Resource Center

Contact

Montefiore Medical Center Corporate Human Resources Division HR-Benefits Office	By U.S. Mail: 111 East 210th Street Bronx, NY 10467-2490 Via interoffice mail or FedEx: 555 South Broadway, Bldg A Tarrytown, NY 10591	T 914.349.8531 F 914.349.8584	[email protected]
Albert Einstein College of Medicine		718.430.2547	[email protected]
Benefits Enrollment		888.860.6166	www.montebenefits.com
COBRA Administrator	Mail Election forms to P.O. Box 226101, Dallas TX 75222 Mail checks to PO Box 660212, Dallas TX 75266-0212	888.678.4881	mybenefits.wageworks.com
Dependent Verification	Winston Benefits	T 866.936.7011 F 732.903.1166	[email protected] www.mymmcbenefits.com
Employment/Income Verification	The Work Number	800.367.5690	www.theworknumber.com
Retiree Administration	HealthEquity/Wageworks 1155 Reliable Parkway Chicago, IL 60686	888.678.4881	www.wageworks.com
1199SEIU Benefit and Pension Fund		646.473.9200	www.1199seiubenefits.org Benefits Overview
Local 30 International Union of Operating Engineers	16-16 Whitestone Expressway Whitestone, NY 11357	718.847.8484	www.iuoelocal30.com
New York State Nurses Associates (NYSNA)	NYSNA Pension Plan & Benefits Fund PO Box 12430 Albany, NY 12212-2430	877.RN.BENEFITS 877.762.3633 800.342.4324 518.869.9501	www.rnbenefits.org
Special & Superior Officers Benevolent Association	199 North Wellwood Avenue Lindehurst, NY 11757	631.587.9116	ssoba.com
Teamsters Local 445	15 Stone Castle Road Rock Tavern, NY 12575	845.564.4076	teamsterslocal445.org

For Your Benefit

Healthcare

Contact

Care Guidance Program		855.MMC.WELL (855.662.9355)	[email protected]
Claims Administrator/Medical MonteCare EPO MonteCare PPO MontePrime EPO (House Staff) Registered Nurses Health Plan	Anthem BlueCross BlueShield	866.236.6748	www.enrollmentempireblue.com/montefiore
	24/7 NurseLine	877.TALK.2RN (877.825.5276)
	Anthem Getting Better Care		www.anthembluecross.com/getting-care
	BlueCross BlueShield Global		www.bcbsglobalcore.com
Claims Administrator/Dental Preventive & Diagnostic Care Cigna DPPO Dental Plan Cigna DHMO Registered Nurses Dental Benefits	Cigna	800.Cigna24 (800.244.6224)	www.mycigna.com DHMO Directory CT – Network – Specialist NJ – Network – Specialist NY – Network – Specialist DPPO Directory CT – Network NJ – Network NY – Network
COBRA	HealthEquity/Wageworks PO Box 14053 Lexington, KY 40512	888.678.4881	www.wageworks.com
Montefiore's Care Management Company		833.MHS.WELL (833.647.9355)
Carebridge EAP		800.225.2527 800.252.4555	www.carebridgenow.com
Montefiore Provider Network	CMO Customer Service Department	914.377.4400	Find a Montefiore or Empire Doctor MonteCare/MontePrime Mental Health Provider Directory
Prescription Drug Program	Montefiore Outpatient Pharmacy	718.920.4937	www.montefiore.org/montefiorepharmacy
Prescription Drug Program	Express Scripts	800.631.7780	www.express-scripts.com
Vision	United Healthcare Vision Plan	800.638.3120	www.myuhcvision.com www.visiondirect.com Laser Vision Network of America

Financial Security

Contact

1199 Benefit and Pension Fund		646.473.9200	www.1199seiubenefits.org
Health Services Retirement Plan (HSRP)		212.956.8340	Notice to Interested Parties
Local 30 International Union of Operating Engineers		718.847.8484	www.iuoelocal30.com
NYSNA Pension		877.RN.BENEFITS 877.762.3633 800.342.4324 518.869.9501	www.rnbenefits.org
Special & Superior Officers Benevolent Association	199 North Wellwood Avenue Lindehurst, NY 11757	631.587.9116	ssoba.com
Teamsters Local 445	15 Stone Castle Road Rock Tavern, NY 12575	845.564.4076	teamsterslocal445.org
Montefiore Medical Center 403(b) Plan	Fidelity	800.343.0860	www.netbenefits.com/atwork

Flexible Spending Accounts
Contact
- HealthEquity/Wageworks
  
  877.924.3967
  
  www.wageworks.com

Group Legal Services
Contact
- MetLife Legal Plans 800.821.6400
  www.legalplans.com
  Password:
  
  3700010/family coverage
  3710010/single coverage

Life, Accident & Disability

Contact

Disability	Central Leave Office	914.349.8528	[email protected]
Life and AD&D Insurance	MetLife	800.275.4638	MetLife.com
STD, LTD and Buy-Up LTD	Principal Life^®	800.245.1522	www.principal.com
LTD – Contributory RNs – 1199	For pending claims Prudential Disability Claims	860.842.1718	reference policy number 44416
LTD – Contributory RNs – 1199	Pending EOI application Medical Underwriting Team	888.257.0412	reference policy number 44416

Scholarship Program & Tuition Reimbursement
Contact
- Tuition Reimbursement
  914.349.8563 [email protected]

Voluntary Benefits

Contact

Commuter Benefits	HealthEquity/Wageworks	888.678.4881	www.wageworks.com
511NY Rideshare	Out-of-state (888.465.1169)	511	www.511ny.org/rideshare
Employee Discounts	Corporate Offers	212.203.1818	www.corporateoffers.com
	PerksConnect	877.253.7100	montefiore.perksconnection.com Group Code: MontefioreMC
	Nationwide Pet Insurance	877.738.7874	www.petsnationwide.com
	Plum Benefits	212.660.1888	www.plumbenefits.com
	Wireless Discounts
	T-Mobile	855-570-9947
	Verizon		www.verizon.com/deals-at-work
Special Promotions	Auto/Homeowner Insurance
	Farmers	855.599.8764	https://www.farmers.com/landing/groupselect/getquote/#/home">
	Travelers	866.360.0590	https://www.travelers.com/affinity/sponsor/perks?sponsor=perks&augeotoken=_AUGEOTOKEN_
	LASIK Surgery	718.920.2020
	Municipal Credit Union	212.693.4900	www.nymcu.org
	Purchasing Power	800.537.3134	www.montefiore.purchasingpower.com
Voluntary Insurance Program (VIP)	Critical Illness Insurance Integrated Disability Benefit Income Protection – 1199 Personal Accident Insurance Universal Life Insurance Whole Life Insurance	866.936.7011	www.mymmcbenefits.com
Individual Disability Income (DI) Insurance	Principal	212.536.6181	[email protected]

HealthyMe!

Contact

www.mymontebenefits.com/healthyme

Retirement

Contact

Montefiore Medical Center 403(b) Plan	Fidelity	800.343.0860	www.netbenefits.com/atwork
Medicare		800.MEDICARE (800.633.4227) TTY Users 877.486.2048	www.medicare.gov
Retiree Administration	Mail Election Forms to: HealthEquity/Wageworks PO Box 226101 Dallas, TX 75222 Mail Checks to: HealthEquity/Wageworks PO Box 660212 Dallas, TX 75266-0212	888.678.4881	www.wageworks.com
Social Security Administration		800.772.1213 TTY Users 800.325.0778	www.socialsecurity.gov

Administration

Forms

Change of Information Form

Direct Deposit Form

For Your Benefit

Healthcare
Forms
- Empire Medical Claim Form
  
  International Claim Form
  
  Medco Prescription Drug Claim Form
  
  Medco Prescription Drug Mail Order Form
  
  Cigna Dental Claim Form

Flexible Spending Accounts
Forms
- WageWorks PayMeBack Healthcare Form
  
  WageWorks PayMeBack Dependent Care Form
  
  WageWorks Letter of Medical Necessity

Life, Accident & Disability
Forms
- Notification of Start and Return from Disability
  
  Beneficiary Designation Form (available on MonteBenefits.com)
  
  Disability Comparison
  
  Voluntary LTD Enrollment Card
  
  Voluntary LTD EOI Form

Scholarship Program & Tuition Reimbursement
Forms
- Scholarship Program & Tuition Reimbursement information and forms are accessible HERE

HealthyMe!

Forms

WW Participation Reimbursement Form

Lactation Room Access Request Form

YMCA's Diabetes Prevention Program (YDPP) Referral Form

Nutrition Counseling Form

Retirement

Forms

Administration

Legal

ACA Non-Discrimintation Notice	Montefiore Non-Discrimination Notice Group Health Plan Covered Entity Grievance Policy
Family and Medical Leave Act	Family and Medical Leave Act (FMLA)
NYC Earned Safe and Sick Time Act	New York City Earned Safe and Sick Time Act (ESSTA)
New York Paid Family Leave	Paid Family Leave Paid Family Leave and the Family Medical Leave Act Claiming PFL Benefits PFL Frequently Asked Questions
Notice of Privacy Practices	Privacy Practices
USERRA	Uniform Services Employment and Re-Employment Rights Act of 1994 (USERRA) Continuation Coverage Under USERRA
Summary Annual Reports (SARs)	Management 2022 Summary Annual Report Montefiore 2022 403(b) Summary Annual Report House Staff 2022 Summary Annual Report Registered Nurse (NYSNA) 2022 Summary Annual Report Registered Nurse (1199) 2021 Summary Annual Report 1199/Local 30 2021 Summary Annual Report Retired Management 2022 Summary Annual Report Retired RN 2022 Summary Annual Report HSRP 2017 5500 Einstein 403(b) Plan 2022 Summary Annual Report
Summary Plan Description (SPD)	Associate Benefits Program SPD Security Guards (SSOBA) SPD House Staff Benefits Program SPD Teamsters Benefits Program SPD RN (NYSNA) Benefits Program SPD Healthcare Flexible Spending Account SPD (RN - 1199) MonteCare Basic EPO SPD Montefiore Medical Center 403(b) Plan SPD Retired Management SPD Retired Registered Nurse (NYSNA) SPD HSRP SPD
New York DBL/PFL	Montefiore Medical Center	Notices of Compliance (Forms DB-120 and PFL-120) Disability Benefits – Statement of Rights (Form DB-271S)
	Montefiore Mount Vernon Hospital Montefiore New Rochelle Hospital Schaffer Extended Care Center	Notices of Compliance - MMV (Forms DB-120 and PFL-120) Notices of Compliance - MNR (Forms DB-120 and PFL-120) Notices of Compliance - SECC (Forms DB-120 and PFL-120) Disability Benefits – Statement of Rights (Form DB-271S)

For Your Benefit

Healthcare

Legal

Notices

Children’s Health Insurance Program (CHIP)

Claiming Healthcare Benefits

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Family and Medical Leave Act (FMLA)

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Marketplace Notice

Medicare Part D Notice

Newborns’ and Mothers’ Health Protection

Uniform Services Employment and Re-Employment Rights Act of 1994 (USERRA)

Women’s Health and Cancer Rights (WHCRA)

Montefiore Legal Notices

Einstein Legal Notices

Summary of Benefits & Coverage (SBC)

2024 MonteCare EPO SBC

2024 MonteCare PPO SBC

2024 MontePrime EPO SBC

2024 Registered Nurses Health Plan SBC

2024 MonteCare Basic EPO SBC

Summary Plan Descriptions (SPD)

Montefiore Medical Center

2024 Associate Benefits Program SPD

2023 House Staff Benefits Program SPD

2023 RN (NYSNA) Benefits Program SPD

2023 Security Guards (SSOBA) Benefits Program SPD

Montefiore Mount Vernon

Montefiore New Rochelle

Schaffer Extended Care Center

2023 Executive Associates and Physicians

2023 Management, Professional and Non-union Associates

2023 House Staff

Registered Nurses

Teamsters

Financial Security
Legal
- Montefiore Medical Center 403(b) Plan SPD
  
  HSRP SPD

Flexible Spending Accounts

Legal

Summary Plan Description (SPD)

2024 Associate Benefits Program SPD

Security Guards (SSOBA) SPD

2023 House Staff Benefits Program SPD

Teamsters Benefits Program SPD

RN (NYSNA) Benefits Program SPD

2023 Healthcare Flexible Spending Account SPD (RN - 1199)

Group Legal Services
Legal
- Summary Plan Description (SPD)
  
  2024 Associate Benefits Program SPD
  
  Security Guards (SSOBA) SPD
  
  2023 House Staff Benefits Program SPD
  
  Teamsters Benefits Program SPD

Life, Accident & Disability

Legal

Insurance Certificates

Montefiore Medical Center

STD - All Other Members

STD - Eligible Registered Nurses

STD - Executive Members

Business Travel Accident SPD

Travel Assist Brochure

Associate Life Insurance SPD

NYSNA RN Life Insurance SPD

AECOM Research and Clinical Fellows Life Insurance SPD

Disabled Retiree Life Insurance SPD

Retirees Age 60 to 64 Life Insurance SPD

Retirees Age 65 and older Life Insurance SPD

LTD Rider and Certificate - Grandfathered Sr Mgrs, Physicians & Appointed Scientists

LTD Rider and Certificate - Mgmt, PTs, Clerical, Security & House Staff

LTD Rider and Certificate - Sr Mgmt, Physicians & Appointed Scientists

LTD Rider and Certificate - RN

Montefiore Mount Vernon Hospital

Montefiore New Rochelle Hospital

Schaffer Extended Care Center

STD - All Other Members

STD - Eligible Registered Nurses

STD - Executive Members

Associate Life Insurance SPD

NYSNA RN Life Insurance SPD

LTD Rider and Certificate - Grandfathered Sr Mgrs, Physicians & Appointed Scientists

LTD Rider and Certificate - Mgmt, PTs, Clerical, Security & House Staff

LTD Rider and Certificate - Sr Mgmt, Physicians & Appointed Scientists

LTD Rider and Certificate - RN

MMV BTA SPD

MMV Travel Assist. Brochure

MNR BTA SPD

MNR Travel Assist Brochure

SECC BTA SPD

SECC Travel Assist Brochure

Scholarship Program & Tuition Reimbursement
Legal

HealthyMe!

Retirement

Legal

Summary Annual Reports (SARs)	Retired Management Summary Annual Report Retired RN Summary Annual Report
Summary Plan Descriptions (SPDs)	Montefiore Medical Center 403(b) Plan SPD Retired Management SPD Retired Registered Nurse (NYSNA) SPD

Administration

For Your Benefit

Healthcare

Tools

Medical	Find a Montefiore or Empire Doctor Empire BC BS − Blue National Doctor and Hospital Finder Apps
Prescription Drug	Express Scripts National Preferred Formulary Express Scripts NPF Exclusions Specialty Medication List
Dental	Cigna DPPO Benefit Summary Cigna Preventive & Diagnostic Benefit Summary Cigna DHMO Benefit Summary Cigna RN Dental Benefit Summary Cigna Retiree Dental Benefit Summary Find a Montefiore Dentist Find a Cigna Dentist

Flexible Spending Accounts

Tools

WageWorks Healthcare FSA Calculator

WageWorks Dependent Care FSA Calculator

www.fsaworks4me.com

Medical & Dental Expenses IRS Publication 502

Child & Dependent Care Expenses IRS Publication 503

WageWorks® Healthcare Card

Life, Accident & Disability
Tools
- An Employee’s Guide to Health Benefits Under COBRA
  
  Social Security Disability Benefits
  
  Financial Planning Calculator – Covering Shortfalls Due to Disability
  
  www.disability.gov

Scholarship Program & Tuition Reimbursement
Tools

Voluntary Benefits
Tools
- Commuter Benefits
  WageWorks Commuter Benefits Calculator
  
  WageWorks4Me
  
  WageWorks PayMeBack Commuter Form
  
  Carpooling Tips and FAQs
  
  WageWorks Commuter Card

HealthyMe!

Tools

www.mymontebenefits.com/healthyme

Retirement

Tools

This site provides only highlights of the Montefiore‘s Benefits & Wellness Programs and does not attempt to cover all details. Complete details are contained in the Plan documents and/or insurance company contracts, which legally govern the Program and which are controlling in the event of the conflict. Montefiore expects to continue these plans indefinitely, but reserves the right to change, modify or terminate the Plans in whole or in part, at any time and for any reason. In addition, the tax treatment of these benefits is subject to change without notice, as determined by federal, state or local tax authorities.