?
A: You may either enroll individually or one may enroll as a dependent of the other, but you may not both be dependents on each other’s coverage. If you are a dependent spouse or domestic partner, you should sign a waiver protecting your right to coverage should your spouse cease employment with the city. All of your children must be enrolled under the contract of one parent if you enroll separately.Q: If I die, will my spouse or domestic partner be covered?
A: If you both work for the city, your spouse or domestic partner should complete an ERB form immediately following your death so that he/she can be covered as a city employee.
If your spouse or domestic partner is not employed by the city, there is no city paid coverage available. However, your spouse or domestic partner can apply for coverage by asking your school secretary for a COBRA application (see next question).

Q: What is COBRA?
A: COBRA (the federal Consolidated Omnibus Budget Reconciliation Act of 1985) requires that the city offer employees, retirees and their families the opportunity to continue group health and Welfare Fund benefits at 102 percent of the group rate in certain instances where the coverage would otherwise terminate. The period of coverage varies from 18 to 36 months, depending on the reason of termination. For more information, see the city’s Summary Program Description.Q: How does no-fault insurance affect my coverage?
A: If you or your covered dependents are involved in an auto accident, auto insurance first pays all reasonable and necessary medical and hospital expenses incurred. Your city health coverage and Welfare Fund disability benefits apply only when no-fault benefits are exhausted.Q: What is coordination of benefits (COB)?
A: This limits coverage of overall medical expenses to no more than 100 percent of charges when a person is covered by more than one health insurance plan.
For example: You are covered as a dependent under the health coverage of your spouse or domestic partner and you incur a medical expense of $100. Your health insurance will pay what it considers to be reasonable and customary; if any expense is left, your spouse’s or domestic partner’s insurance may cover the remainder or part thereof. (This is not true when that person also works for the city.)Q: Can I buy additional insurance?
A: Yes. The American Federation of Teachers and the New York State United Teachers offer group insurance plans which cover auxiliary costs as well as life insurance, income protection insurance for members and their beneficiaries, etc. Contact NYSUT and the AFT for more details.Q: What should I do if I have a problem?
A: If it’s a question of eligibility for coverage that your school secretary cannot resolve, contact:
New York City Department of Education
Office of Employee Health & Welfare Program
65 Court Street, Rm 200
Brooklyn, NY 11201
(718) 935-2312