Vision Care Plan: Eligibility for Coverage

Who is Eligible

An employee in active employment status working at least 50 percent of the time on a regular appointment is eligible for Vision Care coverage.

Note: All eligible employees must meet a 6-month waiting period before using the Vision Care Plan.

Who is Not Eligible

The following employees are not eligible for vision care benefits:

Who is Eligible Under Family Coverage

An eligible employee's dependents are eligible for vision care coverage. Eligible dependents include an employee's spouse, domestic partner, unmarried children, and children adopted by the employee or the employee's spouse. Eligibility requirements for a domestic partner are described in the next block.

Spouse

An employee's current or legally separated spouse is eligible. A divorced spouse is not eligible for coverage.

Unmarried Children

Coverage can include an employee's unmarried children who are under age 19 (or under 25 if full-time students) including, but not limited to, stepchildren living at home and children under the employee's legal guardianship living at home.

An employee's unmarried children of any age, incapable of self-support because of a mental or physical disability, who were disabled before reaching age 19, can be covered subject to medical documentation as required by the plan.

Exclusions

An employee may not be covered both as an employee and as a dependent of another RF employee. If two members of the same family are employed at the Research Foundation, both can have individual coverage or one can have family coverage.

Eligibility Requirements for a Domestic Partner

An employee may include a domestic partner under family coverage provided that the domestic partner is enrolled under the employee's health coverage and is

Children of Domestic Partners

To be eligible for coverage, children of domestic partners must

Domestic Partner Coverage as Taxable Income

Under Internal Revenue Service (IRS) rules, if a domestic partner is not a "dependent" within the meaning of Section 152 of the Internal Revenue Code, the "fair market value" of the partner's health coverage, less any contribution for dependent coverage by the enrollee, is considered taxable (imputed) income for the employee. This is true even in cases where the domestic partner is a same-sex spouse. The fair market value of RF benefits equals the gross individual premium for the benefits (RF share and employee share) less the employee's contribution for dependent coverage.

Deductions for income tax and FICA contributions on the employee's paycheck and W-2 will be adjusted to reflect this higher income level. Value of Imputed Income for Domestic Partner Coverage is a chart that provides the biweekly increase in taxable income that will appear on the payments and deductions section of the employee's paycheck.

Note: The value of the imputed income is not included for retirement contributions and other benefits will not be affected.

Eligibility During Inactive Employment Status

Unpaid Leave of Absence

An employee on an approved leave of absence without pay is eligible for Vision Care coverage continuation if he or she pays the total premium to the RF during the leave period. Vision Care coverage may only be continued in conjunction with dental coverage.

Refer to Leave of Absence: Continuation of Group Coverage While on Leave Other Than Family and Medical Leave for additional information. The procedure includes an application for continuation of coverage under leaves of absence, and the premium amounts for coverage.

Leave of Absence Under the Family and Medical Leave Act (FMLA)

An employee on leave under the Family and Medical Leave Act (FMLA) is eligible for vision care coverage continuation. Refer to the "Family and Medical Leave" section of Benefits Administration > Benefits - Regular Employees > Benefits - Continuation of Coverage for more information.

Disability

A disabled employee receiving a benefit from New York State Disability insurance or Workers' Compensation for a total disability is eligible for Vision Care coverage continuation.

Change History

 

 

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