Health/Medical Insurance

The University currently offers full-time employees the alternative of electing to enroll in two levels of coverage (Preferred Provider Organization (PPO) including a prescription drug plan or Health Maintenance Organization (HMO)), or electing no coverage at all.

» Cigna
(Including a prescription drug plan)

• Adelphi offers two PPO medical plan options with Cigna.
• The Health Reimbursement Account (HRA) is funded solely by Adelphi and can be used to pay for eligible health care expenses. Adelphi will contribute $350 per year if you elect Individual coverage and $700 if you elect Family coverage with United Healthcare.

» 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

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.

» Medicare Creditable Coverage

» Health Insurance Marketplace Coverage (PDF)

» Premium Assistance for Medicaid and CHIP

Summary of Benefits and Coverage:

• Cigna PPO High SBC (PDF)
• Cigna PPO Standard SBC (PDF)
• Cigna Wrap Around SBC (PDF)
• EmblemHealth SBC (PDF)

Summary Plan Descriptions

• Health Reimbursement Arrangement (HRA) (for employees enrolled in United Heathcare) (PDF)
• Cigna Summary – PPO High (In Process) (PDF)
• Cigna Summary – PPO Standard (In Process) (PDF)
• Cigna Summary – Wrap (In Process) (PDF)
• EmblemHealth Benefit Summary (PDF)
• EmblemHealth Certificate of Coverage (PDF)
• EmblemHealth Member Handbook (PDF)
• EmblemHealth ERISA Statement (PDF)

Forms

• Cigna Medical Claim Form (PDF)
• ExpressScripts Mail Order Form (PDF) 
• ExpressScripts Reimbursement Claim Form (PDF)
• United Healthcare Claim Form (PDF) 

Provider Contacts

Cigna:

Call the Cigna One Guide phone line with questions: 888.506.5042

Access your online account at Cigna

EmblemHealth:

For important phone numbers, please choose your plan on the following page:
emblemhealth.com/contact-us