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Benefits Information & Forms

Benefits

Benefits

Our employees are our biggest asset, so we strive to make working for us a great experience for each employee. To this end, we offer benefits and programs that improve the quality of daily life for our employees now and into the future.

Definition of Employment:

  • Full-time is defined as 36+ hours per week or 1 FTE (Full time Equivalent)
  • Part-time is defined as 20 -36 hours per week or .5 FTE – .9 FTE

Definition of Eligibility:

  • Full-time and Part-time employees (.5 FTE or greater) are eligible for benefits on the first of the month following 60 days of employment following date of employment.
  • Per Diem and Hospitals part-time employees not eligible on the first of the month following 60 days of employment of employment, may be eligible for coverage at a latter date in accordance with the Lookback Measurement Period Policy (Notification will be provided if eligible).

Overview Documents

  • Below are documents providing an overview of benefits as well as other pertinent information.

2024

2025

 

Health Insurance

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

  • MVP Forms

Claim Reimbursement Form

PPO Plan Summary

PPO Plan Description

EPO Plan Summary

EPO Plan Description

  • 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

  • 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)

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.

 

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