Health/Medical Insurance

Cigna HDHP with an HSA

• We offer a lower cost high-deductible health plan (HDHP) with a health savings account (HSA).
• Cigna’s network is called: Cigna’s Open Access Plus (OAP) plan.
• Cigna will transition to digital insurance cards for medical and dental plans.
  • Log in to myCigna.com or the myCigna App
  • Click or tap ID Cards
  • View your card(s), as well as any dependents’ card(s)
  • How to access your Digital ID card
• Cigna has a broad national network of pharmacies. You will continue to be able to go to CVS, Walgreens, Costco and Duane Reade for your prescriptions, in addition to many other chains and independent pharmacies.
• Cigna 90 Now Retail Pharmacy. You may now purchase maintenance prescriptions (90 day) at certain retail pharmacies.
• Cigna offers both Quest Diagnostics and LabCorp as in-network laboratories.
• To qualify for an HSA Contribution, you must
  • Be enrolled in a high deductible health plan (HDHP), on the first day of the month
  • Not be enrolled in Medicare
  • Not be claimed as a dependent on someone else’s tax return.
• The HDHP features the same network of doctors, hospitals, and clinics that are in the PPO and all the same healthcare services are covered. 
• The primary difference is the deductible, which is $1,600 for a single enrollee or $3,200 for a family. You must meet the deductible prior to the 20% coinsurance starting, although you will still receive preventive care at no cost. 
• Your out-of-pocket maximum is still the most you will pay in a year. Unique to the HDHP is the HSA. Adelphi will contribute $875 for single enrollees and $1,750 for family enrollees and you also have the option of contributing on a tax-free basis (up to $3,275 for single enrollees and $6,550 for family enrollees). APPWLU and Public Safety employees are not eligible for the Adelphi funded HSA account but may contribute their own pre-tax dollars to an HSA account.
• Employees who are 55 years of age or older can contribute an additional $1,000 into their HSA account.
• The HSA is set up automatically when HDHP Cigna medical is elected. Employees can also elect to contribute their own pre-tax contributions to the HSA.

Cigna PPO

• Preferred Provider Organization (Standard PPO) (High PPO – Public Safety employees only. If you are interested in enrolling, please contact Human Resources.)
• Cigna’s network is called: Cigna’s Open Access Plus (OAP) plan.
• Cigna will transition to digital insurance cards for medical and dental plans.
  • Log in to myCigna.com or the myCigna App
  • Click or tap ID Cards
  • View your card(s), as well as any dependents’ card(s)
  • How to access your Digital ID card
• Cigna has a broad national network of pharmacies. You will continue to be able to go to CVS, Walgreens, Costco and Duane Reade for your prescriptions, in addition to many other chains and independent pharmacies.
• Cigna 90 Now Retail Pharmacy. You may now purchase maintenance prescriptions (90 day) at certain retail pharmacies.
• Cigna offers both Quest Diagnostics and LabCorp as in-network laboratories.
• Health Reimbursement Account (HRA) for the Cigna (PPO Standard) Medical Plan only:
  • For 2024 the Health Reimbursement Account (HRA) is available for APPWLU and Public Safety employees only (please refer to your CBA for details).
    
  • Coordination of HRA/FSA reimbursement: 
    • Your unused Health FSA elections from the prior plan year will pay first
    • followed by new plan year Employee Health FSA elections, 
    • followed by the remaining balance in your HRA (for APPWLU and Public Safety employees only)
  • Your HRA account allows you to use your funds for eligible medical expenses, as well as other expenses including prescriptions, some over-the-counter medications, doctor office co-pays, health insurance deductibles and coinsurance. You can even use your HRA funds for dental services and vision expenses.
  • Your HRA funds may even be used for eligible expenses for your spouse or federal tax dependent(s).
  • For more information or any questions regarding OPTUM claims, please visit Optum Financial or call 888-339-3685.

Dependents under age 26 will be eligible for medical coverage until the end of the calendar month the dependent turns 26, regardless of student and marital status.

EmblemHealth HMO

• Emblem Health is a Health Maintenance Organization (HMO). HIP Prime HMO network connects you to the care you need where you live and work
• Choose an in-network primary care physician (PCP) who provides you with most of your primary and preventive care, refers you to specialist, and arranges for hospital admissions when necessary
• With lower co-pays, no deductible, and no co-insurance, this is a less expensive option.
• You must choose an in-network primary care physician (PCP) who provides you with most of your primary and preventive care, refers you to specialists, and arranges for hospital admissions when necessary.
• All care must be coordinated through your PCP.

As a reminder, effective January 1, 2014, in order to comply with the ACA, EmblemHealth ensures that employee medical cost share (deductibles, coinsurance and copays) accumulate to the medical Out-of-Pocket (OOP) maximum, (inclusive of pharmacy copays). That means once your deductibles, coinsurance and copay amounts reach a maximum OOP amount of $6,350 for individuals or $12,700 for your family, you would not be subject to any other OOP costs for the remainder of the calendar year.

Dependents under age 26 will be eligible for medical coverage until the end of the calendar month he/she turns 26, regardless of student and marital status.

For more information or any questions regarding claims, please visit EmblemHealth.com or call 800.447.8255.

Cigna Wraparound Plan

Employees who were enrolled in the indemnity plan (Wraparound) prior to October 1, 1995, and are still enrolled, have the option of remaining in that plan. The indemnity plan (Wraparound) is not available to new employees, rehired employees and employees who are no longer enrolled in that plan.

The University pays a portion of the premium and the employees pay a portion. The amount of the premium paid by the University depends upon the plan option selected by the employee.

Part-time/Hourly Eligibility for Medical

In order to comply with the Affordable Care Act (ACA), Adelphi will offer group health plan coverage to part-time and hourly employees if they meet the definition under the ACA of a “Full-Time Employee”. Under the ACA, a Full-Time Employee generally is an employee who works an average of at least 30 hours per week. This “full-time status” only applies to medical benefit eligibility. Example: You must complete 1,560 hours of service by October 31, in order to be eligible for coverage during the corresponding 12 month period beginning January 1.

In order to determine which part time and hourly employees will be considered “Full-time Employees” for medical benefit eligibility only, please see Part-time/Hourly Eligibility for Medical (PDF).

Each year, Annual Enrollment is provided in November during which time employees may elect to change plans with the change being effective on the subsequent January 1.

If you are unable to attend one of the annual enrollment sessions, please feel free to view a PowerPoint presentation by Cigna, EmblemHealth, Bright Horizons, Met Life Pet Insurance and/or HSA Bank at your convenience. For your reference, please view the Town Hall Powerpoint Presentation.

Medicare Creditable Coverage

Health Insurance Marketplace Coverage (PDF)

Premium Assistance for Medicaid and CHIP