Benefits Information & Forms

2026

• Holiday Schedule 2026
• Floating Holidays 2026
• Payroll Schedule 2026
• Notices
  • Annual Notice 25-26
  • CHIPRA
  • Medical Creditable Coverage
  • Notice of Marketplace Coverage
  • Notice of Privacy Practices
  • Notice of Special Enrollment Rights

2025

• Benefits Summary 2025
• Benefits Fee Chart 2025
• Holiday Schedule 2025
• Payroll Schedule 2025
• Floating Holiday Schedule 2025
• Waiver Form
• Open Enrollment Presentation PDF
• Open Enrollment Presentation Video
• Notices
  • Annual Notice 24-25
  • CHIPRA
  • Medicare Creditable Coverage
  • Notice of Marketplace Coverage
  • Notice of Privacy Practices
  • Notice of Special Enrollment Rights
  • SAR 2024

Health Insurance

• Cigna
  • Pre-Enrollment Guide
  • Get Started with myCigna.com (access ID card, virtual care, find providers, etc.)
  • EPO Benefit Summary
  • EPO Plan Description
  • PPO Benefit Summary
  • PPO Plan Description
  • Provider Directory
  • Welcome and Register with Cigna
  • ERH is part of Cigna’s Open Access Plus Network
  • 2026 Drug Coverage Changes 

Flexible Spending Account

• 2026 FSA contributions are $3,400.  Current withholdings for 2025 FSA contributions will end 12/31/25.  Any unused balance from 2025 will carryover to 2026 up to $660.
• FSA Eligibility List
• Eligibility – All full-time employees who work at least thirty-six (36) hours per week are eligible for medical coverage beginning the first of the month after 60 days of employment. Part time employees are eligible the first of the month after 60 days of service on a pro-rated contribution basis. Eligibility for this benefit is offered in compliance with the Affordable Care Act (ACA).

Health Insurance Marketplace Coverage Options and Your Health Coverage

• Marketplace Coverage Form

Dental

• Benefit Booklet Including Enrollment/Change Form
• Preventive Advantage
• Eligibility – All Employees, Full-time and Part-time, are eligible the first of the month following 60 days of employment.

• Benefit Forms
  • Claim Form

Vision

• Benefit Booklet Including Enrollment/Change Form
• Claim Form
• Eligibility – All Full-time employees are eligible the first of the month following 60 days of employment. Vision is not available to Part-time employees

Group Life & AD&D Benefits

Group Life and AD&D premiums are paid by the Hospital.  The Group Life Benefit is the employee’s annual salary + $2000

• Benefit Forms
  • Benefit Booklet Including Enrollment/Change Form
  • Benefit Summary: Basic Life
  • Benefit Summary: AD&D
  • Benefit Summary: Retired Life
  • Evidence of Insurability Form
  • Conversion Form

• Eligibility – All Employees, Full-time and Part-time, are eligible the first of the month following 60 days of employment.

Voluntary Life Benefits

• Employee Working 20-36 Hours Per Week
  • Benefit Booklet Including Enrollment/Change Form
• Employee Working 36+ Hours Per Week
  • Benefit Booklet Including Enrollment/Change Form
• Eligibility – All Employees, Full-time and Part-time, are eligible the first of the month following 60 days of employment.
• Benefit Forms
  • Evidence of Insurability Form
  • Conversion Form

College Tuition

• Guardian – The College Tuition Benefit
• New York 529
• New York 529 Payroll Deduction Form
• New York 529 Enrollment Kit

Aflac

• Information Flyer

Retirement – 403(b)

• Eligibility – All employees and is available on the first date of employment.
• Offered by Diversified Investments or HANYS
• Representative Chip Gamello – Link to schedule a one-on-one appointment.

Diversified Investments

• • Salary Reduction Agreement

HANYS

• • Enrollment Kit

Employee Assistance Program

Connect to a counselor for free support services:

Phone: 1-800-386-7055

EAP Work Life Matters Overview

Available 24 hours a day, 7 days a week

Support and guidance is just a phone call away. Professional counselors are available to assist you with family and personal issues you might be facing or questions you might have.  Such as:

• • Anxiety
  • Dependent Care and Care Giving
  • Depression
  • Drug & Alcohol
  • Education
  • Grief Assistance
  • Legal & Financial
  • Lifestyle & Fitness Management
  • Parenting
  • Pet Care
  • Work Issues
  • And More

FirstNet

• FirstNet Flyer

NYSIF FORMS For Paid Family Leave and Disability

• Disability
• PFL Bonding
• PFL Care
• PFL Military

TouchCare

• TouchCare Flyer
• TouchCare.com

Norton LifeLock

LifeLock is an identity theft protection service designed to help keep your personal information safe. It monitors for suspicious activity across a wide range of data sources, including credit reports, bank accounts, and the dark web. If something unusual is detected—like someone using your Social Security number to open a new account—you’ll receive an alert right away.

Members also benefit from dedicated support specialists and reimbursement options for expenses related to identity theft recovery. LifeLock’s goal is simple: to give you peace of mind knowing that your identity is being watched over 24/7.

• 2026 Flyer
• How to Add Family
• Onboarding and FAQ Guide
• Member Services

Legal Service Plan with MetLife

The MetLife Legal Service Plan offers employees affordable access to a nationwide network of experienced attorneys. Through this plan, you can receive legal advice and representation for many common personal matters, such as drafting wills, buying or selling a home, handling traffic violations, dealing with family law issues, or managing landlord/tenant concerns.

With a low monthly cost and no deductibles or claim forms, the plan makes it easy to get professional legal help when you need it most. It’s a practical way to protect yourself and your family—because having a lawyer on your side shouldn’t be a luxury.

• Keep your MetLife Legal Plans Coverage

• Be a MetLaw Champion

• Legal Help Made Easy

• Estate Planning at Your Fingertips

• Why Enroll Using MLP Website

• Legal Coverage to Go

• Individual Plans

• Protect What’s Next with a Legal Plan

• Cover the Costs on Common Legal Issues

Pet Insurance from Nationwide

Nationwide Pet Insurance helps you protect your furry family members and your wallet. The plan offers coverage for accidents, illnesses, and routine care for dogs, cats, and even exotic pets. You can visit any licensed veterinarian—no networks or referrals required—and get reimbursed for eligible expenses.

With Nationwide, you’ll have peace of mind knowing you can give your pet the best care possible without worrying about the high cost of vet bills. Because when it comes to family, every tail wag and purr deserves protection.

• Resource Kit

Ways to Enroll:

     1. Visit partnersolutions.nationwide.com/pet/erhny
     2. Call 877-738-7874 and mention that you are an employee of Ellenville Regional Hospital to receive employee pricing