SUNY Orange

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Benefits: Health Insurance

The program is intended to provide the fullest possible protection for you and your dependents for medical services, including hospitalization, surgical, out-patient and prescription drug care.

You can choose to receive your medical coverage via either of two basic options:

Group Indemnity Program or Health Maintenance Organization (2 options)

1) Group Program:
New York State Empire Plan

Orange County currently partially funds a medical insurance program for all government employees, called the New York State Empire Plan.

The program is a traditional group insurance plan and consists of four basic parts -

  1. Hospital Benefits
  2. Major Medical Benefits
  3. Preferred Provider Organization (which enables you and your family to receive routine medical services from participating physicians, for a nominal fee Aco-payment@.)
  4. Prescription Drug Program (The program enables you to purchase prescribed drugs after paying a nominal fee ("co-payment".)

Two forms of the program are available - short and long term use.

Forms:

2) Health Maintenance Organizations

As you may be aware, a Health Maintenance Organization (HMO) is a privately operated for profit organization which has been established to deliver medical services.

The County has contracts currently with the following two Health Maintenance Organizations which have facilities throughout the Orange County area:

a) GHI HMO Select, Inc.
b) MVP Health Plan

Costs

Regardless of the basic option, Group Indemnity or HMO, the cost approach is the same.

The majority of the premium costs to provide the program is paid by the College, to the County. However, each employee who participates is required to contribute the following amounts via payroll deductions toward any coverage which they might elect for themselves or their dependents. If the cost of an HMO is higher than the County allows, based on their plan, the amount in excess is also deducted from the employee in addition to the Employee Premium Share. For 2006 there is an additional cost for HMO coverage.

Annual Amounts Faculty
Staff & Chair
Management Confidential
Grant- Professional		 Civil Service
Grant - Clerical
Individual 2.5% Maximum Annual $ Amt. $500 $500
Family 2.5% Maximum Annual $ Amt. $750 $750

(% Gross Base Bi-Weekly Pay)

Eligibility Date

Coverage begins on the 1st day of the 3rd month following your application (i.e. 1 full month waiting period)

Coverages

Overall, the coverage between the two basic delivery options and among the two HMO's are comparable - not the same.

You should consult the comparative summary included in your New Employee Information Package or contact Human Resources for a new one.

It is difficult to answer the question which provides better coverage for an individual - as it really depends upon his/her personal circumstances.

Group coverage is generally better for someone who prefers: 1) greater freedom of choice in their physician selection 2) no pre-authorization for referrals 3) no geographic limitations in coverage. However, out-of-pocket costs are higher.

HMO coverage may have lesser out-of-pocket expenses, and no claim forms, but the user can be restricted in physician selection.

Human Resources Information:

Phone: (845) 341-4660
Fax: (845) 341-4670
Located in Orange Hall,
115 South Street Middletown, NY 10940
occchr@sunyorange.edu