Changes to these plans may be made once a month by completing and submitting a QTE Enrollment/Change Form and/or a Salary Reduction Form (TDA Plan) found in the Benefits Forms and Documents page. Your change will take effect on the first of the month you have indicated at the top of the form or the first of the month following receipt of your completed form if no date is indicated. Forms may be scanned and emailed to firstname.lastname@example.org, or sent via U.S. Mail or interoffice mail to The Office of Human Resources/Benefits, 79 Fifth Avenue, 18th Floor, New York, NY 10003, or faxed to 212.229.5884.
If you and/or your qualified dependent(s) lose eligibility under CHIP (Children's Health Insurance Program) or Medicaid or have been determined eligible for state premium assistance under either the CHIP or Medicaid programs, you and your qualified dependents have 60 days from the date coverage ends or the eligibility determination date to end coverage or enroll.
Generally you may only change your elections for these plans once a year, during the university's annual Open Enrollment period. However you may change your elections during the calendar year if you have a Change in Status as defined by the Internal Revenue Code.
Change requests must be made no later than 31 days after the date of the status change as described below.
Marriage, death of spouse, divorce or annulment, legal separation.
Birth, adoption or placement for adoption, death of dependent child, newly eligible dependents due to plan design change, dependent no longer eligible according to the terms of the plan, loss of student status, marriage of dependent child.
Employee or dependent loses other coverage.
Commencement or termination of employment, commencement or return from an unpaid leave of absence, change in employment classification that affects the individual's eligibility under the plans, and change in worksite.
You or another individual is required to provide health coverage for your dependent child(ren).
Establishing a domestic partnership with a state or local municipality, or termination of a domestic partnership or change in residence of the employee, spouse, or dependent child(ren).
The provider of the dependent care changes or your cost for dependent care significantly increases or decreases.
In the case of the birth of a child, the change becomes effective on the child's date of birth. All other changes become effective the first of the month following the event.
The forms and supporting documents may be scanned and emailed to email@example.com or faxed to 212.229.5884, or mailed or sent via interoffice mail to The New School, Office of Human Resources/Benefits, 79 Fifth Avenue, 18th Floor, New York NY 10003. Please keep copies for your own records.
79 Fifth Avenue, 18th floor (Map)Phone: 212.229.5671Fax: 212.229.5884
Monday-Friday9:00 a.m.-5:00 p.m.
Staffing Services212.229.5671 Ext. 3844
HR Information Services212.229.5671 Ext. 4940
Employee Services212.229.5671 Ext. 4941
Benefits Forms and Documents
Employee Assistance Program