How does your health insurance work while you’re out on Workers’ Comp?


By LORRAINE SIMPKINS Work-related injuries can take a toll on


workers on many levels. For many injured workers, confusion and worries about how going out on workers’ compensation leave might affect their health insurance coverage can make an already challenging time worse. How much your health insurance is


affected depends largely on whether your workers’ comp claim and your leave is “accepted” or “controverted” (challenged by your employer).


Accepted workers’ comp If you are enrolled in the state Health


Insurance Program (NYSHIP) and are removed from the payroll because of an accepted work-related injury or occupational condition, you may continue your health insurance while on workers’ comp leave without pay (LWOP) until you return to payroll, your employment ends, or for 12 months (24 months if your injury was caused by an assault) per injury, whichever is earlier. Dental and vision benefits will remain in


effect for the same duration. During the 12- or 24-month workers’


comp LWOP entitlement, you continue to be responsible for paying your employee share of the premium (the same amount deducted from your paycheck while on the payroll).


For example, if you are in a title


allocated or equated to salary grade 10 or above and enrolled in the Empire Plan, then you will continue to pay $45.48 for individual coverage or $171.34 for family coverage per pay period for the remainder of the 2014 plan year. Dental and vision benefits will remain in effect at no cost to the employee. The Employee Benefits Division of the


state Civil Service Department (DCS) will notify you in writing of your payment options for continuing health insurance during workers’ comp LWOP.


Controverted workers’ comp If you are enrolled in NYSHIP and are


removed from the payroll because of a controverted work-related injury or occupational condition, you may continue your health insurance coverage by paying both the employer’s and the employee’s shares of the premium. For example, if you are in a grade 10


title or higher and enrolled in the Empire Plan, then you will pay $284.23 for individual coverage or $690.24 for family coverage per pay period for the remainder of the 2014 plan year. If you are totally disabled for at least six


biweekly pay periods, you may qualify for a waiver of the medical insurance premium while on LWOP if you are enrolled in the Empire Plan.


The premium waiver is not automatic,


so contact your agency’s health benefits administrator (HBA), usually located in the personnel office, for information about this benefit and to request a waiver-of-premium application. Dental and vision coverage is


automatically terminated once your employment status changes to LWOP. You must notify your agency HBA if you wish to continue your dental and/or vision coverage. For dental coverage, you will pay $12.98


for individual coverage or $33.50 for family coverage per pay period. For vision coverage, you will pay $1.66


for individual coverage or $4.30 for family coverage per pay period. These rates apply for the 2014 plan year. The DCS Employee Benefits Division will


mail you a bulletin explaining what you must do to continue medical, dental, and/or vision coverage while you’re on LWOP.


Still have questions? For more information regarding the


continuation of health insurance coverage while on workers’ comp LWOP, visit the PEF website for a list of answers to frequently asked questions. From the home page at www.pef.org,


select “Contract Information” and then “Health Benefits.”


LONG ISLAND’S LARGEST FUNDRAISER –Nearly 40 PEFmembers participate in the annualMarcumWorkplace Challenge, a run/walk fundraiser held July 29 at Jones Beach Park. It benefited Long Island Cares – the Harry Chapin Food Bank, Long Island Children’sMuseum, and Children’sMedical Fund of NY. Amongmore than 200 companies or organizations that competed, the PEF team, led by Bill Pike, placed as one of the top teams. PEF TrusteeMaureen Kellman placed 6th in the “female top dog” category. Brett Garvar and Pete Heuschneider fromPEF Division 170 at the state Department of Transportation were the chefs for the event. The gold T-shirts with a PEF logo were paid for by PEF Region 12 and were easily identified asmembers crossed the finish line. PEF was a sponsor of this community fundraiser.


—Photo by Bill Pike www.pef.org The Communicator September 2014—Page 15


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