Benefit Eligibility
Eligibility Information As an employee working 30 hours or more per week, you and your eligible dependents qualify for Medical, Dental, Vision, and Life/ AD&D Insurance benefits. If your spouse or domestic partner has access to group coverage through his or her own employer, they are not eligible for CSHL medical/vision and/or dental benefits. Special enrollment rules apply if you are married to another CSHL employee or graduate student. Making Changes During the Year Generally you can only change your benefit elections during the annual benefits Open Enrollment period. An exception is made for any Qualifying Life Event (QLE), such as marriage, divorce, birth, or adoption. You must notify Human Resources within 31 days of any QLE to make changes. Otherwise, you’ll have to wait until the next Open Enrollment period. Any changes you make to your benefit choices must be directly related to the QLE. Proof of the change will be requested (example: a marriage license or birth certificate). When Coverage Ends All benefits end on your last day of work. However, under certain circumstances, you may continue your health care benefits through COBRA Insurance. Definitions
United Healthcare (UHC) developed the United Health Premium designation program, which recognizes physicians that meet guidelines for providing quality and cost efficient care. These physicians are designated as Premium Tier 1 and are displayed publicly on myuhc.com and in UHC’s physician directory. The program uses national industry standards to evaluate for quality and local market benchmarks for cost efficiency across 25 specialties, including family practice, internal medicine, pediatrics, cardiology, and orthopedics. The fact that a doctor does not have a quality designation does not mean that the doctor does not provide quality health services. All doctors who are part of the UHC network must meet UHC’s standard credentialing requirements. Medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount was paid. A cost-sharing arrangement in which a covered person pays a specified charge for a specified service, such as $20 for an office visit. The covered person is responsible for payment at the time the health care is rendered. Our co-payments are fixed flat amounts for physician office visits, prescriptions, or hospital services for which the patient is responsible to pay. DED is a portion of the benefits, under a policy, that the employee and dependents must satisfy before any reimbursement occurs. This is called the individual deductible. A dental health maintenance organization (DHMO) is a structured type of dental plan. In this type of plan, a set group of dentists provides broad and affordable care at a low monthly pre- mium. The dentists who work with DHMOs receive a fixed fee each month. Most of the work is done at no cost or for a reduced price. You may need to make a copayment for some types of work. You will need to choose a primary dentist to work with and you must let Cigna know if you want to change your dentist. There are no waiting periods, calendar year maximums, deductibles, or claim forms when you have a DHMO plan. Your dependent child can remain covered under your health plan through the end of the month in which s/he turns 26 regardless of marital or student status or if they have access to an employer-sponsored plan. However, under the Dental Plan, your unmarried child can remain on the plan through the end of the month in which s/he turns 22 or through the end of the month in which s/he ceases being a full-time college student, up to age 26. Each year you will be required to provide supporting documentation that your unmarried child over age 22 is a full-time student each August.
Tier 1 Provider
Co-Insurance
Co-Payment
DED: Deductible
Dental Health Maintenance Organization (DHMO)
Dependent Child(ren)
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