Health and Dental Insurance, Direct Pay, & Waiver Plans

Health insurance is a fringe benefit intended to protect the medical health and well-being of employees. Anthem is the provider organization for employees who are eligible for healthcare coverage. The effective date of coverage is on the 1^st 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 and dental insurance. Full-time employees may enroll in Individual, Parent and Child(ren), Employee and Spouse, Family, or Domestic Partner coverage plans. Employees working on multiple concurrent Part Time B appointments for a period of 90 days or more, where the total hours are equivalent to Full Time or Part Time A status, will be eligible for benefits based on the status equivalent of the total concurrent hours.

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 insurance is available to full-time and part-time A employees who are enrolled in a health insurance plan.

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.

Learn about the following medical plans the RF offers below.

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.

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.

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.

Anthem’s pharmacy benefit manager is Carelon Rx. This Anthem in-house PBM has enhanced services including dedicated 24/7 Pharmacy Support, a fully integrated website, and enhanced digital tools that allow members to price medication, find and compare costs across pharmacies, refill their home delivery and specialty pharmacy prescriptions, and much more. Carelon Rx 24/7 Customer Care number is 833-204-6098.

CareleonRx Mail is available at no extra cost. This ensures you have your prescription refills when you need them. Standard shipping is free for home delivery, and you can set up automatic refills to have your next 9-day supply sent to you before the refill date so you won't run out of your medicine.

Vision Care is offered through Anthem’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 Anthem website. 

Blue View Vision is available to eligible Field employees only. RFCO employees should contact Human Resources regarding vision care coverage.

Anthem Blue Cross provides telemedicine services through their Live Health Online program. This telemedicine program allows members enrolled in the PPO, POS, and EPO plans to access medical and mental healthcare remotely. Live Health Online can be accessed online at www.livehealthonline.com or by calling 1-844-784-8409.  You may also contact the 24/7 Nurseline at 800-337-4770. Remember to have your Anthem Member Enrollment Number handy. You can access your Anthem information including member ID number, check on prescription details, view claim history, or find a provider through the Anthem App - Sydney Health.

Ease of use

• Use your smartphone, tablet or computer with a webcam. Sign up at livehealthonline.com  or download the app on your smart device. Registration is free

24/7 access to doctors

• See a board-certified doctor in minutes, right when you need it. For things like the flu, cold, sinus infection, pink eye, rashes, fever and more.

Convenience

• Maintain social distancing and avoid long appointments or office visit wait times. Get connected to a doctor in about 10 minutes or less.

Learn more or contact your Campus Benefits Coordinator at benefits@rfcuny.org or 212-417-8600 option #4 should you have any questions.

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 41^st 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. 

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.

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 Anthem and members are only responsible for the terms of the contract and agreed upon co-pays.

Out-of-network providers may accept the insurance (Anthem), 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.

The Cigna Dental PPO Plan, also referred to as Cigna Advantage or Cigna Total Dental PPO. Enrollment is automatic once enrolled in RF’s health insurance plans.

Coverage – The Cigna Dental PPO plan is accepted by a large network of providers. You can go to any licensed dentist at any time. You do not need a referral to see a specialist. Network dentist or dental specialist can be found online at Cigna.com. Once enrolled you may go to your personalized website at myCigna.com. You may also call customer service at 800.Cigna24 (800.244.6224) and a representative will help you find a network dentist in your area.

24/7 Customer Service - For questions about Cigna coverage and enrollment, Cigna is available 24/7 by calling 800.564.7642.

Cigna Dental Wellness Plus - When you get preventive care, your annual dollar maximum increases the next plan year. This lets you build your annual dollar maximum for other future needs. Your annual dollar maximum will grow each year up to the level listed in the plan documents. Preventive Care includes cleanings, oral exams, and x-rays

Cigna Dental Oral Health Integration Program - This program reimburses out-of-pocket costs for specific dental services used to treat gum disease and tooth decay. The program is for people with certain medical conditions that have been found to be associated with gum disease and cavities. Fill out the online registration form found on myCigna.com. You may also call the number on the back of your ID card to have an enrollment form sent to you. You only need to complete the form one time per qualifying condition. To learn more call 800.Cigna24 (800.244.6224)

Brighter Score - This online tool may be used to compare dentists. Each dentist is given a score based on things like affordability, patient experience and professional history. Find detailed information to compare dental offices. View dentist profiles with photos and videos. Read verified patient reviews. Write your own review after your appointment. Search for a dentist by service. Information is personalized for your specific plan. Shows price with coinsurance and deductibles.