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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.y1516426032n.reo1516426032g@asf1516426032.

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.

6/15/17 On the Road with The Empire Plan

You’re taking your family on a trip this summer…Your child is going off to college this fall… You’ve finally retired and plan to spend winters in Florida… It’s good to know that The Empire Plan is there wherever you or your family goes. Before you go, however, plan ahead. Do you have your doctors’ phone numbers and your benefit card? Do you have enough of your maintenance medications? If you are Medicare primary, do you also have your Empire Plan Medicare Rx Card? And, don’t forget to pack On the Road with The Empire Plan. This informative booklet has important phone numbers and information you or a family member may need while away from home.

Empire Plan coverage is available worldwide and not just for emergencies. Most parts of The Empire Plan have two levels of benefits known as Network and Non-network. If you use an Empire Plan participating (or network) provider, you will receive medically necessary covered services and supplies at little or no cost and have no claim forms to fill out. If you use a nonparticipating (or non-network) provider, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply.

The Empire Plan Medical/Surgical Program has network providers in many states, and the Hospital Program, Prescription Drug Program and Medicare Rx have nationwide networks. The Empire Plan Mental Health and Substance Abuse Program, the Home Care Advocacy Program (HCAP) and the Managed Physical Medicine Program guarantee access to network benefits nationwide if you call to make the necessary arrangements before you receive services.

In the event you or a family member needs medical care while away from home, be prepared. Request the booklet On the Road with The Empire Plan from your agency health benefits administrator, usually located in your Personnel Office or the Business Services Center. If you are a retiree, contact the Employee Benefits Division of the NYS Department of Civil Service at (518)457-5754 or 1-800-833-4344. It can also be found online at www.cs.ny.gov/employee-benefits.. Select your group and plan to get to the NYSHIP Online homepage. Click Using Your Benefits and then Publications.

6/6/17 Birth Control Pills Recalled

Lupin Pharmaceuticals, the manufacturer of Mibelas 24 Fe oral contraceptive tablets, has announced a voluntary recall of one lot due to a packaging error. The recalled product has Lot #L600518 with an expiration date of 5/31/2018 and is packaged as a wallet of 28 tablets or a carton of 3 wallets. The tablets are supplied as blister packs containing 24 active tablets and 4 inert tablets.

A report showed that the blister was turned 180 degrees within the wallet, reversing the weekly tablet arrangement. This would provide the first 4 days of therapy with 4 non-hormonal placebo tablets vs. the active tablets. The lot number and expiration date were also no longer visible as result of the rotated blister.

Oral contraceptive tablets that are taken in the wrong order may place the user at risk for contraceptive failure and unintended pregnancy. The reversed order may not be obvious to first-time users or previous users, which may further increase the risk of taking the pills out of sequence.

Please call your doctor right away for advice if you are using the affected product, or if you do not know whether or not you used affected product. Your doctor is familiar with your medical history and can suggest the best treatment option for you. If you need a prescription for a different medicine, please call your doctor.

For more information call Lupin Pharmaceuticals (800) 399-2561 or visit www.FDA.gov.

4/20/2017 Enhanced Mammography Coverage Under NYS Breast Cancer Detection Law

Under a new New York State law that went into effect on January 1, 2017, the Empire Plan and all HMOs participating in the New York State Health Insurance Program cannot require cost-sharing for breast cancer screening and diagnostic imaging services when you use a provider in your health plan’s network. No cost-sharing means that your health plan cannot apply covered charges against an annual deductible and also cannot charge patients a copayment or coinsurance.

What services does the law cover?

The law eliminates cost-sharing for screening mammograms, including

  • a single, baseline mammogram for women 35 to 39 years old;
  • yearly mammograms for women 40 years of age or older; and
  • mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative (e.g., parent, sibling, child) with breast cancer.

The law also eliminates cost-sharing for medically necessary diagnostic imaging tests for breast cancer other than standard mammograms – such as diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI).

Empire Plan Now Covers 3-D Mammograms

Both Empire BlueCross BlueShield and UnitedHealthcare now consider 3-D mammograms medically necessary for the screening and diagnosis of breast cancer. This change, which went into effect on February 20, 2017, means that 3-D mammograms are covered with no copayment when you use an in-network provider. 3-D mammograms are also covered when you use an out-of-network provider, but are subject to deductible and coinsurance.

4/14/2017 College-age Students’ Dental, Vision Coverage May End with School Year

If your child is age 19 or older, but not yet 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 to dental or vision care.

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 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.

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 2017 monthly COBRA rates for individual coverage are: $27.76 for dental and $3.45 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 website at https://www.cs.ny.gov/employee-benefits . Follow the prompts to NYSHIP Online, and then click on Other Benefits to access the Dental Plan Certificate Book and NYS Vision Plan Book. Or, call the DCS at 518-457-5754 or 1-800-833-4344.

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4/14/2017 FDA Recall of EpiPen

On March 31, 2017, the U.S. Food and Drug Administration issued a notice regarding a voluntary recall of EpiPen and EpiPen Jr, because of two reports of the auto-injector not working properly. Letters are being sent to Empire Plan enrollees who may have filled a prescription for one of these products at a retail pharmacy, through the mail service or specialty pharmacies.

To see if you have one of the recalled products, check the lot number. The lot number is located on the left flap on the manufacturer’s carton and on the back of the injector itself inside the black box. If your product is not from one of these affected lots, it is not affected by this recall. If your product is from one of these affected lots, please contact Stericycle at 1-877-650-3494 for assistance with a replacement at no charge or contact the pharmacy that filled your prescription for further instructions.

Recalled products and lot numbers:

 

 

Product Name NDC# Affected Lots
EpiPen 2-Pak®
Auto-Injectors 0.3 mg
49502-0500-02 5GM631 exp. 04/17,
5GM640 exp. 05/17,
6GM082 exp. 09/17,
6GM072 exp. 09/17,
6GM081 exp. 09/17,
6GM088 exp. 10/17,
6GM199 exp. 10/17,
6GM091 exp. 10/17,
6GM087 exp. 10/17
EpiPen Jr 2-Pak®
Auto-Injectors 0.15 mg
49502-0501-02 5GN767 exp. 04/17,
5GN773 exp. 04/17,
6GN215 exp. 09/17

 

Submit 2016 Empire Plan Claims by April 30

If the Empire Plan is your primary insurer, April 30, 2017 (120 days after the end of the

calendar year), is the last day to submit your 2016 claims if you have used a non-participating provider or out-of-network pharmacy. If the Empire Plan is your secondary insurer, you must submit claims by April 30, 2017, or within 120 days after your primary health insurance plan processes your claim, whichever is later.

You may submit claims later if it was not reasonably possible to meet the deadlines (for example, due to illness); however, you must provide documentation.

For non-participating 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:

UnitedHealthcare Insurance Co. of New York
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax: 845-336-7716
Online claim submission: https://nyrmo.optummessenger.com/public/opensubmit

Non-network mental health and substance abuse services:

Beacon Health Options, Inc.
P.O. Box 1800
Latham, NY 12110
Claims submission fax: 855-378-8309
Online claim submission: https://ets.valueoptions.com/OnlineClaimSubmission

Prescriptions filled in 2016 at non-network pharmacies or without using your Empire Plan Benefit Card:

CVS Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136

2017 Empire Plan
& HMO Premium Rates/Option Transfer Period

The Empire Plan and HMO premium rates for 2017 have been
finalized by the Department of Civil Service and the Option Transfer Period has
started. Pursuant to the authority established in New York State Insurance Law
§§4235 (j)(1), (2) and (3), Empire Plan premium rates are adjusted annually
based on enrollee utilization and projected costs. These rates are not
negotiated by PEF.

The 2017 Empire Plan rate increases reflect projected cost
increases in all four benefit programs for 2017, as well as 2016 premium levels
which generated a combined $193.5 million loss in the Hospital, Medical, and
Mental Health and Substance Abuse programs, and a $174.2 million gain in the
Prescription Drug program.

The 2017 Empire Plan premium rates will increase as
indicated in the tables below. HMO rates for SG 9 and below and SG 10 and above are attached.

Salary Grade 9 and
Below:

Type
of Coverage

Current
Biweekly Premium Deduction

2017
Biweekly Premium Deduction

$
Change from 2016 to 2017

Individual

$37.50

$39.91

$2.41

Family

$161.62

$175.53

$13.91

Salary Grade 10 and
Above:

Type
of Coverage

Current
Biweekly Premium Deduction

2017
Biweekly Premium Deduction

$
Change from 2016 to 2017

Individual

$50.01

$53.21

$3.20

Family

$192.52

$208.92

$16.40

The option transfer period will run through December 16,
2016. If anyone is considering changing health plans, or enrolling in the
opt-out program for 2017, they should act quickly. Deductions for the 2017 plan
year will begin on December 29, 2016 for Administration Lag Payroll employees
and on January 5, 2017 for Institution Lag Payroll employees.

The NYSHIP Rates and Deadlines for 2017 flyer will be mailed
directly to employees’ homes. In the meantime, members can get option transfer
information, including the premium rates, on the Department of Civil Service
web site at https://cs.ny.gov/employee-benefits. Select your group (PEF) if
prompted, and then click on Health Benefits & Option Transfer. Choose Rates
and Health Plan Choices. Employees can also download, print and complete the
PS-404 form required to change health plan options, and then bring it to their
HBA for processing on or before December 16, 2016. Or, employees can change
their option online using MyNYSHIP.

The actual percentage of rate change varies by HMO and
coverage type (Individual vs. Family). The change in the employee deduction for
each HMO can vary due to the impact of the HMO premium “capping” formula. If a
PS&T Unit employee enrolls in an HMO, the State’s dollar contribution for
the non-prescription drug components (i.e., hospital, medical/surgical and
mental health and substance abuse components) of his or her HMO premium will
not exceed the State’s dollar contribution for the non-prescription drug
components of The Empire Plan premium. The enrollee must pay 100% of the
premium amount exceeding the cap.

We ask that you remind all members to review the NYSHIP
Rates & Deadlines for 2017 flyer even if they don’t plan on changing their
health plan option to avoid the potential of an unpleasant surprise in their
first biweekly paycheck with the new deductions.

It is important to look at more than premium rates when
selecting or remaining with an HMO. PEF (and other unions) only negotiate the
benefits and other elements of plan design for the Empire Plan. PEF does not
negotiate the benefits that HMOs provide. HMOs are allowed to change benefit
levels on an annual basis, independent of the negotiated Empire Plan benefits.
For this reason, we always recommend that HMO enrollees review their plan
options carefully each year during the Option Transfer Period. By now, all
members enrolled in an HMO should have received side-by-side comparisons
illustrating any benefit changes their HMOs will implement for plan year 2017.

If you have any questions about the rates, please contact
Deborah Stayman or Lorraine Simpkins in the Contract Administration Department
(x283) at PEF headquarters.

Important Deadlines for 2017 Benefits Choices

November 7, 2016 – Health Care Spending Account (HCSAccount). The HCSAccount could reduce your 2017 income taxes (payable in 2018) by allowing you to set aside pre-tax salary earned in 2017 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 2017.

November 30, 2016- Pre-Tax Contribution Program (PTCP). The PTCP may lower your 2017 income taxes (payable in 2018) by allowing you to pay for your health insurance premiums before taxes are withheld. If you participate in the PTCP, there are limitations on when you can make changes to your health insurance coverage. You can make the following changes only in November each year when there has been no PTCP-qualifying event: 1) Change from Family to Individual coverage while your dependents are still eligible; or 2) Voluntarily cancel your coverage while you’re still eligible for coverage. Also, you can elect to opt-in or opt-out of the PTCP. For more information, see the September 2016 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 2017. The deadline is the same as the deadline for changing health plans. For more information, see the September 2016 Planning for Option Transfer flyer.

Deadline date to be announced for changing health plans. The annual Option Transfer Period will be announced once 2017 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.

Productivity Enhancement Program (PEP). PEP allows eligible employees 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. The enrollment period for PEP is usually between October and November; however, under the terms of the 2015-2016 PS&T Contract (which expired April 1, 2016), the PEP sunsets (stops) at the end of 2016 for PS&T employees. Extending PEP for 2017 is contingent on ratification of the 2016-2019 PS&T tentative agreement. If the tentative agreement is ratified, then implementation will occur as soon as practicable thereafter. More information will be provided as it becomes available.

For the most up-to-date information on the annual Option Transfer Period, including the 2017 premium rates, visit the NYS Department of Civil Service website at www.cs.ny.gov/employee-benefits. Select your group (PEF) and plan, if prompted, and then select “Health Benefits & Option Transfer”.

Important Update on Dependent Eligibility Verification Audit
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.

 

Protect Your Vision During Summer and Holiday Celebrations

Everyone enjoys the sunshine, warm weather and July 4th celebrations with family and friends. It’s important to remember that your eyes need extra protection during these fun times.

Ultraviolet (UV) light can cause short and long-term damage to your eyes. Find out who is most at risk and steps you can take to protect your eyes here.

Fireworks are a traditional part of July 4th celebrations. Yet each year, thousands of people visit emergency rooms for treatment of fireworks-related injuries, with children the most frequent victims. Although sparklers may seem safe, they are the No.1 cause of all fireworks injuries in both adults and children.

Check out more about fireworks and the safest way to enjoy them here.

Have a great summer!

Health Alliance of the Hudson Valley (HAHV) Hospitals

As of May 31, 2016, the contract between Empire BlueCross BlueShield (the hospital administrator for The Empire Plan) and Health Alliance of the Hudson Valley (HAHV) expired. Effective June 1, 2016, the following HAHV facilities are no longer in The Empire Plan network:

  • Health Alliance Hospital – Broadway Campus (formerly known as Kingston Hospital)
  • Health Alliance Hospital – St. Mary’s Avenue Campus (formerly known as Benedictine Hospital)
  • Margaretville Memorial Hospital

Impact on Empire Plan Enrollee Who Uses a Non-Network Hospital

Except for the special circumstances indicated below, all other services provided by HAHV facilities will now be covered on a non-network basis.

  • Cases of emergency
  • If no in-network hospital exists that can provide the services required
  • If a network hospital is not available within a 30 mile radius from the member’s home
  • For continuation of care for pregnancy or health risk
  • For any services that were previously preauthorized

Non-Network Hospital Coverage (Empire BCBS)

Type of Service Non-Network Level of Benefits
Inpatient Services Enrollee pays 10% of billed charges up to the combined annual coinsurance maximum of $3,000 for the enrollee, $3,000 for the spouse/domestic partner, and $3,000 for all dependent children combined. The Plan then pays 100% of billed charges.
Outpatient Services Enrollee pays 10% of billed charges or $75 copay, whichever is greater, up to the combined annual coinsurance maximum. Then, the enrollee pays the network level copay, if any.
Emergency Services $70 copay; copay waived if patient admitted directly from ER.

 

If an enrollee receives radiology, anesthesiology or pathology services from a physician in connection with inpatient or outpatient hospital services at one of these three (3) hospitals, his or her out-of-pocket costs for these services may be higher as well. UnitedHealthcare (UHC) will provide benefits for these services based on the physician’s participation status. If the physician is not an Empire Plan participating provider, UHC will reimburse the enrollee under the Basic Medical portion of the Plan subject to the out-of-network combined annual deductible of $1,000 for the enrollee, $1,000 for the spouse/domestic partner, and $1,000 for all dependent children combined, and paid at 80% up to the Reasonable and Customary Charge.

Additional Information

Enrollees who are currently receiving services or are scheduled for treatment at HAHV hospitals are encouraged to call The Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447) and select 2 for the Hospital Program. Representatives can also provide assistance in locating an alternative Empire Plan network hospital in the area.

If you have any questions regarding this memo, please contact Lorraine Simpkins at PEF headquarters, 1-800-342-4306, ext. 283, or at gro.f1516426032ep@sn1516426032ikpmi1516426032sl1516426032
Don’t Get Copay Shock When You Refill Your Crestor Prescription

If you or a family member take Crestor, a drug prescribed for high cholesterol, you should know that a generic equivalent became available on 5/2/16.

Unless your doctor has written DAW (Dispense as Written) on your prescription for Crestor, the pharmacy will automatically refill the prescription with the generic.

Once a generic is available in the marketplace, if you continue to use Crestor an ancillary (additional) fee will be charged. You have three options:

1-To fill the generic

2-To continue to fill Crestor and pay the ancillary fee

3-To appeal the ancillary fee (if the appeal is approved you would pay the cost of the brand only which is currently $45 for a 30 day supply, $90 for a 90 day supply)

If you have questions contact the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447), then select option 4 for CVS/caremark.

 

College-age Students’ Dental, Vision Coverage May End with School Year

If your child is age 19 or over, but not yet 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 his/her 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.

Under the EmblemHealth (formerly GHI) Preferred Dental Plan and the NYS Vision Plan, your unmarried dependent children age 19 or over, 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.

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 2016 monthly COBRA rates for individual coverage are: $28.63 for dental and $3.53 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 website at https://www.cs.ny.gov/employee-benefits. Follow the prompts to NYSHIP Online, and then click on Health Benefits & Option Transfer. Choose NYSHIP General Information Book. You may also call the Employee Benefits Division of the NYS Department of Civil Service at 518-457-5754 or 1-800-833-4344.

 

Center of Excellence for Infertility Program – Facility Changes

The Empire Plan’s Center of Excellence (COE) for Infertility Program is partnering with UnitedHealthcare’s Optum Infertility Centers of Excellence network. This change is occurring in order to use Optum’s expertise and to ensure that Plan members continue to have a network of Centers with proven experience and successful outcomes. Benefits will remain the same; however, some facilities in the COE network will change. Please note that as of June 1, 2016, CNY Fertility (locations in Albany and Syracuse, NY) and Reproductive Specialists of New York (located in Mineola, NY) will no longer be part of the COE Program.

Effective June 1, the following facilities will be part of the new COE network:

  • Boston IVF, the Albany Center (Albany)
  • Columbia University for Women’s Reproductive Care (New York)
  • Cornell Center for Reproductive Medicine and Fertility (New York)
  • Genesis Fertility and Reproductive Medicine (Brooklyn)
  • Infertility and IVF Medical Associates of Western NY (Snyder)
  • Long Island IVF (Lake Success, Melville, Port Jefferson)
  • New York University Fertility Center (New York)
  • Reproductive Medicine Associates of Connecticut (Norwalk, CT)
  • Reproductive Medicine Associates of New York (New York)
  • Strong Fertility Center (Rochester)

If you are currently receiving infertility services from a facility that will no longer participate in The Empire Plan COE network, UnitedHealthcare mailed a letter on March 25, 2016 with more information about your specific situation. For certain services, COE-level benefits will continue to be issued until completion of services. If you remain with CNY or Reproductive Specialists of New York after completion of those services, you will be responsible for copayments and the travel and lodging benefit will no longer apply.

If you have questions regarding this change or its impact on any infertility related services you already have in progress or planned, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447), press or say 1 for Medical Program, and then choose Benefits Management Program.

New Immunization Requirements for Students in New York State

Beginning September 1, 2016, students entering seventh and 12th grades in New York State schools must be vaccinated against meningococcal disease, a severe bacterial infection that can lead to meningitis. The new law requires immunizations for children at ages 11 or 12 and again at 16 years of age or older. The meningococcal vaccine is covered in full, without a copayment, when administered by an Empire Plan Participating Provider. For more information about the meningococcal vaccine, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Program.

Empire Plan Claims Deadlines

If The Empire Plan is your primary coverage, April 30, 2016 (120 days after the end of the calendar year), is the last day to submit your 2015 claims if you have used a nonparticipating provider or out-of-network pharmacy. If The Empire Plan is your secondary coverage, you must submit claims by April 30, 2016, or within 120 days after your primary health insurance plan processes your claim, whichever is later.

You may submit claims later if it was not reasonably possible to meet the deadlines (for example, due to illness); however, you must provide documentation.

Nonparticipating and non-network claim forms are available on the NYS Department of Civil Service website. Go to https://www.cs.ny.gov/employee-benefits and follow the prompts to access NYSHIP Online. From the homepage, select Forms. You can also call The Empire Plan toll-free number, 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program.

File claim forms for/to the following:

The Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and non-network physical medicine services:

UnitedHealthcare Insurance Co. of New York

P.O. Box 1600

Kingston, NY 12402-1600

Claims submission fax: 845-336-7716

Online claim submission: nyrmo.optummessenger.com/public/opensubmit

Non-network mental health and substance abuse services:

Beacon Health Options, Inc.

P.O. Box 1800

Latham, NY 12110

Claims submission fax: 855-378-8309

Online claim submission: ets.valueoptions.com/OnlineClaimSumission

Prescriptions filled in 2015 at non-network pharmacies or without using your Empire Plan Benefit Card:

CVS/caremark

P.O. Box 52136

Phoenix, AZ 85072-2136

Mail completed claim forms with supporting bills, receipts and if applicable, a Medicare summary notice or statement from your other primary plan by April 30, 2016.

What is IRS Form 1095-C?

In order 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. View the form here. Watch your mail in mid-February for a notice from NYSHIP about the form with additional information.

Note: If you are enrolled in a NYSHIP HMO, you may receive a 1095-C from NYSHIP and a 1095-B from your HMO.

The Empire Plan Reporting On Prenatal Care describes benefits for enrollees who are expecting a child, offers helpful maternity information and guidelines for during and after pregnancy, including The Empire Plan’s Future Moms Program. (Link Here)

New Empire Plan Reporting On Publications

The December 2015 Empire Plan Reporting On publications describe benefits for enrollees with asthma, special surgery needs, or those trying to quit smoking.

Reporting on Asthma (asthma pdf) discusses the causes and symptoms of asthma, how to avoid asthma triggers, The Empire Plan’s Asthma Management Program and Home Care Advocacy Program (HCAP), types of asthma drugs and smoking cessation benefits.

Reporting on Center of Excellence Programs (centers of excellence pdf) discusses The Empire Plan Centers of Excellence Programs for cancer, transplants and infertility. The Programs offer paid-in-full coverage, including a travel allowance, as well as access to a select group of providers who are recognized as leaders in their fields.

Reporting on Smoking Cessation (smoking cessation pdf) explains the health risks of smoking, tips on how to quit, the e-cigarette trend and information on the smoking cessation treatments covered by The Empire Plan.

Click on the links to read them online, or contact your Health Benefits Administrator (HBA) for a printed copy.

2016 Productivity Enhancement Program Extended to PEF Enrollees PEF and New York State have reached agreement on extending the Productivity Enhancement Program (PEP) for 2016 to eligible PEF enrollees. To elect PEP for 2016, you must apply by January 8, 2016. The attached notice (PEP 2016 HBA Memo and attachments.pdf) explains the application process and credit amounts available. Contact your Health Benefits Administrator (HBA) located in your Personnel Office if you have any questions or want to request an application.

NYSHIP Dependent Eligibility Audit
Beginning in December 2015, the Department of Civil Service (DCS) will conduct a Dependent Eligibility Verification Project (DEVP), similar to the eligibility audit conducted in 2009, to help ensure that every participant who receives benefits through the New York State Health Insurance Program (NYSHIP) is entitled to those benefits. A key component of the audit is an amnesty period. The 2015-16 New York State budget provides legislation for a special amnesty period which will protect employees and retirees who voluntarily identify ineligible dependents during the amnesty period.
Click here for more information.

Productivity Enhancement Program (PEP) Extension for 2016

On December 2, 2015, PEF and New York State reached agreement on a Memorandum of Understanding (MOU) that restores the Productivity Enhancement Program (PEP) for 2016. Under the PEP, eligible full-time 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. Click here to view PDF.

The Memo from the Department of Civil Service can be seen here: http://www.cs.ny.gov/attendance_leave/pb15-03.pdf

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