Benefits-eligible employees enrolled in the Syracuse University medical plan automatically pay the Schedule A medical rates unless they qualify, apply and are approved for reduced Schedule B rates. Graduate Assistants are automatically defaulted to Schedule B medical rates, as are certain employees specified by a collective bargaining agreement.
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Eligibility for this program is based on household income and household size. For 2018, the criteria are:
|Household Size||Household Income|
|1||Less than $36,000|
|2||Less than $49,000|
|3||Less than $61,000|
|4 and up||Less than $74,000|
Household size is the number of individuals declared on your Federal Income Tax Return, and if applicable, your spouse or domestic partner. Also included in household size are your children who are not declared on your tax return, but who are either under age 19 and living with you, or age 19 or older and enrolled as your dependent in the medical plan.
Household income is the combined adjusted gross income disclosed on your Federal Income Tax Return, including for your spouse or domestic partner and your children age 19 or older, if they are enrolled on your medical plan. The adjusted gross income is on the Federal Income Tax Return (line 37 of Form 1040, line 21 of Form 1040A; or line 4 on Form 1040EZ).
- Complete the Syracuse University Application for Schedule B Medical Contributions [PDF].
- Submit the completed application, along with signed copies of all required Federal Income Tax Returns (first 2 pages of Form 1040, 1040A or 1040EZ) to the Office of Human Resources. Please note, documents must be submitted via email or in person in order to ensure receipt.
- Email your application and scanned tax returns to firstname.lastname@example.org OR bring your application and tax returns to the Office of Human Resources (located in Skytop Office Building).
If you are a new employee, applications and Federal Income Tax Returns must be received within 31 days of your hire date.
If your application for Schedule B Medical Rates is approved, you will be notified via email to your syr.edu account, and your new rates will take effect for the 2018 calendar year (unless otherwise noted). You must re-apply each year for Schedule B Medical Rates.
Questions? Contact the HR Service Center at 315.443.4042 or email email@example.com.
Every effort has been made to ensure that the information contained within this website is accurate. However, the benefits are governed by legal documents (which, in certain circumstances, may include insurance contracts). If there is any difference between the information in this website and the official documents, the official documents will control. As is the case with all of Syracuse University’s employee benefit plans, the University reserves the right to modify or terminate these benefits at any time.