Niagara Falls City School District Health Benefits

 

NY44


NFCSD offers medical coverage through the NY44 Health Benefits Plan Trust.  

 

The NY44 Health Benefits Trust is a self-funded ,tax exempt Article 44 trust providing health benefits to employees and eligible retirees of Erie 1 BOCES and school districts. The Nova / Independent Health coverage option provides services for residents of the
eight Western New York counties (www.ny44.e1b.org).

PHCS Network provides coverage for Independent Health enrollees
who permanently live outside the eight-county WNY coverage area. (www.phcs.com)

 

It is important that you understand your benefits and educate yourself on what is available.  Please be sure to read the materials available to learn more about your benefits. Below is important information regarding your benefits.

NY44 Summary of Benefits Coverage
NY44 Summary Plan Description
NY44 Dependent Changes
NY44 Notice of Special Enrollment Rights
Children's Health Insurance Program (CHIP)
NY44 Special Needs Dependent Over Age 26 

Notice of Exchange 

 

Forms 
 
Coordination of Benefits - This form is be completed if you have a secondary insurance such as Medicare. 
 

2016/2017 Healthy Living Program  

The Annual Physical Reward amounts are increasing to $100 for single coverage and $200 for family coverage.  Only annual physicals/ well child exams that occur from July1, 2016 through and including June 30, 2017 are eligible.  Please note, annual OB/GYN visits are not eligible for the reward. Documentation must be submitted on a physician’s script pad or medical facility letterhead only; superbills and after visit summaries will not be accepted as sufficient documentation.

The Gym Membership Reimbursement program will take the place of the Wellness Reimbursement program.   As of July 1, 2016, only monthly/ annual dues for gym memberships are eligible for reimbursement.   All other categories eligible under the former Wellness Reimbursement program are no longer eligible. Reimbursements will remain the same: $150 maximum for family and $100 maximum for single. 

The program will no longer reimburse for gym equipment, exercise/yoga classes, leagues, massage therapy, weight loss programs or anything other than gym membership dues. For a gym membership to qualify for the reimbursement, at the minimum you would need a one-month gym membership. Your gym must promote cardiovascular wellness. For a gym to be considered eligible, it must provide at least two pieces of equipment or activities that promote cardiovascular wellness from the following list:

• Elliptical Cross-Trainer • Group Exercise • Pool • Rowing Machine • Stationary Bicycle • Step Machine • Squash/Tennis/Racquetball Court • Treadmill
 
Only the gym membership fee is eligible for reimbursement. Memberships in sports clubs, country clubs, weight loss clinics, spas or other similar facilities or registration fees for one-time, drop-in, single session events or activities are not eligible under the new guidelines effective July 1, 2016. You must submit proper documentation to be reimbursed. Your gym membership must be valid and payment must be made between July 1, 2016 - June 30, 2017 to be eligible. 

Forms for both programs must be submitted on the 2016-2017 form; out of date forms will not be accepted.  Finally, the deadline for submission will change to July 15, 2017. All submissions must be either postmarked or received by fax by July 15th in order to be eligible, no exceptions.

IRS Deems Wellness Reimbursement/Reward Payments as Income

Effective January 1, 2016, all enrollees receiving wellness reimbursements or reward payments will be subject to taxes on these monies.

Please be advised that the Internal Revenue Service, not the NY44 Health Benefits Plan Trust, has indicated that wellness payments made in connection with the performance of services by an employee for an employer with regard to their health insurance benefit are wages, subject to withholding and payment of employment taxes.

This IRS change affects NY44 enrollees that received payment during 2016 for any amount up to the $150 fitness reimbursement limit and/or the physical exam reward.

Wages are reflected and reported on W-2s. The NY44 Health Trust will be working with the districts’ benefit administrators and business administrators to develop a procedure to address this IRS decision.

As a reminder, starting Sept. 1, enrollees who receive a wellness reimbursement or reward check will receive a memo with their check reminding them of the taxability of the reimbursement/reward.

  
2016/2017 Forms


Medical Opt-Out

You can waive medical coverage and receive District Opt-Out funds   In order to be eligible for Opt-Out Funds, you must submit a copy of your current Health Insurance Provider Insurance Card.  This amount is taxable income and will be paid in installments in your regular payroll check or lump sum in your last check of the school year. If you elect dental, vision and/or life insurance coverage the amount will be deducted from your Opt-Out Funds.

 

 

If you have any questions or concerns regarding your benefits, please contact
Mary Beth Spacone, Benefits Administrator at 716-286-1271 or mspacone@nfschools.net

 

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