The City University of New York
NYS HEALTH INSURANCE PROGRAM
NYSHIP
Student Employee Health Plan (SEHP)
Office of Human Resources Management
University Benefits
ELIGIBILITY
TO BE ELIGIBLE FOR NYSHIP BENEFITS YOU MUST
MEET ALL OF THE FOLLOWING CRITERIA:
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Matriculate in a Doctoral Program at the CUNY
Graduate Center or the Engineering Ph.D. Program at
City College
Work in an eligible title (Graduate Assistant A, B, C, or
D, Adjunct Instructor, Adjunct Lecturer, Adjunct
College Laboratory Technician And Non- Teaching
Adjunct I, II)
Make a minimum $4,122 per year or $2,061 per
semester
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ENROLLMENT
Complete the Health Benefits Enrollment Form (PS-404) and submit it
along with supporting documentation to the NYSHIP Coordinator at
your college:
CUNY Graduate Center – Scott Voorhees - Office of Student Affairs,
Room 7301.05
Phone number 212.817.7406
City College - Kim Ferguson - Office of Human Resources
Shepard Hall, Room 50 – (212) 650-7963
NOTE: Refer to the “SEPH Eligibility Requirements” sheet for list of
required documentation:
www.cuny.edu/doctoralstudenthealthplan
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ENROLLMENT… (Cont’d)
YOU MAY ENROLL IN NYSHIP BENEFITS:

Within 45 days of your appointment - Late enrollments
will be subject to a 30-day waiting period

Within 30 days of a qualifying event

Within 30 days following involuntary loss of other
coverage
.

During the Annual Open Enrollment Period – November
1st – November 30th
*Note: Employees of the CUNY Research Foundation are
not eligible for these benefits.
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EFFECTIVE DATE OF COVERAGE
FOR NEWLY ELIGIBLE EMPLOYEES:
If you apply within 45 days of your
date of appointment in a NYSHIP
eligible title, coverage for you and
your eligible dependents will generally
be effective as of the date of your
appointment.
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EFFECTIVE DATE OF COVERAGE
LATE ENROLLMENT:
If you apply for NYSHIP coverage more than
45 days after your date of appointment in a
NYSHIP eligible title, your coverage will begin
30 days from the date that your enrollment
form is received by the NYSHIP Coordinator at
your college
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COVERAGE OUTSIDE OF THE USA
Services provided outside of the USA
are treated as out-of-network services.
You must complete a claim form to
obtain reimbursement.
Download this claim form at:
http://www.cs.ny.gov/ebd/ebdonlinece
nter/pof/images/OutOfStateForm.pdf
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INSURANCE CARDS
You should expect to receive your insurance card within
3-4 weeks following your enrollment.
You will receive 3 cards:
 Medical/Hospitalization
 Dental
 Vision Care
Note: In case of an emergency, the carrier may use your
SSN or NYSHIP card number to verify your coverage.
Contact the NYSHIP Coordinator at your college if you
need to obtain your NYSHIP card number.
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ELIGIBLE DEPENDENTS
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Spouse
Domestic Partner
Dependent Children - Up to age 26 (natural children,
adopted children, dependent step children).
Disabled Dependents
Notes: Refer to the “SEHP Eligibility Requirements” on the
CUNY website for a list of required documentation.
www.cuny.edu/doctoralstudenthealthplan
[Note: Parents are not considered eligible dependents.]
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NYSHIP BENEFITS PROVIDERS
Medical Benefit – UnitedHealthCare
 Hospital Benefit - Empire BlueCross BlueShield
 Dental Benefit – EmblemHealth
 Vision Care Benefit – Davis Vision

Prescription Drug Benefit - UnitedHealthCare /
Express Scripts/Medco Health Solutions
 Mental Health/Substance Abuse Benefit UnitedHealthCare / OptumHealth

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NYSHIP BIWEEKLY PREMIUM
RATES
[AS OF JANUARY 1, 2013]
INDIVIDUAL – $10.18 PER PAY PERIOD
FAMILY – $69.95 PER PAY PERIOD
 Pre-tax bi-weekly health insurance premiums will be
automatically deducted from your paycheck.
 You may elect to have post-tax health insurance
premium deduction by completing the appropriate
section on the Health Benefits Enrollment Form
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CHANGES TO COVERAGE
You may make changes to your coverage:
 Within 30 days of a Qualifying Event
 During the Annual Open Enrollment Period
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QUALIFYING EVENTS

Marriage

Birth of a child
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Becoming a child’s legal guardian, step-parent
or adoptive parent
Arrival of an eligible dependent to the United
States
Completion of the six month waiting period for
attainment of Domestic Partner Status
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ANNUAL OPEN ENROLLMENT
PERIOD
Generally held in November. For calendar year 2013 it is
November 1st - November 30th.
During the annual open enrollment period you may:
 Enroll in health benefits or add eligible dependents
without the 30-day waiting period for late
enrollments
 Change from individual to family coverage
 Change from family to individual coverage

You may change from pre-tax to post tax status

You may change from post-tax to pre-tax status
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TERMINATION OF COVERAGE
Coverage will cease when you no longer meet
both of the requirements indicated below:
1. Matriculated in a Doctoral Program at the
CUNY Graduate Center or in the Engineering
Ph.D. Program at City College
2. Working in an eligible title (Graduate
Assistant A, B, C, or D, Adjunct Instructor,
Adjunct Lecturer, Adjunct College Laboratory
Technician And Non- Teaching Adjunct I, II)
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TERMINATION OF COVERAGE…
(Cont’d)
Coverage will terminate when you cease
working in a NYSHIP eligible title or when you
graduate or take a leave from your doctoral
program (whichever comes first).
Since you will have pre-paid for two pay
periods of coverage, your coverage will end 28
days following the last date of the pay-period
that your termination date falls within.
You must notify the University Benefits Office immediately once
you no longer meet the eligibility requirements. Otherwise, it
may result in unanticipated cost to you.
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CONSOLIDATED OMNIBUS BUDGET
RECONCILIATION ACT OF 1985 (COBRA)
NOTIFICATION
Under COBRA you and your dependents may continue
group health coverage at a monthly premium of 102% of
the group rate. The maximum period of coverage will vary
depending on the reason for continuation.
The COBRA application process begins once the University
Benefits Office is notified of your loss of eligibility. The NYS
Department of Civil Service will send a COBRA package to
your home address once the University Benefits Office has
terminated your NYSHIP benefits.
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COBRA APPLICATION
Complete and return the COBRA
enrollment application to the address
indicated on the COBRA application form
on a timely basis
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COBRA MONTHLY PREMIUM
RATES
[AS OF JANUARY 2013]
INDIVIDUAL - $225.64
FAMILY - $755.52
 You will receive a monthly bill from
the NYS Department of Civil Service
for your COBRA premium payments
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TO FIND A LIST OF
PARTICIPATING PROVIDERS…

Medical - www.empireplanproviders.com

Dental – EmblemHealth - 1-800-947-0101

Vision Care – Davis Vision – 1-888-588-4823

General Information - 1-877-7-NYSHIP
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TRANSFERS
FILL OUT A NYSHIP TRANSFER FORM
(NYSHIP001 TRF-UBO) IF YOU ARE:
 Transferring to a new college

Changing title

Both transferring and changing title
DOWNLOAD THE FORM FROM:
http://www.cuny.edu/administration/ohrm/university-benefits/dshp.html
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ONLINE HOME ADDRESS CHANGE
To update your home address online:
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.
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Go directly to http://www.cs.ny.gov/
Choose a Civil Service ID and password
You will receive an Activation Code in the mail within
3 to 5 business days
Once you receive your Activation Code, return to
MyNYSHIP and log in with the Civil Service ID and
password
Then go to Employee Self Service and update your
home address
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COMMUNITY COLLEGES
If you are working at a CUNY Community College, contact the
NYSHIP Coordinator at your college to be transferred to the
Graduate Center payroll.
PLEASE NOTE THAT THIS PAYROLL TRANSFER MUST BE
COMPLETED FOR EACH SEMESTER YOU WILL BE WORKING AT
ONE OF THE COMMUNITY COLLEGES.
CUNY Graduate Center – Scott Voorhees - Office of Student
Affairs, Room 7301.05 - Phone number 212.817.7406
City College - Kim Ferguson - Office of Human Resources
Shepard Hall, Room 50 – (212) 650-7963
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PSC/CUNY WELFARE FUND
ADJUNCT HEALTH INSURANCE
If you are eligible for NYSHIP
coverage, you will no longer be eligible
for adjunct health insurance through
the PSC/CUNY Welfare Fund.
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SUMMER COVERAGE


Graduate Assistants - Coverage continues for all who
remain on payroll and receive paychecks during the
months of June, July and August.
Adjunct Instructor, Adjunct Lecturer, Adjunct College
Laboratory Technician and Non- Teaching Adjunct I, II
- Coverage continues if: a) you have or are expected
to have a Fall 2013 appointment; and b) you prepay
premiums to cover health insurance deductions for the
summer months in which you are not expected to
receive a paycheck.
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CONTACTS
CUNY Graduate Center – Scott Voorhees - Office of Student
Affairs, Room 7301.05 - Phone number 212.817.7406
City College - Kim Ferguson - Office of Human Resources
Shepard Hall, Room 50 – (212) 650-7963
You may also contact the University Benefits Office at
(646) 313-8232
You may contact NYSHIP at 1-877-7-NYSHIP
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