Health Insurance, Direct Pay, & Waiver Plans

Health insurance is a fringe benefit intended to protect the medical health and well-being of employees. Empire Blue Cross Blue Shield(Empire) is the provider organization for employees who are eligible for healthcare coverage. The effective date of coverage is on the 1st of the month after a 30-day waiting period from an employee’s start date (e.g., If the start date is June 1, coverage begins on July 1 with the 30-day waiting period. If the start date is June 7, coverage begins on August 1 because of the 30-day waiting period).

Full-time and Part-time A employees assigned to a grant or contract funded project with a duration period of 90 days or more are eligible for health insurance. Full-time employees may enroll in Individual, Parent and Child(ren), Employee and Spouse, Family, or Domestic Partner coverage plans. Dental coverage is included for Full-time employees.

Part-time A employees are solely eligible for Employee Only coverage on a pre-tax basis and have the option to directly purchase additional coverage on a post-tax basis through the Direct Pay Program. Dental coverage is not included for Part-time A employees.

Enrollment in health insurance is self-managed through the My Payroll and Benefits e-Service. The names, dates of birth and social security numbers of all individuals being enrolled in the plan (i.e. spouse, domestic partner, dependent child or children) are required to enroll.

Preferred Provider Organization (PPO) Plan

Does not require a referral to see specialist whether in or out of the provider network. Whether members choose to receive care in or out-of-network, coverage is provided for medically necessary services. The network of providers under the PPO plan consists of national and international participating providers. Prescription plan deductible applies to brand name and non-formulary prescription drugs. There is no deductible for generic drugs

Direct Point-of-Service (POS) Plan

Has a regional network of participating providers in NY and the tristate area. Members can seek care in and out of the provider network. Physician referrals are not required and no deductibles apply to prescription drug plan.

Exclusive Provider Organization (EPO) Plan

An in-network coverage plan. All covered services must either be provided by the primary care physician or participating specialist. No referral is required for participating specialists. Except in cases of emergency, there is no out of network coverage with this plan. The EPO plan shares the national network with the PPO Plan.

Dental XPO Plan

Full-time employees who enroll in one of the health plans will automatically be enrolled in the XPO Dental Plan, which covers dental services provided from both in and out of network participating providers. Orthodontics is covered for dependent children up to age 19 only.

Blue View Vision

Vision Care is offered through Empire’s Blue View Vision Plan. Services indicated in the Blue View Vision document are covered under the plan every 24 months. Covered services include routine eye exams, eyeglass frames and eyeglass lenses (single, bifocal, or trifocal). For information about additional services covered under the plan, eye care providers, locations, or to access the system, call Blue View Vision Customer Service at 866-723-0515 or login to the Empire website.

Prescription Drug Plan

Prescription drug coverage is included with each health insurance plan. The 3 categories of covered drugs are:

  • Tier 1 Generic
  • Tier 2 Brand Name
  • Tier 3 Non-formulary

Prescription drugs are available through a retail pharmacy and the Express Scripts mail-order program. Express Scripts offers a 90-day supply of maintenance drugs. Applicable co-pays will apply.

Direct Pay Program

Individual health insurance coverage is available to all Part-time A employees along with the option to directly purchase additional coverage for a spouse/domestic partner and/or children at 100% of the cost for the dependent or dependents coverage. The employee’s portion of the health insurance premium will be deducted from the employee’s paycheck as a payroll deduction. The dependent or dependents cost of the premium must be made payable to the Research Foundation, CUNY submitted separately by check, money order, or direct debit. Check or money order payments should be made payable and mailed to:

Research Foundation, CUNY
Attention: Human Resources
230 West 41st Street
New York, NY 10036

Payment is due no later than the fifth calendar day of the month for which coverage applies (e.g., payment must be received by July 5 for coverage during the month of July). Failure to provide full payment will result in the cancellation of dependent coverage. 

Enrollment in the Direct Pay Program must be submitted before the employee's initial eligibility date, within 30 days of a qualified life event, or during the annual Open Enrollment period. Once enrollment has been completed, the employee must submit proof of dependent’s relationship to the Office of Human Resources. This includes marriage and/or domestic partnership certificates and birth certificates as applicable. Failure to submit proof of relationship will result in cancellation of the dependent's coverage. 

Health Insurance Waiver Plan

Employees eligible for health insurance may enroll in the opt-out waiver plan if currently enrolled in a non-RFCUNY health insurance plan. To qualify for waiver, employees must provide proof of alternate health insurance coverage. Medicare, Medicaid, Affordable Care Act Marketplace Exchanges, or other government issued insurance do not qualify for the opt-out funds.

There are three options for health insurance waiver participation:

  • Part-time A employees appointed for at least 90 days with alternate coverage may be eligible for the $1000 Individual waiver benefit by declining health insurance coverage.
  • Full-time employees appointed for at least 90 days with alternate coverage may be eligible for the $1000 Individual waiver benefit by declining health insurance coverage. Proof of coverage will only be required for the employee.
  • Full-time employees appointed for at least 90 days with alternate coverage may be eligible for Parent & Child, Employee and Spouse, or Family $1500 waiver benefit by declining health insurance coverage. Employees eligible for $1500 must present proof of coverage for eligible dependents.

Other Considerations

An in-network provider is one who has been contracted by the insurance company to provide services to the member. In-network providers agree to the terms set forth by Empire and members are only responsible for the terms of the contract and agreed upon co-pays.

Out-of-network providers may accept the insurance (Empire), but because they are not contracted with the insurance provider, they are not required to follow the specific terms or payment arrangement. Members seeking out-of-network care, will be subject to annual deductibles and coinsurance (the percentage that an employee is expected to pay compared to the percentage the insurance carrier will pay). Out-of-network providers may also charge members for any difference not covered by the insurance carriers. Whenever possible and for greater cost savings, members are encouraged to utilize in-network providers.

Break in Service

For the purpose of determining benefits eligibility, a break in service is defined as a period of inactive employment of 30 days or greater. Employees rehired after a break in service will be treated as a New Hire with respect to benefits enrollments.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires that group health plans provide a temporary continuation of group health insurance in the event health insurance is discontinued. Under New York State Continuation Coverage, COBRA benefits may extend up to 36 months. COBRA enrollees will pay 102% of the monthly premium. There may be other coverage options available through the Health Insurance Marketplace.  Eligibility for COBRA does not limit eligibility for any applicable tax credit through the Marketplace.

Under federal law, there is a 60-day limit after the date of the COBRA notice (or, if later, 60 days after the date that plan coverage is lost) to elect COBRA coverage under the plan. Employees will be sent a COBRA notice when there is a loss of health insurance eligibility.

Coverage Expansion through Age 29 COBRA

The New York State “Age 29” law permits young adults who have exceeded the age for dependent coverage under their parent's group health insurance plan to purchase individual coverage through their parent's policy or contract through age 29. The young adult must be unmarried, not be insured by or eligible for comprehensive (i.e. medical and hospital) health insurance through their own employer, live, work or reside in New York State or the health insurance company’s service area, and not be covered under Medicare plans.

Essential Forms

Medical, Dental, & Vision Benefits Forms