Benefits Information & Forms

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

Flexible Spending Account

• 2025 FSA contributions are $3,300.  Current withholdings for 2024 FSA contributions will end 12/31/24.  Any unused balance from 2024 will carryover to 2025 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

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
  • 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 Forms
  • 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 Form
  • Beneficiary Form
  • Salary Reduction Form

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

To access forms please visit the NYSIF Website.  Then scroll down to Disability Benefits & Paid Family Leave Claim Forms – Claimant. From there you can find the appropriate forms based upon your leave request.