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11/10/17
CVS Caremark, the Empire Plan Prescription Drug Program administrator, in consultation with the state agencies responsible for administering the New York State Health Insurance Program, has finalized the 2018 Empire Plan Flexible Formulary Drug List (see Attachment 1).

This list identifies the most commonly prescribed generic and brand name drugs included on the Flexible Formulary. This is not a complete list of prescription drugs on the Flexible Formulary or covered under the Empire Plan. The 2018 Empire Plan Flexible Formulary Drug List is posted on the NYS Department of Civil Service website at https://www.cs.ny.gov/employee-benefits. Follow the prompts to NYSHIP Online and then click on “Health Benefits & Option Transfer”. A printed copy of the Flexible Formulary will be included with the January 2018 Empire Plan At A Glance flyer, which will be mailed to enrollees’ homes at the end of the year. To check coverage and copay information for a medication not on this list, visit https://www.empireplanrxprogram.com/ or call 1-877-7NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program.

The Flexible Formulary is updated on January 1st of every year. The following changes can be made to the Flexible Formulary: 1) a prescription drug may be excluded from coverage; 2) a prescription drug may be moved from a lower-level copay to a higher-level copay (uptiers); or 3) a prescription drug may be moved from higher-level copay to a lower-level copay (downtiers). In addition, this year there is one (1) drug (Zomig Nasal) that was excluded in 2017 that will be covered in 2018. Indicated below are the changes that will be made effective January 1, 2018.

Drugs Not Covered (Excluded)

Effective 1/1/18, the ten (10) brand name and generic drugs in Attachment 2 will be excluded from coverage under the Empire Plan Prescription Drug Program. No benefit will be provided for an excluded drug and the enrollee will be responsible for paying the total retail cost of the drug.

Under the terms of the Flexible Formulary side letter, therapeutically equivalent alternatives must be available for each of the excluded drugs. These therapeutically equivalent alternatives can be substituted with the expectation that the substituted drug will produce the same clinical effect and have the same general safety profile as the excluded drug.

There is a medical exception process available if the preferred alternatives have been tried and failed. The prescribing physician may fax a letter of medical necessity to CVS Caremark documenting the Formulary alternatives that have been tried and failed, as well as any other clinical information explaining the reason(s) it is medically necessary for you to use the excluded drug. If the medical exception is approved for the excluded drug, you will pay the Level 3 non-preferred copay. If the excluded drug is a brand-name drug with a generic equivalent available, and there’s no documentation of a treatment failure while using the generic, your out-of-pocket cost will be higher. In addition to the Level 3 non-preferred copay, you will pay the difference in cost between the brand-name drug and the generic, not to exceed the full retail cost of the drug.

Preferred Brand to Non-Preferred Brand Name Drug (Uptiers)

Effective 1/1/18, CVS Caremark is moving one (1) brand name drug from the preferred (Level 2) mid-range copay level to the non-preferred (Level 3) highest copay level. There are therapeutic alternatives available for this drug. The alternatives, which may be either generic or brand name drugs or both, are considered equally effective in treating the same condition. The brand name drug moving from Level 2 to Level 3 is Cardura XL, used to treat Benign Prostatic Hyperplasia (BPH).

Non-Preferred Brand to Preferred Brand Name Drug (Downtiers)

Effective 1/1/18, CVS Caremark is moving eighteen (18) brand name drugs from the non-preferred (Level 3) highest copay level to the preferred (Level 2) mid-range copay level. The brand name drugs moving from Level 3 to Level 2 are listed in Attachment 3.

Disruption Letters

In mid-November, CVS Caremark will mail letters to all enrollees who have filled a prescription for one of the medications that will either be excluded or is moving from the preferred Level 2 copay to the non-preferred Level 3 copay. Attachment 4 is a sample disruption letter. These letters include a list of alternative Level 1 and/or Level 2 medication options, and encourage enrollees to discuss these options with their doctors.

Health Care Spending Account

Since the changes to the Flexible Formulary may affect enrollees’ out-of-pocket expenses for their prescription drugs, members who enrolled in the Health Care Spending Account (HCSAccount) may be concerned that their election amount will now be too low or too high. Fortunately, the state allows employees who enroll in the HCSAccount by the 11/6/17 deadline to change their election amount. After a member enrolls in the HCSAccount, FBMC, the HCSAccount administrator, will send him or her a letter confirming the amount set aside for 2018. This confirmation letter is usually sent in mid-November. Members can change their election amount on this letter and return it to FBMC (members should use the fax number indicated in the letter). FBMC must receive the request to change the election amount no later than 12/4/17. Members who have questions regarding the procedure for changing their election amount should contact FBMC at 1-800-358-7202.

Additional Information

To contact CVS Caremark, call the Empire Plan toll-free at 877-7-NYSHIP or 877-769-7447 and press or say 4 for the Prescription Drug Program. If you have any questions regarding this memo, please contact Lorraine Simpkins or Deborah Stayman at PEF headquarters, ext. 283.

Att. (4)

10/10/17

Time to Make Your Health Benefits Choices for 2018

The Option Transfer Period is here – the time to make your health benefits choices for 2018. Watch your mailbox for 2018 Option Transfer information, health insurance premium rates, and important deadlines for several benefits an d programs. This information will also be posted on the NYS Department of Civil Service website at www.cs.ny.gov/employee-benefits.. Select your group and plan, if prompted, and then Health Benefits & Option Transfer.

Missing the Option Transfer Period deadlines can be very costly. Mark your calendar or set reminders for these important deadlines.

November 6, 2017 – Health Care Spending Account (HCSAccount). The HCSAccount could reduce your 2018 income taxes (payable in 2019) by allowing you to set aside pre-tax salary earned in 2018 to pay for health, dental and vision care expenses that are not reimbursed by your health insurance or other benefit plans. Visit www.flexspend.ny.gov. to enroll online, or call 1-800-358-7202 for more information or to enroll by telephone. If you are currently enrolled in the HCSAccount, you must re-enroll to continue your participation in 2018.

November 6, 2017 – Productivity Enhancement Program (PEP). PEP allows eligible full- and part-time employees in a job title at or below grade 24 to exchange previously accrued annual leave and/or personal leave in return for a credit which reduces their share of New York State Health Insurance Program (NYSHIP) premium on a biweekly basis. If you are currently enrolled in PEP, you must re-enroll to continue in 2018.

November 6, 2017 – Productivity Enhancement Program (PEP). PEP allows eligible full- and part-time employees in a job title at or below grade 24 to exchange previously accrued annual leave and/or personal leave in return for a credit which reduces their share of New York State Health Insurance Program (NYSHIP) premium on a biweekly basis. If you are currently enrolled in PEP, you must re-enroll to continue in 2018.

November 30, 2017- Pre-Tax Contribution Program (PTCP). Under the PTCP, your share of the health insurance premium is deducted from your wages before taxes are withheld, which may lower your tax liability. In exchange for this reduction in your tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you provide timely notification (within 30 days) of a qualifying event, which would allow you to make a change or cancel your coverage.

In November, if you are enrolled in PTCP, you can make the following changes: 1) Change your PTCP election; 2) Change from Family to Individual coverage, while your dependents are still eligible, when there is no qualifying event; 3) Change from Individual to Family coverage without a qualifying event (late enrollment provisions will apply); and 4) Voluntarily cancel your coverage, while you are still eligible for coverage, when there is no qualifying event. Unless you wish to make one of these changes, no action is required to maintain your current PTCP election. For more information, see the September 2017 Planning for Option Transfer flyer.

Deadline date to be announced for electing to participate in the Opt-out Program. The Opt-out Program allows eligible employees who have other employer-sponsored group health insurance to opt out of their NYSHIP coverage in exchange for an annual incentive payment. Other coverage cannot be NYSHIP coverage that is the result of your or your spouse’s, domestic partner’s or parent’s employment relationship with New York State, or the result of your own employment with a NYSHIP Participating Agency (PA) or Participating Employer (PE). If you are covered as a dependent on another NYSHIP policy through a PA or PE, you are eligible to receive the Individual incentive payment of $1,000, but not the Family incentive payment of $3,000. If you currently participate in the Opt-out Program, you must re-enroll to continue to receive incentive payments in 2018. The deadline is the same as the deadline for changing health plans. For more information, see the September 2017 Planning for Option Transfer flyer.

Deadline date to be announced for changing health plans. The annual Option Transfer Period will be announced once 2018 premium rates are approved. You will have 30 days from the date your agency receives the rates to change your health plan. Consider your choice carefully. You may not change your health plan after the deadline except in special circumstances. No action is required if you do not wish to change health plans.

10/3/2017

Save Money by Enrolling in Flex Spending Account

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA’s two benefits–the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)– help you pay for health care or dependent care with pre-tax dollars. Even if you enrolled last year you must enroll again this year.

Enrolling in either benefit is voluntary. Savings will vary depending on your annual income, the number of dependents you claim on your taxes, and the amount of money you contribute through payroll deductions to your HCSAccount and/or DCAAccount.

The 2018 open enrollment period for the FSA is 10/2-11/6/17. An on-line enrollment process allows you to enroll at www.flexspend.ny.gov.. There are no paper forms to mail in. You can also enroll by calling 1-800-358-7202 and a customer service representative will take your application. If you have additional questions you may email them to vog.y1511394712n.reo1511394712g@asf1511394712.

Starting on 1/1/18, WageWorks will be the new administrator of the FSA program. Contact information is unchanged.

You may not pay directly for eligible expenses from these accounts. You must pay the expenses first and then submit claims for reimbursement from your HCSAccount or DCAAccount.

How the Health Care Spending Account works If eligible, you may contribute any amount from $100 to $2,600 annually in pre-tax dollars to pay for out-of-pocket medical, dental, vision, or hearing costs not reimbursed by health insurance. The maximum of $2,600 is the maximum annual election allowed by the federal government. Some examples of allowable costs are office visit copayments, dental implants, and orthodontia fees paid to non-participating providers, deductibles, laser eye surgery and contact lenses.

Federal law limits OTC drug reimbursement. Over-the-counter drugs, medicines, and biologicals require a doctor’s prescription to be eligible for reimbursement under the HCSAccount. Other OTC products (e.g., hearing aid batteries, band-aids, contact lens solution, etc.) are not affected by the law. OTC drug claims must be submitted with a receipt that clearly states the name of the drug or item, store name, purchase date and price.

Enrolling in the HCSAccount to enroll you must estimate your annual out-of-pocket costs, and then decide how much money to have withheld from your paycheck. It’s important to estimate conservatively because if you don’t file claims for reimbursement of the entire amount, you will lose any remaining funds. Once enrolled you can mail or fax claims, then receive reimbursement by check or direct deposit.
The online claims submission process enables enrollees to submit reimbursement requests for the HCSAccount and the DCAAccount online through www.myFBMC.com. . The simple, two-step process allows enrollees to upload scanned images of completed claim forms along with scans of supporting documents. Submitting reimbursement requests online is fast, easy and secure, and will speed the payment of FSA funds to enrollees.

How does the Dependent Care Advantage Account work? If you pay a caregiver to care for your child, elderly parent, or disabled spouse in order to work, you can set aside up to $5,000 in pre-tax salary through payroll deduction to help pay for these expenses. Examples of expenses eligible for DCAAccount reimbursement include child care expenses (under age 13), summer day camp, before/after school programs, adult day care, home aide, and housekeeper or cook (these last two must provide custodial care to be considered eligible expenses).

The employer contribution to DCAAccounts was reinstated in the 2016-2019 PS&T Contract. The Schedule of Employer Contributions for 2018 is: $800 for employees earning up to $30,000; $700 for those earning $30,001 to $40,000; $600 for those earning $40,001 to $50,000; $500 for those earning $50,001 to $60,000; $400 for those earning $60,001 to $70,000; and $300 for those earning over $70,000.

Remember, the 2018 open enrollment period for the FSA is 10/2-11/6/17. You may enroll on-line at www.flexspend.ny.gov or by calling 1-800-358-7202. A customer service representative will take your application. If you have additional questions you may email them to *protected email*.

7/25/17 2017

Empire Plan Participating Provider Directory postcards

The Department of Civil Service recently mailed Empire Plan enrollees their annual postcard for the printed 2017 Participating Provider Directory. Enrollees can request a directory based on their home ZIP code by adding a stamp and returning the postcard. New York versions include New York City, Upstate, Long Island and Hudson Valley. There are northern and southern versions for Florida and the Carolinas. The directories will be mailed as they are printed, from August through October 2017.

The Department of Civil Service website (https://www.cs.ny.gov/employee-benefits.) has an online tool called Find a Provider with the most updated information. From the Active Employees page select I am an active NYS employee, then choose your group (PEF) and plan (Empire Plan). You can also call The Empire Plan at 1-877-7-NYSHIP (1-877-7769-7447) and request information about par providers.

7/18/17 Liberty Medical is Now Edgepark

Empire Plan enrollees who obtain diabetic and/or associated medical supplies through the Home Care Advocacy Program (HCAP) may have used Liberty Medical in the past. Effective July 10, 2017 those supplies will be made available through Edgepark Medical Supplies. Edgepark has enrollees’ previous information that was on file with Liberty to ensure a smooth transition process.
Enrollees who had obtained supplies through Liberty Medical will receive the attached letter explaining the transition, along with contact numbers for any additional questions they may have. Edgepark is working with FedEx and regional carriers to offer Saturday shipping at no cost to enrollees.

For additional information contact Edgepark at 1-888-306-7337.

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