You have 60 days from the date of any event that would add a new dependent to your Benefits Fund coverage to notify the Fund. Events include birth, marriage, adoption, and placement for adoption. If notification is not received within 60 days of the event, the dependent will need to wait until the next open enrollment period (between November 1 and December 31) to be eligible for coverage with the Fund with an effective date of January 1 of the following year.
The Fund requires a copy of your child's birth certificate to add your child; adoption papers to add your adopted child; marriage license to add your spouse; a copy of the ward's birth certificate and certified copy of guardianship appointment for your legal ward.
Eligibility for dependents varies, according to their age and relationship to you:
- Your spouse is eligible for medical, dental, vision, and prescription drug benefits through the Benefits Fund.
- Your children, stepchildren, foster children, and legal wards also are eligible for medical, dental, vision, and prescription drug benefits from birth until their 26th birthday.
- Dependent children living with you while awaiting your legal adoption are eligible for these benefits until their 26th birthday.
The fastest way is to check on Pages 11-12 of your Summary Plan Description. There you'll find a list of hospitals, plan numbers, and eligibility dates. However, please reference your NYSNA contract for the most updated information.
If you can't find either of these two items, call the Benefits Fund at (877) RN BENEFITS [762-3633].
Federal COBRA continuation coverage provides 18 months of medical, vision, prescription drug, and dental care benefits for RNs whose coverage ends due to a reduction in hours or termination of employment. New York's state continuation benefit extends that period an additional 18 months for medical only.
An RN's spouse and dependents who lose eligibility can receive federal COBRA continuation coverage (medical, vision, prescription drug, and dental benefits) for up to 18 months, followed by another 18 months of New York state continuation coverage (medical only) if needed.
Life insurance and disability insurance are not included. You can choose COBRA for yourself, your spouse, and/or your eligible dependents.
Your initial premium must be received within 45 days of the date you elect COBRA, and be paid on a timely, monthly basis thereafter.
For more information about COBRA, click here.
Your children are primary under the health plan covering the parent whose birthday falls first in the year and secondary under the other parent's plan.
Stepchildren and children of divorced or separated parents are primary under the health plan covering the custodial parent, unless specified otherwise. The plan of the custodial parent's spouse is secondary.
The Benefits Fund follows New York State Insurance Department rules for determining primary and secondary carriers. You are primary under the Benefits Fund and secondary under your husband's health plan, if he has one provided by his employer.
Your husband is primary under his health plan and secondary under the Benefits Fund.
Unless you have legally adopted your grandchildren, they cannot be covered under the Benefits Fund's health plans.
Call the Benefits Fund at (877) RN BENEFITS [762-3633] to get a new one. If you need to see a Oxford provider before the new one arrives, he or she can call the Benefits Fund to verify that you're a participant. You and each covered family member should have an individual ID card from Oxford.
Simply put, a copayment is the amount you pay for in-network services, while coinsurance is what you pay for out-of-network benefits.
A copayment is the maximum amount you owe for in-network services. You should not be charged any additional fees for covered services performed by an in-network provider.
Coinsurance, however, is your required percentage of the usual, customary, and reasonable charges that are not payable by Oxford (medical) or, in the case of Aetna (dental), usual and prevailing charges, for out-of-network services. This percentage typically is 20 percent to 50 percent, with Oxford (or Aetna) paying the remaining 50 percent to 80 percent of the UCR (or UP) after you meet any deductible. Any amount above the UCR or UP is the participant's or dependent's responsibility.