College-age Students’ Dental, Vision Coverage May End with School Year
If your child is age 19 or older, but under age 25, and is completing his or her studies in May or June, then he or 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 2019 monthly COBRA rates for individual coverage are: $23.41 for dental and $3.16 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.
Submit 2018 Empire Plan Claims by April 30
If the Empire Plan is your primary insurer, April 30, 2019 (120 days after the end of the
calendar year), is the last day to submit your 2018 claims if you have used a non-network provider or non-network pharmacy. If The Empire Plan is your secondary insurer, you must submit claims by April 30, 2019, or within 120 days after your primary health insurance plan processes your claim, whichever is later.
For non-network provider claim forms, you can ask your agency health benefits administrator or find them online at http://www.cs.ny.gov/employee-benefits. Just follow the prompts there to access NYSHIP Online and select “Forms”. Or, call 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program.
Submit completed claim forms with supporting bills, receipts and if applicable, a Medicare summary notice or statement from your other primary plan as follows:
The Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and non-network physical medicine services:
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax: 845-336-7716
Non-network inpatient and outpatient hospital services:
Empire BlueCross BlueShield
New York State Service Center
P.O. Box 1407, Church Street Station
New York, New York, 10008-1407
Claim submission fax: 888-367-9788
Non-network mental health and substance abuse services:
Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, NY 11802
Claims submission fax: 855-378-8309
Prescriptions filled in 2018 at non-network pharmacies or without using your Empire Plan Benefit Card
P.O. Box 52136
Phoenix, AZ 85072-2136
What is IRS Form 1095-C?
To comply with Federal Health Care Reform provisions, the state of New York is required to send IRS tax form 1095-C to all full-time employees, enrollees in The Empire Plan or NYSHIP HMOs, as well as retirees who are not enrolled in Medicare. Form 1095-C presents data to be provided to the IRS by the State as proof of qualifying health insurance coverage for 2018.
Federal law requires that Form 1095-C be sent to all employees who meet the Patient Protection and Affordable Care Act’s definition of a full-time employee. This is generally defined as individuals who work at least 30 hours per week or 130 hours per month. In addition to full-time employees, the State will also send Form 1095-C to any other individuals who were enrolled in The Empire Plan or the Student Employee Health Plan (SEHP) for all or a portion of 2018. If you were enrolled in a Health Maintenance Organization (HMO) for all or a portion of 2018, you may receive a similar form, Form 1095-B, from your HMO as well.
Individuals who are enrolled in Medicare or who provide coverage to any dependents enrolled in Medicare should note that enrollment information for Medicare enrollees will not appear on Form 1095-C. You may receive a separate Form 1095-B from Medicare for these individuals.
The 1095-C forms will be mailed in early March; please review your form for accuracy and retain it with your tax records. You do not need to return the form to the state of New York, and it does not need to be filed with your federal or state income tax return. If any of the information contained on your Form 1095-C is inaccurate, call the telephone number on the upper right corner of the form to correct any errors.
Acupuncturists to be added to Par Provider Network
Beginning January 1, 2019, the Empire Plan started adding acupuncturists to the participating provider network, initially focusing on in-state providers. As acupuncturists are recruited, they will be added to the on-line directory immediately following receipt of their contract with United HealthCare. As with other providers, the par-provider directory will be able to identify network acupuncture providers by service rendered or name, and can search within a given geographical area by a desired radius. The office visit copayment of $20 will apply.
The Food and Drug Administration considers acupuncture safe when applied by qualified practitioners using sterile needles. Based on current trends, the Empire Plan expects to see increased use of acupuncture services as consumers seek alternative treatments for acute and chronic pain. United HealthCare projects the acupuncture recruitment initiative will take 1 – 2 years to fully evolve and mature into a robust network of acupuncturists that represent geographical areas throughout New York State.
2019 Empire Plan and HMO Rates Released
The Option Transfer Period for NYS employees will be December 10 through January 18, 2019. During the annual Option Transfer Period, members may make changes to their NYSHIP option, including enrolling in the Opt-out Program. If you currently participate in the Opt-out Program and wish to continue receiving incentive payments in 2019, you must re-enroll in the Opt-out Program during the Option Transfer Period. For more option transfer information, go to NYSHIP Online at www.cs.ny.gov/employee-benefits. Select Health Benefits & Option Transfer and then Rates and Health Plan Choices.
Acupuncturists to be added to par provider network
Beginning January 1, 2019, the Empire Plan will begin adding acupuncturists to the participating provider network, initially focusing on in-state providers. As acupuncturists are recruited, they will be added to the on-line directory immediately following receipt of their contract with United Healthcare. As with other providers, the par-provider directory will be able to identify network acupuncture providers by service rendered or name, and can search within a given geographical area by a desired radius. The office visit copayment of $20 will apply.
The Food and Drug Administration considers acupuncture safe when applied by qualified practitioners using sterile needles. Based on current trends, the Empire Plan expects to see increased use of acupuncture services as consumers seek alternative treatments for acute and chronic pain. United Healthcare projects the acupuncture recruitment initiative will take 1 – 2 years to fully evolve and mature into a robust network of acupuncturists that represent geographical areas throughout New York state.
Time to Make Benefits Choices for 2019
It’s that time of year again when you have the opportunity to continue or change your health benefit choices for 2019. In early October, the Planning for Option Transfer flyer was mailed to active employees enrolled in the New York State Health Insurance Program (NYSHIP). This flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Productivity Enhancement Program (PEP), the Pre-Tax Contribution Program (PTCP), and the Opt-Out Program. Watch your mailbox for the Rates & Deadlines for 2019 flyer, which will provide the biweekly premium rates, the deadline for changing health plan options, and other important dates, such as payroll deduction dates.
If you are considering changing your health insurance option for 2019 or wish to review your current option, ask your health benefits administrator (usually located in your personnel office or the New York State Business Services Center) for a copy of Health Insurance Choices for 2019, your guide to NYSHIP options. Or, find Choices and other option transfer publications on NYSHIP Online at www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, and then select Health Benefits & Option Transfer. Choose Rates and Health Plan Choices for the most up-to-date option transfer information.
Missing the Option Transfer Period deadlines can be very costly. Mark your calendars or set reminders for these important deadlines.
November 9 – Health Care Spending Account (HCSAccount). The HCSAccount could reduce your 2019 income taxes (payable in 2020) by allowing you to set aside pre-tax salary earned in 2019 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 2019.
November 16 – 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 2019.
November 30 – 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. Requests made during the PTCP Election Period are effective beginning the 2019 plan year.
Deadline date to be announced – annual Option Transfer Period. During the annual Option Transfer Period, employees may change their NYSHIP health plan option, including enrolling in the Opt-out Program, if eligible. Unlike other NYSHIP options, enrollment in the Opt-out Program does not continue automatically from year to year. If you currently participate in the Opt-out Program and wish to continue receiving incentive payments in 2019, you must re-elect the Opt-out Program during the annual Option Transfer Period.
Deadline date to be announced – Young Adult Option (YAO) Enrollment. The YAO provides coverage to children of NYSHIP enrollees up to age 30. The open enrollment period for the YAO will coincide with the annual Option Transfer Period. During this time, eligible adult children of NYSHIP enrollees can enroll or switch plans. For more information, visit www.cs.ny.gov/employee-benefits/young-adult-option.
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.y1556154003n.reo1556154003g@asf1556154003.
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.y1556154003n.reo1556154003g@asf1556154003.
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