Trade Time Off to Lower Your Health Insurance Premium
Would you like to trade some of your leave to lower your paycheck deduction for health insurance? It’s an option if you work in a salary grade 24 position or lower.
Under the Productivity Enhancement Program (PEP), eligible full- and part-time employees may forfeit previously accrued annual and/or personal leave in return for a credit that reduces their state health insurance premium contribution.
The PEP credit of either $500 or $1,000 is divided by 26 paychecks and applied on a biweekly basis.
To enroll in PEP for 2019, you must apply between October 15 and November 16, 2018. If you are currently enrolled in PEP for 2018 and remain eligible to participate, it will not automatically carry forward into 2019. To continue, you must re-enroll by the November 16, 2018 deadline.
Full-time employees in a job title at or below grade 17 may forfeit a total of either three days or six days of annual and/or personal leave at the time they enroll in PEP in return for a credit of up to either $500 or $1000, respectively, for 2019.
Full-time employees in a job title between salary grade 18 and through 24 may forfeit a total of either two days or four days of annual and/or personal leave at the time they enroll in PEP in return for a credit of up to either $500 or $1000, respectively.
To enroll, PS&T employees must meet all of the following criteria:
- • Be a classified or unclassified service employee in the Executive branch in a title at Salary Grade 24 or below or equated to a position at or below Salary Grade 24;
• Have a combined total of at least eight days of vacation and personal leave left after trading time for the insurance credit; and
• Be a NYS Health Insurance Program contract holder in either the Empire Plan or an HMO at the time of enrollment.
Part-time employees may participate on a prorated basis.
Ask your agency health benefits administrator (HBA), usually located in the Personnel Office, for details and an application.
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 2019 open enrollment period for the FSA is 10/9-11/9/18. 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.y1540044136n.reo1540044136g@asf1540044136.
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 $2,650 annually in pre-tax dollars to pay for out-of-pocket medical, dental, vision, or hearing costs not reimbursed by health insurance. The new maximum of $2,650 is the maximum annual election allowed by the federal government. Some examples of allowable costs are office visit and prescription drug 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 and contact lens solution) 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.
The open enrollment period is early, I don’t know what my out-of-pocket costs will be by the deadline 2019 health plan rates may not be released by the FSA enrollment deadline of 11/9/18, but there is an opportunity to make changes in your withholding for the HCSAccount. After enrolling, you will receive a confirmation notice in the mail that allows you to change your withholding amount. The deadline to submit corrections is 12/10/18.
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 2019 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 2019 open enrollment period for the FSA is 10/9-11/9/18. 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 vog.y1540044136n.reo1540044136g@asf1540044136.
Need compression stockings? Be sure to use an In-Network Provider.
If you suffer from any vein-related condition, including varicose veins, your doctor may prescribe compression stockings to help alleviate your symptoms. Compression stockings are a special kind of hosiery, made of elastic fibers, intended to compress your legs and support healthy blood circulation.
The Medical/Surgical portion of the Empire Plan, administered by UnitedHealthcare (UHC), provides benefits for medically necessary compression stockings when prescribed for the treatment of certain vein-related conditions. UHC contracts with Prosthetic and Orthotic Management Associates Corporation (POMAC) to provide access to its network of certified suppliers of prostheses and orthotic devices under the Participating Provider Program. In addition to prostheses and orthotic devices, many of the POMAC vendors also provide compression stockings. When you use a POMAC network supplier, you have a paid-in-full benefit with no copay.
Using an out-of-network supplier will result in you having to pay at least part of the cost, if not all of it. When you use an out-of-network supplier, you must first satisfy the combined annual deductible ($1,000 for the enrollee, $1,000 for the enrolled spouse/domestic partner and $1,000 for all dependent children combined) and then the Plan will reimburse you 80 percent of the usual and customary rate.
A list of providers of prostheses and orthotic devices is available on the NYS Department of Civil Service website at https://www.cs.ny.gov/employee-benefits Enter your group and plan if prompted, to access NYSHIP Online. Select ”Find a Provider” and then “The Empire Plan Medical/Surgical Provider Directory”. Click on the “Search the Provider Directory” tab and then “Search for physicians, laboratories or other facilities”. Finally, select “Places” and then “Medical Suppliers”.
If you have questions about coverage, benefits, or need assistance in identifying an in-network provider, call The Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447), choose the Medical/Surgical Program and then press or say 1 to speak to a representative.
Do You Have a Student Age 19 or Over? You’ll Need to Submit Verification.
Under the EmblemHealth (formerly GHI) Preferred Dental Plan and the NYS Vision Plan, your unmarried dependent children age 19 or older, but under age 25, are eligible for coverage if they are full-time students. For the dental plan, EmblemHealth is responsible for determining eligibility as a full-time student. For the vision plan, Davis Vision is responsible for determining eligibility as a full-time student. Before paying a claim, both carriers require the employee to verify that his or her dependent child was a full-time student at the time the child received services. We recommend submitting the forms used to verify student status at the beginning of each semester. The forms are available at: www.emblemhealth.com/Members/Forms. and https://www.cs.ny.gov/employee-benefits/nyship/shared/forms/Davis-Vision-Student-Verfication-Form.pdf
The NYS Department of Civil Service recently implemented a new procedure to ensure that the State is not providing dental and vision coverage to dependent children for which the carriers have not received verification of student status. Each month, EmblemHealth and Davis Vision will be providing Civil Service with a list identifying those dependent children age 19 or older, but under age 25, for which the carrier has not received a current student verification form. Civil Service will terminate the dental and vision coverage for these dependents effective the end of the month in which the dependent turned 19, or three months after the most recent semester for which a student verification form was received.
If the dependent’s coverage should not have been terminated because he or she is a full-time student, then the employee will need to submit student verification forms to both EmblemHealth and Davis Vision. The carriers will then notify Civil Service to reinstate coverage. The forms must be submitted within 90 days of the termination to avoid a break (or gap) in the dependent’s coverage. Civil Service will send a letter to the employee when the dependent’s coverage is reinstated.
If you have any questions regarding the student verification forms or the eligibility of your dependent child, please contact the carrier directly. We recommend calling the carriers before scheduling an appointment for a dependent student to confirm that the carrier’s enrollment records indicate the student is eligible. You don’t want your dependent student to arrive at his or her appointment only to find out he or she is no longer covered. The toll-free telephone number for EmblemHealth is 1-800-947-0101. The toll-free telephone number for Davis Vision is 1-888-588-4823.
College-age Students’ Dental and Vision Coverage May End With School Year
If your child is age 19 or older, but under age 25, and is completing his/her studies in May or June, then he/she may lose eligibility for coverage as a dependent child under your dental and vision plans.
You must notify your state agency’s health benefits administrator of your child’s change in student status, and you should request information about how to continue their dental and vision coverage.
The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26, but that only applies to medical care, not dental or vision care.
When coverage ends
Under the EmblemHealth (formerly GHI) Preferred Dental Plan and the NYS Vision Plan, your unmarried dependent children age 19 or older, but under age 25, are eligible for coverage if they are full-time students. They continue to be eligible until the first of the following dates:
• The end of the third month following the month in which they completed the semester as a full-time student;
• The end of the month in which attendance at school ends, if the semester is not completed and proof of the last day of attendance for the semester is provided, or the end of the third month following the month that the last semester was completed, whichever is later;
• The starting date of the semester if the semester is not completed and no proof of attendance is provided, or the end of the third month following the month that the last semester was completed, whichever is later;
• The end of the third month following the month in which they complete course requirements for graduation; or
• The end of the month in which they reach age 25.
How to extend coverage
The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) requires most employers sponsoring group health plans to offer employees and their covered dependents the opportunity for temporary “continuation coverage” at group rates in certain instances where coverage under the employer-sponsored plan would otherwise end.
The dental and vision care benefits your dependent may continue are the same benefits you receive as an active employee. COBRA requires that your child have the opportunity to continue coverage for up to 36 months. The cost of COBRA coverage is the full premium (both the employer and employee shares) plus a 2 percent administrative fee. The 2018 monthly COBRA rates for individual coverage are: $27.55 for dental and $3.37 for vision.
Under COBRA, the employee or dependent is responsible for informing the Employee Benefits Division (EBD) of the state Department of Civil Service (DCS) within 60 days of when the dependent loses eligibility. If you do not notify EBD within that time, regardless of the reason, the dependent will not be entitled to COBRA continuation coverage.
For more information about COBRA continuation coverage, visit the DCS web site at www.cs.ny.gov/employee-benefits.. Follow the prompts to NYSHIP Online, and then select Other Benefits to access the Dental Plan Certificate Book and NYS Vision Plan Book, or you may call the DCS at 518-457-5754 or 1-800-833-4344.
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