To be eligible for coverage under all the health plans, an employee must be included in one of the employee groups:
- Faculty – fulltime
- YSU Police – fulltime
- Administrative – fulltime and part time (.50)
- Administrative Excluded – fulltime and part time (.50)
- Classified – fulltime and part time (.50)
- Classified Excluded – fulltime and part time (.50)
Group coverage is effective on the day the employee becomes eligible for coverage which can be the hire date or status change date. Employees have 30 days from that date to elect coverage. If the employee fails to enroll within the election period of 30 days, he/she will have an opportunity to enroll or make changes to their coverage during annual open enrollment. Employees may make coverage changes within 30 days of a qualifying event such as a marriage, divorce, birth, adoption, or loss of other coverage. Contact the Human Resources department to determine if a family status change qualifies under the Plan document and IRS regulations.
Eligible dependents include:
- Children, stepchildren, legally adopted children or children for whom the employee or domestic partner is the legal guardian or custodian or those who, by court order, must be provided coverage
The Affordable Care Act requires the plan to offer coverage to adult children up to age 26, even if the young adult no longer lives with the parent, is not a dependent on a parent’s tax return, or is no longer a student. Coverage is available until the young adult reaches the age of 26. Coverage is not available for the young adult’s spouse or children.
Working Spouse/Coordination of Benefits
If an employee’s spouse is eligible to participate in their employer’s group health insurance and/or prescription drug insurance, as an active or retired employee, the spouse of the employee MUST enroll with at least single coverage in said employer’s sponsored group insurance coverage(s). If a spouse is self-employed and offers a group health and/or prescription drug plan to his/her employees, such self-employed spouse MUST also enroll with at least single coverage in such employer-sponsored group insurance.
Upon the spouse enrollment in any such group sponsored health and/or prescription drug insurance coverage, as an active or retired employee, that coverage will become the primary payer of benefits, and the coverage sponsored by the University will become the secondary payer of benefits according to the primary plan’s Coordination of Benefits and participation rules.
This requirement does not apply to any spouse who works less than 25 hours per week AND that must pay more than 50% of the monthly single premium paid by the spouse’s employer or $300 per month, whichever is greater. A certification form is required annually for all spouses covered by the University as primary.
More information is available in the employee’s policy handbook.
Employee Contributions - Chart of Rates
Employees contribute to the premiums through payroll deduction on a pre-tax basis and if preferred, can elect to have the deduction taken post-tax. Premiums may be adjusted annually based on the renewal rates and bargaining unit language. Employees may elect:
- Single coverage
- Employee and One Dependent Coverage (spouse or a child)
- Family Coverage (employee with two or more dependents)
Premiums are based on the employee’s salary and coverage election or 15% of the annual premium (based on bargaining agreement).
If you and your spouse both work for the University, the employee with the higher income will be the primary holder of the benefits for the couple/family.
Medical Coverage Summary - Traditional PPO
- 100% Preventive Coverage
- $15 office co-pays
- 90% co-insurance with a maximum of $925/$1,725 family
- $250 deductible/ $500 deductible family coverage
Prescription Coverage Summary - Traditional PPO
- Generic 30 day supply - $4
- Generic 90 supply through mail order - $10
- Formulary 30 day supply - $25% ($30 maximum)
- Formulary 90 day supply through mail order - 25% ($60 maximum)
- List of Preventive Services*/ RX Preventive Benefits
- Traveling Abroad* - Instructions for Claims Handling
- Summary of Benefit Coverage Glossary*
- Summary of Benefit Coverage* ( Traditional PPO and RX)
- Summary of Alternative PPO Benefit Coverage
- Summary of Benefit Coverage (High Deductible Health Plan as of 1/1/2018)
- The Women's Health and Cancer Rights Act of 1998*
*Requires Adobe Acrobat Reader
**Requires Microsoft Word or Word Viewer