Not For Women Only – Paraprofessional Ed.
Nov 1, 2003 12:47 PM
I have the GHI/CBP optional rider. Are my benefits increased?
Yes, the enhanced reimbursement schedule portion of the optional rider significantly increases the maternity allowance if you are using a non-participating GHI obstetrician.
I’m enrolled in a health-maintenance organization (HMO). What are my maternity benefits?
New York City currently offers eight HMO (health-maintenance organization) plans. They are Aetn, CIGNA Healthcare, Empire EPO, Empire HMO, GHI HMO, HealthNet, HIP Prime and Vytra.
Under these plans, you are covered fully (some plans require small office co-payments) for all visits to your primary or medical group physicians. This includes pediatricians and specialists and all obstetric services both in and out of the hospital. All HMOs fully cover well-baby and well-child care and immunizations for infants and children. Hospital benefits are unlimited for both maternity and newborn nursery care. NOTE: All services must be performed or authorized by your primary or medical group physician. Unauthorized visits and use of non-network physicians and hospitals are not covered.
I belong to a POS (point of service) plan. What are my maternity benefits?
The POS plans currently offered by the city are Aetna/US Healthcare Quality Point of Service and HIP Prime POS. These POS plans all offer an HMO base with in-network maternity benefits exactly as described above.
In addition to this HMO base, you may elect to use non-network physicians or hospitals and would be subject to deductibles, co-insurance and fee schedules of various degrees (consult the New York City Summary Program Description).
Both plans require pre-notification that you are going outside the network.
How can I get health coverage after SLOAC expires and I have not returned to work?
If your coverage terminates for any reason other than gross misconduct, you may apply for coverage by obtaining a COBRA application from your payroll secretary. COBRA (the federal Consolidated Omnibus Budget Reconciliation Act of 1985) requires the city to offer employees and their families the opportunity to continue group health and UFT Welfare Fund benefits at 102 percent of the group rate. The period of coverage varies from 18 months if you are healthy to 29 months if you become disabled. This benefit must be applied for within the guidelines. For more information see the New York City Summary Program Description. (The application must be made within 60 days of the qualifying event.)
What must I do to reinstate my health plan when I return to work?
Once you return to work, your school secretary submits form EB 1054 and an ERB form. Your payroll secretary should fax the UFT Welfare Fund a Pending Payroll Notification Form if you are not yet on payroll. This will activate your Fund benefits.
Do you have any other advice after I’m back at work?
Be sure to contact the UFT Welfare Fund in writing to update your dependents and confirm your eligibility.
