Option Transfer - Health Plan

• 2025 Medical Rates (pdf) - effective December 26, 2024
• 2025 Medical Comparison Chart - instructions for online tool:
  • Your group = Management/Confidential (M/C)
  • select county where you work and county where you live
  • click the "View Your Options" button
  • On next page, select the plan(s) you wish to compare, and then the "Compare Plans" button.

You will need to submit a paper copy of the NYS Health Insurance Transaction form (PS-404) to HR Services & Transitions Center.

• Download the Cornell-specific version of the PS-404 form - do not use the state version of the form, and do not submit the form directly to the state. 
• Download the instructions for filling out the form - requirements vary based on the type of change you are making. 

How to submit forms and documentation:

• In person: to the HR Services and Transitions Center, 395 Pine Tree Rd, Suite 130, East Hill Office Building, Ithaca, NY 14850
• Through the Secure File Transfer process: https://sft.cornell.edu (note: when uploading, type in the email address tmw54@cornell.edu under “Prepare Upload,” add your files, and select “21 days” for the expiration period)
• By mail: HR Services and Transitions Center, 395 Pine Tree Rd, Suite 130, East Hill Office Building, Ithaca, NY 14850 (must be postmarked by Saturday, December 30, 2023).

Changes are effective January 1, 2025.

Adding coverage for yourself or dependents is not considered part of Option Transfer. You can request this change at any time of the year, however a 10-week waiting period applies unless you have a qualifying event based on IRS guidelines. A qualifying event is a change of family status, e.g. marriage, birth of a child, etc.

You will need to submit:

• A NYS Health Insurance Transaction Form (PS-404) to HR Services & Transitions Center for each dependent.
• The required documentation .
• If this request is the result of a qualifying event, you must attach proof of that event and the date it occurred.

Removing individual dependents is not considered part of Option Transfer. You can request this change at any time of the year, however a 10-week waiting period applies unless you have a qualifying event based on IRS guidelines.

You will need to submit:

• A NYS Health Insurance Transaction Form (PS-404) to HR Services & Transitions Center for each dependent.
• The required documentation .
• If this request is the result of a qualifying event, you must attach proof of that event and the date it occurred.

Visit the NYSHIP Health Benefits website:

• Select “I am a New York State Active Employee”
• Choose “Management/Confidential (M/C); Legislature” as your Group
• Select either “Empire Plan Enrollee” OR “HMO Enrollee”

Here are some common terms you will find in the NYSHIP plan documents and on our web pages.

Coinsurance

The enrollee’s share of the cost of covered services, which is a fixed percentage of covered medical expenses.

Copayment

The enrollee’s share of the cost of covered services, which is a fixed dollar amount paid when a medical service is received, regardless of the total charge for the service.

Deductible

The dollar amount an enrollee is required to pay before health plan benefits begin to reimburse for services. This amount applies when you use non-network providers.

Dependent

This is a person who is covered by another person’s plan. It can be a child, spouse or domestic partner.

Fee-for-service

A method of billing for health care services. A provider charges a fee each time an enrollee receives a service.

Formulary

A list of preferred drugs used by a health plan. A plan with a closed formulary provides coverage only for drugs that appear on the list. An open or incented formulary encourages use of preferred drugs to non-preferred drugs based on a tiered copayment schedule. In a flexible formulary, brand-name prescription drugs may be assigned to different copayment levels based on value to the plan and clinical judgment. In some cases, drugs may be excluded from coverage under a flexible formulary if a therapeutic equivalent is covered or available as an over-the-counter drug.

Health Benefits Administrator (HBA)

This is the Cornell Benefits team.

An individual responsible for providing benefits assistance to active State employees. HBAs work with the Employee Benefits Division in the Department of Civil Service to process transactions and answer questions regarding eligibility and enrollment. You are responsible for notifying your HBA of changes that affect your enrollment and/or your or your dependents’ eligibility for benefits. 

Health Maintenance Organization (HMO)

A managed-care system organized to deliver health care services in a geographic area. An HMO provides a predetermined set of benefits through a network of selected physicians, laboratories and hospitals for a prepaid premium. Except for emergency services and other services approved by your HMO, you and your enrolled dependents may have coverage only for services received from your HMO’s network. 

Lifetime maximum

This is the total dollar amount of benefits you can receive. It can also be the total number of services you can receive. These totals are limits for a lifetime, not just for a plan year.

Managed Care

A health care program designed to ensure you receive the highest quality medical care for the lowest cost in the most appropriate health care setting. Most managed-care plans require you to select a primary care physician employed by (or who contracts with) the managed health care system. He or she serves as your health care manager by coordinating virtually all health care services you receive. Your primary care physician provides your routine medical care and refers you to a specialist if necessary. 

Network

A group of doctors, hospitals and/or other health care providers who participate in a health plan and agree to follow the plan’s procedures.

New York State Health Insurance Program (NYSHIP)

NYSHIP covers more than 1.2 million public employees, retirees and dependents. It is one of the largest group health insurance programs in the country. The Program provides health care benefits through The Empire Plan and NYSHIP- approved HMOs.

Option

A health insurance plan offered through NYSHIP. Options include The Empire Plan and NYSHIP-approved HMOs within specific geographic areas.

Out-of-pocket maximum

This is a limit on the costs a health plan member must pay for covered services. The limit can be yearly or a dollar amount.

Primary/Medicare primary

A health insurance plan is primary when it is responsible for paying health benefits claims before any other group health insurance plan. It is important to understand when Medicare will become primary to your NYSHIP coverage. Read plan documents for complete information. 

Qualifying event

These are events that let members change their health benefits outside of the Option Transfer period. Examples include death, job loss, divorce and marriage.