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Teachers College, Columbia University
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Benefits > Benefits Home

Benefits Home

Available benefits at Teachers College are based on Job Classification:

If you have further benefit questions, please contact Human Resources at 212.678.3175.

Related Information

Oxford Changes and Updates

2014 Prescription Drug List -  PDF Mobile - PDF

Oxford Preventive Health Care Online Tool:
Preventive health guidelines

Oxford Source4Women Online Seminars (updated 1/6/12)
Source4Women provides tools and resources focused on keeping our UnitedHealthcare and Oxford members and their families healthy. As part of their commitment to helping people live healthier lives, UnitedHealthcare offers an online seminar on an important health topic every month.

Seminars include audio and video, as well as time for questions with expert speakers. All seminars are recorded and available for viewing anytime at

To register for an upcoming Source4Women online seminar, visit and click on ‘online seminars.All seminars are recorded and archived for viewing after the live seminar date.

These webinars are available to all of TC Community, regardless of Oxford membership or gender.

Re: Dependent Age Change effective 1/1/11
Due to a change in regulations, dependent children through age 26 can remain covered under a group health plan starting January 1, 2011 as long as he/she does not have access to an employer sponsored group plan. Any dependent children, regardless of student or marital status, financial dependency or residency, may remain covered through the end of the year of his or her 26th birthday.

If your dependent child’s coverage ended or was dropped from coverage during Open Enrollment based on the previous dependent age limit, you have a 30-day window to enroll him or her in Oxford. Please complete an Oxford Addition/Change Form along with a Benefit Election Form and submit them to HR by January 10, 2011. Enrollment will be effective retroactively to January 1, 2011.

Westchester Medical Center participation in the Oxford network, effective May 22, 2009
Oxford has reached a new multi-year agreement with Westchester Medical Center.
Effective May 22, 2009, Westchester Medical Center will once again be an Oxford participating hospital. Please be assured that as of May 22, you can use Westchester Medical Center on an in-network basis.
Please also note that Westchester Medical Center was a non-participating hospital from March 17, 2009 through May 21, 2009 and, as such, any covered services provided during that time will be reimbursed at the out-of-network rate for those members with out-of-network benefits. Any covered services provided on or after May 22, 2009 will be reimbursed at the in-network rate.

Addresses Swine Flu Concerns
As you may have heard, this past weekend, the United States declared a public health emergency in response to the recent reports of swine flu. We wanted to update you on swine flu, offer you and your employees resources for additional information, and let you know what is being done to address the situation.

What is swine flu?
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease generally found in pigs, caused by one of several swine influenza A viruses. Although humans do not normally get the disease, the current strain of the virus is contagious, and human infections can occur, according to the World Health Organization (WHO). 

Why has a public health emergency been declared?
The United States public health emergency declaration allows the federal government to free up additional resources to help address this situation, much like it recently did during the public health emergency declarations for the recent flooding in Minnesota and North Dakota.

What are the symptoms of swine flu?
Swine flu symptoms are very similar to seasonal influenza and generally include fever, fatigue, lack of appetite, and coughing; although some people also develop a runny nose, sore throat, vomiting, or diarrhea, according to the Centers for Disease Control and Prevention (CDC). Individuals should use reasonable precautions if they suspect they may have been in contact with swine flu and contact their primary physician for specific advice.

What is being done to address the situation?
The company is tracking and responding to developments surrounding this situation. We have strong partnerships in the public and private sector, including the CDC, local and state health agencies. The company is prepared to fully leverage all available resources to address this situation, as needed. We want to assure you and your employees that we will judiciously consider all information and are fully prepared to meet your service needs if this situation escalates.

Quick Reference FAQs
In response to the numerous reports on swine flu, we are providing a quick-reference frequently asked questions (FAQs) document. It includes preventive tips, symptoms of swine flu and more, and can be shared with your employees. We have also posted the FAQs on our member, employer and broker home pages at The information is based on the latest CDC information. Please be aware, however, that this situation is evolving and members should visit the CDC Web site for the most up-to-date information.

More information
For the most up-to-date information, frequently asked questions and more, please refer to the CDC or WHO Web sites: will be updated as new information is made available.

Prescription Drug Changes for May 1, 2009

Effective May 1, 2009there will be tier changes to both the Advantage (Tier 1, Tier 2, Tier 3) and Traditional (Tier1, Tier 2) Prescription Drug Lists (PDL):

The PDL Management Committee makes tier placement decisions based on clinical, economic, and pharmaceutical cost factors. These evidence-based decisions ensure medications with the best overall value are available in the lowest tier.


Tier Change Timing


  • Up-tiering changes are made on an annual basis for the Traditional PDL on January 1 with the exception of up-tiering associated with the launch of new generic medications.
  • Up-tiering changes may be made to the Advantage PDL up to six times per year.
  • Up-tiering due to the launch of a generic drug will take place anytime during the year for both the Advantage and Traditional PDLs to coincide with the introduction of the generic drug.
  • Down-tiering changes to the PDL or implementation of drug exclusions may occur throughout the year for both PDLs.


Up-tiering Changes
  • The following medications will move from Tier 2 to Tier 3 on the Advantage PDL effective May 1, 2009.


    • Metrogel 1% Gel
    • Nascobal
    • Zylet


Down-tiering Changes
  • The following down-tiering changes will take place on May 1, 2009.


    Medication Advantage PDL Traditional PDL

    Current Tier Placement New Tier Placement Current Tier Placement New Tier Placement
    Bystolic Tier 3 Tier 2 Tier 3 Tier 2
    Calomist Tier 3 Tier 2 Tier 3 Tier 2
    divalproex sodium Tier 2 Tier 1 N/A N/A
    Exjade Tier 3 Tier 2 Tier 3 Tier 2
    glyburide/metformin Tier 2 Tier 1 N/A N/A
    Noxafil Tier 3 Tier 2 Tier 3 Tier 2
    ramipril Tier 2 Tier 1 N/A N/A
    Sanctura XL Tier 3 Tier 2 Tier 3 Tier 2



  • Precertification/Prior authorization will be required for the following drugs effective May 1, 2009:

    • Soma 250
    • Venlafaxine ER
Supply Limits Transition
  • Effective June 1, 2009, certain medication supply limits per copayment (formerly quantity limits) will be changed to supply limits per month (formerly quantity duration).
  • This revision will result in revised or new supply limits for certain drugs as listed on the Oxford Benefit website- Effective 05/01/09 and 06/01/09 for the Advantage and Traditional PDLs.

OrthoNet - OptumHealth Transition

Effective April 1, 2009, ACN Group, Inc. (OptumHealth) will begin administering the physical and occupational therapy benefit for UnitedHealthcare Oxford plans.

OptumHealth is a leading physical medicine company that has significant experience in promoting best practices and evidence-based health care, while working with physical and occupational therapists as well as other providers of therapy services and their patients.

As part of this new arrangement, please be aware that your provider will need to collect some basic information from you regarding your current condition, for submission to OptumHealth. Please be prepared to provide this information at your next visit. If this information is not requested, remind the provider’s office of the new physical and occupational therapy benefits administrator for UnitedHealth Oxford plans. This information is helpful to both your provider and OptumHealth in understanding the current status of your condition. Also, failure to provide this information to OptumHealth may result in a denial of services, and delay the claims process.

Oxford Member ID Card Transition

Beginning November 3, 2008, the new ID card will be issued to new Oxford members, any member who requests a replacement ID card and members renewing with changes to their Oxford plan.  Member's medical benefits are not affected by this change.  Click here for the informational brochure.

Medco Mail Interchange Pilot Program 

Effective May 1, 2008, Oxford has implemented the Mail Interchange program for a small group of antihypertensive and antidepressants medications filled through Medco by Mail. Members who submit new or refillable prescriptions for these medications will be contacted by specially trained Medco representative and informed of any lower cost alternatives available to them. This is a voluntary program for members. If a member is interested in changing to the alternative, the pharmacist will contact the prescribing physician for authorization. If the physician authorizes the change, the new medication will be dispensed.

After two attempts, if the member can not be reached or has not responded to messages informing him or her of the possibility of medication interchange, the Medco pharmacist will contact the prescribing physician to request authorization for interchange. If the physician authorizes the change, the new medication will be dispensed and the member will receive an automated phone message and a letter informing him or her that his or her physician approved the interchange.  The message and letter also provide instructions for stopping the interchange if the member prefers the original medication.  If the physician does not authorize the change, the original prescription will be dispensed.

To find out the specific medications, you can contact Oxford at 800.444.6222 or visit

Oxford Premium Designation Program

The UnitedHealthcare Premium Designation program is now live for Oxford branded accounts!  The provider search tool has been upgraded to display and search by Premium Designation status on our web site This value-added program provides Members with another way to help them make informed healthcare decisions. 
The UnitedHealth Premium® designation program is a physician performance assessment initiative that uses evidence and expert-based physician consensus standards to evaluate cardiac facilities and physicians in certain specialties for quality and efficiency of clinical care.
                                One star =  Quality designation only
                                Two stars = Quality and efficiency of care

The primary source of data for performance assessment in the UnitedHealth Premium designation program is claim and other administrative data and is based on externally-developed standards.


  • Physicians who have successfully met the quality criteria or the quality and efficiency of care criteria will receive the designations and will be identified to consumers online and in our directories.
  • Effective immediately, designation status can be viewed using the Oxford Provider Search tool.

Please note these designations are also live on the United Healthcare website and you may already be familiar with the designations. 

Bayonne Medical Center
On January 31, 2008, Bayonne Medical Center was sold to a third-party and renamed as Bayonne Hospital Center. The new entity, Bayonne Hospital Center, has decided not to assume the hospital agreement that Bayonne Medical Center had with UnitedHealthcare. Therefore, Bayonne Hospital Center is considered a non-participating facility and all services other than emergency care will be considered to be out-of-network for UnitedHealthcare as of January 31, 2008.

  • If you have received services from this facility (previously named Bayonne Medical Center) recently or reside in a county neighboring Bayonne Medical Center, it will be necessary for you to select another hospital—one that is participating in the appropriate network—in order to meet your health care needs on an in-network basis.  If you have an elective procedure already scheduled at Bayonne Hospital Center, you must contact your physician for assistance in selecting another participating facility. For help selecting a participating hospital, you should call the Customer Service number on the back of your member ID card. Additionally Oxford members can use the online provider and physician directories available on the appropriate member web site – for UnitedHealthcare members and for Oxford members.  
  •  If you are presently receiving hospital services through Bayonne Hospital Center or are admitted to the hospital on an emergency basis, medically necessary services will continue to be covered on an in-network basis. However, transfer to a participating hospital will be coordinated by your attending physician. Should you decide not to be transferred, additional services will be covered on an out-of-network basis.


As is our standard policy, care for an emergency illness, injury or condition will be treated as in-network care at any hospital. A primary care physician (PCP) or specialist should not refer employees to Bayonne Hospital Center for any treatment or tests. Instead, they should refer employees to one of the major neighboring hospitals in our network, including: Jersey City Medical Center, Meadowlands Hospital Medical Center, Greenville Hospital, Christ Hospital, Hoboken University Medical Center, and Palisades General Hospital.

Medisys Hospital System in NY
The Oxford agreement with Medisys Health Network will terminate on May 1, 2008. Medisys Health Network consists of:

  • Brookdale University Hospital and Medical Center
  • Jamaica Hospital Medical Center and
  • Flushing Hospital Medical Center

Effective May 1, 2008, any care that employees receive from the above listed facilities, other than emergency or transitional care, will be on an out-of-network basis.


As is standard policy, care for an emergency illness, injury or condition will be treated as in-network care at any hospital. A primary care physician or specialist should not refer employees to a Medisys Health Network facility for routine treatment or tests. Instead, they should refer employees to one of the major neighboring hospitals in our network including:

  • Kingsbrook Jewish Medical Center
  • University Hospital of Brooklyn
  • New York Methodist Center
  • Queens Hospital Center
  • New York Hospital Medical Center of Queens
  • Mary Immaculate Hospital

Peconic Bay Medical Center
The Oxford agreement with Peconic Bay Medical Center terminated on March 1, 2008.   

To minimize the disruption that this may cause you and provide you with sufficient time to find another Oxford participating hospital, care received at Peconic Bay Medical Center will be considered in-network through April 30, 2008.

Effective May 1, 2008, any care that you receive from Peconic Bay Medical Center, other than emergency or transitional care, will be on an out-of-network basis.  

As is our standard policy, care for an emergency illness, injury or condition, will be treated as in-network care at any hospital. A primary care physician or specialist should not refer you to a Peconic Bay Medical Center for any treatment or tests. Instead, they should refer you to one of the major neighboring hospitals in our network, including: Southhampton Hospital, Good Samaritan Hospital or Huntington Hospital.


Questions about changes and updates, please contact Oxford at 800.444.6222 or Human Resources at x3175.


Creditable Coverage Notice

Creditable Coverage Notice

You should be provided with a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to COBRA, when COBRA coverage ceases, if you request it before you lose coverage, or if you request it up to 24 months after losing coverage.
Without evidence of creditable coverage from the plan, you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in other coverage.

Creditable Prescription Drug Coverage Notice

Important Notice from Teachers College, Columbia University About

Your Prescription Drug Coverage and Medicare 

(PDF Version)

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Oxford and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 

There are two important things you need to know about your current coverage and Medicare's prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Teachers College, Columbia University has determined that the prescription drug coverage offered by the Oxford is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.


When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Oxford coverage will be affected. Your Oxford coverage will be terminated if you join a Medicare drug plan.

If you do decide to join a Medicare drug plan and drop your current Oxford coverage, be aware that you and your dependents will be able to get this coverage back only after you drop your Medicare drug plan and during the annual open enrollment period for the following calendar year.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Oxford and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.


For More Information About This Notice Or Your Current Prescription Drug Coverage-'

Contact Angela Lee (, 212-678-8146) for further information. NOTE: You'll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Oxford changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage-'

More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage: Visit

Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the "Medicare & You" handbook for their telephone number) for personalized help

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.


If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Name of Entity/Sender: Teachers College, Columbia University/Randy Glazer
Contact - Position/Office: AVP, HR
Address: 525 W 120th Street, New York, NY 10027
Phone Number: (212) 678-3175

Newborns' and Mothers' Health Protection Act

Newborns' and Mothers' Health Protection Act

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Special Enrollment Rights Information

Special Enrollment Rights Information

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents' other coverage). However, you must request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

To request special enrollment or obtain more information, contact Randy Glazer, Human Resources Director, or your Human Resources Representative at 212-678-3175.

USERRA (military leave) notice

Women's Health and Cancer Rights Act of 1998 Information

Women's Health and Cancer Rights Act of 1998 Information

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

1.    all states of reconstruction of the breast on which the mastectomy was performed;
2.    surgery and reconstruction of the other breast to produce a symmetrical appearance;
3.    prostheses, and
4.    treatment of physical complications of the mastectomy, including lymphedemas.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the respective in-network copayments (under the Oxford Access or Oxford Exclusive plans) or deductibles and coinsurance  (under the Oxford Direct or GHI plans) apply, as detailed in the plan descriptions available through your Human Resources Office or your union.

If you would like more information on WHCRA benefits, call your Human Resources Representative or the general Human Resources phone number (212-678-3175).

Employee Discounts

Employees of Teachers College, Columbia University, are eligible for discounts through various vendors.

Medicaid and Children's Health Insurance Program


Medicaid and the Children’s Health Insurance Program (CHIP)

Offer Free Or Low-Cost Health Coverage To Children And Families


If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage.  These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.


If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. 


If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or to find out how to apply.  If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. 


Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan.  This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. 




If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums.  The following list of States is current as of January 22, 2010.  You should contact your State for further information on eligibility –








Phone: 1-800-362-1504



Website: Pages/



Phone: 1-800-635-2570


COLORADO – Medicaid and CHIP




Phone (Outside of Anchorage): 1-888-318-8890


Phone (Anchorage): 907-269-6529



Medicaid Website:


Medicaid Phone: 1-800-866-3513


CHIP Website: http://


CHIP Phone: 303-866-3243





Phone: 602-417-5422



FLORIDA – Medicaid




Phone: 1-888-474-8275




Phone: 1-866-762-2237


GEORGIA – Medicaid

MONTANA – Medicaid




    Click on Programs, then Medicaid


Phone: 1-800-869-1150





Telephone: 1-800-694-3084



IDAHO – Medicaid and CHIP

NEBRASKA – Medicaid


Medicaid Website:


Medicaid Phone: 208-334-5747


CHIP Website:


CHIP Phone: 1-800-926-2588




Phone: 1-877-255-3092



INDIANA – Medicaid

NEVADA – Medicaid and CHIP




Phone: 1-877-438-4479



Medicaid Website:


Medicaid Phone:  1-800-992-0900


CHIP Website:


CHIP Phone: 1-877-543-7669




IOWA – Medicaid




Phone: 1-888-346-9562


KANSAS – Medicaid





Phone: 1-800-635-2570






Phone: 1-800-852-3345 x 5254

KENTUCKY – Medicaid

NEW JERSEY – Medicaid and CHIP




Phone: 1-800-635-2570



Medicaid Website:



Medicaid Phone: 1-800-356-1561


CHIP Website:


CHIP Phone: 1-800-701-0710


LOUISIANA – Medicaid




Phone: 1-888-342-0555






Phone: 1-800-321-5557



Medicaid Website:


Medicaid Phone: 1-888-997-2583


CHIP Website:

      Click on Insure New Mexico


CHIP Phone: 1-888-997-2583




Medicaid & CHIP Website:


Medicaid & CHIP Phone: 1-800-462-1120



MINNESOTA – Medicaid

NEW YORKMedicaid




    Click on Health Care, then Medical Assistance


Phone: 800-657-3739






Phone: 1-800-541-2831


MISSOURI – Medicaid





Phone: 573-751-6944






Phone:  919-855-4100



UTAH – Medicaid




Phone: 1-800-755-2604





Phone: 1-866-435-7414


OKLAHOMA – Medicaid

VERMONT– Medicaid




Phone: 1-888-365-3742





Telephone: 1-800-250-8427


OREGON – Medicaid and CHIP

VIRGINIA – Medicaid and CHIP


Medicaid Website:


Medicaid Phone: 1-800-359-9517


CHIP Website:



CHIP Phone: 1-800-359-9517



Medicaid Website:


Medicaid Phone:  1-800-432-5924


CHIP Website:


CHIP Phone: 1-866-873-2647







Phone: 1-800-644-7730




Website:  http://ihrsa/sites/DCS/COB/default.aspx


Phone:  1-800-562-6136







Phone: 401-462-5300





Phone:  304-342-1604



WISCONSIN – Medicaid




Phone: 1-888-549-0820





Phone: 1-800-362-3002


TEXAS – Medicaid

WYOMING – Medicaid




Phone: 1-800-440-0493




Telephone: 307-777-7531



To see if any more States have added a premium assistance program since January 22, 2010, or for more information on special enrollment rights, you can contact either:


U.S. Department of Labor                                      U.S. Department of Health and Human Services     

Employee Benefits Security Administration              Centers for Medicare & Medicaid Services                                                                                  

1-866-444-EBSA (3272)                                      1-877-267-2323, Ext. 61565




OMB Control Number 1210-0137 (expires 07/31/2010)          

Medical Insurance - Grandfathered Plan

Information about Medical Insurance Plan Grandfathered Plan Status

Teachers College believes our group medical insurance plans provided via Oxford and Emblem (GHI) are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act).  As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.  Being a grandfathered health plan means that your Oxford or Emblem GHI) medical plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing.  However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. 

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at 212-678-3175 or  You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or  This website has a table summarizing which protections do and do not apply to grandfathered health plans.

Michelle's Law

Michelle’s Law Notification:



If your child loses his or her status as a full-time student because medical reasons cause your child to take a leave of absence from school or change to part-time student status, your child will be eligible for continued group health plan coverage for up to one year from the date your child loses full-time student status, unless your child’s eligibility would end earlier for another reason (such as exceeding the plan’s age limit).   

New Health Insurance Marketplace Coverage Options and Your Health Coverage


PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.


What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.


Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.


Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1


Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.


How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact your HR Generalist (call 212-678-3175 to find out who your Generalist is).


The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.


PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Employer Name

Teachers College, Columbia University

Employer Identification Number (EIN)


Employer Address

525 W 120th Street


New York



Zip Code


Employer Phone Number


Who can we contact about employee health coverage at this job?

Your HR Generalist (call 212-678-3175 to find out who your Generalist is)

Email address


Here is some basic information about health coverage offered by this employer:

• As your employer, we offer a health plan to:

Some employees. Eligible employees are:

·         Full time (35 hours/week) Professionals and Executives

·         Full time Faculty, Instructors and Lecturers

·         Employees in positions covered by the Local Union 2110 CBA, Local Union 707 CBA and Local Union 32BJ CBA


• With respect to dependents:

We do offer coverage. Eligible dependents are:

Legal spouse or dependent children of an Employee. Age limits vary depending on benefit.


This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

**Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, will guide you through the process.


1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.


NYC Earned Sick Time Act

Transition to Aetna

Link to Aetna Presentation

Link to Value Plan and HSA Presentation

Link to Aetna Pharmacy - Helpful Information

The College has executed documents to retain Aetna Insurance Company as our health insurance provider for faculty, professional staff and instructional staff, effective January 1, 2015. 

Aetna is one of the largest medical insurance carriers in the United States with 23 million members. Our new plan offers extensive wellness benefits, 24/7 customer service, online health management tools and much more.
  • The Aetna Health Plan designs are extremely close to the current Oxford plan designs for the Access, Exclusive and Direct plans. We were able to match the office visit copays, pharmacy copays, deductibles and coinsurance. Detailed plan summaries will be available during open enrollment. 
  • The Value Plan will be changing to a Consumer Driven Health Plan (CDHP) design with Health Savings Account (HSA). More details will follow later in this communication. 
  • A provider disruption analysis was completed using Aetna’s Open Access Managed Choice Network (OAMC) and the majority of providers utilized by members in calendar year 2013 are also in the Aetna OAMC network. While there will be some Oxford in-network providers that are not in Aetna’s OAMC network, we expect the disruption to be minimal based on our analysis. 
  • By making this change, we were able to minimize the change to your current employee contributions. 
Additional Details
Provider & Hospital Network: All plans will utilize the Aetna Open Access Managed Choice (OAMC) network of preferred providers, which is a nationwide network. We encourage you to contact your doctors/providers to ensure they are participating in the Aetna OAMC network. You can also view the most up to date network online at: 
Click on “Individuals and Families” on the top left 
Click on “Find a Doctor” under “Why Aetna” 
Click on “Find an Aetna doctor 
Click on “Find doctors, dentists and hospitals in our plans” under the text “Thinking of getting an Aetna plan” (once you are enrolled you will go to member site) 
Click on “Through an employer or organization” 
Enter what provider type you are searching 
For network, select “Managed Choice (Open Access)” underneath “Aetna Open Access Plans” 

Some providers can have multiple specialties so sometimes can be difficult to locate online. We recommend contacting your doctor directly also to confirm their network status. 

The pharmacy copays per tier level will not change. However, each insurance carrier does have a different formulary list. Our analysis showed that the majority of the highly utilized prescription drugs will be in the same copay tier, however, there may be some shifts up or down tier. The full formulary can be viewed at: 
Click on “Individuals and Families” on the top left 
Click on “Find a Medication” 
Click on “See if a medication is covered” 
In drop down, choose “Three Tier Open Formulary” 
Type in applicable drug name 

Transition of Care (TOC)
TOC coverage is temporary coverage you may receive when you become a new member of an Aetna medical plan and your in-network doctor with the prior carrier is not in the Aetna network. TOC is limited to situations where a member is in an active course of treatment. Some examples of active courses of treatment are:
(1) members who have completed 20 weeks of pregnancy;
(2) in an ongoing treatment plan such as chemotherapy or radiation therapy;
(3) members who recently had surgery; (4) members who may need a transplant. 

Members must complete a TOC coverage request form and it must be approved by Aetna. TOC is for a limited amount of time; typically 90 days. Aetna will pay your provider based on the in-network level of benefits. The TOC request form will be provided at the open enrollment meetings. 

“New” Value Plan
The Value Plan is being changed to a Consumer Driven Health Plan (CDHP) with a Health Savings Account (HSA). The main difference with this plan are slightly higher deductibles and that the deductible is a true “family” deductible, which means that if you cover dependents, the entire family deductible must be met before any benefits are paid (except in-network preventive care). If you enroll in this plan, you can deposit money tax free in a HSA. Unlike a Flexible Spending Account (FSA), this is an actual bank account you own and there is no “use it or lose it” rules. The money in your HSA must be used for qualified healthcare expenses in order to remain tax free. Another benefit of the HSA is that the employer may make contributions into the employee’s account. For 2015, TC will be providing employees with HSA contributions of $300 for single coverage, $600 for “employee plus one” coverage and $900 for family coverage. This amount will be deposited via 24 payments, consistent with the semi-monthly pay schedule. More details on this plan will be given at the open enrollment meetings. 

To Keep Your Current Coverage: If you wish to remain in the same plan design that you are in now, you will be mapped over to Aetna with no changes. This includes dependents that are enrolled under your plan. If you wish to make a change, you will have an opportunity to do so during open enrollment.