Additional Benefits, including Identity Theft Monitoring & Protection.
- Education Allowance $350-$800/year
- Meal Allowance $1,250/year
- Patient Care Fund $12,000/year
- Malpractice Insurance
Questions about your contract?
Contact: Omara Gerardo-Valdez
firstname.lastname@example.org | (917) 670-2559
- HIPAA Notice of Special Enrollment Rights
- Summary Plan Description
- CIR Legal Services
- Tax Form 1095-B FAQs
- Rights & Protections Against Surprise Medical Bills
+ Mental Health Resources
- NY Project Hope Emotional Support Helpline: 1-844-863-9314
- Crisis Text Line: Text GOT5 to 741741
- National Suicide Prevention Lifeline: 1-800-273-TALK
- Trevor Lifeline: 1-866-488-7386
- Trevor Text: Text START to 678678
- OMH’s Customer Relations: 1-800-597-8481
- NY Office of Mental Health Website
+ Personal Information
- Membership Form
- Update Form – To add new dependents to your plan. Requests to add dependents must be received within 30 days of qualifying event (birth/adoption or marriage), and you must attach requested documentation (see form).
- Affidavit – If you cannot locate the marriage certificate or birth certificate(s), you can submit this affidavit in its place. The affidavit must be notarized.
- Domestic Partnership Application (only same-sex partners eligible) – To add a partner, download an application and return a notarized copy, along with all requested documentation, to the Plan office. You must also complete an Update Form above.
- Opt-Out Benefits Form – Please fill out this form if you would like to remove yourself and/or your dependent(s) from the CIR Benefits Plan.
Membership Form, Update Form, Domestic Partnership Application, Opt-Out Form
- Empire Machine Readable Files
- Empire Health Insurance Claim Form (out-of-network)
- Empire’s website
- Summary of Benefits and Coverage (“SBC”) PPO
- Summary of Benefits and Coverage (“SBC”) POS
- Live Health Online
- Future Moms Materials and Gift Card Details
- The Autism Program
- WINFertility program and WIN app demo video
- Any services rendered prior to January 1, 2022 will not be covered.
- Travel Insurance
- Member ID card – how to access
- Temporary ID card
- Online registration
- Mobile app – download now
- ScriptVisionSM for digital physician engagement
Effective January 15, 2022 – Coverage for over-the-counter at-home COVID-19 diagnostic tests:
For tests purchased on and after January 15, 2022, the Plan will cover FDA-authorized over-the-counter at-home COVID-19 diagnostic tests without any cost-sharing requirements, prior authorization, or other medical management requirements, regardless of whether ordered by a health care provider. Coverage will be available only when tests are purchased for personal use, will not be resold or distributed, are not for employment purposes, and have not been and will not be reimbursed by another source. Reimbursement will only be provided for tests purchased from a pharmacy or a retailer and is limited to eight (8) tests per covered person per 30-day period, unless prescribed by a health care provider.
The Plan is implementing this new benefit with Express Scripts, and we will provide additional information regarding how to take advantage of this benefit soon. In the meantime, please keep receipts of all tests purchased on or after January 15, 2022 and check here or call the Fund Office at (212) 356-8180 for further information on how to obtain reimbursement.
+ Supplemental Benefits
- Mental Health Claim Form – Now available through the Member Portal
+ Employee Assistance Program
The WorkLife Matters Employee Assistance Program offers services to help promote well-being and enhance the quality of life for you and your family. View details.
Connect to a counselor for free support services: 1-800-386-7055 (available 24 hours a day, 7 days a week).
Visit ibhworklife.com and login to “For Employees & Members” (password: wlm70101).
Questions? Email: email@example.com.
Prescription, Vision, Dental, Hearing, Supplemental Benefits & Employee Assistance Program. Supplemental Mental Health claim form now available through the Member Portal.
For purposes of our disability benefits, “disabled” means you can no longer perform the duties of your occupation due to accidental bodily injury, sickness, or a related medical condition, including pregnancy or childbirth. You must also be under the care of a licensed provider as defined by the state in which you work.
- Short-term Disability Claim Form
- If this is your first full-time job, you would have to work four consecutive weeks in order to become eligible for short-term disability. If this isn’t your first full-time job, you will be eligible for short-term disability payments on your first day of employment, unless you worked less than four weeks in previous job.
- Coverage begins on the eighth (8th) day of your disability. The maximum benefit payable is 60% of your weekly salary, up to $692 per week, for up to 26 weeks. See the Summary Plan Description (SPD) for more details.
- If you are going out on a disability leave, contact your employer as soon as possible.
- Please mail or fax the STD disability claims to: Standard Security Life Ins, P.O. Box 25339, Farmington, NY 14425. Fax: (585) 398-2854.
- Paid Family Leave (PFL) Claim Form – Administered by Standard Security Life Insurance Company of New York
- PFL provides wage replacement and job security for three leave types:
- Bonding with a child during the first year after birth, or during the first year after placement of an adopted or foster child.
- Caring for a close family member with a serious health condition.
- A qualifying military event is when a spouse, child, domestic partner, or parent of the employee is on active duty or has been notified of an impending call or order of active duty.
- Coverage includes a maximum weekly payout of $1,131.08 a week for a maximum 12 Weeks.
- Visit www.sslicny.com and click on “I’m a Claimant” to find the New York State PFL Claim Form.
- Paid Family Leave FAQs
- PFL provides wage replacement and job security for three leave types:
- Long-term Disability Claim Form
- The LTD plan pays you 60% of your monthly salary, up to a maximum of $3,500 per month. LTD benefits typically start if you are still disabled after 26 continuous weeks. For detailed information on Long-Term Disability see the Guardian Certificate.
- When you terminate employment, you will have the option to convert this benefit to an individual policy, subject to certain conditions.
- INSMED Portable Disability Coverage – Policies offered to you without any medical underwriting requirements or exams.
+ Life Insurance
Guardian Life Insurance:
- If you die, a death benefit of $125,000 benefit will be paid to any beneficiary you name. You will receive a $20,000 death benefit if your spouse or domestic partner dies.
- For instructions on submitting a Group Life Claim, click here.
- When you terminate employment, you will have the option to continue the life insurance coverage as either group term insurance (this is called “porting” and is similar to how you have been covered during training) or you may convert this benefit to an individual policy, subject to certain conditions.
- Whether you decide to port or convert, the availability and pricing of this coverage does not depend on any past or current medical conditions.
- You have up to 31 days from your date of termination to submit one of these forms directly to Guardian: For an overview of the differences between porting and converting, click here.
What is COBRA continuation coverage?
COBRA continuation coverage allows you to choose to continue and pay for group health benefits provided by CIR for up to 18 months after your termination date.
Who is eligible?
You and your dependents covered under the Plan on the day before you terminated from your employer.
You will receive a COBRA notice mailed to the address we have on file. This notice has important information about your rights related to continued health care coverage in the Voluntary House Staff Benefits Plan.
COBRA Election forms:
To apply for COBRA, you will need to complete the Election form that corresponds to the Dental Plan you had prior to termination. If you don’t remember which Dental Plan you have, look at your Dental ID card. Here is a sample of what the Managed Dental Guard ID card looks like:
Your Cobra Election includes the following benefits: Medical, RX, Vision, and Dental. The only difference in the benefits is the Dental option you had prior to termination. Please select the Election form (also includes the COBRA Credit Card Authorization Form) that applies to you:
DentalGuard Preferred (DGP)
- Individual DGP: COBRA Notice / Election & Payment Form
- Family DGP: COBRA Notice / Election & Payment Form
Managed DentalGuard Preferred (MDG)
- Individual MDG: COBRA Notice / Election & Payment Form
- Family MDG: COBRA Notice / Election & Payment Form
You have up to 31 days from your date of termination to submit one of these forms directly to Guardian:
COBRA Continuation Coverage and election forms.
Regional Vice Presidents:
- Colleen Achong, Internal Medicine,
Interfaith Medical Center
- Anna Ivanova, Emergency Medicine,
Brookdale University Hospital
- Steven Miller, Critical Care Fellowship,
Brooklyn Hospital Center
- Christopher Thipphavong, Psychiatry,
Maimonides Medical Center
- Arham Zia, Pediatrics
- Aya Majzoub, Pediatrics
- Taikchan Lildar, Internal Medicine (alternate)
- Jane Tian, Surgery (alternate)
Attention: In compliance with HIPAA regulations, we are moving to a new, secure email portal. Please use firstname.lastname@example.org to send secure emails to the Benefits Office.