Page 5 - KIPP NYC 2022 Benfits Summary

When Benefits End
Your medical, dental and vision benefits terminate at the end of the month in which your employment ends. Life, disability and FSA benefits terminate on your last day of employment. If your relationship with your domestic partner ends, you must complete a “Declaration of Termination of Domestic Partnership” and submit the completed form to kippnychr@ kippnyc.org or the Benefit Advocate Center.
Eligibility for Medical Benefits Under Healthcare Reform Requirements
Under the Patient Protection Affordability and Accountability Act (PPACA), we are required to offer medical benefits to certain “full-time equivalent” employees. In general, we will track your hours of service during what is called a “measurement period” to determine your eligibility for medical benefits during the corresponding stability period (January 1, 2022 through December 31, 2022).
The measurement period runs from November 1, 2020 through October 31, 2021. To be eligible for medical benefits, you must have at least an average of 30 hours of service per week (or an average of at least 130 hours of service per month) during the measurement period. Hours of service that count towards your eligibility for medical benefits are: (1) those hours for which you are paid to work, and (2) the hours for which you are paid for vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence.
If you average at least 30 hours of service per week during the measurement period, you will be eligible for medical benefits during the “stability period” (January 1 to December 31, 2022). You must elect coverage, pay your share of premiums, and continue to be an employee during this period in order to maintain coverage.
If you do not average at least 30 hours of service per week during the measurement period, then you will not be eligible for medical benefits from January 1, 2022 through December 31, 2022 unless you have a change in employment status that makes you eligible for benefits.
If you are a part-time employee who worked an average of 30 hours during the measurement period, you will receive information on how to enroll in the medical plan. If you elect to enroll, benefits will become effective January 1, 2022. If you do not work an average of 30 hours per week during subsequent measurement periods, you will not be offered benefits during the applicable stability period.
Should you have any questions, please contact the Benefit Advocate Center at 844.905.0433.
New York State Age 29 Young Adult Option (Medical & Prescription Drug Only)
As the result of a New York State mandate, the “young adult” option allows your dependent children the opportunity to be covered until their 30th birthday. This option does not extend coverage for dental and vision. In order for your dependent to be eligible, they must meet the following criteria:
• Be less than 30 years of age
• Be unmarried
• Live, work or reside in New York state
• Live, work or reside in the insurance carrier’s
network service area if they do not live in New
York state
• Not be insured by or eligible for coverage under
the “young adult” own employer-sponsored plan • Not be covered by Medicare
You (the employee) must be enrolled in KIPP NYC’s medical plan in order for your dependent to be eligible to choose the “young adult” option. If you leave KIPP NYC or drop coverage during annual enrollment, your dependent is no longer eligible. If you switch coverage during annual enrollment, your dependent’s coverage will be changed to the coverage you elect.
If your dependent is eligible to continue coverage under COBRA through a former employer’s plan, they are still eligible to elect the “young adult” option under our medical plan.
If your dependent is enrolled under the “young adult” option, they will not be offered COBRA when they attain age 30.
Insurance carriers are required to notify you within 60 days of your dependent’s eligibility for the “young adult” option. This will occur 60 days prior to your dependent no longer meeting the definition of a dependent under our medical plan (they have met the maximum age for dependents covered under our plan).
If you wish to cover your dependent under the “young adult” option, you will be responsible to pay the entire cost of coverage. You are eligible to elect the “young adult” option at the following times:
• Within 60 days of your dependent reaching the maximum age or experiencing a qualifying life status change
• During any future annual enrollment period
To enroll your dependent under the “young adult” option, please contact kippnychr@kippnyc.org or the Benefit Advocate Center at 844.905.0433.
2022 BENEFITS SUMMARY 5