Graduate Student Employee Health Plan (GSEHP)

Effective Date:

April 18, 2018

Function:

Benefits Administration

Contact:

Kathleen Caggiano-Siino

Basis for Procedure

The Research Foundation (RF) offers the Graduate Student Employee Health Plan (GSEHP) to eligible graduate students employed by the RF, graduate and postdoctoral fellows, and their eligible dependents.

Please also refer to the GSEHP Member Handbook.

Plan Administrator

The RF contracts with UMR, a health claims administrator, to administer the medical, surgical, prescription drug, and hospital benefits of the Graduate Student Employee Health Plan. UMR subcontracts with Medco for prescription drugs.

Graduate student employees and fellows who are enrolled in the GSEHP are automatically enrolled in the Graduate Student Delta PPO plan provided through Delta Dental of New York, and the Davis Vision Plan. Separate brochures are provided for these programs, and can be found on the benefits website by clicking the link for each plan.

Plan Year

The plan year is based on benefit type.

Enrollment Period

Employees and fellows can enroll in the plan during the period from August 15 to September 30 each year, or when they are hired or newly eligible.

Description of Plan

The Graduate Student Employee Health Plan includes hospital, medical, surgical, and prescription drug benefits provided by UMR and the MagnaCare/United Healthcare Choice Plus networks of participating providers [effective May 1, 2018]. Plan members may also use the Student Health Center Services on campus. [MagnaCare will be available at University of Buffalo, Buffalo State, and Fredonia - member ID cards will indicate the available networks]

For more information on:

Contributions

Research Foundation (applies only to graduate student employees)

The RF will contribute 90% of the premium cost for individual coverage and 75% of the premium cost for dependent coverage during the period in which the graduate student employee is enrolled and eligible for the plan.

Employee

The employee will contribute 10% of the premium cost for individual coverage and 25% of the premium cost for dependent coverage.

Fellows

The full premium for fellow health coverage must be paid by either

Pretax or After-Tax Biweekly Deductions

Employee contributions will be made as biweekly payroll deductions taken on a pretax basis unless the employee waives pretax deductions. Premiums for fellow coverage cannot be taken on a pretax basis.

Pretax deductions are subject to the limitations of Section 125 of the Federal Tax Code and the terms of the Research Foundation Flexible Benefits Program.

Refer to Eligibility for GSEHP Coverage for domestic partner tax information.

Refer to Health Insurance Deduction and Premium Amounts, a list of biweekly deduction amounts for all health plans and biweekly rates for fellow health coverage. Flexible Benefits Program Guidelines for Graduate Student Employees and the Participant Waiver Form for Graduate Student Employees are used for those participants who do not want their deductions taken on a pre-tax basis.

Coverage When Traveling

Graduate student employees and graduate and postdoctoral fellows and their eligible dependents can receive network medical benefits throughout the United States. Information and names of network providers can be found at the UMR website. Medco Health is the pharmacy network. Davis Vision manages the vision network.

Coverage During the Summer Period

An employee who is covered by the plan during the spring semester may continue to be covered during the summer period, even if not in active pay status, if the project director certifies that the employee is expected to be reappointed in the fall. Refer to the document Summer Period: Continuation of GSEHP Benefits for more information.

International Students

F Visa and J Visa

F visa and J Visa holders are eligible for the GSEHP and are subject to the same terms as other graduate students.

Coordination of Benefits

When a person is covered under two or more benefit plans, coordination of benefits is necessary. UMR is responsible for determining which is the "primary" plan responsible for paying for any covered services before the other plan(s). Secondary plans pay their portion of covered benefits after the primary plan. Refer to the Coordination of Benefits provisions of the UMR Graduate Student Employee Health Plan Member Handbook for more information.

Right to External Claims Appeal

New York State (NYS) law gives employees special rights to appeal a health insurance claim denial on the basis that services performed were not medically necessary or were experimental or investigative. In these instances, the employee is entitled to an independent third-party review of coverage determination. Additional information can be obtained on the NYS Department of Financial Services website. Health plans are also required to provide this information to their members.

To Enroll

Graduate Students and Fellows

An employee or fellow must complete the Research Foundation Graduate Student Employee Health Plan Enrollment Form during the enrollment period or at the beginning of employment or eligible status.

Operating locations who do not do their own inputting must:

Graduate Student Alternative

If the operating location choses they can direct graduate student employees (not fellows) to the Self Service application to enroll on-line. If this is the case, no forms are necessary.

Fellow Health Insurance Premiums Paid by an Award

When award funds are used to pay for all or part of a fellow's health insurance premium, a separate procedure should be followed. Review Fellow Health Insurance Premiums Paid by an Award for detailed information on this process

Notification to Carrier

Operating locations who do their own their own UMR inputting should refer to UMR's enrollment system user reference manual for the Research Foundation of SUNY (http://www.benefitsoft.com.)

Enrolling a Domestic Partner

Employees or fellows who want to enroll a domestic partner should be given Instructions for Enrolling Domestic Partners and Same-Sex spouses in Health, Dental, and Vision Plans.

Required Forms

The following forms must be completed by the employee or the fellow.

Required Documentation

Employees and fellows must produce two documents that substantiate financial interdependency with their partner. Examples of acceptable documentation are provided on the Affidavit of Financial Interdependency.

Submitting the Forms

Required forms and documentation must be submitted to the operating location office responsible for administering Research Foundation benefits. The forms must then be sent to the central office, Benefit Services Unit.

Definitions

None

Related Information

None

Forms

Change History

Date

Summary of Change

April 18, 2018

Updated POMCO to UMR due to acquisition and rebranding.

February 12, 2014

Updated for self service and combined with Graduate Student Employee Health Plan (GSEHP) Enroll an Employee

July 20, 2012

Updated networks

May 9, 2012

Updated links and J visa eligibility

April 29, 2010

Updated links

September 16, 2005

Added links to plan handbooks/brochures and removed sections on maximum reimbursements, cost management services, and professional care.

 

 

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