LIFE EVENTS THAT CAN AFFECT YOUR BENEFITS

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LIFE EVENTS THAT CAN AFFECT YOUR BENEFITS Updated Spring 2015 Department of Human Resources 71 Clinton Road, P.O. Box 9195, Garden City, NY 11530-9195 (516) 396-2337 Fax: (516) 997-2051

Getting Married or Adding a Domestic Partner Medical and Dental Life Insurance CHANGES YOU MAY WANT TO CONSIDER Adding coverage for your new spouse to your medical, dental plans. You may not change medical plans (for example, from Empire to HIP). This can only be done during the month of December. Domestic partners are eligible for medical coverage, pending approval of domestic partner application. Dental is not available for CSEA domestic partners. HOW TO MAKE THE CHANGE Within 31 days of getting married: Complete and send Name/ Address form 2167-HR-1203 to the Department of Human Resources Contact Human Resources for the appropriate health/dental change forms Send copy of spouse/dp birth certificate & Social Security card Send copy of marriage certificate Send a copy of employee's social security card reflecting the new marriage name. ; your Basic Life Insurance/AD&D Insurance these accounts Changing your address for these accounts Contact your appropriate retirement system: TRS, 1-800-356-3128 www.nystrs.org ERS, 1-866-805-0990 www.osc.state.ny.us this account Download./complete/return the forms to Contact your annuity agent to make the change. NYS 457G Deferred Comp this account Call Nationwide-1-800-422-8463. Vested Sick/ Vacation/ Unpaid Salary this account * Forms can be found on the Employee Website under HR/Payroll or Tools & Resources.

Having a Baby or adopting a Baby Medical and Dental Life Insurance ; CHANGES YOU MAY WANT TO CONSIDER Adding coverage for your new dependent(s) to your medical, dental plans. You may not change medical plans (for example, from Empire to HIP).This can only be done during the month of December. your Basic Life Insurance/ AD&D Insurance these accounts HOW TO MAKE THE CHANGE Within 31 days of adopting or giving birth: Contact Human Resources for the appropriate health/dental change forms. Send copy of the birth certificate. Send copy of social security card. Send a copy of court papers in the event of adoption. Contact your appropriate retirement system: TRS, 1-800-356-3128 www.nystrs.org ERS, 1-866-805-0990 www.osc.state.ny.us Beneficiary form to Albany.* Contact your annuity agent to make the change. NYS 457G Deferred Comp Vested Sick/Vacation/ Unpaid Salary Call Nationwide-1-800-422-8463. Contact Human Resources for further information * Forms can be found on the Employee Website under HR/Payroll or Tools & Resources.

Getting Divorced Medical and Dental Life Insurance CHANGES YOU MAY WANT TO CONSIDER You must remove your former spouse from your medical and dental plans. You may not change medical plans (for example, from Empire to HIP). Your former spouse will receive information on continuing their coverage through COBRA. Changing your name HOW TO MAKE THE CHANGE Immediately following your divorce: Contact Human Resources for the appropriate health/dental change forms. Send a copy of the first and last page of your divorce papers, and your ex-spouse s mailing address. If you are changing your name, send Name/Address Change form to HR with a copy of your Social Security card. ; your Basic Life Insurance/ AD&D Insurance these accounts Contact your appropriate retirement system: TRS, 1-800-356-3128 www.nystrs.org ERS, 1-866-805-0990 www.osc.state.ny.us Beneficiary form to Albany*. Contact your annuity agent to make the change. NYS 457G Deferred Comp Call Nationwide-1-800-422-8463. Vested Sick/Vacation/ Unpaid Salary * Forms can be found on the Employee Website under HR/Payroll or Tools & Resources.

Removing a Dependent Benefit tip: When would you remove a dependent child or domestic partner from your benefit coverage? Some examples are: Medical: 1. At age 26 all dependent children are removed from medical coverage. 2. When you are not responsible for your dependent as a result of divorce. Dental: Is no longer a full-time student and/or over age 25. Medical and Dental CHANGES YOU MAY WANT TO CONSIDER Removing a dependent from your medical and dental coverage. HOW TO MAKE THE CHANGE Within 31 days. You may not change medical plans (for example, from Empire to HIP). Contact Human Resources for the appropriate health/detal change forms. Life Insurance Your dependent will receive information on continuing his or her coverage through COBRA. ; your Basic Life Insurance/ AD&D Insurance these accounts Contact your appropriate retirement system: TRS, 1-800-356-3128 www.nystrs.org ERS, 1-866-805-0990 www.osc.state.ny.us Beneficiary form to Albany* this account Contact your annuity agent to make the change. NYS 457G Deferred Comp Vested Sick/Vacation/ Unpaid Salary this account this account Call Nationwide-1-800-422-8463.

A Dependent Dies Benefit tip: Your dependents can be your legally married spouse/domestic partner and eligible dependent children. IMPORTANT steps to take within 31 days of your dependent s death: Notify the Nassau BOCES Human Resource Department. Medical and Dental CHANGES YOU MAY WANT TO CONSIDER HOW TO MAKE THE CHANGE Removing a dependent from your medical and dental coverage. You may not change medical plans (for example, from Empire to HIP). This can only be done during the month of December. Within 31 days of your dependent s death: Contact Human Resources with the name and address, date of death, social security number of the deceased. Send a copy of the death certificate. Life Insurance ; Complete a new Enrollment form if your coverage changes from family to individual as a result of this death. your Basic Life Insurance/ AD&D Insurance these accounts Contact Human Resources for the appropriate health/dental change forms. Contact your appropriate retirement system: TRS, 1-800-356-3128 www.nystrs.org ERS, 1-866-805-0990 www.osc.state.ny.us Download/complete and return the Beneficiary form to Albany.* Contact your annuity agent to make the change. NYS 457G Deferred Comp Call Nationwide-1-800-422-8463. Vested Sick/Vacation/ Unpaid Salary Beneficairy Form to the Dept. of

Taking a Leave: The Family and Medical Leave Act (FMLA) Benefit tip: Discuss taking unpaid leave under the Family and Medical Leave Act with your supervisor. Keep in mind that the rules for a 12-week Family and Medical Leave are complex. If you are thinking of taking a Family and Medical Leave and need information regarding eligibility requirements, contact Patricia Hines in the Department of Human Resources. Medical and Dental Your contributions for coverage, if any, will be deducted from your paycheck as long as you receive one. You will be responsible for the full premium cost when your FMLA expires. After your eligibility is confirmed, the Human Resource Department will contact you regarding your options. You may not change medical plans (for example from Empire to HIP) Life Insurance Your contributions for coverage, if any, will be deducted from your paycheck as long as you receive one. You are responsible for the full premium cost if you wish to continue coverage. Participation in these plans continues while receiving a paycheck, but contributions stop when you cease to receive a paycheck until you return to work. When contributions cease, no service credit is accumulated. NYS 457G Deferred Comp Participation in these plans continues while receiving a paycheck, but contributions stop when you cease to receive a paycheck until you return to work.

Taking a Leave: Medical, Child Care, Education Medical and Dental You are responsible for the full premium cost. You may not change medical plans (for example from Empire to HIP) The Human Resource Department will contact you regarding your options. Life Insurance You will be responsible for the full premium cost if you wish to continue coverage. Contributions stop when you cease to receive a paycheck until you return to work. Participation in these plans continues while receiving a paycheck, but contributions stop when you cease to receive a paycheck until you return to work.

Taking a Leave: Military Leave Medical and Dental Coverage ends on the last day of the month your leave begins. You will receive information on continuing your health/dental benefits. The government covers you but may not cover your dependents. If your dependents are not covered, they may continue their enrollment while you are on a military leave at the full premium cost to you. When you return to BOCES, you will reenroll with new forms. Life Insurance Coverage ends on the last day of the month you leave begins. If you return to work on the first day of the month, you are covered for that month, otherwise you will begin coverage on the first of the next month. Participation in these plans continues but contributions stop when you cease to receive a paycheck until you return to work. Participation in these plans continues but contributions stop when you cease to receive a paycheck until you return to work.

If You Die in Service Medical and Dental Empire health coverage continues for your dependent(s) for three months at no cost. Thereafter, they have the option of continuing health coverage under COBRA or as a surviving spouse. HMO coverage ends the last day of the month in which the enrollee died. Dental coverage is offered to your dependents under the COBRA regulations. Life Insurance When the Department of Human Resources is notified of a death, a Beneficiary Statement/request for payment form will be sent to your beneficiary. An original copy of the death certificate will be required for Nassau BOCES to file a Life Insurance claim. Participation in these plans ends. There may be a death benefit payable to your beneficiary(ies). NYS 457G Deferred Comp Vested Sick/Vacation/ Unpaid Salary Participation ends. Participation ends. Participation ends. Payment will be made to the beneficiary of these monies.

Retirement from Nassau BOCES Medical and Dental Health coverage continues. You will receive information regarding your health coverage. Your premium must be received in the Department of Human Resources by the first of the month for which you are paying. If you will be receiving a pension and are enrolled in the New York State Health Insurance Program, you will be required to send your payment to Human Resources until that portion is automatically deducted from your pension. All other retired enrollees will continue to pay BOCES directly. At age 65, you and/or your spouse is required to enroll in Medicare Part B. After submitting a copy of your Medicare card reflecting Part B coverage, BOCES will reimburse you for its cost. You have the option of continuing your dental coverage for a maximum of 36 months under the COBRA regulations. You will receive information regarding Retiree dental coverage. Cobra and Retiree dental coverage is handled directly through the CSEA Dutchess Dental Company. Dental Retiree plan, call Linda Saxby at 1-800-323-2732, ext 803. Dental Cobra plan, call Pam Waldo at 1-800-323-2732, ext. 883 for information and rates. Life Insurance You will be contacted directly by the life insurance agent. NYS 457G Deferred Comp Participation in these plans ends unless you continue employment with another public agency. If you are filing for service retirement upon leaving BOCES, service retirement application must be sent to the retirement system no later than 30 days and no more than 90 days prior to your date of retirement. Participation ends. Participation ends. Participation ends.

Elimination of Position Medical and Dental Health coverage ends on the last day of the month you are eliminated except for full-time NABCOT members. This group will have their health benefits extended for 4 months at no cost. Dental coverage ends on the last day of the month. You will receive information on continuing your health benefits and dental benefits through COBRA. Life Insurance Coverage ends on the last day of the month in which you are eliminated. Contribution to your plan ends unless you continue employment with another public agency. Unless you make a withdrawal from your account, your membership will remain active up to 7 years after you were last reported to the system. NYS 457G Deferred Comp For all these benefits, participation ends. If you return to work for BOCES, you will have to complete new forms.

Ending Employment with Nassau BOCES Medical and Dental Coverage ends on the last day of the month you terminate. You will receive information on continuing your health and dental benefits through COBRA. Life Insurance Coverage ends on the last day of the month in which you end employment. Participation in these plans ends unless you continue employment with another public agency. NYS 457G Deferred Comp For each of these benefits, participation ends. Getting Rehired at Nassau BOCES Medical and Dental You have the option of beginning health coverage on your rehire date or the first day of the following month you are rehired. Dental coverage begins on the first day of the following month in which you are rehired. Life Insurance Coverage begins on the first day of the following month in which you are rehired. Contributions automatically resume unless you withdrew your contributions. NYS 457G Deferred Comp For both these benefits, if you return to work for BOCES, you will have to complete new forms. Eligible to enroll during the next open enrollment period.