the archdiocese of new york benefits administration resource guide

provide funds to pay claims submitted after the termination date on behalf of or by the terminating
Group’s Enrollees that were incurred prior to the date of termination.
11. Groups terminating coverage under the Benefit Program will be precluded from rejoining the Benefit Program
for a minimum of two years from the group termination date. Reenrollment will be at the discretion of
Archdiocesan management following a review of payment history and claims experience.
C) PREMIUM PAYMENT
12. Basic life, AD&D, and LTD coverage must be provided to eligible employed Enrollees at the Group’s expense.
Enrollees must be enrolled for these coverages within 30 days of the Enrollee’s initial eligibility date. Groups
can charge employed Enrollees the maximum allowable contribution for NYDBL. For entities directly reporting
to the Archdiocese (including parish corporations and Archdiocesan schools), you must comply with the
Archdiocese’s schedule of employed Enrollee contributions for medical coverage as published annually in the
open enrollment packages. For all other Groups, the Group must fund at least 70% of the employed Enrollee and
50% of dependent Enrollee medical premiums for full-time employed Enrollees. Groups must submit any
proposed changes in the Enrollee contribution levels in writing to the Chancellor within 60 days prior to the
Benefit Program anniversary date, currently January 1.
13. Any employee meeting the eligibility requirements for medical coverage is required to contribute towards the
premiums and must be covered under the Benefit Program, unless the employee submits a written waiver of
coverage (form or letter) within 30 days of the eligibility date. All eligible employees must complete and sign a
Group Health Benefits Election Form to indicate their payroll deduction election.
14. Premium Payment is due and expected within 30 days of the premium due date. Groups are responsible for the
payment of the full premium to the Archdiocese of New York.
D) RECORDKEEPING AND ADMINISTRATION
15. Groups providing medical coverage for their eligible Enrollees must obtain (and retain on file) a completed
Group Enrollment Change form and a Group Health Benefits Election form from each eligible employee. If an
employee has elected to waive medical coverage for a given Benefit Program year, this should be so indicated
on both forms.
16. The Group must comply with all data requests in an accurate and timely manner.
17. All Groups must notify Employee Benefit Connections within 30 days of the prescribed effective date for a
change in an Enrollee’s coverage status. Some examples are as follows: an Enrollee becomes eligible for
coverage (new hire or change in job status), retires, terminates from their position, experiences a life status
change such as marriage, birth of a child, or change in spouse’s employment status that affects medical
coverage. The Group must submit a written memo or change form to Employee Benefit Connections to notify
the Benefit Program of the Enrollee’s status change. The Group administrator must include the specific reason
for the requested change as part of the request. Certain Enrollee status changes must also include additional
forms in order for the change to be processed. The following changes require a medical enrollment/ change
form: adding a spouse or child, change of martial status.
18. Under certain circumstances, an Enrollee may need to be retroactively enrolled or reinstated for medical and/ or
other coverages. Generally, the Archdiocese will allow for an Enrollee to be retroactively enrolled or terminated
within two months following the date of the change in coverage. The Archdiocese will credit Groups for no
more than two months of premium for retroactive coverage terminations. Withholding of back premium on
these Enrollees will result in the same consequences as not paying current premium.
Your Group must abide by the coverage and policy rules with respect to eligibility, non-discrimination,
enrollment dates, procedures and vendor contractual requirements. Liabilities arising out of the Archdiocese’s or
Group’s failure to adhere to these policies will be the responsibility of the erring party. Failure to abide by the
policies as outlined above can result in termination of a Group’s coverage under the Benefit Program.
Revised 01/2008