SSMC Employee Health Benefit Plan
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SECTION II - ELIGIBILITY AND ENROLLMENT
A. Eligibility for Plan Enrollment
Plan coverage for you and your Dependents will be according to the eligibility, enrollment, Effective Dates, and
cancellation provisions of the Plan. Rules concerning eligibility for Plan enrollment are established by SSMC.
Based on your eligible employment, you are eligible for Schedule A Benefits or Schedule B Benefits. See
Section I - Summary of Benefits for details on benefits. The content in this section is not intended to
constitute, or be validated as, the origin or basis for Plan eligibility requirements. The SSMC Human
Resources Department can provide full details concerning your eligibility for Plan coverage. Retirees are
covered separately under the SSMC Retiree Health Benefit Plan.
1. Employment Classifications. The following Employees are eligible for Plan enrollment when meeting the
minimum requirements described under Schedule A Benefits-Minimum Requirements and Schedule B-
Benefits Minimum Requirements described later in this section:
a. Physicians, Professional technical and clerical Employees of SSMC; or
b. SSMC Employees represented by Teamsters Local 338 or NYS Nursing Association; and
c. Who are not covered under a collective bargaining agreement that already provides health plan benefits
under another Plan sponsored by SSMC.
2. Schedule A Benefits Minimum Requirements. Eligible employment includes individual and
Dependent coverage unless otherwise shown. See Dependent Eligibility shown later in this section for
description of Dependents. The minimum requirements for Schedule A Benefits are:
a. Full-Time Employees. Eligible Employees who are hired to work a regular full time schedule of not
less than 37.50 hours per week and who have been so employed for a period of three full months
(inclu des sick days) are eligible all Schedule A Benefits.
b. Part time Employees. Eligible Employees who are hired to work a regular part-time schedule of:
1) 30 but less than 37.50 hours per week and who have been so employed for a period of three full
months (includes sick days) are eligible for Preventive Care, Hospital and Medical Expense
Benefits. After five full years of eligible employment, Prescription Drug Expense Benefits become
available.
2) 22.50 but less than 30 hours per week and who have been so employed for a period of six full
months (includes sick days) are eligible for Preventive Care, Hospital and Medical Expense
Benefits. Coverage is not available for Prescription Drug Expense Benefits. After five full years
of eligible employment, Dependent coverage becomes available.
c. Persons not Eligible for Schedule A Benefits. Persons in the following categories are not eligible for
Plan enrollment or coverage under Schedule A Benefits:
1) Any terminated, retired or laid-off employee.
2) Per diem/casual employees, persons hired on a seasonal or temporary basis or student interns or
students employed during school holidays.
3) Regular Part-time employees or employees hired to work less than 22.50 hours per week.
4) Any non-enrolled employee who submits an initial application while temporarily removed (i.e.,
leave of absence, disability, military service) from the payroll.
5) Any employee covered under a collective bargaining Agreement which already provides similar
health benefits under another plan sponsored by SSMC.
6) Any employee on active duty in the military service of any country.
