Employee Handbook - Hudson Valley Community College
Employee Handbook December 2014 Employee Handbook Table of Contents Calendars 1 5 Instructional Calendar College Calendar Mission of The College Major Campus Policies and Judicial Procedures Anti Discrimination/Sexual Harassment Policy and complaint procedure Computer Policy/Email Policy Identity Theft Prevention Program Judicial System 6 10 22 25 32 47 49 51 54 American with Disabilities Act [ADA] Fair Labor Standards Act [FLSA] Family and Medical Leave Act [FMLA] Family Educational Rights and Privacy Act [FERPA] Public Employment Safety and Health Act [PESHA] 56 HVCC Emergency Information 61 73 Security and Privacy of Protected Health Information [HIPAA] Workers’ Compensation Accident/Injury Report example NYS Workers’ Compensation Board Claimant Information Packet Employee Benefits Health Insurance > Plan Parameters > Rates Flexible Spending Account Dental Insurance > Schedule of Allowances > Claim Form Long‐Term Disability Insurance Employee Assistance Program Retirement Savings Programs > NYS Pension Plans > Tax Deferred Programs Employee Time and Attendance 110 116 Tuition Waivers Training College Services Available to Employees Standard Work Day Leave Accruals Leave for Cancer Screening Jury Duty Summer Hours Professional Development Opportunities 83 84 88 92 93 97 102 103 106 107 Dental Hygiene Clinic Recreational Facilities Employee Discounts Automotive Lab 118 Instructional Calendar 2015-2016 Fall 2015 Thursday Monday August 27 August 31 New Faculty Orientation Instruction Begins – Day classes Monday Tuesday Monday Monday September 7 September 8 September 14 September 21 Labor Day - College Closed Evening On-Campus Classes Begin Continuing Education Classes begin Off-Campus All College Meeting 2 p.m. County List Census Date Monday Monday October 12 October 26 No Classes – Columbus Day Mid-Semester Grades Due 10:00 a.m. Sprint Classes Begin Friday Wednesday Thursday Friday Saturday November 20 November 25 November 26 November 27 November 28 Last day to withdraw from classes Holiday - College closed Holiday - College closed Holiday - College closed Holiday - College closed Thursday Friday Saturday Monday Tuesday Wednesday December 17 December 18 December 19 December 21 December 22 December 23 Last day of instruction Final Exams Final Exams Final Exams Final Exams Examination Snow Day Thursday Friday December 24 December 25 Holiday – College Closed Holiday – College Closed Monday December 28 Final Grades Due 10:00 a.m. Thursday Friday December 31 January 1 Holiday – College Closed Holiday – College Closed Instructional Days Monday 14 Tuesday 16 Wednesday 15 Thursday 15 Friday 14 Total 74 Page 1 Instructional Calendar 2015-2016 Intersession 2015 Monday Thursday Friday Monday Friday Monday Tuesday Wednesday Thursday Sunday December 28, 2015 December 31, 2015 January 1, 2016 January 4, 2016 January 8, 2016 January 11, 2016 January 12, 2016 January 13, 2016 January 14, 2016 Classes Begin Holiday – College Closed Holiday – College Closed Classes Resume Last day to withdraw Classes End Final Exams Snow Day Grades Due – 10 a.m. Monday 12/28 9 a.m. – Noon 1 p.m. – 3 p.m. Tuesday 12/29 9a.m. – Noon 1 p.m. – 3 p.m. Wednesday 12/30 9a.m. – Noon 1 p.m. – 3 p.m. Thursday 12/31 Holiday College Closed Friday 1/1 Holiday College Closed 1/3 1/4 9 a.m. – Noon 1 p.m. – 3 p.m. 1/5 9 a.m. – Noon 1 p.m. – 3 p.m. 1/6 9 a.m. – Noon 1 p.m. – 3 p.m. 1/7 9 a.m. – Noon 1 p.m. – 3 p.m. 1/8 9 a.m. - Noon 1 p.m.– 3 p.m. 1/10 1/11 9 a.m. – Noon 1 p.m. – 3 p.m. 1/12 1/13 9a.m. – 11 a.m. Snow Day Final Exams 1/14 Grades Due 10 a.m. 1/15 Saturday 1/2 1/9 Week 1 – 15 hours Week 2 – 25 hours Week 3 – 5 hours Total hours – 45 hours + 2 hour final exam Page 2 Instructional Calendar 2015-2016 Spring 2016 Monday January 18 No Classes – Martin Luther King, Day Tuesday January 19 Monday January25 Monday February 8 Instruction Begins All day & evening On-Campus Classes Continuing Education Classes begin Off-Campus All College Meeting – 2:00 p.m. Monday Wednesday February 8 February 10 County List Census Date Faculty Workshop Day - No classes Monday March 14 Monday Tuesday Wednesday Thursday Friday Saturday Monday Tuesday Wednesday March 21 March 22 March 23 March 24 March 25 March 26 March 28 March 29 March 30 Mid-semester Grades Due 10:00 a.m. Sprint Classes Begin Spring Break – No Classes Spring Break – No Classes Spring Break – No Classes Spring Break – No Classes Holiday – College Closed Holiday – College Closed Holiday – College Closed Holiday – College Closed Classes Resume Friday April 15 Last day to withdraw from classes Thursday May 12 Last day of instruction Faculty Honors Convocation 4:30 p.m. Monday Tuesday Wednesday Thursday Saturday Monday May 16 May 17 May 18 May 19 May 21 May 23 Final Exams Final Exams Final Exams Final Exams Commencement Final Grades Due 10:00 a.m. Instructional Days Monday 14 Tuesday 15 Wednesday 15 Thursday 16 Friday 15 Total 75 Page 3 Summer Sessions 2016 No Classes/College Closed Monday, May 30 No Classes/College Closed Monday, July 4 Summer Session 1 (3 weeks) Monday Friday May 23 June 10 Classes Begin Classes End Summer Session 2 (6 weeks) Monday Friday May 23 July 1 Classes Begin Classes End Summer Session 3 (12 weeks) Monday Friday May 23 August 12 Classes Begin Classes End Summer Session 4 (5 weeks) Tuesday Friday May 31 July 1 Classes Begin Classes End Summer Session 5 (3 weeks) Tuesday Friday July 5 July 22 Classes Begin Classes End Summer Session 6 (6 weeks) Tuesday Friday July 5 August 12 Classes Begin Classes End Page 4 HUDSON VALLEY COMMUNITY COLLEGE CALENDAR 2013/2014 ACADEMIC YEAR Monday August 26 Classes Begin Monday September 2 Labor Day Monday September 16 All College Meeting Monday October 14 Columbus Day No Classes College Open Wednesday November 27 Holiday College Closed Thursday November 28 Thanksgiving College Closed Friday November 29 Holiday College Closed Friday December 13 Classes End Tuesday December 24 Holiday College Closed Wednesday December 25 Holiday College Closed Tuesday Holiday College Closed Wednesday January 1 Holiday College Closed Monday January 20 Martin Luther King Day No Classes College Open Tuesday January 21 Classes Begin Monday January 27 All College Meeting Friday April 18 Holiday College Closed Monday April 21 Holiday College Closed Tuesday April 22 Holiday College Closed Friday May 9 Classes End Saturday May 17 Commencement Monday May 26 Memorial Day Monday June 2 Summer Hours Begin Friday July 4 Holiday Friday August 8 Summer Hours End December 31 College Closed College Closed College Closed Through consultation with bargaining units, the Wednesday before Thanksgiving and the Thursday before Good Friday or Tuesday following Easter may be holidays instead of Columbus Day and Washington’s Birthday. Page 5 Statement of Commitment Hudson Valley Community College is committed to providing caring, personal, high-quality service at a reasonable cost to support students' success in reaching and raising their goals. Mission Statement Hudson Valley Community College’s mission is to provide dynamic, student-centered, comprehensive, and accessible educational opportunities that address the diverse needs of the community. Historical Preamble The college was created to respond to the needs of Rensselaer County and other nearby counties following World War II, and after the closing of the Veteran's Vocational School in 1953. At first, the college’s programs were largely technical, but by 1960 the first science, business, and liberal arts programs were added. In the decades since, the college has steadily increased its offerings, both in degree and certificate programs, so that it is now comprehensive in its majors and mission. Since its inception in 1953, Hudson Valley Community College has been sponsored by Rensselaer County under the supervision of the State University of New York. As one of the 30 community colleges in the state, all of its programs are registered and approved by the New York State Department of Education* with the authority to award certificates and associate degrees in arts, science, applied science, and occupational studies. Hudson Valley Community College is accredited by the Commission on Higher Education of the Middle States Association, an institutional accrediting agency recognized by the U.S. Secretary of Education and the Commission on Recognition of Postsecondary Accreditation. Many of the college’s academic programs also are accredited by specialized national professional accrediting associations. In 1966, the college began administering the Capital District Educational Opportunity Center to better serve the needs of the community. *New York State Education Department Office of Higher Education and the Professions Cultural Education Center, Room 5B28 Albany, NY 12230 (518) 474-5851 Page 6 Goals and Objectives 1. To enhance and promote excellence in teaching and learning. 1.1 To institute an integrated academic and administrative infrastructure that makes optimal employee support a priority. 1.2 To support faculty with the necessary resources for professional and personal development. 1.3 To develop effective teaching and learning methods that will assist the college in adapting to changing student academic needs. 1.4 To increase and strengthen articulation agreements with educational institutions and affiliations with educational partnerships. 1.5 To explore thoroughly all aspects of new educational delivery systems prior to implementation. 1.6 To create an academic atmosphere that encourages and supports innovation in the teaching and learning environment. 1.7 To assess effectiveness in the teaching and learning environment. 1.8 To ensure that the goals and standards of the college's academic programs are achieved. 1.9 To provide and maintain a classroom environment that is conducive to teaching and learning. 2. To develop and support a student centered collegial environment. 2.1 2.2 2.3 2.4 2.5 2.6 To promote and provide friendly, informative and supportive services for students. To develop a systematic and integrated approach to student persistence and success. To provide effective academic advising for all students. To develop and maintain a student scheduling system that is driven by student needs. To increase awareness of student support services, policies and campus events. To foster and promote student responsibility and involvement in his/her education. 3. To promote the integration of pluralism within the college community. 3.1 To develop and promote institutional programs and processes that embrace diversity. 3.2 To promote affirmative action and equal employment opportunities to increase the number of faculty and staff members from under-represented groups. 3.3 To increase the recruitment, retention, success and transfer of students from underrepresented groups. 4. To create and sustain a technological environment that is supportive of academic and Page 7 administrative needs. 4.1 To provide for continuous review and upgrading of technology as it serves academic and administrative applications. 4.2 To promote computer competency for students, faculty and staff. 4.3 To maintain an administrative information system that is useful, integrated and user friendly. 4.4 To provide a supportive environment for the development and implementation of distance learning opportunities. 5. To maintain and improve administrative services. 5.1 To develop and maintain an integrated institutional planning process. 5.2 To regularly assess the effectiveness of all areas under administrative services. 5.3 To promote communication, cooperation and shared decision making among administrative and academic departments. 5.4 To ensure fair and equitable performance evaluation, promotion and compensation systems for all faculty and staff. 5.5 To support the staff with the necessary resources for professional and personal development. 5.6 To implement a non-adversarial and collaborative approach to the bargaining process. 5.7 To provide a clean, safe and accessible environment which meets the needs of students, faculty and staff. 5.8 To promote fiscal responsibility and accountability. 6. To develop and foster beneficial relationships with the community. 6.1 To enrich and increase administrative and academic partnerships with businesses and the community. 6.2 To promote and support the departmental efforts that generate external revenue. 6.3 To develop a comprehensive enrollment management system to achieve and maintain effective recruitment and retention of students. 6.4 To promote the maximum achievable graduation rate for students. 6.5 To promote Hudson Valley Community College as an exemplary educational institution through an institution-wide marketing focus, that highlights the merits of all programs. 6.6 To promote a spirit of community service among students, faculty and staff. 6.7 To serve as a cultural resource for internal and external communities through both curricular and non-curricular programs and activities. 6.8 To cultivate relationships with external funding sources and actively pursue financial support for programming, goods and services not supported by the college budget. Page 8 Community Bill of Rights and Responsibilities Hudson Valley Community College serves residents of the Capital Region and other areas in appropriate and diverse ways, striving always to improve their quality of life by offering affordable education, training and service. As a full-opportunity college dedicated to teaching and learning, Hudson Valley Community College makes it possible for every applicant to pursue an appropriate program of study. In the spirit of its mission, the Community Bill of Rights and Responsibilities states that: All members of the college community have the right and responsibility to work and learn in a collegial setting: Where all members of the college community are treated with courtesy and respect; That has clear ethics and conduct codes with fair and consistently enforced consequences for non-compliance; That is safe, orderly and drug free; That has clearly stated, high academic standards and the instructional materials and equipment necessary to implement rigorous academic programs; Where the college’s mission statement drives all academic and administrative operations and functions. Page 9 Anti-Discrimination And Harassment Policies And Complaint Procedure Administered by: The Office of Affirmative Action & Human Resources Development INTRODUCTION Hudson Valley Community College has established an Equal Employment Opportunity Policy and a Sexual/Discrimination Harassment Policy that is consistent with Federal and State antidiscrimination legislation. The policies which are set forth below represent the College’s ongoing commitment to providing an environment in both education and employment that is free from such unlawful discrimination and harassment on the basis of race, color, national origin, religion, age, sex, sexual orientation, disability, veteran status or marital status. In order to equitably and uniformly enforce these policies, the College must seek to balance the interests of those individuals or groups of individuals allegedly victimized by unlawful discrimination or harassment with the due process rights of the accused. To this end, the College has established a complaint procedure for the review of allegations of unlawful discrimination and harassment. It is the goal of the College that these procedures serve as a mechanism through which the College may fairly and equitably identify, respond to and/or prevent incidents of unlawful discrimination and harassment on its campus and permit, if possible, the resolution of alleged acts of unlawful discrimination or harassment without resorting to the often expensive and time-consuming procedures of State and Federal enforcement agencies or courts. The procedures set forth below are applicable to both employees and students of the College. Employee grievance procedures established through negotiated contracts, academic grievance review committees, student disciplinary grievance boards and any other procedures defined by contract shall continue to operate as before. It is important that neither the student nor the employee is required to pursue resolution of their complaints through the College’s internal procedure. Rather a Complainant may, at his or her discretion, file a complaint with a court of competent jurisdiction or with an outside enforcement agency, such as the New York State Division of Human Rights, the Equal Employment Opportunity Commission, the Office for Civil Rights of the United States Department of Education or the Office of Federal Contract Compliance of the United States Department of Labor. As of the date of this Policy, the following deadlines apply: New York State Division of Human Rights - 365 days after the latest act of alleged unlawful discrimination; Court of Competent Jurisdiction in New York State - 3 years from the accrual date of the action; Equal Employment Opportunity Commission - 365 days after the latest act of alleged unlawful discrimination and generally 90 days after receiving a “right to sue” from the Equal Employment Opportunity Commission with a Federal court; Office for Civil Right of the United States Department of Education - 180 days after the latest act of alleged unlawful discrimination; and Page 10 The Office of Federal Contract Compliance (OFCCP) of the United States Department of Labor.) - Depending on the nature of the complaint, 180 or 300 days. Note: The deadlines referenced herein are provided only as general guidance and do not constitute legal advice, legal opinion, or legal counsel and do not create any legal relationship between the College and its students or employees. It is the Complainant’s responsibility to seek legal counsel and to file his/her actions with any outside agency or court of competent jurisdiction in a timely manner should he/she decide to forego utilizing the College’s internal procedures. Once a Complaint arising from the same set of facts and circumstances is lodged with such outside agencies or a court of competent jurisdiction, the internal procedures set forth herein will not be applicable and the student/employee will have no redress through the College. The Affirmative Action Officer or the Affirmative Action/Sexual Harassment Advisory Council shall receive all complaints of alleged unlawful discrimination and/or harassment; he/she shall assist the Complainant in the use of the complaint form defining the charge(s); and he/she shall provide the Complainant with information about the various options the Complainant has in terms of where a complaint may be filed. While the Affirmative Action Officer or member of the Affirmative Action/Sexual Harassment Advisory Council will provide, to the best of his/ her knowledge, information concerning the processes relevant to outside agencies or courts, he/she is not an attorney at law and can provide no advice as to a Complainant’s procedural or substantive rights with regards to agencies or courts, including deadlines for filing. Equal Employment Opportunity Policy Compliance Statement from the President It is the policy of the Board of Trustees of Hudson Valley Community College to ensure that persons associated with the College receive the fair and equal treatment prescribed within the tenets of equal employment opportunity and affirmative action. All employment decisions are made and will continue to be made on the job-related, objective bases or merit, qualifications, competence and business necessity. Hudson Valley does not discriminate with regard to race, color, religion, age, sex, national origin, marital status, disability, qualified special disabled veterans, veterans of the Vietnam era, recently separated veterans, and other protected veterans, sexual orientation, and all other categories covered by law. The Board of Trustees has entrusted me with the overall responsibility for equal employment opportunity and affirmative action. I expect the support of all employees in attaining and maintaining our goals for a workplace free of discrimination. Equal employment opportunity is not accomplished at the expense of any group or individual, but rather it is good business practice and it contributes to an organization enriched by diversity and excellence. As President, I am committed to ensuring that HVCC acts affirmatively in developing avenues of entry, retention and mobility for persons in all job titles. The Affirmative Action Plan serves as the foundation for the College’s good faith effort to ensure that a wider net is cast for protected group members as the vehicle by which the pool of applicants for vacancies is Page 11 expanded. The Plan applies equally to all appointments of the Board of Trustees. HVCC recognizes that an effective affirmative action plan articulates specific results-oriented procedures to which good faith effort is applied. The goal of such procedures, in combination with good faith efforts, is equal employment opportunity; for procedures without effort to make them work are meaningless and effort, absent specific and meaningful procedures, is inadequate. Employees of and applicants to the College will not be subject to harassment, intimidation, threats, coercion, or discrimination because they have engaged or may engage in filing a complaint, assisting in a review, investigation, or hearing or have otherwise sought to obtain their legal rights related to any Federal, State, or local law regarding EEO for qualified individuals with disabilities or qualified protected veterans. To this end, the President has entrusted Hudson Valley’s Affirmative Action Officer with responsibility for implementation and maintenance of the Plan. The Officer may be contacted in Fitzgibbons Hall, Room 207, or by telephone at 518-629-8110. The Affirmative Action Officer is responsible for monitoring the affirmative action plan and reporting periodically to the President. The Officer should be contacted in the event an HVCC employee or prospective applicant perceives that he or she has not been treated in accord with the Equal Employment Opportunity Policy of the College. As President, I wish to add my personal note of commitment to assuring that our College carries out our Equal Employment Opportunity policy and fulfills the obligations of our Affirmative Action Plan. Dr. Andrew J. Matonak President, Hudson Valley Community College SEXUAL HARASSMENT POLICY Sexual harassment is a violation of Title VII of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972. Hudson Valley Community College is committed to providing an environment that is non-discriminatory, humane and respectful; one that supports and rewards employees and students on the basis of relevant considerations like merit, effort, competence, qualifications and business/academic necessity, and deters inappropriate conduct that occurs in the College’s activities or operations. Sexual harassment is unacceptable and in conflict with the mission and interests of the College. Sexually harassing conduct between supervisors and staff members or between faculty and students unfairly exploits the power inherent in the supervisor or faculty’s role. Through salary increases, performances appraisals, academic advisement and academic evaluation, a Page 12 supervisor or faculty member can have a decisive influence on a staff member’s career or a student’s academic development. Sexual harassment in this context exhibits a lack of decency and integrity, and is considered an abuse of power. While sexual harassment typically occurs in situations where positions of power differentials exist between individuals, this policy also recognizes that sexual harassment can occur between individuals where no such power differential exists, such as in faculty-faculty or student-student interaction. Either men or women can be sexual harassers and either men or women can be the victims of sexual harassment. Sexual harassment can also occur between members of the same sex. Employees and students of either gender may make a claim of sexual harassment under this policy. The College will not tolerate sexual harassment. The College will act promptly and equitably, within the framework of due process, to investigate alleged sexual harassment and to affect a remedy when such allegations are determined valid. Further, this Sexual Harassment Policy and the complaint procedures provided herein, shall be distributed campus-wide and internal training sessions may be made available to employees and students pertaining to sexual harassment. Recognizing Sexual Harassment Sexual harassment takes many forms, ranging from sexual innuendoes made in the context of humor to physical assault. The key to determining whether a conduct constitutes sexual harassment is determining whether the behavior is unwelcomed and/or unreasonably interferes with an employee or student’s performance or creates a hostile, intimidating or offensive environment. Examples may include: Verbal: Sexual innuendo, suggestive comments, sexual propositions, etc. Non-Verbal: obscene gestures, suggestive or degrading sounds, etc. Physical: Unwanted contact, such as groping, pinching, grabbing, etc. Visual: Pin-up calendars, sexually suggestive or explicit cartoons, pictures, objects, etc. Threatening: Demands for sexual favors, stalking, rape, etc. Who You Can Go To For Help For information, assistance in using the informal procedure or to file a Complaint of Unlawful Discrimination or Harassment, a student, faculty or staff member of the college may contact any member of the Affirmative Action/Sexual Harassment Advisory Council or Room 140 Administration Building (518) 629-4552 Page 13 Title IX Compliance Statement Title IX (Department of Education Amendment 1972) prohibits sex discrimination in any education program or activity receiving Federal financial assistance, such as a Federal grant or loan. It encourages recipients to take affirmative action to overcome effects of conditions, which may have resulted in exclusion of women from participation in specific education programs or activities. Title IX applies to student admissions and student affairs policy and the employment of staff in connection with the recipient’s education programs/activities. It mandates the designation of a responsible employee to coordinate compliance with its provision, as well as the establishment of a complaint procedure to resolve student and employee complaints alleging unlawful discrimination. It is the policy of the Board of Trustees of Hudson Valley Community College to ensure that persons associated with the College receives the fair and equal treatment prescribed within the tenets of equal opportunity. All decisions are made and will continue to be made on the job-related, objective bases of merit, competence, qualifications and business or academic necessity. Hudson Valley Community College does not discriminate with regard to race, color, national origin, religion, age, sex, sexual orientation, disability, veteran status, or marital status or any other category protected by civil statute or regulation. The College prohibits discrimination in all programs, policies, standards and activities, maintains an established complaint procedure and assigns compliance responsibility to the Affirmative Action Officer. EQUAL EMPLOYMENT/SEXUAL HARASSMENT COMPLAINT PROCEDURES COVERAGE: Employees, students, and prospective applicants of the College may use these procedures if they believe that they have been the victims of any unlawful discrimination or harassment at the College. PURPOSE: The complaint procedure is provided for the review of complaints alleging unlawful discrimination or harassment in any Hudson Valley Community College policy or program when the alleged Unlawful discrimination or Harassment is perceived to be based on the complainant’s race, color, national origin, religion, age, sex, sexual orientation, disability, veteran status, or marital status or any category protected by civil statute or regulation. DEFINITIONS: Affirmative Action/Sexual Harassment Advisory Council – Representatives of all levels of the College who advise the President and the Affirmative Action Officer on matters relating to Equal Employment Opportunity, Affirmative Action, and Diversity. They are appointed by the President. They serve as the pool of persons from which the Tri-partite Council will be selected Page 14 in the formal stage of the complaint process. Complainant - An employee, applicant for employment, or student of the College who believes that he or she has been the victim of unlawful discrimination or harassment, and submits a complaint. Equal Employment Opportunity - The standard by which decisions that pertain to a person’s employment or academic affairs with the College are made. Discriminatory Harassment - Discriminatory harassment is based on race, color, national origin, religion, age, sex, sexual orientation, disability, veteran status, or marital status or other protected characteristics, which is oral, written, graphic or physical conduct. The actions must be sufficiently severe, pervasive, or persistent so as to interfere with or limit the ability of an individual to participate in or benefit from the College’s programs or activities. Such activities include actions that derogate or humiliate a person or group because of actual or supposed traits. Examples include, but are not limited to, ethnic or racial slurs or jokes, which have the purpose or effect of creating an offensive environment. Sexual Harassment - Under Title VII of the Civil Rights Act (1964), sexual harassment is cited as unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature when (1) Submission to such conduct is made explicitly an employment term or condition [or a condition on which one’s academic standing is predicated]; or (2) Submission to or rejection of such conduct is used as a basis for employment [or academic] decisions; or (3) Such conduct has the purpose or the effect of unreasonably interfering with one’s [academic] or work performance, or creating an offensive, intimidating or hostile [academic] or work environment. Respondent - An individual or entity that answers in a complaint alleging unlawful discrimination or harassment or the person(s) accused of alleged unlawful discrimination or harassment. Unlawful Discrimination - consists of: harassment on the basis of race, color, national origin, religion, age, sex, sexual orientation, disability, veteran or marital status; employment decisions based on stereotypes or assumptions about the abilities, traits, or performance of individuals of a certain race, color, national origin, religion, age, sex, sexual orientation, disability, veteran or marital status; or retaliation against an individual for filing a charge of discrimination, participating in an investigation, or opposing discriminatory practices. APPLICABILITY - This complaint procedure does not supplant nor duplicate any existing complaint procedure. It does not deprive the complainant the right to file with outside Page 15 government agencies, such as the New York State Division of Human Rights (DHR); U.S. Equal Employment Opportunity Commission (EEOC); U.S. Office of Civil Rights of the Department of Health, Education and Welfare (OCR); the Office of Federal Contract Compliance (OFCCP) of the United States Department of Labor (DOL); or with a court of competent jurisdiction. The procedure may not be used if a complaint based on the same facts and circumstances is filed with a State or Federal agency or with a court of competent jurisdiction, or if a complaint has been filed under any collective bargaining agreement. Any investigation underway will terminate, without conclusion, at the time a complaint is filed with a state or federal agency or a collective bargaining representative, or a court action is initiated on the same complaint. It is the responsibility of the complainant to be aware of any filing deadlines for any outside agency or court even in the event he/she initially chooses to attempt to resolve the complaint through the College’s internal procedures. It is also the responsibility of the complainant to inform the Affirmative Action Officer of any previous, pending or initiated actions filed with a state or federal agency or court. While the Affirmative Action Officer of the College will make reasonable attempts to notify the complainant of general time limitations, neither the Affirmative Action Officer, the Affirmative Action/Sexual Harassment Advisory Council, nor the College shall be held responsible for any failure on the part of the complainant to meet any filing deadline. RIGHT TO COUNSEL Both the complainant and the respondent shall have the right to be assisted by an attorney at all stages of both the informal and formal stages of the College’s internal complaint process. CONFIDENTIALITY Unlawful discrimination or Harassment complaints will be handled as confidentially as possible while enabling the College to fully investigate the complaint. Information about the complaint will only be divulged to individuals who have a legitimate need to know. All records pertaining to complaints shall be kept and maintained by the Affirmative Action Officer. SANCTIONS Persons who are found to have engaged in unlawful discrimination and/or harassment may be subject to sanctions that are reasonably calculated to end the unlawful discrimination and prevent its reoccurrence. Sanctions that may be imposed include, but are not limited to, written warnings; letter of reprimands; suspensions; change of job or class assignments; termination; or expulsion. RETALIATION Reprisal actions and encouraging others to retaliate against anyone involved in the investigation of an Unlawful discrimination or harassment complaint is prohibited. This includes anyone who reports, is thought to have reported or cooperates in the investigation process. The College considers retaliation to be a violation of College policy and may be subject Page 16 to sanctions as provided herein. FALSE CHARGES OF DISCRIMINATION Filing a false charge of unlawful discrimination or harassment is a serious offense. If an investigation reveals that a complainant knowingly filed false charges, appropriate actions and sanctions as provided herein may be taken. WHERE TO FILE A COMPLAINT OF DISCRIMINATION For information, assistance in using the informal procedure and/or to file a formal complaint any student, employee or applicant for employment, may contact the Affirmative Action Officer. Affirmative Action Officer Human Resources Room 140 Administration Building (518) 629-4552 ADDITIONAL RESOURCES For personal counseling: Center for Counseling and Transfer, Campus Center, Room 260, (518) 629-7320 For medical services: College Health Services, Fitzgibbons Hall, Room 146, (518) 629-7468 For escort service: Public Safety/Security, Campus Center, Room 170, (518) 629-7210 PROCEDURE FOR FILING A COMPLAINT OF DISCRIMINATION PART A: Informal Resolution 1. The Affirmative Action Officer shall receive initial inquiries, reports and requests for consultation and counseling. Assistance will be available whether or not a written complaint is contemplated. It is the responsibility of the Affirmative Action Officer to respond to all such inquiries, reports and requests as promptly as possible and consider all such facts in an objective manner and in a manner appropriate to the particular circumstances. Note: It is the responsibility of the complainant to be certain that any complaint filed is filed within the 60 calendar day period that is applicable under this paragraph. 2. Complaints or concerns that are reported to an administrator, manager or supervisor concerning an act of discrimination or harassment shall be immediately referred to the Affirmative Action Officer for investigation and resolution. Complaints may also be made directly to a member of the Affirmative Action/Sexual Harassment Advisory Council who will refer the case to the Affirmative Action Officer for investigation and Page 17 resolution. 3. A written complaint must be filed with the Affirmative Action Officer within 60 calendar days following the last act or occurrence of an alleged unlawful discriminatory act or act of harassment. All such complaints must be submitted on the forms provided by the College (see Appendix A). This form will be used for both the initiation of complaints under the informal procedure and the conversion of the complaint to the formal procedure. 4. If the Affirmative Action Officer is the respondent in a complaint of discrimination, the President of the College shall designate a person to investigate and attempt to resolve the complaint. That person shall carry out the duties and responsibilities of the Affirmative Action Officer in that specific complaint. 5. The complaint shall contain: (a) The name, local and permanent address(es), and telephone number(s) of the Complainant. (b) A statement of facts explaining what happened and what the complainant believes constituted the unlawful discriminatory act(s) in sufficient detail to give each respondent reasonable notice of what is claimed against him/her. The statement should include the date(s), approximate time(s) and place(s) where the alleged act(s) of unlawful discrimination or harassment occurred. If the act(s) occurred on more than one date, the statement should also include the last date on which the acts occurred as well as detailed information about any prior acts. The names of any potential witnesses should be provided, if appropriate. (c) The name(s), address(es) and telephone number(s) of the respondent(s), i.e., the person(s) claimed to have committed the act(s) of unlawful discrimination. (d) Identification of the status of the person(s) charged, whether faculty, staff, or student. (e) A statement indicating whether or not the complainant has filed or reported information concerning the incidents referred to in the complaint with a non-college official, court, or agency, under any other complaint or complaint procedure. If an external complaint has been filed, the statement should indicate the name of the court, person, department, or agency with which the information was filed and its address or to which it was reported. (f) Such other or supplemental information as may be requested. 6. If the complainant brings a complaint beyond the period in which the complaint may be addressed under these procedures, the Affirmative Action Officer may terminate any further processing of the complaint or advise the complainant of the alternative forums (see Appendix B for a list of alternative forums). 7. If a complainant elects to have the matter dealt with in an informal manner, the Page 18 Affirmative Action Officer will attempt to reasonably resolve the problem to the mutual satisfaction of the parties. 8. In seeking an informal resolution, the Affirmative Action Officer shall attempt to review all relevant information, interview pertinent witnesses, and bring together the complainant and the respondent, if desirable. If a resolution satisfactory to both the complainant and the respondent is reached within 14 calendar days from the filing of the complaint, through the efforts of the Affirmative Action Officer, the Affirmative Action Officer shall close the case, sending a written notice to that effect to the complainant and respondent. The written notice, a copy of which shall be attached to the original complaint form in the Affirmative Action Officer’s file, shall contain the terms of any agreement reached by complainant and respondent, and shall be signed and dated by the complainant, the respondent and the Affirmative Action Officer. 9. If the Affirmative Action Officer is unable to resolve the complaint to the mutual satisfaction of the complainant and respondent within 14 calendar days from the filing of the complaint, the Affirmative Action Officer will so notify the complainant. The Affirmative Action Officer shall again advise the complainant of his or her right to proceed to the next step internally and/or the right to separately file with appropriate external enforcement agencies. . NOTE: The time limitations set forth above in paragraphs 7 and 8, may be extended by mutual agreement of the complainant and respondent with the approval of the Affirmative Action Officer the complainant and respondent. 10. At any time, subsequent to the filing of the complaint form in Appendix A under the informal procedures provided in Part A above, the complainant may elect to proceed under the Formal Complaint Procedure as specified in Part B of this document and forego the informal resolution procedure. 11. Resolution of informal complaints can include an apology by the harasser, monitoring treatment of the complainant to ensure that s/he is not subjected to retaliation by the alleged harasser or others because of filing a complaint, training or counseling of the alleged harasser or monitoring of the alleged harasser, or other resolutions which the parties may agree. PART B: The Formal Complaint Procedure The Formal Complaint Procedure is structured in a way to promote the timely and fair resolution of a complaint filed hereunder. While the College will make every effort to strictly comply with the timeframes set forth herein, its failure to do so shall not constitute a waiver or otherwise nullify the procedures set forth herein. Moreover, in the event that it is necessary to undertake immediate measures before completing an investigation to ensure that further Harassment or Unlawful discrimination does not occur, a recommendation may be made to the President of the College or his/her designee to make scheduling changes so as to avoid contact between the parties, transferring the respondent or placing the respondent on nondisciplinary leave with pay pending the conclusion of the investigation. Page 19 1. The formal complaint proceeding is commenced by the filing of a complaint form as described in Part A(4). The 60 calendar day time limit also applies to the filing of a formal complaint. 2. If the complainant first pursued the informal process and subsequently wishes to pursue a formal complaint, he/she may do so by checking the appropriate box, and signing and dating the complaint form. 3. If an informal resolution was not pursued, the Affirmative Action Officer shall notify the complainant 14 calendar days from the filing of the complaint. 4. Upon receipt of a complaint, the Affirmative Action Officer will provide an initialed, signed, date-stamped copy of the complaint to the Complainant. As soon as reasonably possible after the date of filing of the complaint, the Affirmative Action Officer will mail a notice of complaint and a copy of the complaint to the respondent(s). Alternatively, such notice with a copy of the complaint may be given by personal delivery, provided such delivery is made by the Affirmative Action Officer (or designee) and, that proper proof of such delivery, including the date, time and place where such delivery occurred is entered in the records maintained by or for the Affirmative Action Officer. 5. Within 7 calendar days of receipt of the complaint, the Affirmative Action Officer shall send notification to the complainant, the respondent and the College President that a review of the matter shall take place in the form of a hearing by a Tripartite Panel to be jointly selected by the complainant and the respondent from a pre-selected pool of eligible participants (see Appendix C). 6. The Tripartite Panel shall consist of one member of the pre-selected pool chosen by the complainant, one member chosen by the respondent and a third chosen by the two designees. The panel members shall choose a Chairperson amongst themselves. Selection must be completed and written notification of designees submitted to the Affirmative action Officer no later than 7 calendar days after the complainant, the respondent and the President received notice under Paragraph 6 above. If the President is the respondent, then the third member of the panel shall be selected by the College Board of Trustees. 7. In the event that the procedural requirements governing the selection of the Tripartite Panel are not completed within 7 calendar days after notification, the Affirmative Action Officer shall complete the selection process. 8. The Tripartite Panel shall review all relevant information, interview pertinent witnesses and, at their discretion, hear testimony from and bring together the complainant and the respondent, if desirable. Both the complainant and the respondent(s) shall be entitled to submit written statements or other relevant and material evidence and to provide rebuttal to the written record compiled by the Tripartite Panel. 9. Within 24 calendar days from the completion of the Tripartite Panel’s review, including a hearing, the Chairperson of the Tripartite Panel shall submit a summary of its findings and the Tripartite Panel’s recommendation(s) for further action or sanctions, if any, on a form to be provided by the Affirmative Action Officer, to the President. If the Page 20 President is the respondent, the findings and recommendation shall be submitted concurrently to the Sponsor of the College, namely Rensselaer County, and to the Chancellor. 10. Within 7 calendar days of receipt of the written summary, the President or his/her designee shall issue a written statement to the complainant and respondent, indicating what action the President proposes to take, if any. The action proposed by the President or designee may consist of: (a) A determination that the complaint was not substantiated. (b) A determination that the complaint was substantiated and will either uphold, reverse or modify the recommendation. If the President is the respondent, the College Sponsor, namely Rensselaer County, and the Chancellor shall concurrently issue a written statement to the complainant and respondent indicating what action the College Sponsor, namely Rensselaer County, and the Chancellor proposes to take. The College Sponsor, namely Rensselaer County, and the Chancellor’s decision shall be final for purposes of this discrimination procedure. 11. If the complainant is dissatisfied with the President’s or the College Sponsor, namely Rensselaer County, and the Chancellor’s decision, the complainant may elect to seek reconsideration of the decision to the Chairperson of the College Board of Trustees, for reconsideration within 7 calendar days of the decision. The decision shall be reversed, amended, or upheld. The decision shall be final. If the complainant is unsatisfied with the result, nothing precludes the complainant from filing a complaint with state and/or federal agencies or a court of competent jurisdiction. (see Appendix B) The Affirmative Action Officer will provide to the best of his/her knowledge, general information concerning the processes relevant to outside agencies or courts but since he/she is not an attorney at law, he/she can provide no advice as to procedural or substantive rights concerning these agencies, or courts, including deadlines for filing. FILING A COMPLAINT WITH AN EXTERNAL (N.Y. STATE OR FEDERAL) AGENCY OR COURT OF COMPETENT JURISDICTION Students or employees of the college may file a complaint of unlawful discrimination with the appropriate state or federal agencies listed in Appendix B. Filing a complaint with a state or federal agency, or a court of competent jurisdiction on the same facts or circumstances as provided in a complaint filed pursuant to the College’s AntiDiscrimination and Harassment Complaint Procedure will terminate the latter procedures for processing a complaint of unlawful discrimination. The Affirmative Action Officer will send a letter to the complainant of the termination, immediately after confirming that the complaint has been filed with a state or federal agency, or with a court of competent jurisdiction. Page 21 Computer Use Policy The goals of Hudson Valley Community College are to provide computer users with state-ofthe-art computing facilities and to keep the number of restrictions on individuals to a minimum, while maintaining excellent service for all users, students in pursuit of their academic goals and employees to conduct assigned work activity. To assist the College in achieving these objectives, users themselves must observe reasonable standards of behavior in the use of these facilities and maintain an atmosphere of civility, mutual respect and high ethical standards. Proper use includes compliance with the following guidelines: • • No attempt will be made to modify or destroy system software components such as operating systems, compilers, utilities, applications or other software residing on any College computer, except the user's own files. No attempt will be made to electronically transmit or post any material which is considered harmful, abusive, threatening, defamatory, derogatory, harassing, vulgar, obscene, sexually explicit, hateful, or racially, ethnically or otherwise objectionable. • No attempt will be made to access, read, modify or destroy files belonging to another user without complete authorization from that user to do so. • No attempt will be made to connect to or use College computers with a user ID which was not assigned to you by the College. Use of another person's user ID or password is prohibited. • No attempt will be made to gain access to a password belonging to another person or place a password other than your own in a file on a College computer. In addition, no attempt will be made to install, run or place software designed for this purpose on any College computer. • No attempt will be made to bypass or otherwise defeat system security to gain access to programs, files or other computer data or to install, run or place software designed for this purpose on any College computer. • No attempt will be made to copy, store, post or distribute computer software, files or any other material in violation of trademark, copyright or confidentiality laws or when you do not have a legal right to do so. • No attempt will be made to interfere with proper operation of a computer or interfere with another person's use of a computer, including for example, the electronic transmission or posting of files or programs containing viruses or any other content intended to interfere with proper operation of a computer. Page 22 • No attempt will be made to impersonate any person, including other Hudson Valley Community College students and employees. No attempt will be made to disguise the origin of any electronically transmitted or posted material. No attempt will be made to make unauthorized use of someone else's electronic signature. • No unauthorized attempts to use, modify, connect or disconnect computer equipment, peripherals, communication equipment and cables. • No unauthorized attempt will be made to use any College computer to electronically transmit chain letters, junk mail, pyramid schemes or any other unsolicited mass mailings to multiple recipients with the exception of employees conducting College business and students completing required College course assignments. • No unauthorized attempt will be made to connect to and/or gain access to information being transported by computer networks, or to install, run or place software designed for this purpose on any College computer. Installation or use of any network communication software not approved by the College is prohibited. • No user will make their password known to anyone other than an employee of the College authorized to assist employees or students with computer related problems. • No food or drink is permitted in any computer classroom or computer learning center with the exception of the Computer Café in the Campus Center. • Users of College computers will comply with all local, state, federal and international laws relating to the use of computers and any other electronic communication services provided by the College. • Use of College computers for commercial, business purposes or personal profit is prohibited without specific authorization from the College for such use. Commercial or business purposes include advertising the sale of goods and services not directly related to Hudson Valley Community College or campus based organizations. • Use of College computers to falsify or modify documents in a manner which is unauthorized, is a violation of the rights of owners, is a violation of copyright laws or is not properly attributed is prohibited. • Use of College computers and network services for local or remote game playing is prohibited unless specifically required as part of a course in which a student is currently registered or a faculty member is currently teaching. In addition, the installation, uploading, downloading or storage of any game software on College computers is prohibited. • Use of College computers and network services for IRC (Internet Relay Chat) or any other form of interactive chat communication is prohibited unless specifically required Page 23 for communication as part of a course in which a student is currently registered or a faculty member is currently teaching. • Web site services for the entire campus community are provided on a centralized server by the Office of Computer Services. Use of any other College computer for the purpose of serving a web site is prohibited. The Computer Services department regularly monitors all computer systems usage. All occurrences of computer usage abuse, which interfere with other users or with proper functioning of the computer system will be investigated "in depth." When placing files on the College's computer systems, users should be aware that Computer Services has access to their files and may review the contents of their account at any time when investigating problems or suspected computer usage abuse. Findings of each investigation are forwarded to the Vice President for Student Services. In addition, Hudson Valley Community College reserves the right to remove or otherwise restrict access to material stored on any College computer system in violation of the College's computer policy as stated above. All instances of unethical or irresponsible use of computing facilities are grounds for disciplinary action by the College's Regulations Review Board (see section in the College Catalog on Campus Regulations for Students, Visitors and College Personnel and Organizations). Instances of abuse may result in civil and/or criminal proceedings. The College expects that all users of computing facilities will observe reasonable standards of behavior. Page 24 Identity Theft Prevention Program for Hudson Valley Community College Program Adoption Hudson Valley Community College developed this Identity Theft Prevention Program (“Program”) in order to comply with the Federal Trade Commission’s Red Flags Rule (16 CFR 681.2). The Board of Trustees determined that this Program was appropriate for Hudson Valley Community College, and therefore approved this Program on April 23, 2009. Purpose The purpose of the Identity Theft Prevention Program is to prevent frauds committed by the misuse of identifying information. The Program is designed to detect, prevent and mitigate identity theft in connection with covered accounts, and to provide for continued administration of the Program. The Program shall include reasonable policies and procedures to: 1. Identify relevant red flags for covered accounts and incorporate those red flags into the Program; 2. Detect red flags; 3. Respond appropriately to any red flags that are detected; and 4. Review and update the Program periodically to consider and incorporate changes in risks. Definitions Account: A relationship established with an institution by a student, employee, or other person to obtain educational, medical, or financial services. Covered Account: An account that permits multiple transactions or poses a reasonably foreseeable risk of being used to promote an identity theft. Identity Theft: A fraud committed or attempted using the identifying information of another person without authority. Red Flag: A pattern, practice, or specific activity that indicates the possible existence of identity theft. Responsible Staff: Personnel who regularly work with Covered Accounts and are responsible for performing the day-to-day application of the Program to a specific Covered Account by detecting and responding to Red Flags. Program Administrator: The individual designated with primary responsibility for oversight of the Program. Page 25 Covered Accounts; Responsible Staff; Red Flags; Responses: Covered Account: Student Refund Checks Responsible Staff: Cashier Background: Students are required to present either a Hudson Valley Community College Identification Card, or a driver’s license or other government issued photo identification when picking up a check. All checks are either mailed to students, or picked up by student in the Cashier’s Office. Red Flag 1: Insufficient or suspicious identification is presented by a student who is trying to pick up a check. Response: Withhold check unless or until the student’s identity has been established through acceptable means. Covered Account: Hudson Valley Community College Identification Card Responsible Staff: ID Card Equipment Operators Background: Students are required to present a driver’s license or other government issued photo identification in order to obtain a Hudson Valley Community College identification card. Red Flag 1: Insufficient or suspicious identification is presented by a student who is trying to obtain an identification card. Response: Do not issue Hudson Valley Community College identification card unless or until the student provides acceptable documentation of identity. Covered Account: Student Accounts Responsible Staff: Cashier Background: Students must present a Hudson Valley Community College identification card or other government issued photo identification to obtain information about their student account. Red Flag 1: Insufficient or suspicious identification is presented by a student who is trying to obtain information regarding a student account. Page 26 Response: Do not provide information regarding student account unless or until the student provides acceptable documentation of identity. Covered Account: Student WIReD (Banner Self-Service via Web) Responsible Staff: Computer Services Background: Students are assigned a username and password to access their student records via web using Banner Self-Service. Red Flag 1: The student notifies Computer Services that he or she believes that someone else has gained access to his or her student records via Banner Self-Service. Response: Notify student that he or she should change his/her password. If student does not want to change his/her own password, have student contact the Computer Learning Center. If student provides proper identification, inperson, Computer Learning Center will reset password and provide the student with a new password. If student provides sufficient identification over the telephone, Computer Learning Center will cause a new password to be mailed to the student’s current address on file. Red Flag 2: A college office notifies Computer Services that it appears that someone else has gained access to records of a student via Banner Self-Service. Response: Computer Services will investigate. If Computer Services agrees that this is a reasonable assumption, Computer Services will disable the student’s computer access to prevent further unauthorized access. The student will need to be provided with a new password before computer access may be restored. Covered Account: Student E-mail Responsible Staff: Computer Services Red Flag 1: The student notifies Computer Services that he or she believes that someone else has gained access to his/her college e-mail account. Page 27 Response: Notify student that he or she should change his/her password. If student does not want to change his/her own password, have student contact the Computer Learning Center. If student provides proper identification, inperson, Computer Learning Center will reset password and provide the student with a new password. If student provides sufficient identification over the telephone, Computer Learning Center will cause a new password to be mailed to the student’s current address on file. Red Flag 2: A college office notifies Computer Services that it appears that someone else has gained access to a student’s e-mail account. Response: Computer Services will investigate. If Computer Services agrees that this is a reasonable assumption, Computer Services will disable the student’s computer access to prevent further unauthorized access. The student will need to be provided with a new password before computer access may be restored. Covered Account: Employee WIReD (Banner Self-Service via Web) Responsible Staff: Computer Services Background: Employees are assigned a username and password to access their own records and records of their students via web using Banner Self-Service. Red Flag 1: The employee notifies Computer Services that he or she believes that someone else has gained access to his/her records via Banner Self-Service by using his/her username/password. Response: Notify employee that he or she should change his/her password. If employee does not want to change his/her own password, Computer Services will reset it. If employee provides proper identification, inperson, Computer Services will reset password and provide the employee with a new password. If employee provides sufficient identification over the telephone, Computer Services will mail a new password to the employee’s current address on file. Red Flag 2: A college office notifies Computer Services that it appears that someone else has gained access to records via Banner Self-Service using a username/password assigned to an employee. Page 28 Response: Computer Services will investigate. If Computer Services agrees that this is a reasonable assumption, Computer Services will disable the employee’s computer access to prevent further unauthorized access. The employee will need to be provided with a new password before computer access may be restored. Covered Account: Employee E-mail Responsible Staff: Computer Services Red Flag 1: The employee notifies Computer Services that he or she believes that someone else has gained access to his/her college e-mail account. Response: Notify employee that he or she should change their password. If employee does not want to change his/her own password, Computer Services will reset it. If employee provides proper identification, inperson, Computer Services will reset password and provide the employee with a new password. If employee provides sufficient identification over the telephone, Computer Services will mail a new password to the employee’s current address on file. Red Flag 2: A college office notifies Computer Services that it appears that someone else has gained access to an employee’s e-mail account. Response: Computer Services will investigate. If Computer Services agrees that this is a reasonable assumption, Computer Services will disable the employee’s computer access to prevent further unauthorized access. The employee will need to be provided with a new password before computer access may be restored. Covered Account: Student Record Responsible Staff: Staff in the following offices: Admissions, Community Education, Continuing Education and Summer Sessions, Human Resources, Registrar Red Flag 1: A change of address request occurs under suspicious circumstances. Page 29 Response: Ask student to come in and personally verify address and any suspicious usage activity. Red Flag 2: A change of name request occurs without appropriate identification and/or documentation. Response: Deny name change request until student’s identity has been established through acceptable means and/or appropriate documentation is provided. Covered Account: Financial Aid Accounts Responsible Staff: Financial Aid Staff Background: Students are required to present either a Hudson Valley Community College Identification Card or a driver’s license or other government issued photo identification when submitting financial aid paperwork and/or discussing student financial aid account information. Red Flag 1: Insufficient or suspicious identification is presented by a student who is trying to obtain financial aid information. Response: Withhold information until the student’s identity has been established through acceptable means. Red Flag 2: Department of Education selects student’s FAFSA for verification. Response: Students are required to submit all requested supplemental information and resolve any conflict between the FAFSA and supplemental information provided. Red Flag 3: Student submits multiple FAFSAs containing conflicting information. Response: Contact student to resolve conflicting information and verify information. Program Administration and Oversight The Executive to the President for Institutional Effectiveness and Strategic Planning will be the Program Administrator and will be responsible for overseeing the administration of this Program. The Program Administrator may designate additional staff of the College to Page 30 undertake responsibility for training personnel, monitoring service providers, and updating the Program, all under the supervision of the Program Adminstrator. Staff Training The Program Administrator or his or her designees shall train responsible staff, as neceessary, in the detection of Red Flags, and the responsive steps to be taken when a Red Flag is detected. Responsible staff are expected to notify the Program Administrator of any incidents of identity theft. Updating The Program The Program will be reviewed annually, or if and when a problem arises, to ensure the effectiveness of the procedures in place, and to update the Program based on new events, institutional changes or changes in risks. Oversight of Service Provider Arrangements The Program Administrator will ensure that the activity of a service provider is conducted in accordance with reasonable policies and procedures designed to detect, prevent, and mitigate the risk of identity theft whenever the organization engages a service provider to perform an activity with one or more covered accounts. Page 31 Judicial System 1.1 2.1 2.2 3.1 3.2 3.3 3.4 ARTICLE I. PREAMBLE Hudson Valley Community College (“College”) is primarily concerned with academic achievement, the personal integrity of its students and the wellness and safety of the members of its community. In addition, the College is committed to preserving peace, supporting a moral and just climate, maintaining a community where people are treated with courtesy and respect, meeting its contractual obligations, and protecting its property and that of its community members. The College, therefore, has established this Code of Conduct to communicate its expectations of students, visitors, college personnel and organizations. ARTICLE II. PURPOSE AND INTENT The purpose of the College’s having codes and adjudication procedures is to enforce standards of conduct and curtail inappropriate behavior as well as to assist the individual in resolving problems in an institutionally acceptable manner. The adjudication procedure provides a framework for the review of the substance of any alleged violation of the Code of Conduct. The individual is not absolved of the responsibility for his or her own behavior. Each individual is responsible for accepting the fact that rights come with concomitant responsibilities and that violations of the codes may result in discipline. The student is charged with the responsibility of becoming familiar with the codes and regulations and the procedures for enforcing them and acting accordingly. ARTICLE III. DEFINITIONS “Campus Coordinator” means the Coordinator of the College Judicial System. This is the person appointed by the College who is charged with the responsibility of ensuring that the procedures provided herein are adhered to in the processing and adjudication of complaints under the Code of Conduct. Campus Coordinator may also mean a designee of that office. “Code of Conduct” means the list of prohibited conduct established by the College, as more fully set forth in Article V herein, which includes behavior that violates the College’s Academic Ethics, Computer Ethics and Campus Regulations, and also includes the procedures for enforcing the Code of Conduct. “College” means Hudson Valley Community College, with its main campus located at 80 Vandenburgh Avenue in Troy, New York. “College premises” means all buildings or grounds owned, leased, operated, controlled Page 32 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 4.1 4.2 or supervised by the College including any buildings or grounds that are located off campus. “College-sponsored activity” means any activity on or off campus which is initiated, aided, authorized or supervised by the College. “College Official” means any full-time or part-time administrator or security guard or security officer. “College Personnel” means all employees of the College who work either on the campus or on other property used for educational purposes by the College. “Faculty Member” means any full-time or part-time faculty member. “Organization” means any group of individuals recognized or otherwise licensed by the College, which includes student groups, faculty groups or any group existing outside of the College community which seeks to utilize the College Premises for its own organizational purposes. “President” shall mean the President of the College. “Vice President” or “Vice President for Enrollment Services and Student Development” means the Vice President for Enrollment Management and Student Development or his/her designee. “Student” means a person, including College Personnel, either enrolled in or auditing credit or non-credit courses at the College, on either a full-time or part-time basis. Reference to any “Time Limits”, days shall be defined as any day the College is open for business and shall EXCLUDE Saturdays and Sundays, any holiday the College has published as "College closed," and emergency closings. Time limits may be waived for just cause under conditions that are set forth under the procedure affected. “Visitor” means any individual who is not a Student nor otherwise affiliated with the College but who is on the College Premises for a legitimate purpose. ARTICLE IV. JURISDICTION Generally, College jurisdiction and discipline will be applied to conduct which occurs on College Premises, during off-campus activities related to the College, or which violates federal, state or local laws on or off the College Premises. Jurisdiction and discipline may also be applied at the discretion of the College to conduct which occurs off-campus and which adversely affects the College, the College community or the interests and mission of the College. Students are responsible for the conduct of their guests, and may be subject to discipline for the conduct of their guests. College disciplinary proceedings may be instituted against a Student or an Organization charged with conduct that potentially violates both the criminal law and the College’s Code of Conduct (that is, if both possible violations result from the same factual situation) without regard to the pendency of civil or criminal litigation in court or criminal arrest and prosecution. Proceedings under this Code of Conduct may be carried Page 33 out prior to, simultaneously with, or following civil or criminal proceedings off campus. Determinations made or sanctions imposed under this Code of Conduct shall not be subject to change because criminal charges arising out of the same facts giving rise to violation of the College’s Code were dismissed, reduced, or resolved in favor of or against the criminal law defendant. The College has the obligation to cooperate with all police authorities. When the protection of life and property and the regular, orderly operation of the College require it, the assistance of these agencies will be requested as a matter of policy. ARTICLE V. CODE OF CONDUCT 5.1 ACADEMIC ETHICS Hudson Valley Community College expects all members of the College community to conduct themselves in a manner befitting the tradition of scholarship, honor and integrity. They are expected to assist the College by reporting suspected violations of academic integrity to appropriate faculty and/or other College Personnel. These guidelines define a context of values for individual and institutional decisions concerning academic integrity. It is every Student's responsibility to become familiar with the standards of academic ethics at the College. Claims of ignorance, unintentional error, or academic or personal pressures do not excuse violations. The following is a list of the types of behavior which breach the College Academic Ethics guidelines and are therefore unacceptable. Commission of such acts, or attempts to commit them fall under the term academic dishonesty and are subject to penalty. No set of guidelines can, of course, define all possible types or degrees of academic dishonesty; thus, the following descriptions should be understood as examples of infractions rather than an exhaustive list. Individual Faculty Members and the College Committee on Ethics and Conduct will continue to judge each case according to its particular circumstance. PROHIBITED CONDUCT 5.1.1 PLAGIARISM. Plagiarism is a form of academic dishonesty that is considered a serious offense and carries severe penalties ranging from failing an assignment to suspension from school. A Student is guilty of plagiarism any time s/he attempts to obtain academic credit by presenting someone else's ideas as her/his own without appropriately documenting the original source. Appropriate documentation requires credit to the original source in a current manuscript style that is appropriate to the assignment and the discipline. Examples of someone else's ideas may include the following: -Language, words, phrases, symbols -Style (written, oral or graphic presentation) Page 34 5.1.2 5.1.3 5.1.4 5.1.5 5.1.6 5.1.7 5.1.8 -Data, statistics -Evidence, research -Computer programs, creative projects, artwork -Intellectual ideas such as theories and lectures -Web sites, digital forms of communication such as e-mail, chat room, and instant messaging -Photographs, video, audio CHEATING ON EXAMINATIONS. Giving or receiving unauthorized help before, during, or after an examination. Examples of unauthorized help include collaboration of any sort during an examination (unless specifically approved by the instructor); collaboration before an examination (when such collaboration is specifically forbidden by the instructor); the use of notes, books, or other aids during an examination (unless permitted by the instructor); arranging for another person to take an examination in one's place; looking on someone else's examination during the examination period; the unauthorized discussion of test items during the examination period; and the passing of any examination information to Students who have not yet taken the examination. There can be no conversation while an examination is in progress unless specifically authorized by the instructor. MULTIPLE SUBMISSION. Submitting substantial portions of the same work for credit more than once, without the prior explicit consent of the instructor to whom the material is being (or has in the past been) submitted. FORGERY. Imitating another person's signature or mark on academic or other official documents (e.g., the signing of a Faculty Member's name to a College document). SABOTAGE. Destroying, damaging, or stealing of another's work or working materials (including lab experiments, computer programs, term papers, or projects). UNAUTHORIZED COLLABORATION. Collaborating on projects, papers, or other academic exercises which is regarded as inappropriate by the instructor(s). Although the usual Faculty assumption is that work submitted for credit is entirely one's own, standards on appropriate and inappropriate collaboration vary widely among individual Faculty. Faculty Members are, therefore, expected to establish explicit expectations and standards. Students who want to confer or collaborate with one another on work receiving academic credit should make certain of the instructor's expectations and standards. FALSIFICATION. Misrepresenting materials or fabricating information in an academic exercise or assignment (for example, the false or misleading citation of sources, the falsification of experimental or computer data, etc.). THEFT, DAMAGE, OR MISUSE OF LIBRARY OR COMPUTER RESOURCES. Removing uncharged materials from the Library Building, defacing or Page 35 5.2 damaging materials, intentionally displacing or hoarding materials within the Library Building for one's unauthorized private use, or other abuse of reservebook privileges. Or, without authorization, using the College's or another person's computer accounts, codes, passwords, or facilities; damaging computer equipment; or interfering with the operation of the computer system of the College. The College and the computer center has established specific rules governing the use of computing facilities. The rules appear under Computer Ethics. It is every Student's responsibility to become familiar with them. CAMPUS REGULATIONS FOR STUDENTS, VISITORS, COLLEGE PERSONNEL AND ORGANIZATIONS The College is charged by its sponsoring agency and by the State University to attain its stated objectives. To properly discharge these responsibilities and to ensure a desirable relationship with the community as well as the protection of all Students, Visitors, guests, College Personnel, and Organizations, certain regulations have been established. Students enrolling in the College’s education programs and Visitors, guests, College Personnel and Organizations that are associated with or use the College facilities do so subject to the Code of Conduct. In cases where there is an alleged violation of the Code of Conduct, it is the policy of the College to afford each Student and Organization associated with the College the right to adjudicate the allegation in accordance with the adjudication procedures as set forth in this Code. However, in cases where the Vice President for Enrollment Management and Student Development or his/her designee deems the conduct, condition, or infraction to be of such nature that the alleged violator poses a present or future threat to the health, safety and welfare of himself or herself or the College or its community, he/she may take immediate action to suspend the Student or disband any Organization associated with the College prior to the initiation of the formal adjudication procedures. Visitors, guests and organizations not affiliated with the College, while subject to these regulations, do not have rights to adjudicate any decision made which results in their removal from the College Premises. PROHIBITED CONDUCT 5.2.1 The obstruction or disruption of any College function or activity, including the classroom instructional environment, administration of the parking program or service functions and activities is prohibited. This includes obstruction of the free flow of pedestrian or vehicular traffic, or the free access to, or exit from any part of the College Premises as well as the unauthorized use or occupation of College buildings or College Premises. 5.2.2 Harassment of a Student or Students, Faculty Member, College Personnel, College Official, Visitor, or the College as an institution by Student or Students, or by a non-student or non-students is prohibited. Harassment includes any threat, in any way expressed or implied, to the person or property, or any obstruction or attempted obstruction of any individual’s authorized Page 36 5.2.3 5.2.4 5.2.5 5.2.6 5.2.7 5.2.8 5.2.9 5.2.10 5.2.11 5.2.12 movement on the College Premises. Harassment may also include the persistent use of abusive or offensive language or any language or action that may promote physical violence or physical or psychological intimidation. The display of any inflammatory or incendiary signs, posters, or banners or the distribution of literature which encourages or promotes any actions that are prohibited under these Campus Regulations. No firearms of any kind (including pellet, B-B guns, handguns, and rifles), explosives (including firecrackers and fireworks), live ammunition of any kind, noxious bombs or any other devices which are illegal under city, town, county, state or federal ordinance or law may be brought, possessed, or used on the College Premises. Duly authorized peace officers or police officers are exempted. No cutting instruments, knives, blades nor any other weapon is allowed on College Premises except folding pocket knives two inches or under or those instruments needed for legitimate school purposes. Possession, transportation, and/or the use of any illegal drug on the College Premises is prohibited. (a) No alcoholic beverage may be brought, possessed, or consumed on College Premises. (b) No person who may appear to be intoxicated or affected by an illegal drug is allowed on the College Premises. Gambling of any kind is prohibited. Unauthorized use of the College’s duplicating or reproduction equipment, public address systems, email or radio station is prohibited. Authorization for such use may be granted only by the College President or his designee. Any and all official information related to the College and its operation shall be transmitted to news media only through the College’s Public Information Office. Arrangements for reporters and/or radio or television station representatives to report or televise events on the College Premises shall be made only by the Public Information Office. Any other arrangements are unauthorized and the College reserves the right to bar (or remove) from the College Premises unauthorized news media representatives. Defacing, damaging, or maliciously destroying any College, Faculty, or Student property is prohibited. (a) All Visitors must be on the College Premises for a legitimate purpose. The College reserves the right to determine whether the purpose is legitimate. If it is not, Visitors will be asked to leave. (b) Visitors are required to show identification when requested to do so by security or administrative officers. Failure to do so, or to leave when requested will result in such Visitors being considered as trespassers Page 37 5.2.13 5.2.14 5.2.15 5.2.16 5.2.17 5.2.18 5.2.19 5.2.20 5.2.21 5.2.22 5.2.23 5.2.24 subject to arrest. Student Identification: All Students and College Personnel are required to obtain and carry College identification cards at all times and to present them upon request to any College Official, or Faculty Member. Other identification must be shown if such a request is made and the person questioned does not have an ID card in his/her possession. Disorderly or unlawful behavior is prohibited and may be prosecuted by the College under this procedure whether or not such behavior is the subject of prosecution in any civil or criminal court. Reckless or intentional actions which endanger mental or physical health are prohibited. The forced consumption of liquor or drugs for the purpose of initiation into or affiliation with any organization is prohibited. Smoking or chewing tobacco is prohibited in all buildings on the College Premises. False alarms, bomb scares or any form of false reporting submitted to any law enforcement or College agency involving alleged incidents or occurrences on College Premises is prohibited. Unlawful behavior that is motivated in the selection of the victim or commission of an offense by a perception regarding the race, color, national origin, ancestry, gender, religion, religious practice, age, disability, or sexual orientation is prohibited and may result in the imposition of more severe penalties. Certain violations of the Academic Code of Ethics at the discretion of the Vice President for Enrollment Management and Student Development can be pursued as violations of Campus Regulations. Willfully failing to comply with the directives of College Personnel is prohibited. Intentionally furnishing the College with false information is prohibited. Any activity that would be a violation of any federal, state or local statute is prohibited on College Premises. Any retaliatory action of any kind taken against a person seeking redress under these procedures is prohibited and shall be regarded as a separate and distinct cause for complaint under these procedures. Violation of published College policies or regulations, including, without limitation the following: (a) Parking and traffic regulations (b) Smoking policy (c) Alcohol and drug policy (d) Any other published College policies, rules and regulations including those related to the entry into and/or use of College rooms, buildings, grounds, and Page 38 5.3 facilities. COMPUTER ETHICS POLICY Hudson Valley Community College seeks to provide computer users with state of the art computing facilities and to keep the number of restrictions on individuals to a minimum, while maintaining excellent service for all users, Students in pursuit of their academic goals and College Personnel to conduct assigned work activity. To assist the College in achieving these objectives, users themselves must observe reasonable standards of behavior in the use of these facilities and maintain an atmosphere of civility, mutual respect and high ethical standards. PROHIBITED CONDUCT 5.3.1 No attempt will be made to modify or destroy system software components such as operating systems, compilers, utilities, applications or other software residing on any College computer, except the user's own files. 5.3.2 No attempt will be made to electronically transmit or post any material which is sexually explicit, hateful, or deemed prohibited conduct under the Campus Regulations as set forth in Article 5.2. 5.3.3 No attempt will be made to access, read, modify or destroy files belonging to another user without complete authorization from that user to do so. 5.3.4 No attempt will be made to connect to or use College computers with a user ID which was not assigned to you by the College. Use of another person's user ID or password is prohibited. 5.3.5 No attempt will be made to gain access to a password belonging to another person or place a password other than your own in a file on a College computer. In addition, no attempt will be made to install, run or place software designed for this purpose on any College computer. 5.3.6 No attempt will be made to bypass or otherwise defeat system security to gain access to programs, files or other computer data or to install, run or place software designed for this purpose on any College computer. 5.3.7 No attempt will be made to copy, store, post or distribute computer software, files or any other material in violation of trademark, copyright or confidentiality laws or when you do not have a legal right to do so. 5.3.8 No attempt will be made to interfere with proper operation of a computer or interfere with another person's use of a computer, including for example, the electronic transmission or posting of files or programs containing viruses or any other content intended to interfere with proper operation of a computer. 5.3.9 No attempt will be made to impersonate any person, including other Students and College Personnel. No attempt will be made to disguise the origin of any electronically transmitted or posted material. No attempt will be made to make unauthorized use of someone else’s electronic signature. Page 39 5.3.10 5.3.11 5.3.12 5.3.13 5.3.14 5.3.15 5.3.16 5.3.17 5.3.18 5.3.19 5.3.20 No unauthorized attempt will be made to use, modify, connect or disconnect computer equipment, peripherals, communication equipment and cables. No unauthorized attempt will be made to use any college computer to electronically transmit chain letters, junk mail, pyramid schemes or any other unsolicited mass mailings to multiple recipients with the exception of employees conducting College business and Students completing required College course assignments. No unauthorized attempt will be made to connect to and/or gain access to information being transported by computer networks, or to install, run or place software designed for this purpose on any College computer. Installation or use of any network communication software not approved by the College is prohibited. No user will make their password known to anyone other than an employee of the College authorized to assist College Personnel or Students with computer related problems. No food or drink is permitted in any computer classroom or computer learning center with the exception of the Computer Cafe. Users of College computers will comply with all local, state, federal and international laws relating to the use of computers and any other electronic communication services provided by the College. Use of College computers for commercial, business purposes or personal profit is prohibited without specific authorization from the College for such use. Commercial or business purposes includes advertising the sale of goods and services not directly related to Hudson Valley Community College or campus based Organizations. Use of College computers to falsify or modify documents in a manner which is unauthorized, is a violation of the rights of owners, is a violation of copyright laws or is not properly attributed is prohibited. Use of College computers and network services for local or remote game playing is prohibited unless specifically required as part of a course in which a Student is currently registered or a Faculty Member is currently teaching. In addition, the installation, uploading, downloading or storage of any game software on College computers is prohibited. Use of College computers and network services for IRC (Internet Relay Chat) or any other form of interactive chat communication is prohibited except for use by College Personnel in counseling, scheduling or admissions or where specifically required for communication as part of a course in which a Student is currently registered or a Faculty Member is currently teaching. Web site services for the entire College community are provided on a centralized server by the Office of Computer Services. Use of any other College computer for the purpose of serving a web site is prohibited. Page 40 ARTICLE VI. INFORMAL PROCEDURES FOR PROCESSING VIOLATIONS OF THE CODE OF ACADEMIC ETHICS 6.1 Academic Ethics - A Student shall inform the Faculty Member responsible for the course or program when he/she has knowledge of violations of the Code of Academic Ethics. In addition, any College Official or a Faculty Member of a course or program for which he/she is responsible who has information that a Student may have violated the Academic Ethics Code, may follow the procedures established in this Article VI or, if either party so chooses, proceed with the formal procedures set forth in Article VIII whereby disciplinary sanctions, as articulated in Article VII may also be imposed. 6.2 When a Faculty Member has knowledge that a violation of the Code of Academic Ethics has occurred, the Faculty Member should take appropriate action. If the Faculty Member is not the instructor for the course involved, that instructor should be notified immediately. 6.3 6.4 The course instructor should meet with the Student as soon as possible and discuss the allegation. If, after the discussion, the Faculty Member feels the Student did violate one or more of the provisions of the Code of Academic Ethics, the Faculty Member may impose one of the following sanctions. (Cases of plagiarism should proceed to § 6.4 which follows.) 6.2.1 Warning without further penalty 6.2.2 Retaking a test or rewriting an assignment 6.2.3 Lowering a grade on a project, assignment or test 6.2.4 Issuing a failing grade on a project, assignment or test 6.2.5 Lowering a final grade 6.2.6 Issuing a failing grade for a course 6.2.7 Imposing a penalty uniquely designed for the particular infraction. Whenever a Faculty Member sanctions a Student for a violation of the Code of Academic Ethics, a memorandum should be forwarded to the Campus Coordinator advising that office of the allegation, the sanction imposed and whether the Student accepted the sanction. Plagiarism 6.4.1 Level 1 Violation: A Student commits any act of plagiarism as determined by the instructor. 6.4.2 Level 1 Consequence: (a) The Student will receive a failing grade for the assignment; and (b) The Student’s Name will be forwarded to the Vice President for Academic Affairs, the Vice President for Enrollment Services and Student Development, the Student’s Department Chair and the Campus Coordinator. Page 41 6.4.3 6.5 Level 2 Violation: A Student commits any significant act of plagiarism as determined by the instructor. A significant act of Plagiarism may include but is not limited to one of the following: (a) The Student commits numerous acts of plagiarism with numerous sources within one particular assignment; (b) The Student plagiarizes a significant portion of his or her assignment from one source; or (c) The Student borrows, purchases, or steals an entire paper and submits it as his/her own. 6.4.4 Level 2 Consequence: (a) The Student will receive a failing grade for the course; and (b) The Student’s name will be forwarded to the Vice President for Academic Affairs, the Vice President for Enrollment Management and Student Development, the Student’s Department Chair and the Campus Coordinator. 6.4.5 Level 3 Violation: A Student commits any act of plagiarism as determined by the instructor(s) or administrator(s) on multiple assignments at any time during his/her tenure at the College. 6.4.6 Level 3 Consequence: (a) The Student will receive a failing grade for the course; (b) The Student’s name will be forwarded to the Vice President for Academic Affairs, the Vice President for Enrollment Management and Student Development, the Student’s Department Chair and the Campus Coordinator; and (c) The Student may be suspended from the College for one semester. The sanction imposed by the Faculty Member or College Official shall constitute a final resolution of the matter unless the Student submits a request for a Hearing through the office of the Campus Coordinator as set forth in Article VIII within five (5) days from the date the sanction was imposed. ARTICLE VII. PROCEDURE FOR PROCESSING COMPLAINTS INVOLVING ALLEGED VIOLATIONS OF CAMPUS REGULATIONS AND COMPUTER ETHICS. 7.1 Campus Regulations for Students, Visitors, College Personnel and Organizations - In cases of alleged violations of Computer Ethics and/or Campus Regulations, any College Personnel or Student shall notify the College’s Office of Public Safety or the Vice President and the complaint shall be processed consistent with the procedures set forth in Article VII or Article VIII. However, although College Personnel are subject to and must abide by Campus Regulations, they shall have no right to a hearing or appeal under this Code of Conduct and they shall utilize other applicable mechanisms to Page 42 7.2 7.3 7.4 7.5 7.7 7.8 contest adverse actions. All charges must be submitted in writing and signed. It is strongly recommended that any party exercising his/her rights under this system or any party accused of violating any of the Codes of Conduct consult with the Campus Coordinator as soon as possible so rights, remedies and procedures can be explained. The Student shall meet with the Vice President within five (5) days of receiving notice of charges. The Vice President for Enrollment Management and Student Development may also meet with the complainant, security officers and/or any witnesses at the Vice President’s discretion. If, at the conclusion of the Vice President’s investigation, s/he finds the accused individual did violate one or more provisions of the Campus Regulations and/or Computer Ethics, the Vice President may impose one of the following sanctions: 7.6.1 Letter of Warning. Letter of Warning to be placed in an individual’s permanent record file for a 7.6.2 stated period of time. 7.6.3 Restitution. 7.6.4 Community Service 7.6.5 Counseling Services provided by the College. 7.6.6 Mandatory Course requirements (in civility, human relations, anger management, race or gender relations or a similar course designed to raise consciousness or awareness). 7.6.7 Disciplinary Removal from a Curriculum. 7.6.8 Disciplinary Probation. 7.6.9 Disciplinary Suspension (Current or deferred, subject to conditions) 7.6.10 Disciplinary Dismissal. 7.6.11 Disciplinary Expulsion – Termination of Student status without the possibility of readmission 7.6.12 Restricted Access to classrooms or buildings 7.6.13 Restricted Access to or loss of Computer Accounts 7.6.14 Any other sanction uniquely designed for the particular infraction. The sanction imposed by the Vice President shall constitute a final resolution of the matter unless the accused individual submits a request for a Hearing through the office of the Campus Coordinator as set forth in Article VIII within five (5) days from the date the sanction was imposed. During the pendency of any proceeding under the Code of Conduct, the Vice President may, in his or her sole discretion, have the accused individual removed from the College Premises and enforce the restraint of the accused’s access to the College Premises in Page 43 7.9 8.1 8.2 8.3 8.4 8.5 8.6 8.7 whole or in part, until his/her presence is required for the adjudication of the case if the Vice President views the violation as jeopardizing property of the College or another person or the individual’s safety or welfare or the physical or emotional safety or welfare of others, or the orderly operation of the College. Disciplinary suspension, dismissal, or expulsion from the College will most likely be imposed for, among others, the following: (1) permitting or engaging in hazing (2) setting fires or intentionally causing a false fire alarm (3) possession of or threats involving weapons or explosives (4) possession or sale of illegal drugs (5) physical abuse, violence, sexual assault or threats directed toward anyone on the College Premises or any member of the College community off College Premises (6) serious forms of computer misconduct (7) repeated violations of the College Code of Conduct. ARTICLE VIII. HEARING PROCEDURES UNDER THE CODE OF CONDUCT In the event the accused timely files a written request for a Review Board hearing (“Hearing”), the procedure set forth in this Article VIII shall apply. Use of and Responsibility for Obtaining and Compensating an Advisor: During the Hearing an advisor may be allowed but such advisor must be individually obtained and compensated by the person(s) involved. An advisor may only serve in an advisory capacity and may not speak or otherwise participate directly in the formal procedure. An advisor may be a parent or child of the accused, a spouse or partner or a member of the College community. A Student may bring a lawyer to the Hearing only as an advisor and only if the allegations may also constitute a crime. The lawyer may not participate in the Hearing, and participation is limited to advising the Student. If the conduct of the lawyer is deemed to be inconsistent with the process, the Hearing may be terminated or the lawyer excused for the remainder of the Hearing. The Campus Coordinator, once advised by an accused that a Hearing has been requested, shall immediately notify the Committee on Ethics and Conduct. Within ten (10) days of the notification, a Hearing shall be held. The Review Board will be comprised of three members of the Ethics and Conduct Committee. It shall not contain more than one (1) administrator; one (1) Faculty Member, one (1) non teaching professional or one (1) union employee and shall always contain one (1) Student. If the dispute arose from a particular division or department, no individual from that division or department is permitted to sit on the Review Board. One of the members of the Review Board shall be designated as Chairperson and shall have the responsibility of reporting the decision of the Review Board to the appropriate College Official in writing. If the accused does not appear for the Review Board Hearing and was properly notified of its date, time and place, the accused individual shall be deemed to have forfeited his/her right to a Hearing and the sanction imposed by the Vice President or Faculty Member shall be automatically upheld and the accused individual will have no further Page 44 recourse. 8.8 The Review Board shall not be bound by the technical rules of evidence but may hear and receive any reports, documents, testimony, evidence or other information which is relevant and material to the issues. The weight to be given such items shall be determined solely by the Review Board. 8.9 The Review Board adjudication shall be transcribed or taped and those witnesses appearing before the Review Board shall be sworn. 8.10 Only the primary parties in interest (and their advisors, if any), transcriber, the members of the Review Board and the Coordinator of the Judicial System shall be present throughout the Hearing. The Hearing shall be conducted in private. The advisors may not speak for or take the place of a primary party in interest. 8.11 Conduct of the Hearing 8.11.1 The coordinator of the Judicial System may provide to the Review Board and to the accused copies of documents to be considered by the Review Board in advance of the Hearing, but no party shall be limited to such documents. 8.11.2 The Chairperson will read the charges. 8.11.3 Each party may make an opening statement, beginning with the individual bringing the charge. 8.11.4 The person bringing the charge, whether by a Faculty Member or College Official accusing a Student of violating the Code of Academic Ethics or the Vice President accusing any Student, or Organization of violating the Campus Regulations will read, summarize, or identify all of the material information which has been submitted by witnesses, the Public Safety Office, or others. Materials will usually consist of, but are not restricted to, a summary case written by the Public Safety Office plus statements from witnesses or other persons involved in the situation. Documents shall also be submitted at this time. The Vice President may also give testimony, submit evidence or call witnesses to give testimony or submit evidence or other information. 8.11.5 The other party and the members of the Review Board may ask questions of any witness. After the submitted materials and evidence have been read, the accused will have the opportunity to refute or explain the materials or evidence or add information. The accused may choose to remain silent and not make any statements or participate in the discussion. The accused may call witnesses. 8.11.6 Each party will be provided an opportunity to give a summation of their respective positions. 8.11.7 The Chairperson will conclude the Hearing when he or she is satisfied that all information has been submitted. 8.11.8 The Review Board will then convene in closed session and consider only information presented at the Hearing. If necessary, the Review Board may Page 45 8.11.9 9.1 9.2 9.3 9.4 adjourn and reconvene, ask for further documentation, or call or recall witnesses with the assistance of the Campus Coordinator, if required. The decision of the Review Board as to whether the alleged infraction occurred and whether the sanction imposed is appropriate shall be made based on the information presented at the Hearing. The decision shall be in writing and delivered to the parties by hand or via United States Mail within a reasonable time after the Hearing. Deposit, postage prepaid, in an official United States Postal Service receptacle shall be deemed delivery on the date it is deposited. ARTICLE IX. APPEALS Within seven (7) days of the delivery of the decision of the Review Board, either party may appeal the decision, in writing, and submit the appeal to the Campus Coordinator. S/he will forward the appeal to the other party who may submit a written response which must be received within three (3) days of the receipt of the appeal. The opposing party is under no obligation to respond to an appeal. Within three (3) days of receiving the appeal the Campus Coordinator will present it to the President. The President, after receipt of such appeal, shall make a final adjudication and determination in the matter. The accused individual, Vice President or appropriate Faculty Member shall be notified of the final decision of the President by the Campus Coordinator. There shall be no further appeals. Page 46 American with Disabilities Act This is a federal law which requires employers to “reasonably accommodate” disabled employees who can perform the “essential tasks” of a job. Please note that employees are also covered under the New York State Human Rights Disability Law. These laws require employers to provide “reasonable” accommodations to qualified disabled employees who can perform essential functions of the job. Basic elements of the American with Disabilities act are as follows: • A disability is defined as a physical or mental impairment that substantially limits one or more of the major life activities of such individual, a record of such impairment or being regarded as having such impairment. While some temporary disabilities are covered, temporary impairments which are excluded from coverage include: o o o o • Current illegal drug use Common illnesses or injuries Pregnancy Personality traits Employer makes reasonable accommodation to permit employee to perform essential functions such as : o Making facilities accessible o Job restructuring o Job reassignment o Modifying work schedule o Acquiring adaptive equipment Employer need not suffer “undue hardship” in providing accommodation, defined as: o Costly modifications/equipment o Disruption of workflow • Enforced by EEOC with remedies including injunctive relief and monetary damages Employees are also covered by the New York State Disability Law. The Human Rights law defines a disabled individual as someone who has a physical, mental, or medical impairment resulting from anatomical, physiological, genetic, or neurological conditions, which prevents the exercise of a normal bodily function or is demonstrable by medically accepted, clinical, or laboratory diagnostic techniques or record of such impairment or has a condition regarded by others as such an impairment, provided however, that such an impairment shall be limited to disabilities which upon the provision of reasonable accommodations, do not prevent the Page 47 individual from performing in a reasonable manner the activities involved in the job or occupation sought or held. The College has a coordinator for ADA compliance. Contact the Office of Disability Resources for assistance. Page 48 Fair Labor Standards The College is subject to many provisions of the Fair Labor Standards Act administered by the NYS Department of Labor. The act applies to wage and hour issues and subjects of regulation include: minimum wages, hours worked, overtime pay and equal pay for equal work. The act allows eligible public employees, such as at the College, to receive compensatory time at a time and one-half rate for overtime in lieu of cash payments, subject to choice by the employee. Page 49 Page 50 Family and Medical Leave Act [FMLA] Federal law, which provides up to 12 weeks of job protected leave for: Birth and care of a newborn child of employee; Placement with an employee of a child for adoption or foster care; Taking care of a spouse, child, or parent with a serious health condition; or Taking medical leave when employee is unable to work because of a serious health condition Exigency leave associated with a family member’s covered active duty service or call to covered service. Taking care of a servicemember or veteran undergoing medical treatment, recuperation or therapy for serious injury or illness (up to 26 weeks in a 12 month period) Basic elements of the law are as follows: Provides security for employees who have worked at least 1,250 hours for current employer in the last 12 months. Child defined as biological, adopted or foster, step, legal ward who is under 18 or over 18 and incapable of self‐care because of mental or physical disability that limits one or more of the “major life activities.” Parent does not include a parent “in law”. Serious health condition is defined as an illness , injury, impairment, or physical or mental condition that involves either any period of incapacity or treatment connected with inpatient care ex; an overnight stay in a hospital, hospice, or residential medical care facility and any period of incapacity or subsequent treatment in connection with such inpatient care of continuing treatment by a health care provider, which includes any period of incapacity ex; the inability to work attend school, or perform other regular duties due to: o A health condition, including treatment therefore or recovery there from lasting more than three consecutive days and any subsequent treatment or period of incapacity relating to the same condition that also includes treatment two or more times by or under the supervision of a health care provider with a continuing regimen of treatment; or o Pregnancy or prenatal care; a visit to the health care provider is not necessary for each absence; or o A chronic serious health condition which continues over an extended period of time, requires periodic visits to a health care provider, and may involve occasional episodes Page 51 of incapacity; example asthma, diabetes, a visit to a health care provider is not necessary for each absence; or o A permanent of long term condition for which treatment may not be effective: example; terminal cancer. Only supervision by a health care provider is required, rather than active treatment; or o Any absence to receive multiple treatments for restorative surgery or for a condition which would likely result in a period of incapacity of more than three days if not treated; example, chemotherapy or radiation treatments for cancer. Serious injury or illness for a member of the armed forces (including a member of the National Guard or reserves) must have been incurred by the member in the line of duty on active duty in the armed forces and that may render the member medically unfit to perform the duties of the member’s office, grade, rank or rating or for a veteran who was a covered servicemember of the armed forces an injury or illness that was incurred by the member in the line of duty on active duty in the armed forces and that manifested itself before or after the member became a veteran. Health Care Provider means doctors of medicine or osteopathy authorized to practice medicine or surgery by the state in which that doctor practices; or podiatrists, dentists, clinical psychologists, optometrists, and chiropractors, authorized to practice and perform within the scope of their practice under state law or nurse practitioners, nurse midwives, and clinical social workers authorized to practice and perform within the scope of their practice and perform within the scope of their practice as defined by state law; or any health care provider recognized by the employer or the employer’s group health plan benefits manager. Time taken off work due to pregnancy complications can be counted against the 12 weeks of family leave. Spouses employed by the same employer are jointly entitled to a combined total of 12 work weeks of family leave for birth and care of the newborn child, for placement of a child for adoption or foster care, and to care for a parent who has a serious health condition. Leave for birth and care or placement for adoption or foster care if used intermittently is subject to the employer’s approval. There must be need for medical leave, as distinguished from voluntary treatments and procedures, and it must be that such medical need can be best accommodated to an intermittent or reduced leave schedule. Elective cosmetic treatments which are not medically necessary are excluded, such as orthodontia or acne. While the leave is unpaid, the employer may allow or mandate use of accrued leave to produce pay. Employer must maintain contribution to health insurance during absence. Page 52 Workers compensation leave can count against an employee’s FMLA leave entitlement, as they run together, if the reason for the absence is due a qualifying serious injury, and the employer properly notifies the employee in writing that the leave will be counted as FMLA leave. Upon return from FMLA leave, an employee must be restored to his or her original job or to an “equivalent” job, which means virtually identical to the original job in terms of pay, benefits, and other employment terms and conditions. An employer may require medical certification to qualify for leave and again for return to position. Employer may ask questions to confirm whether the leave needed or being taken qualifies for FMLA purposes and may require periodic reports on an employee’s status and intent to return to work after leave. Leave may be taken at once or intermittently during a rolling 12 month period which begins at point of first day of leave. Employer is not required to continue FMLA benefits or reinstate employees who would have been laid off or otherwise had their employment terminated had they continued to work during the FMLA period. FMLA does not require that employees on FMLA leave be allowed to accrue benefits or seniority. When use of leave for medical reasons is planned or known in advance the leave should be discussed with both your immediate supervisor and the Office of Human Resources to ensure all contractual and other legal rights are applied and understood. The administration of the FMLA tends to be based on the unique characteristics of each medical case. Early consultation with the Office of Human Resources is encouraged. When returning from an injury, hospitalization, any surgery or protracted illness, all employees must report first to the College Health Service to submit physician’s clearance to resume job duties. In some cases, the College Physician or Health Service Director may wish to discuss or examine the condition. This process is necessary to protect both college and employee. In general “light duty” is not allowed. Page 53 The Family Educational Rights and Privacy Act (FERPA) The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their education records. In addition, parents are afforded the same rights as students are, as long as the student is claimed as a dependent on either of their parent’s Federal Income Tax return, and there is proper presentation of the dependency condition. Please remember that students must present their Hudson Valley Community College Student ID card or another type of photo identification in order to receive information about their student record. This requirement helps to ensure privacy. These rights are: 1. The right to inspect and review the student's education records within 45 days of the day the college receives a request for access. . Students should complete the request form available in the Registrar's Office identifying the record(s) they wish to inspect. The registrar will make arrangements for access and notify the student of the time and place where the records may be inspected. If the records are not maintained by the registrar, the student will be advised to whom the request should be addressed. 2. The right to request the amendment of the student's education records that the student believes are inaccurate or misleading. . Students may ask the college to amend a record that they believe is inaccurate or misleading. They should complete the request form available in the Registrar's Office, clearly identify the part of the record they want changed, and specify why it is inaccurate or misleading. . If the college decides not to amend the record as requested by the student, the college will notify the student of the decision and advise the student of his or her right to a hearing regarding the request for amendment. Additional information regarding the hearing procedures will be provided to the student when notified of the right to a hearing. 3. The right to consent to disclosures of personally identifiable information contained in the student's education records, except to the extent that FERPA authorizes disclosure without consent. . Page 54 One exception which permits disclosure without consent is disclosure to school officials with legitimate educational interests. A school official is a person employed, appointed or hired by the college in an administrative, supervisory, academic or research, or support staff position (including law enforcement unit and personal health staff); a person or company with whom the college has contracted (such as an attorney, auditor, or college agent); a person serving on the Board of Trustees; or a student serving on an official committee, such as a disciplinary or grievance committee, or assisting another school official in performing his or her tasks. . A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility. 4. Hudson Valley Community College designates the following items as directory information: student's name, dates of attendance, date of birth, enrollment status, major, date of graduation, honors and awards received, and student campus e-mail address. The college may disclose any of those items without prior consent, unless notified in writing to the contrary within thirty days of the beginning of the term. 5. The right to file a complaint with the U.S. Department of Education concerning alleged failures by State University to comply with the requirements of FERPA. The name and address of the office that administers FERPA is: . Family Policy Compliance Office, U.S. Department of Education, 400 Maryland Avenue, SW., Washington, DC, 20202-4605 Page 55 PESHA (OSHA) The College is subject to the Public Employment Safety and Health Act, the public sector version of the Occupational Safety and Health Act, to provide for workplace safety and wellness regulation. The act is administered by the NYS Department of Labor, which receives employee complaints of unsafe conditions, investigates unsafe workplace situations and conducts periodic inspections of the worksite for compliance. Page 56 HVCC Emergency Information for Faculty, Staff & Students 1. To Call for assistance during ANY Emergency: Dial 911 from a campus phone or 629-7210 from a cell phone You will be connected with the College Department of Public Safety. Explain the nature of the emergency and stay on the line for further instruction. Do not call County 911 from your cell phone. This will delay the response time as the call is redirected to the College Department of Public Safety. 2. Communicating Emergencies to the Campus Community: HVCC has instituted the SUNY NY-Alert system to warn students and college employees of an impending or ongoing emergency, and provide timely emergency information to the same groups to protect lives and minimize campus disruption. Participants need to “opt in” to receive the Alerts. Messages can be received via cell phone (text and/or voice), telephone, e-mail and fax. Find out more at: https://www.hvcc.edu/nyalert/index.html 3. Fire Emergencies a. When the fire alarm is sounded: Everyone must leave the building. Even in a drill, it is a clear policy violation to disregard alarms and such conduct may be pursued as a disciplinary matter. Do not re-enter the building in alarm until the all clear is given by response officials. b. If you observe fire or smoke: Go to the nearest fire alarm pull station located in hallways and pull the handle to activate the building alarm. Public Safety will notify the Fire Department and dispatch an officer to the building. Report any information pertaining to the emergency to Public Safety or the FD as soon as possible. c. Fire Extinguishers: Extinguishers are available in all buildings. Only attempt to extinguish a fire if you know how to and it is safe to do so. You are not required to perform this task. Page 57 d. Fire Drills Drills are held 3 times per year, as required by State law. Everyone must evacuate during all alarms, whether it is a drill or not. Each building has a number of Floor Marshals who will assist in the evacuation. Please follow their instructions. e. Mobility-impaired persons If you can, please help assist mobility-impaired persons evacuate. Keep in mind that elevators cannot be used in a fire emergency. People can safely exit by going to an adjoining building and using that elevator or exit. Also, Public Safety has “evac chairs” available if a person needs to be carried down the stairs. If waiting for assistance, go to a location furthest from the fire and call Public Safety and report your exact location and nature of the emergency. 4. Procedures for Medical Emergencies Call the College Public Safety Office: a. b. c. d. Dial 911 from a campus phone Dial 629-7210 from a cell phone Use a red emergency phones located in campus buildings Use an outdoor emergency phone identified by the blue light If possible, have someone else stay with the patient if you need to go to a phone. Give Public Safety as much information as you can about the nature of the emergency. Public Safety will dispatch an officer to the scene and will also connect your call to the Rensselaer County 911 by conference call. You will receive instructions on what to do until the Fire Department and EMTs arrive. Data suggests that the average response time by the Troy Fire Department and EMTs to emergency calls on campus has been in the range of 3 to 4 minutes. Every effort will be made to keep this response time as short as possible. 5. AEDs (Automatic External Defibrillators) AEDs are emergency medical units that may be used in cardiac emergencies to restore heart beat. AEDs are emergency medical units that may be used in cardiac emergencies to restore heart beat. These devices are publicly accessible on campus at the following locations: Page 58 BTC Day Care Fitz HRC Hudson Jordan Road LaPan McDonough Stadium Class room Main Lobby near elevator 2nd floor by room 134 Health Services -storage room 141 Inside Dental Clinic room 113 center of room 3rd Floor Corridor by Vending rm 329 Main hall way by rest rooms 2nd Floor lobby, Suite B Main Hall way between Rest Rooms Main Lobby by ticket booth Trainers Room Inside Room 107 , south wall of room If you suspect a patient is in cardiac arrest, report this to Public Safety when calling. A Public Safety Officer will respond with an AED. 6. Work Related Accidents and Injuries If an injury or illness occurs on campus, go to the College Health Service in Fitzgibbons 146 for medical attention. An incident report will be completed while at the College Health Service. No claim for worker’s compensation may be processed without such an incident report which must, by law, be filed within 30 days of the incident. In the case of a medical emergency where an ambulance is called, report to the College Health Service upon return to work. 7. Employee Return from Illness/Injury/Hospitalization/Surgery When returning from any protracted illness or injury, all employees must report first to the College Health Service to submit a physician’s clearance to resume job duties. In some cases, the College Physician or Health Service Director may wish to discuss or examine the condition. This process is necessary to protect both college and employee. In general, “light duty” is not allowed. 8. Reporting a Theft or Assault: During an emergency, if a theft or assault is in progress, please call 911. After the incident has occurred, please call 629-7210 so that a Public Safety staff member can be dispatched to take a report. In either case, please be certain to report details such as descriptions of property and of suspects: i.e.: clothing, height/weight, hair color, eye color, etc. 9. Reporting a Motor Vehicle Accident: Minor property damage car crashes/accidents, can be reported directly to Public Safety by calling 629-7210. Injury accidents and more serious property damage accidents can be initially reported to Public Safety. However, we will then contact the appropriate Police Agency to take the report and investigate Page 59 further. 10. Employee Rights and Responsibilities under State OSHA law: As an employee of the College, you have the right to ask questions related to potential safety & health conditions in your work area. Such issues should be directed to the Department of Environmental Health & Safety (629-7163 or 7787). Or, you can report the issue to the College Safety Committee through our web page: https://www.hvcc.edu/ehs/safety_committee/index.html . At a minimum, all College employees must have safety orientation training provided by the Department of Environmental Health & Safety. Additional environmental health & safety training may be required based on your job responsibilities and will be provided by your department or Environmental Health & Safety. 11. Safety & Health Resources: The following College departments can provide you with safety and health assistance: a. Department of Public Safety https://www.hvcc.edu/public_safety/index.html Located in the south end of the Campus Center, Public Safety’s mission is to provide a safe, secure atmosphere. The office, located at the south end of the Siek Campus Center is open 24 hours a day. Contact Public Safety for all emergencies by dialing 911 from a campus phone or 629-7210 from a cell phone. b. College Health Service https://www.hvcc.edu/healthsvcs/index.html Provides staff and students with health information and medical attention. For assistance, report to the Health Office in Fitzgibbons Hall, room146. c. Department of Environmental Health & Safety https://www.hvcc.edu/ehs/health/index.html Provides guidance and training on all occupational safety and environmental health issues. Contact the department at 629-7163 or 629-7787. d. College Safety Committee https://www.hvcc.edu/ehs/safety_committee/index.html With representatives from across campus, the committee is responsible for promoting and strengthening all aspects of safety and health on the campus. To contact the committee, click on “reporting a safety issue” link on the web page. Page 60 SECURITY AND PRIVACY OF PROTECTED HEALTH INFORMATION (CREATED 12/02) Rationale: Hudson Valley Community College recognizes a duty to avoid wrongful disclosure of Protected Health Information (PHI) of students, staff, faculty and others. It is a requirement of the College that every effort be made to protect the medical privacy of persons who have PHI on file with the College. This is done by protecting paper and electronic records as well as other health information through physical, administrative and technological means directed at maintaining the integrity and security of those records. Goal: Secure and Protected Health Information Objectives: Training: 1. To maintain a training schedule for Health Science students to meet the requirements of affiliated institutions 2. To maintain an annual security and privacy training schedule for appropriate staff. 3. To update training modules as required. Privacy and Security: 1. To maintain a secure environment wherever PHI is located, including areas of use and storage of medical and other health records. 2. To ensure staff behavior will uphold the privacy and security of PHI. Page 61 3. To maintain continuing review of security and privacy processes within the College and to develop or amend policies and procedures when necessary to protect PHI. 4. To maintain a program which allows for the transfer of Individually Identifiable Health Information upon written request of the individual and the revocation of that request as well. 5. To inform individuals submitting PHI of their privacy rights and to maintain a process to allow for satisfaction of complaints concerning the privacy and security of PHI. 6. To maintain accurate reporting, investigation and review of violations of security or privacy policy and determine sanctions for such violations. 7. To support a program which allows for amendments to medical and other health records. 8. To maintain an accurate accounting of disclosures of PHI. 9. To document all aspects of the security and privacy program. Guidance for Disclosure of Protected Health Information General Guidelines: Generally, every disclosure must be evaluated on an individual basis. Identity of a requester of PHI must be appropriately verified. Discussion for medical treatment, insurance processing and other normal business operations is allowed. Incidental observations are not appropriate. Page 62 Sharing identifiable information with the risk manager in case of possible liability, conversations with Human Resources Director or his/her Designee regarding ability of an employee to perform assigned duties, discussion of immunization information with Health Science Department Chairs and affiliating hospitals are examples of allowed communication because they fall under necessary disclosure for normal business operations. The Privacy Officer will advise staff with questions concerning disclosures of a questionable nature. Policies: Policy, Maintaining Physical Security of the PHI The physical security of medical and other records containing Individually Identifiable Health Information will be maintained at all times. Procedures: Records containing PHI will not be left unattended in any place accessible to non-medical people. Areas of location of Individually Identifiable Health Information must be locked at all times when staff members are not present in the immediate area to protect the security of PHI. Keys to such areas should be available only to those who need access to the health information. At the end of each working day, all records containing PHI will be put in secure locked areas. Records containing PHI will not be removed from their assigned location without permission of the Privacy Officer. Page 63 Policy, Staff Practices: Staff will discuss or release PHI only for the purposes of treatment, insurance processing or when necessary to maintain normal business operations of the college and will take measures to avoid accidental release of PHI by careless record handling or verbal indiscretions. Violators of any privacy policies will be subject to disciplinary action that ranges from reprimand to termination. Procedures: • Oral disclosures of information will be made only in emergency situations and then written or witnessed verbal consent of the concerned individual must be obtained if possible. • Staff will never discuss an individual’s PHI with another staff member within hearing distance of others. • Staff will ensure identity of persons requesting PHI. SUNY card, Drivers License or other picture ID is acceptable identification. • When speaking to someone concerning their health information, doors to an interview area should be closed. A TV, radio, CD or tape player should be used as sound for masking during interviews as well. • Records containing PHI will not be left unattended and never be left where anyone other than appropriate staff can see or touch them. Policy, College PHI Security and Privacy Committee: A College PHI Security and Privacy Committee will be responsible for the security and privacy policies, procedures and protocols. This does not abrogate the responsibility of individual employees to be vigilant with respect to any circumstances that may facilitate a breach of the security and privacy system. Page 64 • The College PHI Security and Privacy Committee comprised of representatives from Health Services, Health Sciences, Human Resources, Finance, and Computer Services and FSA will review the security and privacy plan annually or more often if a need for policy change becomes apparent or applicable changes to the law occur. The Committee will make recommendations for change to the policy when necessary. • Minutes of these meetings will be kept permanently. • If the committee makes recommendations that are not approved by the relevant director or department chair, the recommendation must be reviewed by the Privacy Officer and the appropriate Vice President the ultimate decision concerning enactment of the recommendations will be made by the appropriate Vice President. • In keeping with other Health Service policy, all changes to policy will be documented as revisions to the original policy and previous policies will be maintained for a minimum of 10 years. Policy, Staff Training: All Staff who may come in contact with PHI while performing their duties will be trained annually regarding HIPAA and HVCC policies and procedures of security and privacy. Procedure: • In general training will be conducted as a web based activity. Training will be developed the Privacy Officer or others as assigned. • Any changes in policies or procedures will be disseminated and explained to staff immediately. The training module will be updated immediately upon change. Page 65 • In keeping with other College policy, training in which each individual staff member participates will be recorded in the Office of Human Resource Development. Policy, Release of Medical Information: (See Faxing Policy) All written requests for release of health or medical information will be reviewed and the minimum information necessary to meet the purposes of the request will be released. Research involving access to any individually identifiable student information is prohibited. health Medical information will be released only upon written permission of the patient, a judicial subpoena or other legal requirements. This includes all information released to another medical office. Information regarding medical history or treatment will not be shared with faculty or administration unless the patient has requested such in writing (verbal permission is acceptable in extreme emergency but must be given in presence of witness). The exception to this is that accident reports will be faxed to the College Risk Manager immediately upon completion. Procedure: • Subpoenas and other legal forms will be evaluated by the Privacy Officer and/or the College Attorney, if necessary, before honoring the legal request for transfer of records . • A “Request for Disclosure” form should be completed by the patient or his/her legal representative. • Request for Disclosure forms must contain the following information: Name, address, Social Security number, and relationship of person requesting transfer, Exact description of information to be transferred, Purpose of disclosure, Name, address and, if appropriate, fax number of where the records should be sent, Page 66 Signature of person requesting the transfer and date of signature, Witnessing signature of transfer request. • All requests for disclosure must be examined carefully and with the exception of a request for Immunization or Physical Exam information that is signed by the student or staff member, all requests will be reviewed by the Privacy Officer who will use discretion in referring these requests to the College Attorney. • Information disclosed will always be limited to the exact information authorized. • Written permission must be signed by the student/ patient unless that person is under the legal age of consent, in which case the legal guardian should sign the letter/form. Proof of legal guardianship will be approved by the College Attorney. • If a Request for Disclosure form or a letter of request is signed by someone claiming to be a legal representative, the request must be approved by the Privacy Officer or the College Attorney. The documentation of representation must be attached to the form. • The letter/form must specifically address what information is to be released and cannot be used for more than one transfer of information. • When the “Request for Disclosure” Form is completed the information will be photocopied and mailed to the address indicated or given to the individual requesting his/her records. • The request will be retained with the Health information released and in the Disclosure Log. A note that the copy was faxed and mailed or given to the individual and the date will be noted on the request and, if appropriate, on the Clinical notes of the patient’s record. Page 67 • ONLY FORMS ORIGINATING AT HVCC OR AT THE REQUEST OF HVCC CAN BE COPIED AND SHARED WITH OTHERS. FORMS GENERATED AT OTHER PLACES CANNOT BE TRANSFERRED. Faxing of PHI: Faxing of Protected Health Information will be done only after a request by the subject of the PHI. Procedure: • Numbers to which information will be faxed may be accepted if given by the subject of the PHI. • Numbers which are researched by college staff must be verified by calling the office to which the information is to be faxed. • A cover sheet must accompany the information and the cover sheet must have the standard information: 1. Name, telephone and fax number of the person the PHI is being faxed to, 2. Name, address and telephone number of the person from whom the PHI is being faxed, Date the fax is being initiated, 3. Number of pages being faxed, including cover page, 4. Subject or topic of the fax. 5. The cover sheet should also contain a confidentiality notice. The statement should include: CONFIDENTIALITY NOTICE INFORMATION ACCOMPANYING THIS FACSIMILE COVER SHEET CONTAINS PRIVILEGED AND CONFIDENTIAL INFORMATION INTENDED SOLELY FOR THE USE OF THE INDIVIDIUAL OR ENTITY TO WHOM IT IS ADDRESSED. IF THE READER OF THIS NOTICE IS NOT THE INTENDED ADDRESSEE, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. THE IF YOU HAVE RECEIVED THIS FACSIMILE IN ERROR, PLEASE NOTIFY US BY TELEPHONE IMMEDIATELY AND EITHER RETURN THE FAXED INFORMATION TO THE SENDER, BY US MAIL, AT THE ADDRESS LISTED ON THIS FACSIMILE, OR DISPOSE OF THE DOCUMENT BY SHREDDING. THANK YOU Page 68 • After a fax transmission is completed, the fax the number on the transmittal form will be verified as the proper number to which the information should have been faxed. The transmittal form will then be attached to the cover sheet and a copy of the information that was faxed. These papers will be kept in the medical record with the original information. Policy, Right to Revoke Authorization: Each individual has a right to revoke an authorization previously signed by completing an “Authorization Revocation Form”. Procedure: • After signing and witnessing of the “Authorization Revocation Form” a copy shall be given to: The patient requesting revocation The Privacy Officer A third will be filed with the health information • The revocation will be entered in the revocation log. Policy, Accounting of Disclosure of Protected Health Information: A complete accounting of individual disclosures of protected health information will be maintained on each individual record and in a disclosure log. A separate record will be maintained by the Privacy Officer. Procedure: • Required information to maintain in the Disclosure Log for each disclosure is as follows: 1. Date of disclosure 2. Name and address of person to receive the disclosed information 3. Description of disclosed information 4. Statement of purpose of disclosure 5. Written accounting of disclosure will be provided to the individual 6. Title of person who approved the disclosure 7. The disclosure log will be archived annually. Page 69 Policy, Right to Request Restriction of Use and Disclosure of Protected Health Information: A person requesting restriction of use or disclosure of his/her protected health information should be informed that the College may be unable to restrict disclosure. Other restriction requests will be processed by the Privacy Officer. Procedure: • Upon request for restriction of use or disclosure, the individual will be given a request for restriction form. • The Privacy Officer will process the request with in 10 working days. During that time no PHI will be disclosed. • If the request is denied, the requestor may appeal to the appropriate Vice President by completing an appeal form. The Vice President will notify the individual of the decision within 10 days. • Upon approval of a “Request of Restriction of Use and Disclosure Form”, a copy will be placed with the student’s health information and a “Restriction” stamp will be applied on the outside of the folder. If put in storage without a file jacket, the file will have a red “Restricted” sticker put on the front page of the health information. Policy, Notice of Privacy Practice: Every effort will be made to inform students and employees of the College Privacy Practice. Procedure: A copy of the Notice of Privacy Practice will be placed in the College Catalog, the Student Handbook and the Employee Orientation Packet. Page 70 Policy, Processing of Complaints Regarding Privacy Policies Students have a right to have complaints heard and responded to in a timely manner. Procedure: • Upon request, the complainant will be given a Privacy Complaint Form to complete. • The completed form will be sent to the Privacy Officer at once. • All complaints regarding privacy policy will be processed by the Privacy Officer within 10 working days. • Appeal of unsatisfied complaints will be sent to the Vice President of Student Services upon completion of an Appeals Form. Appeals Forms must be completed within 10 days of notification of the Privacy Officer’s decision. Policy, Investigations of Violations of Privacy Policy All complaints of violations of privacy will be thoroughly investigated. Procedure: • Investigations of privacy violations will be directed by the Privacy Officer and completed within 10 working days of the complaint. • A complete report of any investigation will be given to the Vice President of Student Services upon completion of the investigation. Page 71 Policy, Review and Amendment of protected Health Information: Anyone wishing to review or amend his or her health information may apply to do so. Procedure: • Persons wishing to review or amend their health information must process a “Request for Review” or “Request for Amendment of Medical Record” form that will be processed by the Privacy Officer. These requests will be processed within 10 business days. Review and Amendment Decision: The applicant will be notified of the Privacy Officers” decision concerning the review/amendment request within 15 working days of the date of the original request. Procedure: • If the review/amendment is approved the Privacy Officer will direct the involved administrator to place the amendment in the health information. • If the review/amendment is denied, the Privacy Officer will explain to the applicant in writing reasons for denial within 15 days of the application. The Privacy Officer will also explain the process for appeal to the appropriate Vice President. • The applicant may appeal a denial to the Vice President by filing an appeal form within 10 working days of the decision. • The Vice President will notify the applicant of his/her decision within 10 working days of receiving the appeal. • In the case of denial of the appeal, the Vice President will notify the complainant of his/her right to complain to US Health and Human Services. • The Vice President may allow the involved administrator to file an opposing view of the amendment in the health record. Page 72 Workers Compensation Job related injury or illness may qualify you for compensation for loss of income or leave accruals. The college is a member of the Rensselaer County Workers Compensation Pool administered by Rensselaer County and benefits are prescribed by NYS law. Basic operation of the law includes: • • • • • The requirement that a case be initiated by the filing of an incident report with the college through the College Health Service or the Public Safety Office [if Health Service is closed] and Office of Human Resources to be forwarded to the current consultant, Benetech, Inc. Need to report the claim in writing on forms provided by the college within thirty days of occurrence. Use of accrued sick leave ( or other leaves once sick leave is exhausted) to cover pay while absent until the claim is adjudicated. Awards resulting in restoration of leave accruals and or actual dollar awards in cases of disabilities. Compensation available directly from the system when college leaves are exhausted or the injured individual so chooses. When returning from an injury, hospitalization, any surgery or protracted illness, all employees must report first to the College Health Service to submit physician’s clearance to resume job duties. In some cases, the College Physician or Health Service Director may wish to discuss or examine the condition. This process is necessary to protect both college and employee. In general “light duty” is not allowed. Page 73 PL E AM EX Page 74 STATE OF NEW YORK WORKERS’ COMPENSATION BOARD 100 BROADWAY-MENANDS ALBANY, NY 12241 (877) 632-4996 You were injured at work. What now? The New York State Workers’ Compensation Board has received notice you suffered a workplace injury or illness, so we’re preparing a workers’ compensation case in your name. You may have already received medical treatment. If you haven’t, you should seek medical care as soon as possible. A Worker’s Responsibilities You must tell your employer, in writing, when, where and how you were injured. Do this within 30 days of injury. Medical reports are necessary for your case. Advise your doctors that you have a workrelated injury, and give the name of your employer. Do not pay for your care yourself or use other health insurance. Tell your doctor to file reports with the Board and with your employer or its insurance carrier. If your case is disputed, the Board needs a medical report on your injury to begin resolving your claim. Starting a Case Once your employer knows of your injury, it must notify this Board by filing a C-2 form. You should file an employee claim (C-3 form) reporting your injury as soon as possible. (You must notify the Board of your injury or illness within two years.) If you injured the same body part before, or had a similar illness, you must also file a Form C-3.3. If you haven’t already filed a C-3 or C-3.3 (if necessary), there are three ways to do it. Visit www.wcb.state.ny.us/content/main/onthejob/howto.jsp to complete the form. Complete the enclosed paper forms, and mail them to the Board. Call 1-866-396-8314. A Board employee will complete the form with you. Health Care Bills Do not pay your doctor or hospital. Those bills are paid by the insurer unless the Board disallows your case. If your case is disputed, the providers are paid when the Board decides your case. If the Board decides against you, or if you don’t pursue a case, you will have to pay the doctor or hospital. Your employer’s insurance covers medically necessary drugs and equipment your doctor prescribes. You’re also entitled to carfare or necessary expenses incurred when traveling for treatment. (Get receipts for those expenses.) THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION Page 75 Claimant Information Packet Generally, you can choose any doctor authorized by the Board. You can also use occupational health clinics. However, if your employer’s insurer has a preferred provider organization to provide care for workers' compensation injuries, you must get your initial treatment from those providers. If that insurer also has a pharmacy or diagnostic network, you must get service within these networks. If the carrier uses these networks, it must also tell you its service providers and how to use them. Benefits for Lost Wages You are entitled to a portion of your lost wages if your injury affects you in one or more ways: 1. It keeps you from work for more than seven days; 2. Part of your body is permanently disabled; 3. Your pay is reduced because you now work fewer hours or do other work. An employer or insurer can accept your claim and begin paying your lost wage benefit promptly. Sometimes, employers and carriers dispute a claim. When that occurs, the Board strives to resolve most cases within 90 days. You may hire an attorney or licensed representative, who can be helpful with complex or disputed claims, but it isn’t required. The Board sets their fees and they will be deducted from your lost wages award. You or your family should not pay anything directly to your attorney or licensed representative. If your case is disputed, you may receive disability benefits while the case is heard. You’d pay them back out of your lost wages award. To get a DB-450 form, visit www.wcb.state.ny.us/content/main/forms/db450.pdf or a Board office, or call (800) 353-3092. Help is Available People sometimes need help getting back to work. Your employer may have a return to work program that can get you back to work in light duty or an alternative position while you heal. An injury can also cause family or financial problems. The Workers' Compensation Board has rehabilitation counselors and social workers to help. Call (877) 632-4996 for more assistance. What’s Next? Your employer or its insurance carrier will contact you if your claim is accepted. When that happens, your treatment will be paid and lost wage benefits begin. If your case is challenged, the Board will notify you about resolving the case. If more information is necessary, the Board will contact you and tell you how to file it. Important Contact Information Workers’ Compensation Board Disability Benefits NYS Bar Association Lawyer Referral and Information Service (877)632-4996 (800)353-3092 (800)342-3661 [email protected] www.WCB.State.NY.US [email protected]. NEW YORK STATE WORKERS' COMPENSATION BOARD Page 76 Employee Claim C-3 State of New York - Workers' Compensation Board Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. Type or print neatly. This form may also be filled out on-line at www.wcb.state.ny.us. WCB Case Number (if you know it): A. YOUR INFORMATION (Employee) 1. Name: 2. Date of Birth: ______/______/______ First 3. Mailing address: MI Number and Street/PO Box - 4. Social Security Number: 7. Do you speak English? Last City - Yes State Zip Code 5. Phone Number: (_____)_______________ 6. Gender: Male Female No If no, what language do you speak? B. YOUR EMPLOYER(S) 2. Phone Number: (_____)_______________ 1. Employer when injured: 3. Your work address: Number and Street 4. Date you were hired: _____/_____/_____ City State Zip Code 5. Your supervisor's name: 6. List names/addresses of any other employer(s) at the time of your injury/illness: 7. Did you lose time from work at the other employment(s) as a result of your injury/illness? Yes No C. YOUR JOB on the date of the injury or illness 1. What was your job title or description? 2. What types of activities did you normally perform at work?_________________________________________________________________ 3. Was your job? (check one) Full Time Part Time Seasonal 4. What was your gross pay (before taxes) per pay period? 6. Did you receive lodging or tips in addition to your pay? Volunteer Other:____________________ 5. How often were you paid? Yes No If yes, describe: D. YOUR INJURY OR ILLNESS 1. Date of injury or date of onset of illness: ______/______/______ 2. Time of injury: AM PM 3. Where did the injury/illness happen? (e.g., 1 Main Street, Pottersville, at the front door) 4. Was this your usual work location? Yes No If no, why were you at this location? 5. What were you doing when you were injured or became ill? (e.g., unloading a truck, typing a report) _______________________________ 6. How did the injury/illness happen? (e.g., I tripped over a pipe and fell on the floor) 7. Explain fully the nature of your injury/illness; list body parts affected (e.g., twisted left ankle and cut to forehead):______________________ C-3.0 (8-09) Page 1 of 2 THE WORKERS' COMPENSATION BOARD EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION Page 77 www.wcb.state.ny.us YOUR NAME:________________________________________________ First MI DATE OF INJURY/ILLNESS: ______/______/______ Last D. YOUR INJURY OR ILLNESS continued 8. Was an object (e.g., forklift, hammer, acid) involved in the injury/illness? Yes 9. Was the injury the result of the use or operation of a licensed motor vehicle? your vehicle If yes, employer's vehicle other vehicle If yes, what? No Yes No License plate number (if known): If your vehicle was involved, give name and address of your motor vehicle insurance carrier: 10. Have you given your employer (or supervisor) notice of injury/illness? Yes If yes, notice was given to: ____________________________________ 11. Did anyone see your injury happen? Yes No orally No in writing Date notice given: _____/_____/_____ Unknown If yes, list names:________________________________________ E. RETURN TO WORK Yes, on what date? _____/_____/_____ 1. Did you stop work because of your injury/illness? 2. Have you returned to work? Yes No If yes, on what date? _____/_____/_____ 3. If you have returned to work, who are you working for now? regular duty New employer Same employer 4. What is your gross pay (before taxes) per pay period? No , skip to Section F. limited duty Self employed How often are you paid? F. MEDICAL TREATMENT FOR THIS INJURY OR ILLNESS None received (skip to question F-5) 1. What was the date of your first treatment? ______/______/______ 2. Were you treated on site? Yes No 3. Where did you receive your first off site medical treatment for your injury/illness? Doctor's office Clinic/Hospital/Urgent Care none received Emergency Room Hospital Stay over 24 hours Name and address where you were first treated: Phone Number: (_____)_______________ 4. Are you still being treated for this injury/illness? Yes No Give the name and address of the doctor(s) treating you for this injury/illness: Phone Number: (_____)_______________ 5. Do you remember having another injury to the same body part or a similar illness? Yes No If yes, provide the names and addresses of the doctor(s) who treated If yes, were you treated by a doctor? Yes No you and COMPLETE AND FILE FORM C-3.3 TOGETHER WITH THIS FORM: 6. Was the previous injury/illness work related? Yes No If yes, were you working for the same employer that you work for now? Yes No I am hereby making a claim for benefits under the Workers' Compensation Law. My signature affirms that the information I am providing is true and accurate to the best of my knowledge and belief. Any person who knowingly and with INTENT TO DEFRAUD presents, causes to be presented, or prepares with knowledge or belief that it will be presented to, or by an insurer, or self-insurer, any information containing any FALSE MATERIAL STATEMENT or conceals any material fact, SHALL BE GUILTY OF A CRIME and subject to substantial FINES AND IMPRISONMENT. Employee's Signature: Print Name: Date: _____/_____/_____ On behalf of Employee: Print Name: Date: _____/_____/_____ An individual may sign on behalf of the employee only if he or she is legally authorized to do so and the employee is a minor, mentally incompetent or incapacitated. I certify to the best of my knowledge, information and belief, formed after an inquiry reasonable under the circumstances, that the allegations and other factual matters asserted above have evidentiary support, or are likely to have evidentiary support after a reasonable opportunity for further investigations or discovery. Signature of Attorney/Representative (if any): Print Name: ID No., if any: R C-3.0 (8-09) Page 2 of 2 Date: _______/_______/_______ Title: If Licensed Representative, License No.: Expiration Date: _______/_______/_______ Page 78 C-3.3 Limited Release of Health Information (HIPAA) State of New York - Workers' Compensation Board WCB Case No. (if you know it):___________________________ To Claimant: If you received treatment for a previous injury to the same body part or for an illness similar to the one described in your current Claim, fill out this form. This form allows the health care providers you list below to release health care information about your previous injury/ illness to your employer's workers' compensation insurer. The federal HIPAA law (Health Insurance Portability and Accountability Act of 1996) says you have a right to get a copy of this form. If you do not understand this form, talk to your legal representative. If you do not have a legal representative, the Advocate for Injured Workers at the Workers' Compensation Board can help you. Call: 800-580-6665. To Health Care Provider: A copy of this HIPAA-compliant release allows you to disclose health information. If you send records to the employer's workers' compensation insurer in response to this release, also mail copies to the Claimant's legal representative. (If no legal representative is listed below, send copies to the Claimant.) Health care providers who release records must follow New York state law and HIPAA. This release is: Voluntary. Your health care provider(s) must give you the same care, payment terms, and benefits, whether you sign this form or not. Limited. It gives your health care provider(s) permission to release only those health records that are related to the previous illness/condition you describe below. Temporary. It ends when your current claim for compensation is established or disallowed and all appeals are exhausted. Revocable. You can cancel this release at any time. To cancel, send a letter to the health care provider(s) listed on this form. Also, send a copy of your letter to your employer's workers' compensation insurer and the Workers' Compensation Board. Note: You may not cancel this release with respect to medical records already provided. For records only. It gives your health care provider(s) listed on this form permission to send copies of your health care records to your employer's workers' compensation insurer. This form does NOT allow your health care provider(s) to release the following types of information: HIV-related information Psychotherapy notes Alcohol/Drug treatment Mental Health treatment (unless you check below) Verbal information (your health care providers may not discuss your health care information with anyone) Any medical records released will become part of your workers' compensation file and are confidential under the Workers' Compensation Law. A. YOUR INFORMATION (Claimant) 1. Name:__________________________________________________________________ 2. Social Security Number:______-_____-______ 3. Mailing Address: _________________________________________________________________________________________________ 4. Date of Birth: ______/______/______ 5. Date of the current injury/illness: ______/_______/_______ 6. Current injury/illness, including all body parts injured:_____________________________________________________________________ ______________________________________________________________________________________________________________ 7. Your legal representative's name and address (if any):___________________________________________________________________ ______________________________________________________________________________________________________________ Check here if you allow your health care provider(s) to release mental health care information. B. YOUR HEALTH CARE PROVIDER(S) (List all health care providers who treated you for a previous injury to the same body part or similar illness. If more than 2 providers attach their contact information to this form.) 1. Provider:__________________________________________________________________ 2. Phone Number: (______)_______________ 3. Mailing Address: _________________________________________________________________________________________________ 4. Other provider (if any):_______________________________________________________ 5. Phone Number: (______)_______________ 6. Mailing Address:_________________________________________________________________________________________________ C. READ AND SIGN BELOW. I hereby request that the health care provider(s) listed above give my employer's workers' compensation insurer copies of all health records related to any previous injury/illness, to all body parts, described above. ____________________________________________________________________________________________________________ Claimant's signature (ink only -- use blue ballpoint pen, if possible.) Date If the claimant is unable to sign, the person signing on his/her behalf must fill out and sign below: ______________________________________________________________________________________________________________ Your name C-3.3 (12-09) Relationship to Claimant Signature (ink only -- use blue ballpoint pen, if possible.) Versión en español al reverso de la forma. Date Page 79 www.wcb.state.ny.us Divulgación limitada de información sobre la salud (HIPAA) Estado de NuevaYork - Junta de Compensación Obrera (WCB) C-3.3 WCB Case No. (if you know it) (Número de caso WCB [si lo sabe]) Al reclamante: Si usted recibió tratamiento por una lesión anterior en la misma parte del cuerpo o por una enfermedad similar a la que motiva ahora su reclamación, complete este formulario. Este formulario les permite a los proveedores de salud que usted señala a continuación divulgar a la compañía de seguros de compensación obrera de su empleador la información sobre su salud relacionada con su lesión/enfermedad anterior. La Ley federal HIPAA (Ley de portabilidad y responsabilidad del seguro de salud de 1996) establece que usted tiene derecho a recibir una copia de este formulario. Si no comprende este formulario, hable con su representante legal. Si no tiene un representante legal, el Representante de los obreros lesionados de la Junta de Compensación Obrera puede ayudarlo. Llame al 800-580-6665. Al proveedor de salud: Una copia de esta divulgación, redactada según lo que establece la ley HIPAA, le permite divulgar información sobre la salud. Si envía los registros al asegurador de compensación obrera del empleador en respuesta a la presente divulgación, también debe enviar por correo copias al representante legal del reclamante. (Si a continuación no se especifica un representante legal, envíe las copias al reclamante). Los proveedores de salud que divulgan los registros deben cumplir con las leyes del estado de Nueva York y la HIPAA. Esta divulgación es: Este formulario NO autoriza a su(s) proveedor(es) de Voluntaria. Su(s) proveedor(es) de salud deben otorgarle la misma salud a divulgar los siguientes tipos de información: atención, condiciones de pago y beneficios, independientemente de que usted firme este formulario o no. Limitada. Le otorga a su(s) proveedor(es) de salud permiso para divulgar Información relacionada con el VIH únicamente los registros médicos que se relacionen con la enfermedad/ afección anterior que usted describe a continuación. Notas de terapia psicológica Temporal. Termina cuando se otorgue o desestime su actual reclamación de compensación y se hayan agotado todas las apelaciones. Revocable. Usted puede cancelar esta divulgación en cualquier momento. Tratamientos por abuso de alcohol o drogas Para hacerlo, envíe una carta al (a los) proveedor(es) de salud que se indican en este formulario. Además, envíe una copia de su carta a la compañía de seguros de compensación obrera de su empleador y a la Junta Tratamiento de salud mental (a menos que usted lo de Compensación Obrera. Nota: No podrá cancelar esta divulgación en lo indique a continuación) que se refiere a registros médicos que ya se hayan provisto. Solamente para registros. Le otorga a su(s) proveedor(es) de salud que se Información verbal (sus doctores no pueden hablar indica(n) en este formulario permiso para enviar copias de sus registros de con nadie sobre su información de salud) salud a la compañía de seguros de compensación obrera de su empleador. Los registros médicos divulgados se incorporarán a su expediente de compensación obrera y son confidenciales conforme a la Ley de compensación obrera. CONTESTA LAS SIGUIENTES PREGUNTAS, EN INGLÉS SI ES POSIBLE, EN LOS ESPACIOS PROVISTOS Y FIRMA AL FRENTE DE LA FORMA. A. YOUR INFORMATION (Claimant) INFORMACIÓN PERSONAL (Reclamante) 1. Name (Nombre) 2. Social Security Number (Número de seguro social) 3. Mailing Address (Dirección postal) 4. Date of Birth (Fecha de nacimiento) 5. Date of the current injury/illness (Fecha de la lesión/enfermedad actual) 6. Current injury/illness, including all body parts injured (Descripción de la lesión/enfermedad actual, incluyendo todas las partes del cuerpo lesionadas) 7. Your legal representative's name and address (if any) (Nombre y dirección de su representante legal [si corresponde]) Check here if you allow your health provider(s) to release mental health care information. (Marque aquí si autoriza a su(s) proveedor(es) de salud a divulgar información sobre tratamientos de salud mental.) B. YOUR HEALTH CARE PROVIDERS (List all health care providers who treated you for a previous injury to the same body part or similar illness. If more than 2 providers, attach their contact information to this form. SU(S) PROVEEDOR(ES) DE SALUD (Enumere todos los proveedores de salud que le han tratado por lesiones previas a las mismas areas del cuerpo ó por enfermedades semejantes.Si son más de 2 proveedores, adjunte su información de contacto a este formulario.) 1. Provider (Proveedor de salud) 2. Phone Number (No de teléfono) 3. Mailing Address (Dirección postal) 4. Other provider (if any) (Otro proveedor [si corresponde]) 5. Phone Number (No de teléfono) 6. Mailing Adress (Dirección postal) C. READ AND SIGN BELOW I hereby request that the health care provider(s) listed above give my employer's workers' compensation insurer copies of all health records related to any previous injury/illness, to all body parts, described above. LEA Y FIRME A CONTINUACIÓN. Por la presente solicito que los proveedores de salud aquí enumerados le provean al asegurador de compensación obrera de mi patrono copias de todos los records médicos relacionados a cualquier lesión/enfermedad aquí enumeradas. If the claimant is unable to sign, the person signing on his/her behalf must fill out and sign below: (Si el reclamante no puede firmar, la persona que firme el formulario en su nombre y representación debe llenar y firmar a continuación) xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Claimant's signature (Firma del reclamante ) use solo tinta - preferiblemente azul Date (Fecha) xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Your name (Su nombre) Relationship to Claimant (Relación con el reclamante) Signature(Firma) Date(Fecha) C-3.3 (12-09) Page 80 www.wcb.state.ny.us Instructions for Completing Form C-3, “Employee Claim” Please complete this form and send it to your local Workers' Compensation Board district office (DO) to apply for workers' compensation benefits. The addresses are listed at the bottom of these instructions. If you need additional help in completing this form, contact the Worke rs' Compensation Board at 1-877-632-4996. You may also fill this form out online at: http:// www.wcb.state.ny.us/ If you do not have or know your Workers' Compensation Board Case Number, please leave this field blank. It is not required to process your claim. Remember to enter your name and the date of your injury/illness on the top of page two. Section A - Your Information (Employee): Item 1: Enter your full name, including first name, middle initial, and last name. Item 2: Enter your date of birth in month/day/year format. Include the four digit year. Item 3: Enter your mailing address, including P.O. Box, if applicable, city or town, state, and Zip code. Item 4: Enter your Social Security Number. This is very important to help service your claim faster. Item 5: Indicate the primary contact phone number, including area code. This may include a cell phone number. Item 6: Indicate your gender (Male or Female). Item 7: Check Yes if you can speak and understand English. If not, then check No and indicate which language you speak. Section B - Your Employer(s): Item 1: Indicate the employer you were working for at the time you were injured or became ill. Item 2: Enter the phone number for this employer, either a primary contact number or the number for your supervisor. Item 3: Enter the employer's address, including P.O. Box, if applicable, city or town, state, and Zip code. Item 4: Indicate the date you were hired by this employer. Item 5: Enter your direct supervisor's name, whom you report to on a regular basis. Item 6: If you have more than one job, please indicate the names and addresses of all other employers you work for besides the one you were injured at. Please attach a separate sheet if you need more room. Item 7: Check Yes if you lost time from any of your other jobs as a result of your injury or illness; otherwise, check No. Section C - Your Job on the Date of the Injury or Illness: Item 1: Indicate your current job title or job description (e.g., warehouse worker). Item 2: Indicate your typical work activities for this job (e.g., keeping inventory, unloading trucks, etc.). Item 3: Check the type of job you had. Item 4: Enter your gross pay (before taxes) per pay period. Item 5: Indicate how often you received a paycheck (weekly, bi-weekly, etc.). Item 6: Indicate if you received any tips or lodging in addition to your regular pay. If you did, describe them. Section D - Your Injury or Illness: Item 1: Enter the date when you were injured or the first date you noticed you became ill. Enter the date in month/day/year format. Include the four digit year. If this is an illness or occupational disease, then skip item 2. Item 2: Enter the time when the injury occurred. Check whether it was AM or PM. Item 3: Indicate the location where the injury/illness occurred, including the address of the building and the physical location in the building where the injury/illness happened. Item 4: Check whether this was your normal work location. If it was not, explain why you were at this location. Item 5: Describe in detail what you were doing at the time of the injury/illness (e.g., unloading boxes from a truck by hand). This explains the events leading up to the injury. Item 6: Describe in detail how the injury/illness occurred (e.g., I was lifting a heavy box off a truck). This should include all people and events involved in the injury/illness. Item 7: Indicate fully the nature and extent of your injury/illness, including all body parts injured. Be as specific as possible. (e.g., I strained my back trying to lift a heavy box. It hurts to bend over or hold even lighter objects now.) Item 8: Indicate if some object was involved in the accident OTHER THAN a licensed motor vehicle. Other objects may include a tool (e.g., hammer), a chemical (e.g., acid), machinery (e.g., forklift or drill press), etc. Item 9: Indicate if a licensed motor vehicle was involved in the accident. If so, check if the motor vehicle involved was yours, your employer's, or a third party's. Include the license plate number (if known). If your vehicle was involved, fill out the name and address of your automobile liability insurance carrier. Item 10: Check if you gave your employer or supervisor notice of your injury or illness. If so, indicate who you gave notice to as well as if it was orally or in writing. Include the date you gave notice. Item 11: Check if anyone else saw the injury happen. If anyone did see it, include their name(s). Section E - Return to Work: Item 1: If you stopped working as a result of your work-related injury/illness, check Yes and indicate on what date you stopped working. If you have not stopped working, check No and skip to the next section. Page 81 C-3.0 (3-09) Section E - Return to Work (cont): Item 2: If you have since returned to work, check Yes. Also indicate on what date you started working again, as well as if you have returned to your Normal Duties or if you are on Limited or Restricted Duty. (If you have not returned to your full pre-injury or illness work duties, then you are on Limited Duty.) Item 3: If you have returned to work, indicate who you are working for now. Item 4: Enter your gross pay (before tax pay) per pay period for the job you are working at now. Indicate how often you are receiving a paycheck (weekly, bi-weekly, etc.). Section F - Medical Treatment for This Injury or Illness: Item 1: If you did not receive medical treatment for this injury/illness, check None Received and skip to item 5. Otherwise, enter the date you first received treatment for this injury/illness and complete the rest of this section. Item 2: Check if you were first treated on the job for this injury or illness. Item 3: Check the location where you first received off site medical treatment for your injury or illness. Include the name and address of the facility as well as the phone number (including area code). Item 4: If you are still receiving ongoing treatment for the same injury or illness, check Yes and indicate the name and address of the doctor(s) providing treatment as well as the phone number (including area code); otherwise check No. Item 5: If you believe you already had an injury to the same body part or a similar illness, check Yes and indicate if you were treated by a doctor for this injury or illness. If you were treated by a doctor, indicate the name(s) and address(es) of the doctor(s) whom provided care and complete and file Form C-3.3 together with this form. Item 6: If you had a previous injury or illness, check if your previous injury or illness was work-related. If Yes, check if the injury or illness happened while working for your current employer. Sign Form C-3 in the place provided for "Employee's Signature on page 2, print your name, and enter the date you signed the form. If a third-party is signing on behalf of the employee, that person should sign on the second signature line. If you have legal representation, your representative must complete and sign the attorney/representative's certification section on the bottom of page 2. What Every Worker Should Do in Case of On-The-Job Injury or Occupational Disease: 1. 2. 3. 4. 5. 6. Immediately tell your employer or supervisor when, where and how you were injured. Secure medical care immediately. Tell your doctor to file medical reports with the Board and with your employer or its insurance carrier. Make out this claim for compensation and send it to the nearest Workers' Compensation Board Office. (See below.) Failure to file within two years after the date of injury may result in your claim being denied. If you need help in completing this form, telephone or visit the nearest Workers' Compensation Board Office listed below. Go to all hearings when notified to appear. Go back to work as soon as you are able; compensation is never as high as your wage. Your Rights: 1. 2. 3. 4. 5. 6. 7. Generally, you are entitled to be treated by a doctor of your choice, provided he/she is authorized by the Board. If your employer is involved in a preferred provider organization (PPO) arrangement, you must obtain initial treatment from the preferred provider organization which has been designated to provide health care services for workers' compensation injuries. DO NOT pay your doctor or hospital. Their bills will be paid by the insurance carrier if your case is not disputed. If your case is disputed, the doctor or hospital must wait for payment until the Board decides your case. In the event you fail to prosecute your case or the Board decides against you, you will have to pay the doctor or hospital. You are also entitled to be reimbursed for drugs, crutches, or any apparatus properly prescribed by your doctor and for carfares or other necessary expenses going to and from your doctor's office or the hospital. (Get receipts for such expenses.) You are entitled to compensation if your injury keeps you from work for more than seven days, compels you to work at lower wages, or results in permanent disability to any part of your body. Compensation is payable directly and without waiting for an award, except when the claim is disputed. Injured workers or dependents of deceased workers may represent themselves in matters before the Board or may retain an attorney or licensed representative to represent them. If an attorney or licensed representative is retained, his/her fee for legal services will be reviewed by the Board and if approved will be paid by the employer or insurance company out of any compensation benefits due. Injured workers or dependents of deceased workers should not directly pay anything to the attorney or licensed representative representing them in a compensation case. If you need help returning to work, or with family or financial problems because of your injury, contact the Workers' Compensation Board office nearest you and ask for a rehabilitation counselor or social worker. This form should be filed by sending directly to the appropriate WCB district office (DO) at the address listed below: Albany DO - 100 Broadway-Menands, Albany NY 12241 (866) 750-5157 (for accidents in the following counties: Albany, Clinton, Columbia, Dutchess, Essex, Franklin, Fulton,Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Ulster, Warren, Washington) Binghamton DO - State Office Building, 44 Hawley Street, Binghamton NY13901 (866) 802-3604 (for accidents in the following counties: Broome, Chemung, Chenango, Cortland,Delaware, Otsego, Schuyler, Sullivan, Tioga, Tompkins) Buffalo DO - 369 Franklin Street, Buffalo NY 14202 (866) 211-0645 (for accidents in the following counties: Cattaraugus, Chautauqua, Erie, Niagara) Rochester DO - 130 Main Street West, Rochester NY 14614 (866) 211-0644 (for accidents in the following counties: Allegany, Genesee, Livingston, Monroe, Ontario, Orleans,Seneca, Steuben, Wayne, Wyoming, Yates) Syracuse DO - 935 James Street, Syracuse NY 13203 (866) 802-3730 (for accidents in the following counties: Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga,Oswego,St. Lawrence) Downstate Centralized Mailing - PO Box 5205, Binghamton NY, 13902-5205 for all DO's in NYC (800) 877-1373; in Hempstead (866) 805-3630; in Hauppauge (866) 681-5354; in Peekskill (866) 746-0552 (for accidents in the following counties: Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester) Page 82 C-3.0 (8-09) STATEWIDE FAX LINE: 877-533-0337 Health Insurance If you are employed in a qualifying position which includes health insurance as a benefit the following plan summaries and associated rates should provide sufficient information for decisions about appropriate coverage. If you decline the insurance coverage the College has a “waiver” or “opt‐out” payment of $50 per month which is paid out in December of each calendar year for the preceding January‐December period. The College currently offers four (4) different carriers: Capital District Physicians’ Health Plan [CDPHP], MVP, Community Blue, and Traditional Blue Shield Indemnity. Part‐time faculty teaching at least twelve (12) contact hours may enroll only in CDPHP at 102% of full premium cost. Health Insurance premium deductions are taken a month in advance i.e. January deductions pay for February coverage, February deductions pay for March coverage, etc… therefore as you begin your coverage, your first payroll deduction may be larger than a normal bi‐weekly amount in order to get you on schedule with your payments. The employee’s share of Health Insurance premium costs are established through the collective bargaining process. If you have any questions on your deductions please contact the Office of Human Resources. The following plan parameters are subject to change and any specific coverage questions should be directed to the Office of Human Resources or to our third party administrator: Capital Benefits Consulting. Prescription drug coverage is Creditable Coverage with respect to Medicare Part D for all plans. Page 83 BLUE SHIELD COMMUNITY BLUE 202 PLUS This is a summary only. It is not intended to be a complete description of benefits which are governed by the Contract between the College and the insurer. In Network Out of Network None $500 Individual/$1000 Family Annual Deductible Coinsurance Annual Out of Pocket Maximum Annual Maximum Benefit Lifetime Maximum Benefit Dependent Coverage Inpatient Hospitalization Outpatient Hospital Services Outpatient Hospital Surgery Well Child Care Annual Gynecological Visit Routine Mammograms Maternity Immunizations Annual Physical Exam Primary Care Physician Office Visit Specialist Office Visit Diagnostic Radiology Diagnostic Laboratory Tests Routine Vision Exam Dental check-up routine (every 6 months) Physical, Speech and Occupational Therapy Chiropractic Mental Health Inpatient Mental Health Outpatient Alcohol/Substance Abuse Inpatient Alcohol/Substance Abuse Outpatient Emergency Room Care Ambulance* Urgent Care Durable Medical Equipment Prescription Drugs (Retail) 30 day supply Prescription Drugs (Mail Order) 90 day supply Inpatient Hospitalization Precertification Primary Care Physician Required Specialty Referral Required None $6350 Individual/$12700 Family Unlimited Unlimited to Age 26 Covered In Full $10, $15 or $20 co-pay $75 co-pay Covered In Full Covered In Full Covered In Full Covered In Full Coverage Varies Covered In Full $0, $5 or $10 co-pay $10, $15 or $20 co-pay $10, $15 or $20 co-pay Covered In Full Once every 2 years, covered in full $10, $15 or $20 co-pay $10, $15 or $20 co-pay (30 visits combined) $10, $15 or $20 co-pay Covered In Full $10, $15 or $20 co-pay Covered In Full $10, $15 or $20 co-pay $50 co-pay $50 co-pay $10 co-pay 50% co-insurance $10 Generic/$20 Brand/$40 Non-Formulary $25 Generic/$50 Brand/$100 Non-Formulary Yes Yes No You pay 20% $5,000 Individual/ $10,000 Family Unlimited Unlimited to Age 26 Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Covered In Network Only Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Covered In Network Only Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Not covered Not covered Deductible and 20% Coinsurance Deductible and 20% Coinsurance 30 Days Deductible and Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance Deductible and 20% Coinsurance $50 co-pay $50 co-pay $10 co-pay Deductible and 50% Coinsurance $10 Generic/$20 Brand/$40 Non-Formulary N/A Yes No No NOTE* The current 2015 Blue Shield plan option automatically includes out of network benefits. You have a choice of Primary Care/Specialist co-pays: $10/$10; $0/$20 or $5/$15. *Ambulance - Please note: Must be deemed a trul life threatening emergency Prescription drug coverage is Creditable Coverage with respect to Medicare Part D. Participating Provider information is available by visiting their website at www.bsneny.com. Your selection is binding for one year until the next open enrollment period. Page 84 MVP HEALTH PLAN NY CO-PLAN 15 PLUS This is a summary only. It is not intended to be a complete description of benefits which are governed by the Contract between the College and the insurer. In Network Annual Deductible Coinsurance Annual Out of Pocket Maximum Annual Maximum Benefit Lifetime Maximum Benefit Dependent Coverage Inpatient Hospitalization Outpatient Hospital Surgery Well Child Care & Immunizations Annual Gynecological Visit Routine Mammograms Maternity Annual Physical Exam Physician Office Visit Specialist Office Visit Diagnostic Radiology Diagnostic Laboratory Tests Dental - (Preventative for children) Routine Vision Exam Physical/Speech/Occupational Therapy Chiropractic Durable Medical Equipment Mental Health Inpatient Mental Health Outpatient Alcohol/Substance Abuse Inpatient Alcohol/Substance Abuse Outpatient Emergency Room Care Ambulance Urgent Care Prescription Drugs (Retail) 30 day supply Prescription Drugs (Mail Order) 90 day supply Inpatient Hospitalization Precertification Primary Care Physician Required Specialty Referral Required None None Unlimited Unlimited Unlimited to Age 26 Covered In Full $15 co-pay Covered In Full Covered In Full Covered In Full Covered In Full Covered In Full $15 co-pay $15 co-pay $15 co-pay Covered In Full Exam & x-ray for children to age 19, $25 co-pay One every 2 years, $15 co-pay $15 co-pay (30 visits combined) $15 co-pay 50% co-insurance Covered In Full $15 co-pay Covered In Full $15 co-pay $50 co-pay Covered in Full $15 co-pay $5 Generic/$20 Brand/$40 Non-Formulary $12.50 Generic/$50 Brand/$100 Non-Formulary Yes Yes No Prescription drug coverage is Creditable Coverage with respect to Medicare Part D. MVP is a traditional HMO. You must select a Primary Care Physician, however, effective 1/1/09 you no longer need to obtain referrals for specialty care. There are no out-of-network benefits unless specifically authorized in advance by MVP. Participating Provider information is available through their web site at www.mvphealthplan.com. Your selection is binding for one year until the next open enrollment period. Page 85 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (HMO) This is a summary only. It is not intended to be a complete description of benefits which are governed by the Contract between the College and the insurer. 2015 AVID CARE $25 In Network Annual Deductible Coinsurance Annual Out of Pocket Maximum Annual Maximum Benefit Lifetime Maximum Benefit Dependent Coverage Inpatient Hospitalization Outpatient Hospital Surgery Well Child Care & Immunizations Annual Gynecological Visit Routine Mammograms Maternity - (Physician Services) Annual Physical Exam Physician Office Visit Specialist Office Visit Diagnostic Radiology Diagnostic Laboratory Tests Dental Routine Vision Exam Physical & Occupational Therapy Speech Therapy Chiropractic Durable Medical Equipment Mental Health Inpatient Mental HealthOutpatient Alcohol/Substance Abuse Inpatient Alcohol/Substance Abuse Outpatient Emergency Room Care Ambulance Urgent Care Prescription Drugs (Retail) 30 day supply Prescription Drugs (Mail Order) 90 day supply Inpatient Hospitalization Precertification Primary Care Physician Required Specialty Referral Required None None $6600 Individual/$13200 Family Unlimited Unlimited to Age 26 $240 Co-pay $25 co-pay Covered In Full Covered In Full Covered In Full Covered In Full Covered In Full $25 co-pay $25 co-pay $25 co-pay, waived at preferred facilities $25 co-pay,waived at preferred facilities Not covered One every 2 years, $25 copay $25 co-pay, 120 days $25 co-pay, 60 days $25 co-pay 20% co-insurance $240 co-pay $25 co-pay $240 co-pay $25 co-pay/visit $100 co-pay $100 co-pay $35 per visit $5 Generic/$20 Brand/$35 Non-Formulary $12.50 Generic/$50 Brand/$87.50 Non-Formulary Yes Yes Yes Reimbursement Amount $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $50 $50 $10 NOTE* You are eligible to receive reimbursement for the difference between the 2005 Avid 15 plan co-pays and the new 2015 Avid 25 plan co-pays. You must keep and submit all applicable receipts within 20 months of the date of service. Submission forms are available on the Office of Human Resources website. Prescription drug coverage is Creditable Coverage with respect to Medicare Part D. CDPHP is a traditional HMO. You must select a Primary Care Physician and obtain referrals for specialty care. There are no outof-network benefits unless specifically authorized in advance by CDPHP. Participating Provider information is available by visiting their web site at www.cdphp.com. Your selection is binding for one year until the next open enrollment period. Page 86 BLUE SHIELD/ENVISION INDEMNITY PLAN This is a summary only. It is not intended to be a complete description of benefits which are governed by the Contract between the College and the insurer. $100 Individual/$300 Family for Major Medical Benefits $240 Individual/$720 Family for IP&OP Hospital Benefits 20% of Usual & Customary When 20% coinsurance reaches $500 Unlimited Unlimited to Age 26 Annual Deductible Coinsurance Lifetime Out of Pocket Maximum Annual Maximum Benefit Lifetime Maximum Benefit Dependent Coverage HOSPITAL COVERAGE There is a $240 Deductible that is reimbursed by HVCC Inpatient Hospitalization Covered In Full - 365 days Outpatient Hospital Services Covered In Full Outpatient Hospital Surgery Covered In Full Mental Health Inpatient Covered In Full - 365 days Alcohol/Substance Abuse Inpatient Covered In Full Maternity Covered In Full Diagnostic Radiology Covered In Full Diagnostic Laboratory Tests Covered In Full Emergency Room Covered in Full MEDICAL/SURGICAL COVERAGE IN NETWORK Covered In Full Covered In Full Covered In Full Covered In Full Covered In Full Covered In Full Diagnostic Radiology Diagnostic Laboratory Tests Maternity Surgical Procedures Routine Mammograms Anesthesia Medical/Surgical benefits for covered services received from out-of-network providers are paid at the in-network fee schedule with any balances paid as a Major Medical Benefit subject to deductible and coinsurance. MAJOR MEDICAL COVERAGE Primary Care Physician Office Visit Specialist Office Visit Durable Medical Equipment Urgent Care Rehabilitation Services (PT,OT,ST) Chiropractic Dental Routine Vision Exam Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance limited benefit limited benefit OTHER COVERAGE Alcohol/Substance Abuse Outpatient Mental Health - outpatient Well Child Care & Immunizations Annual Gynecological Visit Adult Immunizations Annual Physical Exam Prescription Drugs Inpatient Hospitalization Precertification Primary Care Physician Required Specialty Referral Required *Mandates Covered in Full* Covered in Full* Covered in Full* Covered in Full* Coverage varies* Covered in Full* $5 Generic/$20 Brand No No No Prescription drug coverage is Creditable Coverage with respect to Medicare Part D. This is a traditional Indemnity Plan. It does not require selection of a Primary Care Physician nor do you need a referral for specialty care. You may select any licensed provider. However, benefits are maximized if you use participating providers. Physician visits are subject to deductible and coinsurance and you may need to submit claim forms in some cases. Your selection is binding for one year until the next open enrollment period. Page 87 Hudson Valley Community College Classified Staff Are you a Classified Staff member covered under the NIEU Collective Bargaining Agreement first employed after August 14, 2014 in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Monthly Monthly Total Monthly Per Pay Period Employee Share Employer Share Premium 86.67 173.34 982.24 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 2,139.41 3,085.73 48.65 97.30 551.38 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 52.77 105.54 597.99 703.53 CDPHP Individual Coverage MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 194.58 389.16 551.37 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 Are you a Classified Staff member covered under the NIEU Collective Bargaining Agreement first employed after March 23, 2007 and prior to August 14, 2014 who has been employed in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Monthly Monthly Total Monthly Per Pay Period Employee Share Employer Share Premium 57.78 115.56 1,040.02 1,155.58 Traditional Blue Shield Indemnity Individual Coverage 473.16 946.32 2,139.41 3,085.73 32.43 64.86 583.82 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 35.18 70.36 633.17 703.53 221.86 443.72 1,315.11 1,758.83 Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage MVP Family Coverage Community Blue Shield Individual Coverage 178.36 356.72 583.81 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 Are you a Classified Staff member covered under the NIEU Collective Bargaining Agreement first employed prior to March 23, 2007 who has been employed in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Monthly Monthly Total Monthly Per Pay Period Employee Share Employer Share Premium 1,155.58 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage 145.92 Community Blue Shield Family Coverage 318.44 CDPHP Individual Coverage 2,139.41 3,085.73 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 291.84 648.69 940.53 636.88 1,734.09 2,370.97 Page 88 Hudson Valley Community College Classified Staff Are you a Classified Staff member covered under the UPSEU Collective Bargaining Agreement employed in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Monthly Monthly Total Monthly Per Pay Period Employee Share Employer Share Premium 86.67 173.34 982.24 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 2,139.41 3,085.73 48.65 97.30 551.38 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 52.77 105.54 597.99 703.53 CDPHP Individual Coverage MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 194.58 389.16 551.37 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 Page 89 Hudson Valley Community College Department Chairs Are you a Department Chair first employed for or after 2009/2010 academic year not yet tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Traditional Blue Shield Indemnity Individual Coverage Per Pay Monthly Period Employee Share 86.67 173.34 Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 2,139.41 3,085.73 48.65 97.30 551.38 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 52.77 105.54 597.99 703.53 MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 194.58 389.16 551.37 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 CDPHP Individual Coverage Monthly Employer Share 982.24 Total Monthly Premium 1,155.58 Are you a Department Chair first employed for or after 2009/2010 academic year, tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Traditional Blue Shield Indemnity Individual Coverage Per Pay Monthly Period Employee Share 57.78 28.89 Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 2,139.41 3,085.73 CDPHP Individual Coverage 16.22 199.59 32.44 616.24 648.68 399.18 1,222.50 1,621.68 17.59 221.86 35.18 668.35 703.53 443.72 1,315.11 1,758.83 324.30 616.23 940.53 636.88 1,734.09 2,370.97 CDPHP Family Coverage MVP Individual Coverage MVP Family Coverage Community Blue Shield Individual Coverage Community Blue Shield Family Coverage 162.15 318.44 Monthly Employer Share 1,097.80 Total Monthly Premium 1,155.58 Are you a Department Chair first employed prior to September 1, 2009 in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium Traditional Blue Shield Indemnity Individual Coverage 1,155.58 1,155.58 Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage Community Blue Shield Family Coverage CDPHP Individual Coverage 2,139.41 3,085.73 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 145.92 291.84 648.69 940.53 318.44 636.88 1,734.09 2,370.97 Page 90 Educational Opportunity Center Alliance Are you an EOC Alliance member (including Faculty & Counselors) employed after September 1, 2011 in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 115.56 231.12 924.46 1,155.58 Traditional Blue Shield Indemnity Individual Coverage 473.16 946.32 2,139.41 3,085.73 64.87 129.74 518.94 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 70.36 140.72 562.81 703.53 MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 210.80 421.60 518.93 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage Are you an EOC Alliance member (including Faculty & Counselors) first employed subsequent to September 1, 2001 and prior to September 1, 2011 and not yet tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 231.12 462.24 693.34 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage 617.15 1,234.30 1,851.43 3,085.73 CDPHP Individual Coverage 129.74 259.48 389.20 648.68 CDPHP Family Coverage 324.34 648.68 973.00 1,621.68 MVP Individual Coverage 140.71 281.42 422.11 703.53 MVP Family Coverage 351.77 703.54 1,055.29 1,758.83 Community Blue Shield Individual Coverage 275.67 551.34 389.19 940.53 Community Blue Shield Family Coverage 474.19 948.38 1,422.59 2,370.97 Are you an EOC Alliance member (including Faculty & Counselors) first employed prior to September 1, 2011 and/or tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 1,155.58 1,155.58 Traditional Blue Shield Indemnity Individual Coverage 473.16 946.32 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage Community Blue Shield Family Coverage Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage 2,139.41 3,085.73 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 145.92 291.84 648.69 940.53 318.44 636.88 1,734.09 2,370.97 Page 91 Hudson Valley Community College Faculty Are you a Faculty member first employed for or after 2010/2011 academic year, in a qualifying position which includes health insurance benefits? Then your health insurance rates are: Per Pay Period Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage 57.78 473.16 32.43 CDPHP Family Coverage 199.59 MVP Individual Coverage 35.18 MVP Family Coverage 221.86 Community Blue Shield Individual Coverage 178.36 Community Blue Shield Family Coverage 318.44 Monthly Employee Share Monthly Employer Share Total Monthly Premium 115.56 946.32 1,040.02 2,139.41 1,155.58 3,085.73 64.86 399.18 583.82 1,222.50 1,621.68 70.36 443.72 633.17 1,315.11 1,758.83 356.72 636.88 583.81 1,734.09 648.68 703.53 940.53 2,370.97 Are you a Faculty member first employed for or after the 2001/2002 academic year and prior to the 2010/2011 academic year and not yet tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage Per Pay Period Monthly Employee Share Monthly Employer Share 86.67 173.34 982.24 1,155.58 473.16 946.32 2,139.41 3,085.73 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage 145.92 Community Blue Shield Family Coverage 318.44 CDPHP Individual Coverage Total Monthly Premium 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 291.84 648.69 940.53 636.88 1,734.09 2,370.97 Are you a Faculty member first employed prior to the 2010/2011 academic year, tenured in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Period Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage Monthly Employee Share Total Monthly Premium - - 1,155.58 1,155.58 473.16 946.32 2,139.41 3,085.73 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage 145.92 Community Blue Shield Family Coverage 318.44 CDPHP Individual Coverage Monthly Employer Share 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 291.84 648.69 940.53 636.88 1,734.09 2,370.97 Page 92 Hudson Valley Community College Non-Teaching Professionals Are you a Non Teaching Professional covered under the NTP Collective Bargaining Agreement first employed after November 6, 2014 in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 86.67 173.34 982.24 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage 473.16 946.32 2,139.41 3,085.73 48.65 97.30 551.38 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 52.77 105.54 597.99 703.53 MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 194.58 389.16 551.37 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 CDPHP Individual Coverage Are you a Non Teaching Professional covered under the NTP Collective Bargaining Agreement first employed prior to November 6, 2014 in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 28.89 57.78 1,097.80 1,155.58 Traditional Blue Shield Indemnity Individual Coverage 473.16 946.32 2,139.41 3,085.73 16.22 32.44 616.24 648.68 CDPHP Family Coverage 199.59 399.18 1,222.50 1,621.68 MVP Individual Coverage 17.59 35.18 668.35 703.53 221.86 443.72 1,315.11 1,758.83 Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage MVP Family Coverage Community Blue Shield Individual Coverage 162.15 324.30 616.23 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 Are you a Non Teaching Professional not covered under the NTP Collective Bargaining Agreement employed less than 36 Months in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 144.45 288.90 866.68 1,155.58 Traditional Blue Shield Indemnity Individual Coverage Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage CDPHP Family Coverage 473.16 946.32 2,139.41 3,085.73 81.08 162.16 486.52 648.68 202.71 405.42 1,216.26 1,621.68 87.95 175.90 527.63 703.53 MVP Family Coverage 221.86 443.72 1,315.11 1,758.83 Community Blue Shield Individual Coverage 145.92 291.84 648.69 940.53 Community Blue Shield Family Coverage 318.44 636.88 1,734.09 2,370.97 MVP Individual Coverage Page 93 Hudson Valley Community College Non-Teaching Professionals Are you a Non Teaching Professional not covered under the NTP Collective Bargaining Agreement employed more than 36 Months in a qualifying position which includes health insurance as a benefit? Then your health insurance rates are: Per Pay Monthly Monthly Total Monthly Period Employee Share Employer Share Premium 1,155.58 1,155.58 Traditional Blue Shield Indemnity Individual Coverage 473.16 946.32 - - CDPHP Family Coverage 199.59 399.18 MVP Individual Coverage - - MVP Family Coverage 221.86 Community Blue Shield Individual Coverage Community Blue Shield Family Coverage Traditional Blue Shield Indemnity Family Coverage CDPHP Individual Coverage 2,139.41 3,085.73 648.68 648.68 1,222.50 1,621.68 703.53 703.53 443.72 1,315.11 1,758.83 145.92 291.84 648.69 940.53 318.44 636.88 1,734.09 2,370.97 Page 94 Flex Spending Accounts A Flexible Spending Account (FSA) is a tax-favored program that allows employees to pay for eligible out-of-pocket health care and dependent care expenses with pre-tax dollars. By using pre-tax dollars to pay for eligible health care and dependent care expenses, an FSA gives you an immediate discount on these expenses that equals the taxes you would otherwise pay on that money. • • The Medical Expense Flexible Spending Account can be used to pay for qualified medical costs and health care expenses that are not paid by your health insurance plan or any other insurance. PLEASE NOTE: This cannot be used to pay for any type of insurance premiums, including long-term care insurance premiums. The Dependent Care Flexible Spending Account is to pay for eligible dependent care expenses such as child care for children under age 13 or day care for anyone who you claim as a dependent on your Federal tax return who is physically or mentally incapable of self-care so that you (and your spouse, if you are married) can work, look for work, or attend school full-time. Your participation in the Flex Spending Account is completely voluntary, and it’s important to remember that unlike other benefits, your FSA election is only effective for one Benefit Period. In other words, you must enroll each year that you choose to participate. If you do not enroll during Open Enrollment [December 1-31], you will not participate in the next Benefit Period, unless you experience a qualifying life event that allows you to make an election outside of Open Enrollment. The Benefit Period will always run from January 1 of the current Benefit Period through March 15 of the following year. This includes a 2 ½ month grace period from January 1 through March 15 of the following year. During the grace period, eligible expenses incurred from January 1 through March 15 of the following year can be applied towards your prior year's balance. The intent is to help account holders avoid forfeiting any of the funds they deposited in FSA accounts. It is important to carefully consider the amount you choose to elect. Eligibility to participate is contingent on an employee’s funding source and employment status; therefore please contact the Office of Human Resources to enquire about your ability to enroll. Page 95 Dental Insurance The Dental Benefits Plan described is made available to eligible employees. HVCC’s Dental Benefits Program has been designed to encourage you to maintain good dental care while keeping dental care expenses at a minimum. By visiting your dentist for check-ups on a regular basis (at least once a year) and receiving prompt treatment of small disorders when they are first discovered, you will be avoiding more serious dental problems from developing at a later date. This makes good sense from both a health and financial standpoint. The Dental Benefit Program allows you complete freedom of choice in the selection of any licensed dentist. In addition, you are not required to submit to a preliminary examination in order to establish your eligibility or the Dental Benefits Program. To determine if you are eligible for this Plan, please contact the Office of Human Resources. ELEIGIBILITY Benefits are available to all eligible employees on the effective date of the Dental Plan. The Office of Human Resources will determine your eligibility. New employees become eligible on the first day of the seventh month following the date of active employment. There is no payroll contribution for individual coverage. BASIC SCHEDULE OF ALLOWANCES Schedule of Allowances is published on the Office of Human Resources website. For each dental procedure listed, the plan will pay the Benefit Payable or the actual charge, whichever is less. TERMINATION OF BENEFITS Dental benefits will cease on the same day of the month you are removed from the payroll, or if you fail to make the required contributions, if any, toward the cost of your benefits. There are no benefits for dental services performed after termination of coverage. PARTICIPATING DENTISTS Participating Dentists are those dentists in this area who will accept, as payment in full, the Plan’s Schedule of Benefits. This service is made available as a convenience to you through BENETECH, the Plan Administrator. The list of Participating Dentists is subject to change at any time. There are instances when a Participating Dentist may not be able to perform a particular procedure for the prescribed maximum payment. In such cases, the Participating Dentist has agreed to notify you or your eligible dependent of any dollar difference prior to the actual commencement of treatment. Page 96 YOUR DENTIST The Dental Plan does not require that you go to a Participating Dentist for treatment. If you use a nonparticipating dentist for treatment, then you will be responsible for paying any difference between the amount charged by the dentist and the maximum payment under the Plan’s Schedule of Benefits. It is not the intention of the College to disturb the dentist-patient relationship, and the College will not, under ordinary circumstances, interfere with the free exercise of professional judgment by the dentist as to the care provided. There are instances when differences of opinion arise. If an employee disagrees with benefit payments under the Plan, he may present his disagreement to the College’s Office of Human Resources. If agreement is not reached, the disagreement will be presented to the Plan’s Administrator for review by a dentist, if necessary. The Plan Administrator’s decision shall be final. EXCLUSIONS The Dental Benefits Plan will not allow benefits for the following: 1) Loss or theft of a denture. 2) Extra duplicate prosthetic device. 3) Injuries, diseases or conditions, the treatment of which is available without cost to the person treated under the laws enacted by the legislature of any State or the Congress of the United States (such as Worker’s Compensation, Veteran’s Compensation, etc.) 4) Cosmetic dentistry. 5) Oral hygiene, dietary instructions, or education programs. 6) Any charge for failure to keep a scheduled appointment. 7) Orthodontics. 8) Any charges for appliances or restorations, other than full dentures, whose purpose is to alter vertical dimension, stabilize periodontically involved teeth or restorative occlusions. 9) Any charge for completing a claim form. 10) Services or supplies which do not meet accepted standards of dental practice or are experimental in nature. 11) Dental disease or defect incurred or resulting from war, declared or undeclared, military or naval service to any country, riot, civil disorder, insurrection or while committing a felonious act. 12) Dental mechanic or denturist, unless practicing according to applicable dental practice acts and related statutes. 13) Any service or appliance received from a dental or medical department maintained by an employer, a mutual benefit association, labor union, trustee or other similar person or group. 14) Any service unless rendered in connection with the care of an employee by a duly licensed dentist, and any service or appliance for which the patient incurs no dentist’s charge. 15) Any type of service or appliance not described in the Plan or in any Rider modifying the Plan. Page 97 CLAIM ADMINISTRATION Whenever you have an appointment with the dentist, the following steps should be taken: 1) Obtain an Attending Dentist’s Statement (claim form) from either the Office of Human Resources or your work location. Fully complete the form and sign the employee’s section of the claim form, indicating your name as employee, the name of the patient, your social security number, your complete home mailing address and fill in all the other information requested. Remember, an incomplete claim form will be returned to you for further information, which may cause a delay in processing the dental claim. 2) Give the claim form to the attending dentist. If dental work is anticipated to cost less than $200.00, have the dentist full complete his portion of the form and return it to BENETECH, PO Box 348, Wynantskill, NY, 12198-0348 once treatment has been rendered. If dental charges are anticipated to exceed $200.00, then ask the dentist to submit a Pre-treatment Estimate before the actual treatment begins. Pre-treatment Estimates will assist you and the dentist in determining what expenses are or are not covered under the Dental Plan. This will be an aid in eliminating any uncertainty regarding allowances payable and benefits remaining in the calendar year. BENETECH will complete the Pre-treatment Estimate and will return it to the attending dentist. The attending dentist will discuss the treatment and indicated benefits with you. While Pretreatment Estimates are not required, they certainly are recommended. If the dentist you go to is participating in the Dental Benefits Plan, it will be required that you inform the Participating Dentist of your enrollment in the College’s Plan. Notification will be accomplished by presenting the Dental Benefits Identification Card that has been issued to you. 3) BENETECH will pay the applicable benefit amount (for all completed dental work) to the attending dentist or directly to you, as indicated on the claim form. However, benefits are always payable to the dentist if such dentist is participating in the Plan. 4) For any dental work, it is a good idea to discuss the anticipated treatment plan and estimated cost before treatment begins. 5) When another dental appointment has been scheduled, merely obtain a new claim form for you and your dentist to complete. 6) The College reserves the right to deny payment of any claim submitted to the Dental Plan more than 90 days following the last date of treatment indicated on the claim form. COORDINATION OF BENEFITS If you are entitled to receive benefits from another group plan, benefits under this plan will be coordinated with the benefits from any of your other group plans so that up to 100% of the “allowable expenses” incurred during a calendar year will be paid by the plans. An “allowable expense” is any necessary, reasonable, and customary item of expense covered in full or in part under any one of the group plans involved. A “Plan” is considered to be any group insurance benefits or other arrangement of benefits for individuals in a group which provides dental benefits or services on an insured or an uninsured basis. Page 98 The College reserves the right to obtain and exchange benefit information from any other insurance company, organization, or individual to determine the applicability of the Coordination of Benefits provisions. When an overpayment has been made, the College has the right to recover the excess amount from the individual, insurance company, or organization to whom payment has been made. In order to obtain all of the benefits available, you should file claims under each plan. DENTAL CLAIMS QUESTIONS Dental claims will be processed and records stored at BENETECH’S Office. If you have a question concerning the status of a claim, benefit coverage, who was paid, the amount of payment, etc., then contact: Claims Manager BERNETECH P.O. Box 348 Wynantskill, NY 12198-0348 (518) 283-8500 or the Office of Human Resources. This communication is intended to explain dental benefits in a non-technical language. It does not constitute the Master Agreement which is on file with the Office of Human Resources. Page 99 HUDSON VALLEY COMMUNITY COLLEGE DENTAL BENEFITS PLAN SCHEDULE OF ALLOWANCES PLAN ADMINISTERED BY DELTA DENTAL Effective January 1, 2015 Annual Maximum for all services - $1200 CODE DENTAL PROCEDURE CLASS DIAGNOSTIC Clinical Oral Examinations (Not more than one examination of either type in a 6 consecutive month period) 0120 PERIODIC ORAL EXAMINATION 0140 LIMITED ORAL EXAM - PROBLEM FOCUSED 0150 COMPHRENSIVE ORAL EVALUATION Radiographs (includes examination and diagnosis) 0210 INTRAORAL FMS & BITEWINGS - limited to one series in a 36 conseacutive month period 0220 INTRAORAL SINGLE FIRST FILM 0230 INTRAORAL EACH ADDITIONAL FILM 0240 INTRAORAL, OCCLUSAL, SGL FILM 0250 EXTRAORAL, SGL, FIRST FILM 0260 EXTRAORAL EACH ADDITIONAL FILM 0270 BITEWING - SINGLE FILM ** 0272 XRAYS-BITEWINGS-2 FILMS** 0274 X-RAYS-BITEWINGS-4 FILMS** ** Bitewings are limited to one service in a 6 consecutive month period. 0290 POSTERIOR-ANTERIOR OR LATERAL SKULL/FACI 0321 TMJ JOINT SINGLE FILM/PER FILM 0330 PANOREX-MAX/MAND SINGLE FILM - limited to one service in a 36 consecutive month period. 0340 CEPHALOMETRIC FILM SERIES PREVENTATIVE Dental Prophylaxis, not more than one in a 6 consecutive month period) 1110 PROPHYLAXIS-ADULT 'OVER 14' 1120 PROPHYLAXIS-CHILD 'UNDER 14' Fluoride Treatments (limited to one service in a 12 month 1 1 1 $29.00 $29.00 $38.65 1 $58.00 1 1 1 1 1 1 1 1 $6.44 $6.44 $19.33 $12.88 $12.88 $11.27 $19.33 $35.43 1 1 1 $58.00 $58.00 $58.00 1 $48.32 1 1 $58.00 $38.65 1 $28.99 1 1 1 $144.95 $193.26 $96.63 2 2 2 2 2 2 2 $58.00 $77.30 $96.63 $96.63 $58.00 $77.30 $96.63 2 2 2 2 $67.64 $87.00 $96.63 $77.30 consecutive month period to persons under 19) 1203 TOPICAL APPLICATION OF FLUORIDE - CHILD Space Maintainers (to replace permaturely lost teeth of dependent child under age 14) 1510 SPACE MAINT, FIXED BAND TYPE 1515 SPACE MAINT, FIXED, S S CROWN TYPE 1525 SPACE MAINT - REMOVABLE RESTORATIVE Amalgam Restorations (inc. polishing) 2110 AMALGAM ONE SURFACE DECIDUOUS 2120 AMALGAM 2 SURFACE DECIDUOUS 2130 AMALGAM 3 SURFACE DECIDUOUS 2131 AMALGAM 4 SURFACE PRIMARY 2140 AMALGAM ONE SURFACE PERMANENT 2150 AMALGAM TWO SURFACE PERMANENT 2160 AMALGAM THREE SURFACE PERMANENT Composite Restorations 2330 COMPOSITE RESIN ONE SURFACE 2331 COMPOSITE RESIN TWO SURFACE 2332 COMPOSITE RESIN THREE SURFACE 2335 RESIN-FOUR OR MORE SURFACES OR INCISAL ANGLE Page 100 CODE DENTAL PROCEDURE 2337 RESIN - BASED COMPOSIT CROWN ANT-PERM 2385 RESIN - ONE SURFACE POSTERIOR PERMANENT 2386 RESIN - TWO SURFACES POSTERIOR PERMANENT 2387 RESIN-THREE OR MORE SURFACES POSTERIOR Gold Foil Restorations 2410 GOLD FOIL ONE SURFACE 2420 GOLD FOIL TWO SURFACES 2430 GOLD FOIL THREE SURFACES Gold Inlay Restorations 2520 INLAY GOLD TWO SURFACE 2530 INLAY GOLD THREE SURFACE 2542 INLAY GOLD THREE SURFACE 2710 PLASTIC ACRYLIC CROWN 2720 PLASTIC WITH METAL CROWN 2721 CROWN-PLASTIC TO NON-PRECIOUS METAL 2722 CROWN-PLASTIC TO SEMI-PRECIOUS METAL 2740 PORCELAIN CROWN 2750 PORCELAIN WITH METAL CROWN 2751 CROWN-PORCELAIN TO NON-PRECIOUS METAL 2752 CROWN PORCELAIN - SEMI PRECIOUS METAL 2780 CROWN PORCELAIN - SEMI PRECIOUS METAL 2790 GOLD FULL CAST CROWN 2791 NON-PRECIOUS METAL (FULL CAST) 2792 SEMI-PRECIOUS METAL (FULL CAST) 2910 RECEMENT INLAYS-PER TOOTH 2920 RECEMENT CROWNS-PER TOOTH 2930 PREFABRICATED STAINLESS STEEL CROWN - PRIMARY 2950 CORE BUILDUP INCLUDING ANY PINS 2951 PIN RETENTION-PER TOOTH, IN ADD TO RESTORATION 2952 CAST POST AND CORE IN ADDITION TO CROWN 2954 PREFABRICATED POST AND CORE IN ADD CROWN 3220 THERAPEUTIC PULPOTOMY (EXC FINAL RESTOR) Root Canal Therapy (includes treatment plan, clinical CLASS 2 2 2 2 $67.64 $67.64 $87.00 $96.63 2 2 2 $67.64 $87.00 $96.63 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 $144.95 $193.26 $96.63 $125.62 $360.75 $360.75 $360.75 $360.75 $360.75 $360.75 $360.75 $360.75 $289.89 $360.75 $360.75 $67.64 $67.64 $116.00 $106.29 $29.00 $96.63 $183.60 $96.63 2 2 2 2 2 2 $338.21 $434.84 $531.47 $338.21 $434.84 $531.47 2 2 2 2 2 2 $270.57 $270.57 $270.57 $96.63 $473.49 $96.63 2 2 2 2 2 2 2 $260.90 $164.27 $483.15 $483.15 $483.15 $483.15 $483.15 procedures and follow-up care but excludes final restoration) 3310 ONE CANAL TRADITIONAL 3320 TWO CANALS TRADITIONAL 3330 THREE CANALS-TRADITIONAL 3346 RETREATMENT - ANTERIOR 3347 RETREATMENT - BICUSPID 3348 RETREATMENT - MOLAR Periapical Services 3410 APICOECTOMY - SEPARATE PROCEDURE 3421 APICOECTOMY - BICUSPID 1ST ROOT 3425 APICOECTOMY - MOLAR 1ST ROOT 3426 APIOECTOMY/PERIRADICULAR SURGERY EA ADD 3450 ROOT RESECTION-PER ROOT 3920 HEMISECTION PERIODONTICS Surgical Services (including usual post-operative services; only one of the following services is covered per quadrant) 4210 4220 4240 4250 4260 4263 4264 GINGIVECTOMY GINGIVOPLASTY PER QUAD GINGIVAL CURETTAGE PER QUAD GINGIVAL FLAP PROCEDURE MUCOGINGIVAL SURG PER QUAD OSS SURG FLAP PER QUAD OSSEOUS SURGERY W/FLAP & CLOSURES EXTANT OSSEOUS SURGERY W/FLAP & CLOSURE TOOTH Page 101 CODE DENTAL PROCEDURE 4270 PEDICLE, SOFT TISSUE GRAFTS 4271 FREE, SOFT TISSUE GRAFTS 4341 PERIO SCALING/ROOT PLANING-PER QUADRANT 4910 PERIODONTAL MAIN PROCED (FOLLOW ACTIVE) PROSTHODONTICS - REMOVABLE CLASS 2 2 2 2 $483.15 $483.15 $77.30 $135.28 3 3 3 3 $386.52 $386.52 $241.58 $241.58 3 3 3 3 3 $277.01 $277.01 $409.07 $409.07 $309.22 3 3 3 3 3 3 3 3 $87.00 $96.63 $87.00 $54.76 $144.95 $96.63 $96.63 $135.28 3 3 3 3 3 3 3 3 3 3 3 3 $309.22 $309.22 $309.22 $309.22 $145.00 $145.00 $145.00 $145.00 $193.26 $193.26 $193.26 $193.26 3 3 3 $386.52 $386.52 $386.52 3 3 3 3 3 3 3 3 3 $174.00 $174.00 $193.26 $193.26 $193.26 $193.26 $193.26 $193.26 $193.26 3 $145.00 Benefits for dentures and partial dentures include adjustments within 6 months after installation) Complete Dentures - including six months postdelivery care 5110 COMPLETE UPPER DENTURE 5120 COMPLETE LOWER 5130 IMMEDIATE UPPER 5140 IMMEDIATE UPPER Partial Dentures - includeing six months postdelivery care 5211 DENTURE-PART UPPER W/OUT CLASPS, ACRYLIC BASE 5212 DENTURE-PART LOWER W/OUT CLASPS, ACRYLIC BASE 5213 UPPER PARTIAL-CAST METAL BASE W/RESIN BASE 5214 LOWER PARTIAL-CAST METAL BASE W/RESIN BASE 5281 REMOV. UNILAT PART DENTURE-1 PIECE CAST METAL Repairs to Dentures 5510 REPAIR BROKEN COMPLETE DENTURE BASE 5520 REPLACE MISSING OR BROKEN TEETH (COMPLETE) 5610 REPAIR PART DENTURE-NO TEETH DAMAGE 5620 REPAIR DENT REPLACE 1 BROKEN TOOTH 5630 REPAIR OR REPLACE BROKEN CLASP 5640 REPL BKN TEETH ON PARTIAL DENT PER TOOTH 5650 ADD TOOTH/PAR REPL EXT TOOTH NO CLASP 5660 ADD TOOTH/PAR REPL EXT TOOTH WITH CLASP Denture Relining 5710 REBASE COMPLETE MAXILLARY DENTURE 5711 REBASE COMPLETE LOWER DENTURE 5720 DENTURE-DUP UP/LOW PARTIAL /JUMP CASE 5721 REBASE LOWER PARTIAL DENTURE 5730 DENTURE RELINE, COMPLETE 'OFFICE' 5731 RELINE COMPLETE LOWER DENTURE (CHAIRSIDE) 5740 DENTURE RELINE, PARTIAL 'OFFICE' 5741 RELINE LOWER PARTIAL DENTURE (CHAIRSIDE) 5750 DENTURE RELINE, COMPLETE 'LAB' 5751 RELINE COMPLETE LOWER DENTURE (LAB) 5760 DENTURE RELINE, PARTIAL 'LAB' 5761 RELINE LOWER PARTIAL DENTURE (LAB) PROSTHODONTICS - FIXED (each abutment and each pontic constitutes a unit in a bridge) 5931 OBTURATOR PROSTHESIS, SURGICAL 5932 OBTURATOR PROSTHESIS, DEFINITIVE 5933 OBTURATOR PROSTHESIS, MODIFICATION Bridge Pontics 6210 PONTIC-CAST GOLD 6211 PONTIC-CAST PREDOMINANTLY BASE METAL 6212 PONTIC - CAST NOBLE METAL 6240 PONTIC-PORCELAIN FUSED TO METAL 6241 PONTIC-PORCELAIN FUSED TO PREDOM BASE METAL 6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL 6250 PONTIC-RESIN WITH HIGH NOBLE METAL 6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL 6252 PONTIC-PLASTIC RESIN WITH NOBLE METAL Retainers 6520 INLAY- METALLIC-TWO SURFACES Page 102 CODE DENTAL PROCEDURE 6530 INLAY-METALLIC-THREE OR MORE SURFACES 6543 ONLAY-METALLIC-THREE SURFACES 6545 RETAINER-CAST METAL FOR ACID ETCH FIXED Crowns 6720 CROWN - RESIN W/HIGH NOBLE METAL 6721 CROWN - RESIN W/PREDOMINANTLY BASE METAL 6722 CROWN - RESIN W/NOBLE METAL 6750 CROWN - PROCELAIN FUSED TO HIGH NOBLE METAL 6751 CROWN - PORCELAIN FUSED TO PREDOM BASE METAL 6752 CROWN-PORCELAIN FUSED TO NOBLE METAL 6780 CROWN - 3/4 CAST HIGH NOBLE METAL 6790 CROWN - FULL CAST HIGH NOBLE METAL 6791 CROWN FULL CAST PREDOMINANTLY BASE METAL 6792 CROWN FULL CAST NOBLE METAL Other Prosthetic Services 6930 RECEMENT BRIDGE 6950 PRECISION ATTACHMENT ORAL SURGERY Simple extractions (includes local anesthesia and routine CLASS 3 3 3 $193.26 $116.00 $116.00 3 3 3 3 3 3 3 3 3 3 $318.88 $289.89 $289.89 $367.20 $289.89 $289.89 $212.59 $289.89 $289.89 $289.89 3 3 $58.00 $193.26 2 2 2 2 2 2 2 2 2 $58.00 $58.00 $96.63 $193.26 $241.58 $289.89 $328.54 $96.63 $386.52 2 2 2 2 $96.63 $96.63 $96.63 $96.63 2 2 2 $96.63 $193.26 $193.26 2 2 2 2 2 2 2 2 2 2 2 2 2 2 $145.00 $145.00 $67.64 $48.32 $145.00 $869.68 $579.78 $869.68 $676.41 $579.78 $193.26 $289.89 $145.00 $77.30 1 1 $29.00 $67.64 postoperative care) 7110 SINGLE TOOTH 7120 EXTRACTION SIMPLE EACH ADDITIONAL 7210 SURGICAL REMOVAL ERUPTED TOOTH 7220 REMOVAL OF IMPACTED TOOTH - SOFT TISSUE 7230 REMOVAL IMPACTED TOOTH PARTIALLY BONY 7240 REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY 7241 REMOVAL OF IMPACTED TOOTH COMPLETELY BONY 7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS 7260 ORAL ANTRAL FISTULA CLOS &/OR ROOT REC Other Surgical Procdures 7270 TOOTH REPLANTATION 7280 SURG EXPOS IMPACT TOOTH ORTHO RESONS 7285 BIOPSY OF ORAL TISSUE-HARD 7286 BIOPSY-ORAL TISSUE-SOFT Alevoplasty (surgical preparation of ridge for dentures) 7310 ALVEOLOPLASTY IN CONJUNCTION W/EXTRACTION 7320 ALVEOLOPLASTY NOT IN CONJUNCTION W/EXTRACTION 7340 VESTIBULOPLASTY-RIDGE EXTENSION OTHER SERVICES 7450 RMVL OF ODONT CYST/TUMOR UP TO 1/ INCH 7460 RMVL OF NONODONT CYST/TUMOR UP TO 1/2" 7510 INCISION & DRAINAGE ABSCESS EXTRAORAL 7520 I & D ABSCESS EXTRAORAL 7560 MAXIL SINUSOTOMY FOR RMVL TOOTH FRAG/ FB 7610 MAXILLA - OPEN REDUCTION 7620 MAXILLA - CLOSED REDUCTION 7630 MANDIBLE - OPEN REDUCTION 7640 MANDIBLE CLOSED REDUCTION 7650 FRACT SMPL MALAR OR ZYG ARCH OPRED 7660 FRACT SMPL MALAR OR ZYG ARCH CLRED 7810 OPEN REDUCTION OF DISLOCATION 7820 CLOSED REDUCTION OF DISLOCATION 7960 FRENULECTOMY-SEP PROC Emergency Treatment 9110 PALLIATIVE TREATMENT-MINOR 9310 CONSULTATION - PER SESSION Anesthesia Page 103 CODE DENTAL PROCEDURE 9220 ANESTHESIA-GENERAL FIRST 30 MINUTES Miscellaneous Procedures 9410 VISIT-HOUSE CALL 9420 HOSPITAL CALL CLASS 2 $193.26 1 2 $38.65 $38.65 Page 104 Select your Plan TRANSACTION AND PREDETERMINATION INFORMATION 13. Type of Transaction (Mark all Applicable Boxes) SUBSCRIBER INFORMATION 1. Policyholder / Subscriber Name (Last, First, Middle Initial, Suffix), Address, City, State, ZIP Code Statement of Actual Services Request for Predetermination/Pre-treatment Estimate EPSDT/ Title XIX Encounter 14. Predetermination/ Pre-treatment Estimate Number TREATMENT INFORMATION 15. Treatment Resulting From Occupational Illness/injury Auto accident Other accident 16. Date of Accident (MMDDCCYY) 2. Date of Birth (MMDDCCYY) 3. Gender Hospital ECF Radiograph(s) Other 20. Is Treatment for Orthodontics? No (Skip 21-22) Dependent Child Other Oral Image(s) Model(s) 21. Date Appliance Placed (MMDDCCYY) Yes (Complete 21-22) 22. Months of Treatment Remaining 7. Relationship to Policyholder/Subscriber in #1 Above Spouse 19. Number of Enclosures (00 to 99) Provider's Office 6. Employer Name PATIENT INFORMATION Self 17. Auto Accident State 18. Place of Treatment F M 5. Plan or Group Number 4. Policyholder / Subscriber ID (SSN or ID#) 23. Replacement of Prosthesis? No 24. Date of Prior Placement (MMDDCCYY) Yes (Complete 44) OTHER INSURANCE COVERAGE 8. Patient Name (Last, First, Middle Initial, Suffix), Address, City, State, ZIP Code 25. Other Coverage? Dental (Complete 26-32) None Medical (Complete 26-32) 26. Name of Other Coverage Policyholder / Subscriber (Last, First, Middle Initial, Suffix) 27. Date of Birth (MMDDCCYY) 9. Date of Birth (MMDDCCYY) 10. Gender 11. Patient ID/Account # (Assigned by Dentist) 12. Remarks 33. Diagnosis Codes 29. Policyholder / Subscriber ID (SSN or ID#) F 31. Patient's Relationship to Person Named in #26 30. Plan or Group Number F M 28. Gender M Self Spouse Dependent Other 32. Other Insurance Company / Dental Benefit Plan Name, Address, City, State, ZIP Code A. B. D. C. RECORD OF SERVICES PROVIDED 34. Procedure Date (MMDDCCYY) 38. Quantity 35. Area of 36. Tooth Number(s) 37. Tooth Oral Cavity Surface or Letter(s) 40. Diagnosis Pointer (A, B, etc.) 39. Procedure Code 41. Description 42. Fee 1 2 3 4 5 6 7 8 Permanent MISSING TEETH INFORMATION 44. (Place an 'X' on each missing tooth) Primary 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 A B C D E F G H I J 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 T S R Q P O N M L K AUTHORIZATION - RELEASE OF INFORMATION 0.00 AUTHORIZATION - ASSIGNMENT OF BENEFITS 45. I have been informed of the treatment plan and associated fees. I agree to be responsible for all charges for dental services and materials not paid by my dental benefit plan, unless prohibited by law, or the treating dentist or dental practice has a contractual agreement with my plan prohibiting all or a portion of such charges. To the extent permitted by law, I consent to your use and disclosure of my protected health information to carry out payment activities in connection with this claim. X 43. Total Fee 46. I hereby authorize and direct payment of the dental benefits otherwise payable to me, directly to the below named dentist or dental entity X Subscriber signature Date TREATING DENTIST AND TREATMENT LOCATION INFORMATION Patient/Guardian signature Date 53. I hereby certify that the procedures as indicated by date are in progress (for procedures that require multiple visits) or have been completed BILLING DENTIST OR DENTAL ENTITY 47. Dentist or Entity Name, Address, City, State, ZIP Code X Signed (Treating Dentist) Date 54. Treatment Location Address, City, State, ZIP Code - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 48. NPI 55. NPI 49. License Number 50. SSN or TIN 56. License Number 57. Provider Specialty Code 51. Phone Number 52. Additional Provider ID 58. Phone Number 59. Additional Provider ID Delta Dental Enterprise Claim Form Version 1, Rev 0 10/12/2011 Page 105 Claim Form Disclosure You may be subject to civil and criminal penalties for knowingly providing false or misleading information. Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. Alaska: A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete or For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. Arkansas: Any person who knowingly presents a false or misleading information may be prosecuted under this title. Arizona: fraudulent claim for payment for a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. California: For your protection, California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies. Delaware: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony. District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Florida: Any person who knowingly and with intent to injure, defraud or deceive any insurance company files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Hawaii: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment, or both. Idaho: Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement containing any false, incomplete, or misleading information is guilty of a felony. Indiana: Any person who knowingly, and with intent to defraud an insurer, files a statement of claim containing false, incomplete or misleading information commits a felony. Kansas: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties. Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information any fact material thereto commits a fraudulent insurance act, which is a crime. Louisiana: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Maine: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purposes of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. Maryland: Any person who knowingly and willfully presents a false or fraudulent claim for payment for a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud as provided in R.S.A. 638.20. New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to civil and criminal penalties. New Mexico: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. New York: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Ohio: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Puerto Rico: Any person who knowingly and with the intention to defraud presents false information in an insurance application or, who presents helps or has a fraudulent claim presented for the payment of a loss or other benefit, or presents more than one claim for the same loss or damage, will incur in a felony and if convicted, will be sanctioned for each violation with a fine of no less than five thousand ($5,000) dollars or no more than ten thousand ($10,000) dollars or imprisonment by the fixed term of three years, or both punishments. With aggravating circumstances the fixed term of the punishment could go up to five (5) years; with mitigating circumstances the punishment could be reduced to a minimum of two (2) years. Rhode Island: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Tennessee: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purposes of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. Utah: Any person who knowingly presents false or fraudulent underwriting information, files or causes to be filed a false or fraudulent claim for disability compensation or medical benefits, or submits a false or fraudulent report or billing for health care fees or other professional services is guilty of a crime and may be subject to fines and confinement in state prison. Virginia: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. Washington: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits. West Virginia: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit Page 106 or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Long Term Disability Eligibility for Long Term Disability [LTD] is subject to collective bargaining agreement. If you have any questions on your coverage, contact the Office of Human Resources. The College’s long term disability program provides disability income and waiver of annuity premium benefits only. It does not provide basic hospital, basic medical or major medical insurance as defined by the NYS Insurance Department. Amount of Benefits • 60% (benefit percentage) of the first $2,000 of basic monthly earnings, plus 40% of the excess not to exceed the maximum benefit, less other income benefits. • The maximum monthly benefit is $2,500 • The minimum monthly benefit is $50 Maximum Benefit Period Benefits begin on the first of the month following six (6) consecutive months of Total Disability, and continues as follows: • For a period of continuous Total Disability which commences prior to or on your 60th birthday, benefits will be paid until the first day of the month in which you reach age 65 or until the first day of the month in which Total Disability terminates, whichever occurs first. • For a period of continuous Total Disability which commences after your 60th birthday, benefits will be paid until the first day of the month in which you reach age 70 or until the first day of the month in which you have been in a period of Total Disability for five years, whichever occurs first. In no event, however, will any benefits be paid beyond the first day of the month in which Total Disability terminates. Examples: ♦ If you become totally and continuously disabled on March 15, 1984 at age 40 and you remain so disabled, your benefit payments will begin on October 1, 1984 (1st of the month next following six (6) months of disability) and will continue until the 1st of the month in which your each your 65th birthday. ♦ If you become totally and continuously disabled on March 11, 1984, at age 61 and you remain so disabled your benefit payments will begin on October 1, 1984 (1st of the month next following six (6) months of disability) and will continue until March 1, 1989 (1st of the month in which you have been disabled for a period of five years). ♦ If you become totally and continuously disabled on March 15, 1984 at age 66 and you remain so disabled, your benefit payments will begin on October 1, 1984 (1st of the month next following six (6) months of disability) and will continue until the 1st of the month in which you reach your 70th birthday. ♦ Regardless of your age, benefit payments sill cease on the first day of the month in which Total Disability ends. Elimination Period: Six (6) Months Page 107 Monthly Waiver Benefit The Monthly Waiver Benefit will be equal to 12% of that portion of your monthly salary base at the commencement of the period of continuous Total Disability which is subject to Social Security [FICA] taxes on such date, plus 15% of the remainder of such monthly salary base. The Monthly Waiver Benefit will be credited as monthly premiums to a TIAA retirement annuity contract [Form 1000.18] and if you so elect a College Retirement Equities Fund retirement annuity certificate [Form C1000.7] issued on your life. The allocation of a portion of the Monthly Waiver Benefit to CREDF will be in accordance with the options then available. In no event will the Monthly Waiver Benefit be credited to such contract or certificate earlier than the date a satisfactorily completed application for such TIAA contract or CREF certificate is received by TIAA. The portion of the Monthly Waiver Benefit allocated to a TIAA contract of CREFD certificate will terminate at any time premiums are no longer payable on such contract of certificate. Terms you should know Many terms in your certificate of coverage have special meanings. A list of these terms and meanings follows: Total Disability – the term total disability will mean you inability, by reason of sickness or bodily injury, to engage in any occupation for which you are reasonably fitted by education, training, or experience. Monthly Salary Base – the term Monthly Salary Base as of any given date will mean 1/12 of your basic annual salary rate (exclusive of overtime, bonuses, and other forms of additional compensation) receivable from your employer. Reduction Amount – the term Reduction Amount will include and benefits 1. Payable on your wage record under the Social Security Act of the United States including any benefits for dependents, or under any governmental program in Canada, as in effect at the commencement of benefit payments, hereunder, without regard to any deductions from such benefits which may be made for work or for your refusal to accept rehabilitation 2. Paid under any Workmen’s Compensation Law or similar statute except for any such benefits to which you were entitled prior to the occurrence of the accident or sickness resulting in the period of continuous Total Disability for which benefits are payable hereunder and 3. Any disability benefits payable under any insurance or retirement plan for which contributions or payroll deductions are made by your employer. Any such benefits under (1) will be deemed to be payable for the purpose of the group policy unless, after submitting the required application for such benefits together with all proofs required, such benefits have been declined by the Social Security Administration. The term Reduction Amount will also include any payments receivable by you under your employer’s sick leave or salary continuation program. General Exclusions Benefits will not be payable if Total Disability results from Injury or sickness as a result of war, declared or undeclared Injuries sustained in an accident which occurred or sickness which commenced prior to the date you became covered under the group plan, but this exclusion will not apply to a period of Total Disability commencing after a period of at least nine months during which you are continuously covered under the group plan Intentional self-inflicted injury or sickness Pregnancy, except that this exclusion will to apply to a period of Total Disability commencing after termination of pregnancy Page 108 Termination of Insurance Your coverage will terminate up on the occurrence of the first of the following events: • Termination of the group plan • Modification of the group plan to terminate coverage for the class of employees to which you belong • The last day of the month which is seven (7) months prior to the month in which you attain your 70th birthday • Termination of you employment, or cessation of your active service, in the classes of employees eligible for coverage. If you cease active work, without actual termination of employment ask your employer when cessation of active service will be deemed to occur under the group plan. • Termination of you required contribution, if any, toward payment of premiums. Termination of your coverage will not affect your benefits for a Total Disability existing on the date such termination is effective. General Provisions Notice and Proof of Claim: On receipt of written notice of claim by the College, the College will furnish forms for filing proof of claim. Initial written proof of Total Disability must be furnished to the College on an approved claim form within twelve (12) months after the commencement of the period of continuance of Total Disability. Subsequent written proofs of the continuance of Total Disability must similarly be furnished to the College at such intervals as the College may reasonably require. Failure to furnish such proof within such time will not invalidate or reduce your claim if it was not reasonably possible for you to furnish proof within such time and if proof was given as soon as was reasonably possible. The College will have the right and opportunity to examine you whenever it may reasonably required during the period of continuous Total Disability. The College may require as part of the proof of claim, statements of attending physicians or surgeons, copies of laboratory reports or examinations, x-rays, or extracts of hospital records, and in addition, satisfactory evidence that you have made application for all benefits included in the Reduction Amount and furnished all required proofs for such benefits. Payment of Benefits: Monthly Income Benefits will be paid to you, and Monthly Waiver Benefits will be paid or credited in accordance with the provision entitled Monthly Waiver Benefit, on the first day of each calendar month subject to due proof on the continuance of Total Disability. The College may, in its discretion, pay any Monthly Income Benefit to any person or institution by whom or in which you are being maintained, as trustee for you, if it is shown to the satisfaction of the College that you are physically or mentally incapable of personally receipting for such payment, and such payment will discharge the College’s obligation with respect to payment so made. Page 109 Employee Assistance Program [EAP] Hudson Valley Community College subscribes to the Capital Employee Assistance Program, a confidential assistance program designed to allow an employee experiencing a problem to selfrefer for two (2) counseling visits designed to provide problem resolution or guidance to an appropriate agent for further assistance. This program is entirely confidential. Professional counseling services offered include but are not limited to marriage or relationship problems, difficulties with children or elder relatives, depression, grief and loss, stress-related concerns, substance abuse, fear and anxiety, anger management, or legal and financial issues. Capital EAP also provides training workshops at different locations throughout the area. Schedules are distributed quarterly (usually with your paycheck) and are also available on the EAP website; www.capitaleap.org. To make an appointment contact Capital EAP at (518) 465-3813 or 1-800-777-6531. Counseling appointments are typically made within three to five business days. There are no co-pays or costs for this initial contact. There are affiliate locations throughout the region, NYS and the U.S. and several office locations in our area: 650 Warren Street, Albany, NY 12208 632 Plank Road, Clifton Park, NY 12065 15 Maple Dell, Saratoga Springs, NY 12866 Page 110 Retirement The SUNY Optional Retirement Program (ORP) TIAA-CREF membership is open to full time unclassified staff members. New York State Employees’ Retirement System membership is open to all employees. New York State Teachers’ Retirement System membership is open to employees in the unclassified service employed in a select group of titles: faculty, librarian or coach title, chancellor, president, vice-president, dean, associate dean or assistant dean. If you are a full-time employee, you must elect to participate in one of these programs within thirty (30) days of the effective date of your appointment. If you do not make a timely election, and are in a position eligible for TRS membership, you will then be required to join TRS. All other full-time employees who do not make a timely election will be required to join ERS. Parttime employees are not required to join a retirement system. Once you become a participant in one of these programs, either through election or by failure to make a timely election, you will not be able to change from one to another during employment at Hudson Valley Community College. Exception: if you are not now eligible for a particular retirement program, and later become eligible for that program, you will be permitted to change to that program at that time. Example: you are a classified staff member and become a full time faculty member; you would then be eligible to elect either TIAA or TRS since you were not eligible for either as a classified staff member. NTPs that change status to full time faculty need to contact the Office of Human Resources on the ability to change systems when changing positions as several other caveats may apply. The public retirement systems (TRS and ERS) are both “defined benefit” retirement programs. The benefits you receive at retirement will be determined based on a formula, using specific formula factor, your final average salary, age and years of service. The Optional Retirement Program is a “defined contribution” program. The amount of benefits you receive at retirement will be based on the amount of funds contributed to your account, the investment earnings on those funds, your age when you take income and the benefit option you choose. Detailed information on each plan is available on the systems’ websites. You should review these prior to making your decision. The site addresses are: www.tiaa-cref.org www.osc.state.ny.us www.nystrs.org Page 111 Tax Deferred Retirement Savings Program As an employee of Hudson Valley Community College you are eligible to participate in the taxdeferred voluntary Retirement Savings Program. This Program provides a way for you to save extra money for retirement through payroll deduction; there is no employer contribution. We offer two (2) vehicles for deferred savings; NYS Deferred Compensation [IRS section 457] and Tax Shelter Annuity [IRS section 403(b)]. You choose the amount to contribute, within certain limits. You may change your contribution as frequently as you wish, but the rules for withdrawal of funds and maximum contributions may vary by plan and should be reviewed prior to selection. For the 403(b) plans, you choose the provider you wish to invest with. All contributions to 403(b) and 457 are always 100% vested. Your contribution is subtracted from your income before federal and state taxes are computed on your paycheck. You will be taxed on your contributions plus earnings at the time you withdraw the funds. NYS Deferred Compensation Plan [IRS 457] Detailed information and enrollment forms are available on line at www.nysdcp.com or you may contact them at 1-800-422-8463. This plan is administered directly by NYSDCP, therefore all applications and changes are communicated to Hudson Valley Community College through NYSDCP. The minimum bi-weekly deduction amount allowed is $10. The maximum allowances are currently the same as the 403(b). Tax Shelter Annuity [IRS 403(b)] To participate in the program or change the amount of your contribution you and your company representative must sign a Salary Reduction agreement. Limit if under age 50 in 2010 – $16,500 Limit if age 50 or over (by 12/31) in 2010- $21,500 Employees who have at least 15 years of service with SUNY may be eligible to contribute an extra $3,000 per year (lifetime maximum $15,000) in addition to the amounts listed above. Contributions to the 457 (deferred compensation) plans do not affect contributions to 403(b). Approved providers for 403(b) plans TIAA-CREF 1-800-842-2776 or www.tiaa-cref.org VALIC 1-888-569-7055 or www.AIGRetirement.com ING 1-800-677-4636 or www.ingretirementplans.com MetLife 716-634-2117 or www.metlife.com Fidelity 1-800-343-0860 or www.fidelity.com Page 112 HUDSON VALLEY COMMUNITY COLLEGE SUNY 403(b) VOLUNTARY SAVINGS PLAN SALARY REDUCTION AGREEMENT By this AGREEMENT, made between _____________________________________________________________, Employee Name-Please Print Hudson Valley Community College and the State University of New York, the parties hereto agree as follows: This Agreement represents a: _____New Agreement _____Change to an existing Agreement _____Cancellation of existing Agreement Effective with respect to amounts paid on or after ____________________________________________________, Date which is subsequent to the execution of this Agreement, the employee’s salary will be reduced by the amount indicated below. At the same time, the College agrees to contribute that amount to the employee’s account with: _____TIAA-CREF _____VALIC _____ING _____METLIFE _____FIDEITY The amount of the salary reduction shall be $____________________ annually OR $____________________ per pay period (total amount of annual reduction divided by 26 pay periods) which will produce a total contribution that does not exceed the employee’s statutory exclusion allowance under IRS Code Section 403(b), Section 415, or Section 402(g), whichever is least. Responsibility for assuring that total annual salary reduction contributions do not exceed the maximum exclusion allowance defined in the IRS Code rests solely with the employee. This Agreement shall be legally binding and irrevocable as to each of parties hereto while employment continues and shall replace any existing Agreement currently in effect. Either party may terminate or modify this Agreement as of the end of any payroll period by giving at lease thirty (30) days written notice, so that this Agreement will not apply to salary subsequently paid. Date __________________________ ____________________________________________________________ Employee Signature Date __________________________ ____________________________________________________________ Company Representative Signature Administration Use Only ___________________________________________________ Office of Human Resources ____________________________ Date Annual Contribution $___________ Date Deductions Begin ___________ Catch-up 50+__________ 15 Year ____________ Page 113 Standard Work Day The College has a standard work day with two options for most Classified and NTP employees working 37.5 hours per week: 8:00 a.m. to 4:30 p.m. or 8:30 a.m. to 5:00 p.m., both with a one hour lunch period. It is not permissible to take lunch at the end of the day and leave early, nor is it permissible to take only a ½ hour lunch to shorten the work day. A student, employee or member of the public should always be able to contract a College office until at least 4:30 p.m. Where work demands are better served by a non-standard schedule, different arrangements may be made through consultation with Human Resources. Time and Attendance Forms As a public institution, the College must be able to demonstrate that employees are paid for services rendered. While completion of timesheets my seem unnecessary, records of attendance and leave use meet a basic audit standard and must be kept up to date. Timely completion is expected of all employees. Failure to submit time sheets may result in withholding of pay. Leave Accruals Leave which is accrued on a pay period basis (for NTP and Classified staff), is not actually ‘earned’ until the end of the pay period. One cannot use the accrued hours in advance of the end of the period. In other words, one earns the bi-weekly accrual by working all the days in the pay period, or by covering those days with leave already on the books at the beginning of the period. The only exceptions to this are in the areas of half-pay and termination payouts. Sick Leave All bargaining units have Sick Leave in the event of personal or family illness, but amount and conditions for use are function of contract. In general sick leave may not be utilized in conjunction with holidays or vacations unless validated by a physician’s statement or unless a known condition exists. Sick leave is not a payout item at point of resignation, and may not be “liquidated” immediately prior to termination. The College always has the right to require validation of sick leave use, but will almost always do so when sick leave is being used at a rate which exceeds accrual, or when sick leave is used to extend a break in schedule. Any planned medical leave, such as for surgery or childbirth, needs to be arranged with the supervisor and the Office of Human Resources in advance and be documented by physician’s certification of need and projected dates of absence. See FMLA. Sick leave at ½ pay is a form of short-term disability insurance available upon exhaustion of sick leave for NTP and Classified staff. An additional sick leave benefit which is becoming more recognized and important is the use of accrued sick leave to fund health insurance coverage in retirement. While contractual Page 114 provisions differ with respect to options and contribution, the basic principle for all employees is that the college converts sick leave time on the books at point of retirement to a dollar amount based on salary at that time. An employee then decides how much to leave for health insurance payment of take in cash depending up on the contractual options available. For certain long-servicing employees who are leaving employment but not retiring there are also cash payments for unused sick leave. These are increasingly important benefits which should encourage maintenance of the largest possible sick leave balance. Personal Leave is available to all categories of employee but amount and conditions of use are a function of contract. In general personal leave may not be utilized in blocks of days unless the employee is prepared to document that its use was actually for personal business which could not be otherwise accomplished. As with sick leave, it is not to be used to extend holiday or vacation periods. Personal leave is not a payout item at point of termination. Vacation Leave or Annual Leave is accorded to both NTP and Classified staffs and the amount of accrual differs with bargaining unit and longevity. Sabbatical Leave is available to both Faculty and NTP employees. Request forms may be found on the Office of Human Resources website. Bereavement Leave is available to NTP and Classified staff in the event of a death in the immediate family. Employees with faculty rank utilize Personal Leave for this purpose. Page 115 Leave for Breast Cancer and/or Prostate Cancer Screening Employees are eligible to take up to four (4) hours of paid leave, without charge to leave credits for breast cancer screening and/or prostate cancer screening per year. Cancer screening includes physical exams and mammograms for the detection of breast cancer, and physical exams and blood work for the detection of prostate cancer. Travel time is included in the four (4) hour cap. Absence beyond the four (4) hour cap must be charged to leave credits. Employees who undergo screenings outside of their regular work schedule do so on their own time. A Hudson Valley Community College Cancer Screening Leave form must be completed by the Physician’s office to authorize this leave. Page 116 Hudson Valley Community College Cancer Screening Leave Employee Name Prostate Cancer Screening Breast Cancer Screening Date Time In Time Out Physician’s Office Signature Please send completed form with your timesheet to the Office of Human Resources. Pursuant to Civil Service Law [Chapter 362 (as amended)] Community College employees are entitled to take up to four (4) hours of paid leave, without charge to leave credits for breast cancer and/or prostate cancer screening. Cancer screening includes physical exams and mammograms for the detection of breast cancer, and physical exams and blood work for the detection of prostate cancer. Travel time is included in the four (4) hour cap. Absence beyond the four (4) hour cap must be charged to leave credits. Leave for breast and/or prostate cancer screening is not cumulative and expires at the close of business on the last day of the calendar year. This form is to document that the employee’s absence was for the purpose of screening for breast and/or prostate cancer. The completed form will be retained by the Campus Health Office. Page 117 Jury Duty Although different contracts address the topic differently, if at all, the college policy has certain common expectations of all employees: ♦ Upon receipt of a jury duty summons, an employee should notify the immediate supervisor and notify the Office of Human Resources ♦ A copy of the jury duty summons must be provided to the Office of Human Resources prior to jury duty service to validate the jury duty leave. ♦ When actually on jury duty, the employee must obtain validation from the court clerk of hours served and provide that validation to the Office of Human Resources. ♦ If jury service does not take up an employee’s entire normal workday, the employee must return to work for the balance of the day. In addition, any time taken for jury duty service should be noted on the employee’s timesheet for that period. (Note: Special arrangements are made for employees who work late shifts. Contact the Office of Human Resources for advice.) ♦ Public employees are not supposed to receive pay from the court (since you are being paid anyway). Do not sign any form provided by the court that would produce pay for service. Federal jury service is an exception to this rule. Compliance with this procedure is expected. Failure to comply may result in a charge to accrued leave or loss of pay. Page 118 To: Classified and Non-Teaching Professional Staff From: John R. Tibbetts, Director of Human Resources Subject: Summer Hours Summer hours are in effect beginning Monday next following Memorial Day for a period of ten (10) weeks in accordance with the administrative calendar. Most importantly, the College and all of its offices will remain open until 4:00 p.m., and certain offices which provide direct student services may remain open later. No exceptions will be made for offices wishing to close at 3:30p.m. Staff of all offices must be assigned flexibly to ensure that the 4:00 p.m. or later closing time is observed. Please note that unit-covered NTPs will observe summer hours this year in the same manner as do Classified staff i.e. a one-half hour lunch and a seven-hour workday resulting in departure from campus one hour earlier than is normal during the regular academic year. This should not result in any conflict between NTP and Classified staff as to who leaves early and who stays later. Supervisors in each office should consult with Human Resources where the potential for any such problem exists. Please remember; all offices must remain open until 4:00 p.m. The choice of schedule is 8:00 a.m. to 3:30 p.m. or 8:30 a.m. to 4: 00 p.m. unless otherwise specified by the responsible Vice President. Physical Plant, Central Receiving and Public Safety staff will be granted two (2) work days off during this period and may use these days up until November 30. These days should be arranged in advance with supervisory personnel and are to be denoted as “summer leave day.” The following is provided to remind you of the record keeping requirements and procedures which were implemented in association with this employee benefit: • • • • • • Eligible Classified and Non-Teaching Professional employees currently scheduled for a 5-day, 37 ½ hour work week will be required to work 35 hours per week and will reduce their lunch period from one hour to one-half hour. Bear in mind that the actual schedule for classified staff will be subject to coordination with the schedules of NTP office staff. Timesheets should reflect actual hours worked. During the time of “Summer Hours”, employees will continue to accrue sick leave and vacation leave as though they were working 37 ½ hours. Therefore, charges to these leave accrual categories must be made on the basis of a normal 37 ½ hour work week and employees must make charges to such above categories to account for a full 7 ½ hour workday. For example, if an employee works for 3 ½ hours and covers the balance of the day with leave, 4 hours must be charged. Charges to personal leave, flex time and compensatory time may be made to reflect the 7 hour work day in effect during the period of “Summer Hours.” Excess time for eligible classified employees will be paid at overtime rate for work performed beyond 35 hours. Excess time for eligible NTP employees will be paid at special assignment rate for work performed beyond 35 hours per week, and eligible NTP employees will be paid at overtime rate for work performed in excess of 40 hours. Employees working less than 37 ½ hours per week (part-time) or who have been appointed to temporary positions on a non-benefitted basis will continue to be paid only for hours worked. Page 119 Professional Development Opportunities and Funding Hudson Valley Community College offers employees a multitude of ways to increase professional development and incentives for furthering your education. Some of these are negotiated in your employee contract and guidelines can be found in all employee contracts. Listed below are some of the opportunities that are available to you, since these opportunities do change periodically a complete and current list of funding resources can always be located on our website. Tuition Waivers You could be eligible for a tuition waiver! Eligible employees may request a waiver of up to eight evening credit hours and up to four credit hours during the normal workday. Consult with your employee contract for specific guidelines. Personnel Resources Committee: Hudson Valley Community College allocates monies to the Personnel Resources Committee each year to support faculty and staff professional development requests. For more information on the guidelines for funding, please consult the Personnel Resources web page. SUNY Tuition Waiver, funded by SUNY SUNY sponsors a $4,383 tuition waiver fund that grants faculty and NTPs 50% of tuition, up to six credit hours per semester, at any SUNY Institution. Funds are allocated on a first come-first served basis. Fees are not reimbursable. Contact Suzanne Kalkbrenner in the President’s Office at 629-4530 or [email protected] for more information. SUNY Tuition Reimbursement funded by Hudson Valley Community College Hudson Valley Community College sponsors a $47,500 tuition reimbursement fund that grants faculty, NTP and Classified staff 50% of tuition, up to six credit hours per semester, at any SUNY institution. Funds are allocated on a first come-first served basis. Fees are not reimbursable. Contact Suzanne Kalkbrenner in the President’s office at 629-4530 or [email protected] for more information. President’s Innovation Fund Grants are offered each year by President Andrew J. Matonak to fund innovative projects that explore teaching and learning processes and assessment thereof. The president seeks novel approaches and creative activities at Hudson Valley Community College to enrich the college’s teaching and learning environment and/or the assessment of student outcomes. Additional information may be found on the College’s website or by contacting the President’s Office at 629-4530. Page 120 Personnel Resources Committee: Hudson Valley Community College allocates funding to the Personnel Resources Committee each year to support faculty and staff professional development requests. For more information on the guidelines for funding, please consult the Personnel Resources web page. Faculty Workshop Day The College budgets each year to support professional development opportunities for Faculty Workshop Day in February. Staff Development Day The College budgets each year to support professional development opportunities for Staff Development Day in May. Training The College is required by a variety of statutes at the state and federal level to provide training to its employees. Where such training is mandated, the college will comply with the law. This may require an employee to attend training sessions and sign certification forms. Failure to comply with such mandates may result in disciplinary action. Page 121 College Services Available to Employees Dental Hygiene Clinic Located in Fitzgibbons Hall, the clinic provides preventative dental services while providing our students with an excellent learning experience. Dentists and/or licensed dental hygienists are always present during clinic sessions and many treatments are free to Hudson Valley Community College faculty and staff. Appointments are required and clinic hours are posted on the Clinic’s website. Please contact extension 7400 for an appointment. Food Service Chartwells Dining Services is the Hudson Valley Community College food service provider. They offer several food service locations on campus as well as catering services for special meetings. The daily menu items are available on the website at www.diningoncampus.com/hvcc . To arrange catering for a meeting you may contact Chartwells on campus at extension 7173. Fitness Room/Racquetball Courts/Ice Skating The McDonough Sports Complex, Fitness room, and Racquetball courts are all available to Hudson Valley Community College employees. All have a mandatory registration procedure that needs to be completed prior to utilization of these facilities. A valid employee ID must be presented for access to all recreational facilities. For the current recreation schedule please check the website at https://www.hvcc.edu/facilities/schedule.html or contact the Office of Institutional Events at campus extension 4829. Employee Discounts Occasionally businesses will offer discounts to our employees. Currently, we are offered discounts through a program entitled SUNY Perks, which you may sign up for this using your Hudson Valley Community College email address. Computer Services also maintains a list on their website of any discounts available to our employees for software or hardware (MircoUB, Verizon, etc). Auto Lab Automotive service and repair for employee’s personal vehicles is available through the senior automotive lab for a low cost (parts and lab fee). Appointments are necessary and prior registration is required. For information on vehicle repair and criteria please contact the Automotive Department at campus extension 7189. 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