The City University of New York Chap

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Office of the Vice Chancellor for Faculty and Staff Relations

# 535 East 80 Street, New York, N.Y. 10021
boa (212) 794-5341
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January 21, 1986

Dear Adjunct Member of The Instructional Staff:

The recently signed contract between the Professional Stafet
Congress and The City University of New york offers basic
individual health care (insurance) coverage for adjunct members of
the instructional staff who meet the criteria listed herein. This
coverage will be administered by the PSC-CUNY Welfare Fund.

The benefit shall be available only to those
adjuncts who are teaching six or more hours
(or the equivalent), in the semester and who
have taught one or more courses in the same
department at the same college for ten con-
secutive semesters (not including Summer
Sessions) and who are not covered by other
primary health care insurance provided by or
through another source.

An adjunct who has established eligibility
for this health benefit shall lose
eligibittty if-in any two out of three
academic years the adjunct teaches in only
one semester of the year at that college.

It appears that you have already met the service requirements.
If you are working a minimum of six credit hours or its equivalent
within your department during the spring semester and have no other
primary (basic) health coverage, you will be certified) by jehe
University to be eligible for this new benefit.

Each eligible person will have an interim choice of fully-paid
individual coverage in the Health Insurance Plan of Greater New
york HIP/HMO or individual coverage in the Blue Cross-Blue Shield
Wraparound policy. The HIP/HMO policy includes riders providing
for additional mental health, private duty nursing, and drug
coverage. The Blue Cross-Blue Shield policy includes the
wraparound feature. Each policy includes a conversion privilege
that would enable a participant to continue certain coverages
through private payment when eligibility ceases. You are urged to
review these clauses carefully as well as the basic benefits
described in the enclosed material.


If you will be employed in the same department of your college
for the requisite time during the spring semester, and have no
primary (basic) health insurance coverage, complete the enclosed
CUNY application form along with a completed enrollment form from
either Blue Cross-Blue Shield Wraparound or HIP/HMO and return them
to the University Pension and Welfare Benefits Office Room 602, 535
E80: Street, NY .100213)

Coverage will not begin until you have been notified in
writing of the inception date by the PSC-CUNY Welfare Fund. Leivou
are purchasing insurance privately or are named on another person's
policy, do not cease coverage unless you receive official
notification of coverage from the PSC-CUNY Welfare Fund.

If you have:-a question pertaining to eligibility see the
Personnel Officer at your college or call the University Pension
and Welfare Benefits Office at 212-794-5341. For information on
coverage and benefits, call the PSC-CUNY Welfare Fund at
212-354-5230.

Your syeruly,

: CL
enneth J. eedy
University Director of
Pension and Welfare
Benefits

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Enclosures:
CUNY Application Form
Blue Cross-Blue Shield Wraparound brochure
Blue Cross-Blue Shield Wraparound Enrollment Form
HIP/HMO Brochure
HIP/HMO Enrollment Form


APPLICATION FORM FOR INDIVIDUAL HEALTH COVERAGE
FOR ADJUNCT MEMBERS OF THE INSTRUCTIONAL STAFF

Recqurn: (6.026 CUNY,
Office of Pension
& Welfare Benefits
Room 602
S35 Ew oOtne Seneet
New UYor ky oN. Yo.
TOO 22

DATE:

Name

a a

ey ee First ~ Middle
Soc. Sec.#

College

a a a

Department

Home Address_

a a re

Home Phone ( )

Birthdate o Name and address of
full-time employer if any

Marital Status at (Si My DD
Dependent Children (Number )

os a

——

Insurance Plan selected (check one)

Blue Cross-Blue Shield
HIP/HMO

I attest that I am not currently covered by any primary health plan,
or that I will terminate any other primary coverage upon
certification of coverage by the PSC-CUNY Welfare Fund.

Signature

PLEASE COMPLETE AND RETURN ALL _FORMS BY RETURN MAIL. Coverage will

not begin until you are notified by the PSC-CUNY Welfare Fund.

Reviewed by Pension and Welfare Benefits Office
Office of Faculty and Staff Relations
The City University of iNew York

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