Since December 2015, the NYS Department of Civil Service has been conducting a Dependent Eligibility Verification Audit, using a vendor called Health Management Systems, Inc. (HMS). Similar to the audit conducted in 2009, its purpose is to ensure that every person who receives NYSHIP health benefits from the Empire Plan or an HMO is entitled to those benefits.
HMS has completed the Verification Period of the audit for state agency enrollees. Enrollees were required to provide proof of eligibility for those dependents identified by HMS no later than August 19, 2016. A grace period extended this deadline to September 7, 2016. Civil Service will now send a “Notice of Cancellation of Coverage” to enrollees with unverified dependents.
On October 2, 2016, unverified dependents will be removed from NYSHIP coverage retroactive to January 1, 2016. Once coverage is terminated, enrollees may be responsible for repaying all health insurance claims for services the ineligible dependent received on or after January 1, 2016 (or if enrolled after January 1, 2016, for dates of service back to the date coverage started).
A 90-day reinstatement period is available through December 6, 2016. Enrollees who wish to appeal the cancellation of a dependent’s coverage must contact HMS at 1-866-252-0635. This number is available from 8 a.m. to 11 p.m., Monday through Friday. For an appeal to be successful, the enrollee will have to provide the documents required to verify the dependent’s eligibility. Enrollees may fax documentation to 1-877-223-8478 or upload the documentation via www.VerifyOS.com.
Dependents who are determined eligible through HMS based on documentation provided by the December 6, 2016 deadline will be reinstated with no break in coverage. Dependents reinstated after December 6, 2016 will be subject to the waiting period for late enrollees. Coverage for late enrollees does not begin until the first day of the fifth payroll period following the payroll period in which the application for coverage is received.
Upon completion of the audit, Civil Service will terminate the coverage of unverified dependents enrolled in the state-administered dental and vision care plans administered by EmblemHealth and Davis Vision, respectively.