Health Option Program (HOP)
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What happens if my basic workweek changes between 37.5 and 40 hours while participating in HOP?
When a HOP participants basic workweek changes between 37.5 and 40 hours, there will be no change in the amount of the health insurance contribution credit as long as the employees payroll percentage remains the same. However, the sick leave accrual rate for HOP participants will change when the basic workweek changes between 37.5 and 40 hours, just as it does for non-participants.
Once I elect to participate, are there circumstances under which I could become ineligible to continue participation?
Yes. ANY of the following events will result in loss of eligibility:
- Change to a pay basis other than annual-salaried;
- Movement to a position in a different negotiating unit than the one the employee was in at time of enrollment (except movement between CSEA Units);
- Voluntary or involuntary cancellation of health insurance coverage in either the Empire Plan or an HMO under NYSHIP;
- Waiver of NYSHIP premiums; or
- Separation from service, other than layoff resulting in placement on a preferred list.
Participating employees who separate from service as a result of a layoff, but who are eligible to continue participation in NYSHIP in preferred list status, continue to be eligible for the reduced employee share of the health insurance premium for the remainder of the calendar year in which they were laid off. For ALL other employees, any separation from service terminates participation in HOP.
Once the program is implemented on January 1 of each year that it is offered, any loss of eligibility before the end of that calendar year will disqualify employees from further participation for the remainder of that calendar year.
Employees who lose eligibility after electing to participate in November, but before the January 1 start date for each calendar year that the program is available, will have their participation for the calendar year in question cancelled. They will continue to pay health insurance premiums at the normal (non-HOP participant) rate and continue to earn sick leave at their normal contractually mandated rate.
What happens if I elect to participate, applying my credit against the cost of my health insurance premium, and then during the year I go on sick leave at half pay, Short-Term Disability (STD), or Long-Term Disability (LTD)?
Employees on sick leave at half pay continue to participate. They continue to receive the health insurance contribution credit, paying the employee share of the NYSHIP health insurance premium at the reduced rate through payroll deduction. No sick leave credits are forfeited for pay periods in which employees are ineligible to earn leave credits.
Employees in the IPP who go on STD during a period of HOP participation continue to participate in HOP. They are credited with sick leave on grant dates that fall during a period of STD. Sick leave credited on such grant dates continues to be at the reduced rate. Employees on STD continue to receive the health insurance contribution credit. They make direct payment for the employee share of NYSHIP premiums at the reduced rate.
Employees in the IPP who go on LTD during a period of HOP participation continue receiving the health insurance contribution credit. However, if they receive a waiver of premium or their employment terminates, they are ineligible to continue participation in HOP. Employees on LTD who are eligible to continue participation in HOP are responsible for the employee share of NYSHIP premiums at the reduced rate plus the employers share. The health insurance contribution credit cannot be applied against the employer share of the premium. If an employees sick leave grant date falls during a period of LTD under the IPP, the employees grant date changes to the date of return to pay status. If the adjusted grant date falls during a period of HOP participation, the employee is credited with sick leave at the reduced rate.
What happens if I elect to participate, applying my credit against the cost of my health insurance premium, and then during the year I go on leave without pay (LWOP)?
Employees on LWOP who do NOT receive a waiver of premium continue to participate in HOP, paying the employee share of the NYSHIP health insurance premium at the reduced rate. Additionally, they pay the employer share of the health insurance premium where required. Employees who receive a waiver of premium are ineligible to continue participation in HOP.
No portion of the credit available under HOP can be applied toward the employer share of the health insurance premium. For example, a participating employee who would normally pay an employee health insurance premium of $200 over the course of the calendar year enrolls in HOP and receives a credit of $200 toward the employee share of her health insurance premium. If she goes on LWOP during the course of her participation, her credit will remain capped at $200 despite the increased out of pocket expenses associated with her responsibility to pay the employer share of the premium while on LWOP.
Employees on LWOP whose NYSHIP coverage is cancelled (either voluntarily or because of failure to make payment of premiums as required) will lose eligibility to participate in HOP for the remainder of the calendar year.
What happens if I enroll in HOP and then go on workers compensation leave?
Employees who go on workers compensation leave continue to participate in HOP. They continue to receive the health insurance contribution credit during the calendar year of HOP participation. For employees eligible to defer NYSHIP premiums until return to the payroll, only that portion of the employee share premium which is not offset by the health insurance contribution credit, if any, is deferred until the employee returns to the payroll. However, employees eligible to receive supplemental payments while on workers compensation leave will have the health insurance contribution credit applied to any employee share premium deducted from such supplemental payments.
Employees who are eligible to earn leave credits during a period of workers compensation leave do so at the reduced HOP rate.
What happens to my NYSHIP premium when my employment percentage changes but I continue to be eligible for HOP (i.e. my employment percentage does not fall below 50%)?
If you are in the IPP, there is no change in the amount of your health insurance contribution credit. It continues to be based on whether you were part-time or full-time when you enrolled.
If you are not in the IPP, your health insurance contribution credit is re-calculated for the remainder of the calendar year based on your new status.
What happens to my NYSHIP premium when I lose eligibility to participate in HOP?
Regardless of whether you are in the IPP, your premium will be adjusted to reflect your new non-participant status.
When does my sick leave accrual rate change if I lose eligibility to continue participation in HOP because of cancellation of NYSHIP coverage or waiver of NYSHIP premiums?
In most cases, your accrual rate will be changed to the non-HOP participant rate in the pay period in which the effective date of cancellation of NYSHIP coverage occurred.
In cases where an employee loses NYSHIP coverage as a result of his/her employment percentage dropping below 50%, the sick leave accrual rate will be adjusted twice: