Benefits Syracuse University
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Benefits
Schedule B Medical Contributions

Benefits-eligible employees enrolled in the Syracuse University medical plan default into the Schedule A medical contribution rates unless they qualify, apply and are approved for Schedule B contribution rates. Graduate Assistants and Fellows are automatically defaulted to Schedule B medical contribution rates.

Application Process

  1. Complete the Syracuse University Application for Schedule B Medical Contributions.

  2. 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 can only be submitted via e-mail or in person in order to ensure receipt.

    • E-mail your application and scanned tax returns to hrservic@syr.edu

      OR

    • Bring your application and tax returns to the Office of Human Resources (located in Skytop Office Building).

Applications and Federal Income Tax Returns must be received no later than 31 days of your hire date.

If your application for Schedule B Medical Contributions is approved, you will be notified via e-mail to your syr.edu account and your new rates will take effect for the 2013 calendar year (unless otherwise noted). You must apply each year for Schedule B Medical Contributions.

Eligibility

Eligibility for this program is based on household income and household size according to the chart below:

Employees Eligible for Schedule B Contributions
Household Size Household Income
1 Less than $34,000
2 Less than $45,000
3 Less than $57,000
4 and up Less than $69,000

Household size is the number of individuals declared on your Federal Income Tax Return, if applicable, your spouse or domestic partner. Also included in household size are your children who are not declared on your tax return but are either under age 19 and living with you or age 19 or older and enrolled on your medical plan.

Household income is the combined adjusted gross income disclosed on your Federal Income Tax Return, and if applicable, 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).

Helpful Links

Questions? Contact the HR Service Center at 443-4042 or e-mail hrservic@syr.edu.

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The web pages summarize your Syracuse University benefit options. Every effort has been made to ensure this information is accurate. However, the programs are governed by legal documents and insurance contracts. If there is any difference between the information on these web pages and the official documents and contracts, the official documents and contracts will rule. Our benefits are governed by current laws and operated according to Internal Revenue Service (IRS) regulations. We will notify you if changes in plans are necessary to comply with the law or with IRS regulations.

Employees electing to participate in the SU benefit plans are bound by the terms of the governing Plan documents. If you have any questions regarding the plans, you may request a copy of the Plan document from the Plan Administrator by contacting the HR Service Center at the number indicated at the end of this page.

As is the case with all benefits offered by SU, (1) the Plan Administrator has the discretionary authority to interpret the terms of the Plan and such interpretation will be binding on all interested parties to the fullest extent permitted by law, and (2) the University reserves the right to modify or terminate the Plan at any time.