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Health Insurance Options

SUNY Canton offers the following group health insurance options:

The Empire Plan

The Empire Plan provides coverage for hospitalization through Blue Cross and combined medical, surgical and major medical coverage through Metropolitan Life Insurance Company.

There is a co-payment for each out-patient visit to a hospital, with the exception of visits for chemotherapy, radiation therapy, physical therapy or kidney dialysis.

The plan features a network of participating providers (hospitals, physicians, laboratories, chiropractors and other specialists and establishments). Services rendered by these providers will be paid in full with the exception of a co-payment for office visits, lab tests, x-rays and out-patient surgeries. You pay nothing out of pocket for all other services; the insurance carrier pays the provider directly. Claims for services by providers who do not participate in the Empire Plan must be submitted on a major medical claim form. Once a deductible amount is met, major medical will pay 80% of reasonable and customary charges. After deductible and coinsurance limits have been met, the plan pays 100% of covered expenses.

HMO Blue Health Plan (HMO)

Health Maintenance organizations (HMO's) maintain their own health care centers and employ their own physicians and other health professionals. HMO's differ from conventional medical plans in that they provide medical services rather than reimbursing their members for the cost of services received elsewhere.

HMO's provide a wide range of health services from office visits to complex medical treatment and hospitalization for a fixed, prepaid payment which you share by payroll deductions with the State.

Under an HMO you choose your own primary care physician from a list of local physicians. In most cases, your medical care will be provided by the designated physician in their office. If you need a diagnosis or treatment that is not available from your primary care physician, they will arrange for you to see a specialist.

Services received by your primary care physician, or by a specialist when referred by your primary care physician, are paid in full except for a minimal per office visit charge. There are no claim forms to be filed and all administrative details are completed by your physician's office staff. All referrals and hospital admissions must be authorized in advance by your primary care physician. Non-emergency care received without authorization is not covered and payment will be your responsibility. Emergency care of a life threatening nature is covered in full providing upon arrival at an emergency room your HMO is notified.

Eligibility

The following employees are eligible for health insurance coverage for themselves and their eligible dependents at the group rate:

  • Full-time faculty and professional staff
  • Part-time faculty who teach at least two courses per semester; and
  • Part-time professional staff who earn at least $10,502 per year.

Effective Date of Coverage

Providing you apply for coverage within the first 42 days of employment, coverage will become effective on the 43rd day of employment.

Cost of Coverage

The State pays 90% of your health insurance premium and 75% of the premium for your eligible dependents. You may elect to have your bi-weekly health insurance premium deducted from your pay on a pre-tax basis. Effective January of each year, your bi-weekly premium cost is subject to change.

Eligible full-time employees who have at least 15 days accumulated sick leave may exchange three days of sick leave accruals that would normally be earned for a maximum $300 reduction in health insurance premiums for the year. Election of the sick leave exchange program is made in November of each year.

How to Enroll

To apply for enrollment, you must complete a health insurance enrollment form, and an HMO application, if necessary, available in the Human Resources Office.

Change of Plan Option or Coverage

There is an annual transfer period (usually in November of each year) during which time you can change you health insurance option and coverage for eligible dependents.

Retirement Coverage

If you meet specific criteria, you will be eligible to continue your health insurance in retirement. In general, you must have complete ten (10) years of service to the College, be a member of a state administered retirement system and be enrolled in one of the health insurance programs at the time of retirement.

Prescription Drug Program

The Prescription Drug Program allows you and your eligible dependents to purchase prescription drugs at minimal cost. The plan has a co-pay feature when you have a prescription filled at a participating pharmacy (any pharmacy displaying a green NPA Participating Pharmacy decal). To encourage the use of generic equivalents and reduce the overall cost of prescription drug plans, this plan has a mandatory generic reimbursement program.

You may obtain a prescription drug written for a brand name when there is no existing generic equivalent and pay the deductible amount. You may choose a generic equivalent, when available, and pay only the deductible amount.

When a brand name prescription drug has an existing generic equivalent, you can still get the brand name, but you will be responsible for the difference between the cost of the brand name drug and the cost of the generic equivalent, plus the co-pay amount. Pharmacies have requested to charge the difference between the brand name average wholesale price, or the posted price, whichever is less than the generic equivalent price.

Dental Insurance

There is no premium cost to employees for coverage and there are no co-pay or deductible requirements.

Payments under this plan are made according to a schedule of allowances. If you use a participating dentist you should have no additional expenses for services other than those outlined in the plan. For the most part, participating dentists limit their fees to the plan's payment schedule. However, there are minor exceptions.

Should you elect a non-participating dentist, the plan will pay up to the maximum allowance in its payment schedule. You will be responsible for any costs over and above this allowance.

Part-time or temporary employees whose employment is expected to last less than six (6) months are not eligible for enrollment in this plan.

Vision Care

Once every 24 months, through one of the Plan's providers, eligible employees and their dependents are entitled to an eye examination, one pair of glasses (lenses and frames). The benefit may also be applies towards contact lenses instead.

Should you elect a non-participating optometrist, the plan will pay up to the maximum allowance in its payment schedule. You will be responsible for any costs over and above this allowance.

Part-time or temporary employees whose employment is expected to last less than six (6) months are not eligible for enrollment in this plan.

Health Insurance Rates (Effective Jan 1, 2012)

Employee cost per pay period:

Empire Plan

Individual

Family

CSEA Grade 9 and below $32.93 $132.48
CSEA Grade 10 and above $43.90 $158.19
M/C $43.90 $158.19
PBA (formerly Council 82) $28.97 $125.52
UUP $28.06 $122.13

If interested in rates for HMO’s (there are none in St. Lawrence County), please contact the Human Resources Office at 7010.

Detailed information concerning the health insurance programs is available from the Human Resources Office or NYS OnLine.

Human Resources
SUNY Canton
34 Cornell Drive
Canton, NY 13617

(315) 386-7325
Fax: (315) 386-7064