FOR CONTRACT COLLEGE EMPLOYEES

[Pages:32]New Employee

Benefits Decision & Enrollment Guide

FOR CONTRACT COLLEGE EMPLOYEES

? Decision worksheets ? Step-by-step instructions

2021

03.24.2021

Welcome to Cornell!

Working at Cornell comes with great benefits!

This booklet guides you through your benefits enrollment options as a new employee, and provides step-by-step instructions on how to enroll online in Workday.

HR Services and Transitions Center (HRSTC)

WE'RE HERE TO HELP

Have questions about your benefits?

LOOK ONLINE: hr.cornell.edu

EMAIL US: hrservices@cornell.edu

PHONE US: 607-255-3936, (TTY) 711

SEND US MAIL: HR Services & Transitions Center 395 Pine Tree Road East Hill Office Building, Suite 110 Ithaca, New York 14850

HOURS: 8am - 4:30pm, M-F

CONTENTS

Decision Worksheets

1 Decide who will be covered 2 Choose your medical plan 3 Dental coverage 4 PS404 enrollment instructions 5 Flexible spending accounts 6 Insurance 7 Retirement Savings

page 2 3 4 5 - 6 7 - 9 10 11 - 13

Optional Benefits

14 - 15

Enrollment in Workday 16 - 29

This booklet is for new employees with

CONTRACT COLLEGE BENEFITS.

Not sure if this is the right guide for you? Check your formal offer letter, or contact the HR Services & Transitions Center.

IMPORTANT NOTES:

? ENROLLMENT DEADLINES FROM DATE OF HIRE 30 Days: Employees' Retirement System (ERS) with New York State and Local Retirement System (NYSLRS) or State University of New York Optional Retirement Plan (SUNY ORP). 56 Days: Health and Dental Plan Coverage 60 Days: Flexible Spending Accounts, Group Universal Life (GUL) Insurance, Legal Plan Insurance Anytime: Personal Accident Insurance, Cornell University Tax-Deferred Annuity Plan (CUTDAP), 457(b) Deferred Compensation Plan, Auto/Home/Pet Insurance, NY's 529 College Savings Program, Long Term Care Insurance There are exceptions for certain qualifying events, such as marriage, birth of a child or adoption, divorce, etc. more info about qualifying events.

? Review and complete worksheets Choose your medical and dental plan, decide on your coverage level, and calculate any flexible savings account contributions. Worksheets are located in first 13 pages of this guide. We recommend reviewing this information before your onboarding appointment, so that an HRSTC counselor can answer any questions.

? Have personal information and documents ready When you enroll, you'll need date of birth for yourself and each of your dependents, and your social security number or ITIN (Individual Taxpayer ID Number); other documentation may also be required. More details about required documentation.

? Enroll An HRSTC counselor will help you get enrolled during your appointment. Or follow the step-by-step instructions starting on page 16 of this booklet.

1

Decision Worksheets

Decide who will be covered

Gather the information below for yourself and each dependent you wish to include in your coverage. You'll need to enter this info into Workday.

IMPORTANT! You will also need to provide documentation to the HR Services & Transitions Center. NOTE: DO NOT UPLOAD documents to Workday; documentation must be submitted by postal mail or secure file transfer.

? Legal Name: ? Social Security Number: ? Date of Birth: ? Gender:

Submit documentation by mail to: HR Services and Transitions Center 395 Pine Tree Road East Hill Office Building, Suite 110 Ithaca, New York 14850

Documentation can also be submitted through the Cornell Secure File Transfer Site: Call the HRSTC at 607-255-3936 if you need help to upload your files.

? Legal Name: ? Social Security Number: ? Date of Birth: ? Gender:

? Legal Name: ? Social Security Number: ? Date of Birth: ? Gender:

? Legal Name: ? Social Security Number: ? Date of Birth: ? Gender:

2

Choose one:

Empire Plan The Empire Plan is a unique plan designed exclusively for New York State's public employees. This plan allows you to choose care either in-network with Empire or out of network. If you use out-of-network providers, you risk paying higher costs.

NYSHIP Health Maintenance Organization (HMO) Plan: In an HMO plan, you choose an in-network primary care physician (PCP) for routine medical care and for referrals to specialists and hospitals. Your HMO choice will depend on the county in which you live or work.

Prescription drug coverage Prescription drug coverage is included with your health insurance enrollment, regardless of which plan you choose.

How the plans work See the NYSHIP Health Insurance Choices 2021 booklet for details about benefits, services and programs under the Empire Plan and the NYSHIP HMOs. Access NYSHIP online (first-time user login instructions here) to obtain additional information about health and dental plan benefits.

You can enroll and/or add eligible dependents within the 56 day waiting period for coverage effective the 57th day. You can enroll or add eligible dependents anytime with a 10-week waiting period unless you have a qualifying event based on IRS guidelines (such as marriage, birth of child, etc; see documentation requirements for Contract College employees). Limited changes can be made without the 10-week wait during the annual Option Transfer Period in the fall.

2021 Comparison Chart and Rates This pdf comparison chart shows plan features for the contract college health plan choices, including both HMOs and Empire Plan participating and non-participating providers. View 2021 rates here. Note: NYS requires 2 advance premiums, so double deductions will be reflected in your pay. This does provide you with 28 days of coverage after you last day worked if you were to leave Cornell.

3

Dental Plan

The state of New York pays the full cost of this coverage, but you must enroll to participate in the plan (check the dental box on Form PS404 when enrolling in health care). Learn more about the NYSHIP dental insurance plan. Coverage is provided through Emblem Health. Effective Date: If you enroll and/or add eligible dependents within the 56 day waiting period, coverage is effective the 57th day.

44

If enrolling dependent family members (B), complete (G)

Enroll in Health & Dental Plans with Form PS404

Download Form PS404: hr.cornell.edu/contractcollegehealthplans

Enrollment process: 1. Select your plan and dependents in Workday when you enroll in other benefits (instructions begin on page 16 of this booklet). 2. Submit the PS404 and any other required documentation as indicated below and on the following page.

IMPORTANT: ENROLLMENT, PS404, AND DOCUMENTATION MUST BE SUBMITTED WITHIN 56 DAYS OF DATE OF HIRE

EMPLOYEE BENEFITS DIVISION Health Insurance Transaction Form

for NYS Employees

PS-404 (5/20)

INSTRUCTIONS: READ AND COMPLETE BOTH SIDES/PAGES. PLEASE PRINT AND CHECK THE APPROPRIATE CHOICES.

EMPLOYEE INFORMATION

(All employees must complete)

1. Last Name

First Name

MI

2. Social Security Number 3. Sex

Male Female

4. Permanent Address Street

City

State

Zip

5. Mailing Address (If different) Street

City

State

Zip

6. Work Location & Address Street

City

State

Zip

7. Date of Birth

8. Telephone Numbers Primary (

)

Work (

)

9. Marital Status

Single

Married

Widowed

Divorced

Separated

Marital Status Date

10. Covered under Medicare? Self: Yes No Spouse/Domestic Partner: Yes No Child: Yes No

11.

ELECT OR DECLINE COVERAGE

A. Choose a Pre-Tax election

1. Elect Pre-Tax Status for Premium deduction

2. Elect After-Tax Status for Premium deduction

You are only eligible for Pre-Tax deductions if newly eligible or if requested during the Pre-Tax Contribution Program (PTCP) Election Period

B. Select a NYSHIP Coverage Option (Choose option 1, 2, 3 or 4)

1. Individual Enrollment

Medical (10)

(Select Empire Plan or HMO)

Empire Plan

HMO Code

Name

Dental (11)

2. Family Enrollment

(Complete box 13 on page 2)

Medical (10)

(Select Empire Plan or HMO)

Empire Plan

HMO Code

Name

Dental (11)

3. Decline Coverage

Medical (10)

Dental (11)

12.

CHANGE OR CANCEL EXISTING COVERAGE

A. Change Coverage:

Medical (10)

Dental (11)

Date of Event:

Change to FAMILY (Complete box 13)

Change to INDIVIDUAL

Marriage Domestic Partner

Divorce Termination of Domestic Partnership (Attach completed

Newborn Request coverage for dependents not previously covered Previous coverage terminated (proof required)

PS-425.4) Only dependent ineligible due to age I voluntarily cancel coverage for my dependents Only dependent died

Dependent returned to full-time student status

Only dependent married

Only dependent graduated

Other:

Other:

NOTE: If you are indicating a change in marital status to Divorced or Separated, please be sure to update the address information for the dependent in Box 13 if applicable.

B. Voluntarily Cancel Coverage:

Medical (10)

Dental (11)

Qualifying Event:

NOTE: If you are enrolled in the PTCP, you may make changes during the Annual Option Transfer Period or when experiencing a PTCP qualifying event.

Page 1 of 2

5

Complete items 1 - 10.

Complete 11 (A). You must indicate a before or after tax election for health insurance premiums. If you elect before tax, (which most do), your premiums will be deducted before taxes have been calculated.

Complete 11 (B), #1 or #2, to choose individual or family enrollment.

Enroll with Form PS404, continued

Back:

NYS Department of Civil Service Albany, NY 12239

Health Insurance Transaction Form Page 2 - PS-404 (5/20)

13.

DEPENDENT INFORMATION

Must be provided when choosing to enroll in NYSHIP family coverage (use additional sheets if necessary)

Check One: A (Add), D (Delete) or C (Change) Check all that apply: M (Medical), D (Dental)

Date of Event:

Last Name First Name MI

Relationship Date of Birth Sex

Address (if different)

A

M

D

D

C

A

M

D

D

C

A

M

D

D

C

A

M

D

D

C

Social Security Number

14. Change NYSHIP Option

ENTER ANNUAL OPTION TRANSFER REQUEST(S) BELOW

Change to: Empire Plan HMO Code

HMO Name:

Change Pre-Tax Status Change to: Pre-Tax

After-Tax

Submit during the Pre-Tax Contribution Program Election Period

Personal Privacy Protection Law Notification

The information you provide on this application is requested in accordance with Section 163 of the New York State Civil Service Law for the principal purpose of enabling the Department of Civil Service to process your request concerning health insurance coverage. This information will be used in accordance with Section 96 (1) of the Personal Privacy Protection Law, particularly subdivisions (b), (e) and (f). Failure to provide the information requested may interfere with our ability to comply with your request. This information will be maintained by the Director, Employee Benefits Division, Department of Civil Service, Albany, NY 12239; (518) 473-1977. For information relating only to the Personal Privacy Protection Law, call (518) 457-9375.

AUTHORIZATION

I have read the Pre-Tax Contribution Program materials and the Opt-out Attestation Form (if applicable) and have made my selection on Page 1 of this document. I understand that if my coverage is declined or canceled, I may subject myself and/or my dependents to waiting periods if I decide to enroll at a later date and may forfeit the right to such coverage after leaving State service (vest, retirement, etc.). I am aware of how to obtain a current Summary of Benefits and Coverage for the NYSHIP option I have selected. I understand that my failure to provide required proof(s) within 30 days may delay the availability of benefits for me or any dependent for whom I fail to provide such proof. Any person who makes a material misstatement of fact or conceals any pertinent information shall be guilty of a crime, conviction of which may lead to substantial monetary penalties and/or imprisonment, as well as an order for reimbursement of claims. I certify that the information I have supplied is true and correct. I hereby authorize deduction from my salary or retirement allowance of the amount required, if any, for the coverage indicated above.

Employee Signature (Required):

Date:

Retirement Tier

Registration #

AGENCY USE ONLY

Sick Leave Information

# Hours

Hourly Rate of Pay

Date Entered on NYBEAS

Effective Date

HBA Signature (Required):

Date:

If you are enrolling as a family from item 11 (B) #2, complete item 13, dependent information, on page 2 of form.

Be sure to sign and date!

Page 2 of 2

Submit this form and any documentation to:

HR Services and Transitions Center 395 Pine Tree Road East Hill Office Building, Suite 110 Ithaca, New York 14850

Documentation can also be submitted through the Cornell Secure File Transfer Site:

Call the HRSTC at 607-255-3936 if you need help to upload your files.

6

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download