Eligibility
As an employee of the City University of New York- Brooklyn College, you are eligible for health coverage under the City of New York Health Benefits Program (NYCHBP).

Eligible Dependents
You may also enroll your dependents in the NYCHBP. Dependents are eligible if their relationship to the eligible participant is one the following:

1. A legally married spouse never an ex-spouse regardless of any provisions of a legal settlement.
   
2. A domestic partner at least 18 years of age, living together with a participant in a current continuous and committed relationship, although not related by blood to the participant in a manner that would bar marriage in New York State.
   
3. Unmarried children under 19, including natural children and those whose dependence on the employee is recognized by a court of law. Coverage terminates at age 19.
   
4. Unmarried dependent children between 19-23 who are full time college students at an accredited degree-granting educational institution.
   
5. Unmarried children who cannot support themselves because of a disability, including mental illness, developmental disability, mental retardation or physical handicap, so long as their disability occurred while the dependent was covered by the City.

Effective Dates of Coverage
Coverage begins on your appointment date, if you are in the instructional staff titles, provided your application (Form ERB 2000) has been received by the Benefits Office within 31 days of your appointment date.

Coverage begins after 90 days and a six month appointment if you're employed part time, provisional, temporary, provided your application (Form ERB 2000) has been received by the Benefits Office.

Coverage begins on your appointment date if you are appointed from a civil service list, provided your application (Form ERB 2000) has been received by the Benefits Office within 31 days of your appointment date.

Coverage for eligible dependents listed on your application will also become effective on the date that you become eligible.

Dependents acquired after you have submitted your health insurance application (Form ERB 2000) as a result of marriage, domestic partnership, birth or adoption will be covered provided that you submit the required documentation within 31 days of the event.

Enrollment
To enroll you must complete a health insurance application (Form ERB 2000), which can be obtained from the Benefits Office. You must also submit documentation to support the eligibility status of all persons you wish to cover under your health insurance.

You cannot be covered by two health contracts for which the City pays to or which the City contributes.

As an eligible participant of the NYC Health Benefits Program (NYCHBP) you may choose from several plans listed below. These plans provide basic coverage, which may or may not require an additional premium by the employee.

The health plans offered by the NYCHBP are:

1. Empire HMO New York www.empireblue.com/nyc
   
2. GHI-CBP Empire Blue Cross/Blue Shield www.ghi.com
   
3. HIP Prime HMO www.hipusa.com
   
4. HIP Prime POS www.hipusa.com
   
5. Health net (formerly Physicians Health Services) www.healthnet.com
   
6. Vytra Health Plans www.vytra.com
   
7. Aetna US Healthcare Quality Point of Service www.aetna.com
   
8. Aetna US Healthcare Healthcare Maintenance Organization www.aetna.com
   
9. Cigna Healthcare www.cigna.com
   
10. Empire EPO www.empireblue.com/nyc
    
11. GHI HMO www.ghi.com
    
12. DC 37 Med-Team/Choice *DC 37 titles only www.ghi.com
    

Selection of Health Plan
An employee should consider a health plan that best meets one's need and you should consider the following factors:

• Coverage - services covered by the plan differ. For example, some provide preventive services while others do not cover them at all; some plans cover routine foot care, while others do not.
  
• Choice of doctor - some plans provide partial reimbursement when non-participating providers are used, other plans only pay for or allow the use of participating providers.
  
• Convenience of Access - certain plans have participating providers or centers that are more convenient to your home or workplace.
  
• Cost - some plans require payroll deductions for basic coverage.

To obtain further information about these benefits please visit the Office of Labor Relations/NYC Health Benefits website at www.nyc.gov/olr.

Coordination of Benefits
You may be covered by two or more group health benefit plans that may provide similar benefits. Should this occur the City health plan will coordinate benefit payments with the other plan. The City program follows certain rules that have been established to determine which plan is primary; these rules apply whether or not you make a claim under both plans. The rules are as follows:

1. The plan covering you, as employee is primary before a plan covering you as a dependent.
   
2. When two plans cover the same child as a dependent, the child's coverage will be as follows:
   · the plan of the parent whose birthday falls earlier in the year provides primary coverage.
   · If both parents have the same birthday, the plan that has been in effect the longest is primary.
   · If the other plan has a gender rule the rule of the other plan will determine which plan cover the child.

3. When no other criteria apply, the plan covering you the longest is primary. However the plan covering you as a laid-ff or retired employee, or as a dependent of such person is secondary, and the plan covering you as an active employee, or as a dependent of such a person, is primary, as long as the other plan has a COB provision similar to this one.

Special Rules for Dependents of Separated or Divorced Parents
If two or more plans cover a dependent child of divorced or separated parents, benefits are to be determined in the following order:

a) The plan of the parent who has custody of the child is primary
b) If the parent with custody of a dependent child remarries, that parent's plan is primary. The step-parent plan is secondary and the plan covering the parent without custody is third.
c) If the specific decree of the court states one parent is responsible for the health care of the child, the benefits of that parent' plan are determined first. You must provide the appropriate plan with a copy of the portion of the court order showing responsibility for health care expenses of the child.

Termination of Coverage
Coverage terminates:

• For an employee or retiree and covered dependents, when the retiree stops receiving a paycheck or pension check (with the exception of employees eligible for SLOAC or FMLA).
  
• For a spouse, when divorce from an employee or retiree.
  
• For a domestic partner, when partnership terminates.
  
• For a child, upon marriage or reaching an ineligible age, except for unmarried dependent full time students who are covered on all plans up to age 23.
  
• For all dependents, unless otherwise eligible, when the City employee or retiree dies.
  
  
• Options Available When City Coverage Terminates
  Employees and covered dependents may purchase individual health coverage through their health plan if their City group coverage ceases for any of the following reasons:
  • An employee leaves City employment.
    
  • An employee loses City coverage due to a reduction in the work schedule.
    
  • An employee or retiree dies.
    
  • A dependent spouse is divorced from the employee or retiree.
    
  • A domestic partnership terminates.
    
  • Dependent children exceed the age limits established under the group contract.

COBRA Continuation of Benefits
The Federal Consolidates Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that the City offer employees, retirees and their families the opportunity to continue group health and/or welfare coverage in certain instances where coverage would otherwise terminate. The monthly premium will be 102% of the group rate (or 150% of the group rate for the 19th through 29 months in cases for total disability. All group health benefits, including optional riders are available. The maximum period of coverage is 18, 29 or 36 months depending on the reason for continuation.

COBRA Eligibility
Employees Not eligible for Medicare - employees whose health and/or welfare fund coverage are terminated due to a reduction in hours of employment or termination of employment (for reasons other than gross misconduct). Termination of employment includes unpaid leaves of absence of any kind.

Spouses/domestic Partners Not Eligible for Medicare - spouses/domestic partners who lose coverage for any of the following reasons: (1) death of the City employee or retiree; (2) the termination of employee's City employment (for reasons other than gross misconduct); (3) loss of health coverage due to a reduction in the employee's hours of employment; (4) divorce from the City employee or retiree; (5) termination of domestic partnership with the City employee or retiree; (6) retirement of the employee.

Dependent Children Not Eligible for Medicare - dependent children who lose coverage for any of the following reasons; (1) death of a covered parent; (2) termination of a covered parent's employment (for reasons other than gross misconduct); (3) loss of health coverage due to the covered parent's reduction in hours of employment; (4) the dependent ceases to be a "dependent child" under the terms of the Health Benefits Program; (5) retirement of a covered parent.

COBRA Periods of Continuation
If the benefits are lost due to termination of employment or reduction in work schedule, the maximum period for which COBRA can continue is 18 months. This period is calculated from the date of loss of coverage under the City program.

If a COBRA beneficiary becomes disabled (as determined under Title 11 or XVI of the Social Security Act) during the first 60 days of the 18-month COBRA continuation period, coverage can be extended for an additional 11 months after the end of the original continuation period.

If dependents lose benefits as a result of death, divorce, domestic partnership termination or loss of coverage due to the Medicare eligibility of the contract holder or due to the loss of dependent child status, the maximum period for which COBRA can continue coverage is 36 months. This period is calculated from the date of loss of coverage under the City program.

Continuation of coverage can never exceed 36 months in total, regardless of the number of events that relate to the loss in coverage. Coverage during the continuation period will terminate if the enrollee fails to make timely premium payments or become enrolled in another group health plan (unless the new plan contains a pre-existing condition exclusion).

COBRA Notification Responsibilities
Under the law, the employee or family member has the responsibility of notifying their human resources department/benefits office and the applicable welfare fund within 60 days of the death, divorce or domestic partnership termination, or change of address of an employee or of a child's losing dependent status. Retirees and or family members must notify the New York City Health Benefits Program City agency and the applicable welfare fund within 60 days on the case of death of the retiree or the occurrence of any of the events mentioned above.

Election of COBRA Continuation
To continue continuation of coverage under COBRA, the eligible person must complete a "COBRA-Continuation Coverage Application. Employees and family can contact the Benefits Office. Retirees and or family members must contact the New York City Health benefits Program at (212) 513-0470.

Eligible persons electing COBRA must do so within 60 days of the date on which they receive notification of their rights, and must pay the initial premium within 45 days of their election. Premium payments will be made on a monthly basis. Payments after the initial will have a 30-day grace period.