HealthBenefits
Updated February 19, 2010 - Health Benefits Homepage

Previous News Articles

Deadlines Approaching for Flex Spending and Empire Plan Claims (2/19/10)

Employees enrolled in the Flex Spending Account for the 2009 plan year have until March 31, 2010 to send in reimbursement claims for eligible expenses incurred under the Health Care Spending Account and the Dependent Care Advantage Account. Visit the Flex Spending Account web site at www.flexspend.state.ny.us to download a reimbursement claim form or call Fringe Benefits Management Company at 1-800-342-8017 to request one

Empire Plan Pharmacy Network Changes (1/25/10)

On 9/26/09, the benchmark used to determine pharmacy reimbursement, known as “Average Wholesale Price” or AWP, was reduced by 4 percent as a result of a settlement in a class action lawsuit.   This settlement is impacting all pharmacy benefit programs, including the Empire Plan Prescription Drug Program.  For the Empire Plan, the AWP rollback will result in a cost savings. When determining the 2010 Empire Plan premium rates, United Healthcare (UHC), the Empire Plan Prescription Drug Program insurer, projected cost savings of at least $60M due to the AWP rollback

St  Status of the Dependent Eligibility Audit

UPDATED 1/7/10

Audit: Thousands of dependents ineligible for health coverage

Empire Plan Changes Coming 1/1/10 (12/5/09)

If you’re in the state’s Empire Plan, certain benefit changes authorized in the 2007-2011 PS&T contract, will start January 1, 2010. Included are selected copayments, the annual deductible and coinsurance maximum, summarized in a table here.

New Federal Parity Law

In addition to these negotiated benefit changes, additional changes to the Empire Plan Mental Health and Substance Abuse Program take effect January 1, 2010, under The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Empire Plan and HMO rates for 2010  were released on 11/25/09 and are posted here. The deadline for Option Transfer is 12/31/09. If you are thinking about changing your health plan option, there are two useful resources available: Planning for Option Transfer and Health Insurance Choices for 2010. These files can only be viewed with Adobe Acrobat Reader which can be downloaded for free at Adobe.

Use the Flex Spending Account to Save $$$ (10/7/09)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

Em Is Your Student Ready for College? (7/28/09)

Do you have a son or daughter getting ready to start college in August? If the answer is yes, chances are you already have a to-do list of things to buy and errands to run before the big day when you load up the car and make the trip to campus. There are some important health benefits matters to take care of before sending your son or daughter to college miles from home. The following checklist is designed to help you have everything ready by the time your new freshman leaves for campus.

Empire Plan Copay Changes Coming 7/1/09 (6/11/09)

If you’re enrolled in the Empire Plan, look for these benefit changes, authorized in the 2007-2011 PS&T contract, to start July 1, 2009. Copayments which are currently $18 will increase to $20. All other copayments remain the same.

The Flex Spending Account plan administrator, FBMC, has implemented a new online claims submission process.  As a result, Flex Spending Account enrollees are now able to submit  reimbursement requests for the Health Care Spending Account (HCSA) and the Dependent Care Advantage Account (DCAA) 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 documentation.  

’08 Frequently Asked Questions: Dependent Eligibility Audit  (4/13/09)

Q1. Why does Civil Service want to do an audit verifying the eligibility of dependents enrolled in the New York State Health Insurance Program (NYSHIP)? 

A. Health care continues to be one of the fastest-growing costs for employers and employees alike. An audit verifying dependent eligibility serves a very important purpose in holding down health care costs.  Audit results show that many dependents remain covered even though they are no longer eligible under employer-sponsored health plan rules

UniEmpire Plan Claims Due March 31(3/12/09)

Empire Plan enrollees take note:  Time is running out for filing claims for covered medical services and items received in 2008.

March 31 is the last day to submit your 2008 claims to: 

• United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;
• ValueOptions for non-network mental health and substance abuse services; and
• Medco for prescriptions filled in 2008 at non-participating pharmacies or without using your Empire Plan Benefit Card

Unit UnitedHealth Care Must Overhaul Databases Used to Pay Non-par Claims  (1/16/09)

New York state attorney general Andrew Cuomo has ordered UnitedHealth Care (UHC) to overhaul the Reasonable and Customary (R&C) Charge databases it uses to determine how much to pay when an enrollee uses a non-participating provider. Ingenix, a subsidiary of UHC, controls the databases. Many other health insurance carriers use Ingenix databases to pay claims.

Empire Plan MHSA: Transition of Care Benefit FAQs (12/4/08)

Q: What is the transition of care benefit? A: The transition of care benefit allows you to continue to receive network benefits even if your provider has not joined the OptumHealth network as of January 1, 2009.  All levels of care are covered under the transition of care benefit. Q: How do I access my transition of care benefit? A: You do not need to call or complete any forms to access the transition of care benefit.

Q: What is the Empire Plan Flexible Formulary? A: The Empire Plan Flexible Formulary is a list of preferred drugs, classified by therapeutic category or disease, designed to manage prescription costs without affecting the quality of care. A therapeutic category is a group of drugs that treat a specific health condition or that work in a certain way.

Vision Plan Improvements on the Way  (10/22/08)

Beginning January 1^st, PEF-represented employees will see some significant improvements to the vision plan.  These improvements were negotiated in the 2007-2011 PS&T contract. We took one step forward when the 90-day purchase period for dress eyewear was implemented on July 1, 2008.  Prior to this change, members had to purchase their dress eyewear on the same date as their vision exam.

Empire Plan Changes Coming 1/1/09 (10/20/08)

If you’re in the state’s Empire Plan, look for several benefit changes, authorized in the 2007-2011 PS&T contract, to start January 1, 2009. Services received at non-network hospitals and facilities – When you use a non-network hospital, skilled nursing facility or hospice care facility, you are responsible for: 10 percent of the billed charges for inpatient services up to the coinsurance maximum.

Use the Flex Spending Account to Save $$$ (9/3/08)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

New Half Tablet Program Saves $ on Rx Drugs (9/3/08)

Beginning October 1^st, The Empire Plan will begin offering a Half Tablet Program to help enrollees save on out-of-pocket costs for select medications.  “Since the escalating cost of prescription drugs is a concern to our members, we’re pleased that members who choose to participate in this Program will see a reduction in their copayments,” said PEF Health Benefits Specialist, Lorraine Simpkins. The Half Tablet Program is completely voluntary and works as follows.

HMO Options to Expand in 2009 (9/3/08)

The Joint Labor/Management Committees on Health Benefits (JLMC) have completed reviewing proposals submitted by HMOs for inclusion or continued participation in the New York State Health Insurance Program (NYSHIP). The Committee limited new requests for inclusion in NYSHIP, as well as expansion requests from those already participating, to six underserved counties in New York:  Chemung, Franklin, St. Lawrence, Schuyler, Steuben and Tompkins. The Committee approved requests for all of the HMOs currently participating in NYSHIP to continue.

Empire Plan Disease Management Program Update (7/16/08)

The Empire Plan offers a number of disease management (DM) programs for individuals with a chronic medical and/or mental health condition.  DM programs are available for individuals with:  asthma, cardiovascular/coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, depression, diabetes and sleep apnea.  All of the DM programs use nationally-recognized clinical practice guidelines and recommendations. Participation is voluntary, free of charge to the participant, and confidential.

Enjoy Good Health on Vacation: Plan Ahead to Travel (6/9/08)

Summer is traditionally the time when most of us take that much-needed vacation.  But when you're planning a trip, don't overlook the health care needs of you and your family.  Here are some things to consider: Can you take your benefits? It's no fun to have a vacation interrupted by a medical problem.  But it could be even worse to discover later that your health insurance does not provide the level of benefits you expected.

CDC Recommends Shingles Vaccine (5/23/08)

People age 60 and older should be vaccinated against shingles, or herpes zoster, a condition often marked by debilitating chronic pain, the Centers for Disease Control and Prevention (CDC) recommended recently. CDC recommends a single dose of the zoster vaccine, Zostavax, for adults 60 years of age and older even if they have had a prior episode of shingles. The good news is effective 7/1/08, Empire Plan enrollees will be able to get the shingles vaccine at age 55.

Albuterol inhalers are used for asthma and related conditions. The U.S. Food and Drug Administration (FDA) has mandated that albuterol inhalers containing the propellant chlorofluorocarbon (CFC) be discontinued from the market by December 31, 2008. They are being replaced by albuterol inhalers containing a more environmentally friendly propellant known as hydrofluoroalkane (HFA). Several HFA inhalers are available as alternatives to albuterol CFC inhalers; however, they are available only as brand name medications.

Act now to preserve health benefits for student dependents (4/25/08)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage. Your unmarried dependent children who are age 19 or over but under age 25 are eligible if they are full-time students at an accredited educational institution, and are otherwise not eligible for employer group or military health care coverage (e.g., cadets at U.S. military academies).

Why is This “Nosy” Company Asking About My Accident? (2/26/08)

If you get a letter from a company called Healthcare Recoveries, Inc. (HRI) asking about a medical claim you have made for benefits under the Empire Plan, it’s O.K. to answer it. Answering won’t delay or reduce the payment of your claim, and it might save the Empire Plan money and help reduce premiums for all Empire Plan enrollees. Here’s how it works. If you or one of your covered dependents is injured, another person or their insurance company may be legally responsible.

Important Claim Deadlines (2/26/08)

March 31, 2008 is the last day to submit your 2007 claims to: United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services; ValueOptions for non-network mental health and substance abuse services; and Caremark for prescriptions filled in 2007 at non-participating pharmacies or without using your Empire Plan Benefit Card.

Flex Spending Account Reminders (2/21/08)

Now that we're well into 2008, here are some tips to help you make the most of the pre-tax dollars in your Health Care Spending Account (HCSA) or Dependent Care Advantage Account (DCAA). The following apply to both HCSA and DCAA: 1) New employees can submit a change in status application within 60 days of their start date. This change will benefit employees who don't receive their new employee orientation in a timely fashion. 

Important News About Zyrtec (2/4/08)

The Department of Civil Service has posted the following information : As of January 24, 2008, Zyrtec and Zyrtec-D (generic name cetirizine) are available over the counter without a prescription. Generic cetirizine is also available over the counter in various strengths and forms. Effective January 25, 2008, Zyrtec and Zyrtec-D are no longer covered drugs under The Empire Plan.

Empire Plan Prescription Drug Program Update (12/19/07)

On January 1, 2008, UnitedHealth Care (UHC) and Medco will replace Empire Blue Cross Blue Shield (BCBS) and Caremark as vendors for the Empire Plan Prescription Drug Program. The following information is current as of 12/19/07. It will be updated as more information becomes available. UHC/Medco is contracting with both retail chain pharmacies and independent pharmacies to participate in the Empire Plan pharmacy network. 

E-Healthbeat: Understanding Pathology Reports (11/30/07)

Pathology reports can be the most difficult medical records for patients to understand. Yet they're among the most important because they help doctors plan treatment. A web site developed by the College of American Pathologists is attempting to explain the medical jargon, and help cancer patients and their families understand their illness and participate in their care. 

Make the Most of Your Vision Care Benefits (11/16/07)

PEF’s PS&T members receive vision care benefits through the NYS Vision Plan, which is administered by the NYS Department of Civil Service. Through a competitive bid process, Civil Service awarded the five-year vision contract to EyeMed Vision Care effective January 1, 2007. The vision contract was previously held for decades by Davis Vision. Members’ familiarity with Davis Vision made it easy for them to use the plan and minimize their costs.

Now’s the Time for Flu Shots (11/1/07)

This is the time of year to get a flu shot. According to the federal Centers for Disease Control and Prevention (CDC) there will be plentiful supplies of flu vaccine over the course of the 2007-08 flu season. It’s anticipated that about 140 million doses of vaccine will be available this year, more than has ever been distributed in the U.S. during a single influenza season. It's important to get a flu shot annually since viruses that cause flu often change from year to year.

November 16 is the deadline for enrolling in the Health Care Spending Account (HCSAccount). The HCSAccount saves you money by allowing you to set aside up to $4,000 in pre-tax salary to pay for health care expenses that are not reimbursed by health insurance or other benefit plans. Apply for enrollment online at www.flexspend.state.ny.us, or by calling toll free 1-800-358-7202 by 11/16/07.

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

What You Can Do to Stop Cervical Cancer (8/14/07)

The Coalition of Labor Union Women (CLUW) is reaching out to all union women to inform them about the importance of cervical cancer awareness.  September is Gynecological Cancer Awareness Month. Did you know that...Cervical cancer is highly preventable through regular screening. Cervical cancer is almost always caused by a common virus: human papillomavirus (HPV). Most women will have HPV at some point in their lives, but few will develop cervical cancer.

Empire Plan Rx Vendor Award (8/1/07)

The state has announced the contract for the Empire Plan Prescription Drug Program is being awarded to United Health Care/Medco. The 4-year contract will become effective January 1, 2008. The Program is currently insured by Empire Blue Cross Blue Shield with Caremark serving as Pharmacy Benefit Manager. United Health Care (UHC) is the insurer for the medical portion of the Empire Plan. 

Timothy’s Law and Mental Health Parity in the Empire Plan (6/11/07)

Legislation known as “Timothy’s Law” changed coverage requirements for mental health benefits in group health plans, including the Empire Plan and NYSHIP HMOs, effective 1/1/07. Timothy’s Law requires that health plans provide for no less than 30 days of inpatient care and 20 days of outpatient care for the diagnosis and treatment of mental, nervous or emotional disorders. Timothy’s Law does not affect substance abuse benefits.

NYSHIP Now Recognizes Same-Sex Marriage for Spousal Benefits Eligibility (5/8/07)

Effective May 1, 2007, the New York State Department of Civil Service policy was revised to recognize any same-sex marriage that is legal in the jurisdiction where it was performed for the purposes of extending spousal benefits eligibility in the New York State Health Insurance Program (NYSHIP), and for all other benefit programs administered by the Department's Employee Benefits Division...

Effective May 1, 2007, the New York State Department of Civil Service will alter its prior policy and afford recognition to any same-sex marriage that is legal in the jurisdiction where it was performed, for purposes of providing spousal benefits eligibility in the New York State Health Insurance Program (NYSHIP) and for all other benefit programs administered by the Department’s Employee Benefits Division...

New Empire Plan Disease Management Program (5/2/07)

Effective March 1, 2007, there is a new Empire Plan Disease Management Program. The new program combines the individual programs for cardiovascular disease, asthma, and diabetes into a single program, and adds two new conditions - congestive heart failure and chronic obstructive pulmonary disease.

Enjoy Good Health on Vacation: Plan Ahead to Travel (5/2/07)

Summer is traditionally the time when most of us take that much-needed vacation. But when you're planning a trip, don't overlook the health care needs of you and your family. Here are some things to consider: Can you take your benefits? It's no fun to have a vacation interrupted by a medical problem. But it could be even worse to discover later that your health insurance does not provide the benefits you expected. 

Act now to preserve health benefits for student dependents (4/10/07)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage. 

Vision Plan: It Pays to Know the Details (3/22/07)

If you have had an opportunity to use the vision plan since EyeMed Vision Care replaced Davis Vision on January 1, 2007, you may have noticed some differences.  This is especially true when it comes to choosing frames for your eyeglasses when using an in-network vision care provider.

New Biweekly Premium Rates Effective (4/1/07)

In January 2006, the state began requiring state employees and retirees to share in the cost of reimbursing Medicare-primary enrollees in the New York State Health Insurance Program (NYSHIP) for their Medicare Part B premium contribution.  The state accomplished this by adding the expense for the Medicare Part B premium reimbursement to the NYSHIP premium rates.  This action was challenged by PEF working with a coalition of other state employee unions.

Empire Plan Offers Special Services for Cancer (1/18/07)

If tomorrow you found out you had cancer, what would you do? If you're in the Empire Plan, you have access to special Cancer Resource Services (CRS) that you may not know about. The program provides paid-in-full coverage for cancer-related expenses received through a select group of providers recognized as leaders in cancer treatment.

UHC Fined for Errors in Provider Directories (1/3/07)

On 12/19/06, Attorney General Eliot Spitzer announced a settlement that will require United Healthcare (UHC) to stop providing misleading information to its policyholders and to provide restitution to consumers. "Consumers should not be saddled with improper bills when they rely on health plan directories to choose their doctors," said Spitzer.

Quest No Longer Empire Plan Par Provider (12/22/06)

  Effective 1/1/07, Quest Diagnostics will no longer be an Empire Plan par provider of lab services. As of 1/1/07, LabCorp will be the sole national Empire Plan par provider of lab services.  In addition to LabCorp, other regional and local lab providers continue to participate in the Empire Plan.

New Vision Plan Administrator (12/12/06) 

  Effective 1/1/07, the New York State Vision Plan will be administered by EyeMed Vision Care, LLC. EyeMed has an extensive network of eye care providers throughout New York state and nationwide. The EyeMed network includes independent practitioners as well as optical retailers LensCrafters, Target Optical, Sears Optical, JCPenney Optical, and most Pearle Vision locations. There is no change in negotiated vision benefits, which are covered in Article 9.25 of the 2003-2007 PS&T Contract.

Victory in Medicare Part B Lawsuit (11/29/06)

PEF received an extremely favorable decision from the Appellate Division in our Medicare Part B lawsuit against New York State. By a vote of 5-0, the Appellate Division reversed the lower court’s ruling and granted PEF’s petition. This is a significant victory for all public sector employees and retirees in New York, and represents a major cooperative effort among public sector unions.

Important Dates for Benefit Choices (11/15/06)

November 24, 2006 is the deadline for electing to participate in the Productivity Enhancement Program (PEP) for 2007. Eligible full- and part-time employees may exchange previously accrued vacation credits and/or personal leave in exchange for a credit of up to $400 to be applied toward their health insurance premium.

If you’re in the state’s Empire Plan, look for these benefit changes, authorized in the 2003-2007 PS&T contract, to start January 1, 2007. In addition to changes in copayment amounts, there will be two changes to the Empire Plan Basic Medical Program.  The annual deductible for medical services performed and supplies prescribed by non-participating providers will increase from $322 to $335.

2007 HMO Changes (11/15/06)

 The NYS Joint Labor-Management Committees on  Health Benefits (JLMC) has completed reviewing proposals submitted by HMOs for inclusion or continued participation in the New York State Health Insurance Program (NYSHIP) in the year 2007. The JLMC has announced the following changes.

New Empire Plan Vaccine Benefit (9/8/06)

A new vaccine called Gardasil, which is designed to prevent cervical cancer and other conditions caused by the human papillomavirus (HPV), is now a covered benefit under the Empire Plan. The effective date of coverage is June 29, 2006, which is the date Gardasil was endorsed by the Advisory Committee on Immunization Practices (ACIP).

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

e-healthbeat: www. searchclinicaltrials.org (7/25/06)

The Center for Information & Study on Clinical Research Participation (CISCRP) is a non-profit organization focused on educating and informing the public about clinical research participation. Clinical trials sometimes offer the last hope for sick patients and their families hunting for a cure for a serious illness. Finding information about any of the hundreds of ongoing clinical trials in the U.S. can be extremely frustrating and time-consuming.

First New York Health Care Report Card Released (6/29/06) 

 The New York State Health Accountability Foundation has released the first New York State Health Care Report Card, a unique interactive report on the performance of the state’s health plans and hospitals. The report card, available at www.AboutHealthQuality.org, provides data on the quality, volume, length of stay and pricing of care provided by health insurers and hospitals.

Make the Most of Your Vision Care Benefits (6/7/06)

The State of New York provides vision care benefits to PEF-represented state employees.  The Vision Plan is administered and fully paid for by the state.  It offers quality eyewear services at little or no cost to eligible employees and their dependents who obtain covered services from a participating optometrist (Panel Provider).  For those who obtain services from a non-participating optometrist (Non-Panel Provider), reimbursement is available based on a fixed payment schedule

Is your freshman ready for college? (5/30/06)  

Do you have a son or daughter getting ready to start college in August? If the answer is yes, chances are you already have a to-do list of things to buy and errands to run before the big day when you load up the car and make the trip to campus. There are some important health benefits matters to take care of before sending your son or daughter to college miles from home. The following checklist is designed to help you have everything ready by the time your new freshman leaves for campus.  

Continuing Coverage for Dependent Students (4/12/06)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage. Your unmarried dependent children who are age 19 or over but under age 25 are eligible if they are full-time students at an accredited educational institution and are otherwise not eligible for employer group coverage.

Empire Plan Prescription Drug Program Update (3/6/06)

On January 1, 2006, Empire Blue Cross Blue Shield (BCBS) and Caremark replaced Cigna and Express Scripts as vendors for the Empire Plan Prescription Drug Program. The following information is current as of 3/6/06. State Comptroller Alan G. Hevesi announced the Department of Civil Service should conduct a new competitive bid for the three-year $4.9 billion contract for prescription drug coverage for Empire Plan enrollees. The selected proposal from Empire Blue Cross Blue Shield/Caremark did not meet bid requirements because after the initial submission, Empire Blue Cross was allowed to change its bid three times in order to meet mandatory requirements. This is a violation of contracting rules designed to ensure fair competition.  

Important Claim Deadlines (2/15/06) 

March 31, 2006 is the last day to submit your 2005 claims to: United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;  ValueOptions for non-network mental health and substance abuse services; and Express Scripts for prescriptions filled in 2005 at non-participating pharmacies or without using your New York Government Employee Benefit Card. 

Empire Plan Prescription Drug Program Update (1/5/06)

On January 1, 2006, Empire Blue Cross Blue Shield (BCBS) and Caremark replaced Cigna and Express Scripts as vendors for the Empire Plan Prescription Drug Program. The following information is current as of 1/5/06. Empire BCBS/Caremark expected to contract with most of the retail chain pharmacies and independent pharmacies that were in the Empire Plan Pharmacy Network in 2005.

Attention: Parents of Disabled Dependents (1/5/06)

Medicare Part D, the new federal prescription drug plan, became effective on  January 1, 2006 . Under this plan, Medicare will offer prescription drug benefits to an individual who is Medicare eligible, or receives both Medicare and Medicaid benefits (referred to as a dual eligible recipient). A dual eligible recipient with disabilities usually receives Social Security and Medicare benefits and Supplemental Security Income (SSI) and Medicaid benefits.

Consider Carefully When Choosing Your Health Plan (11/15/05)

The annual window for changing your health plan option will open as soon as the premium rates for 2006 are set.  You will have 30 days after the rates are delivered to the state agencies to change health plans. If you don’t request a change during that period, you will automatically remain enrolled with the same health plan you are in.  

Health Benefit Changes Starting January 2006 (10/31/05)

Enhancements and other changes to the health benefits negotiated in the 2003-2007 PS&T contract will take effect January 1, 2006.  “We've received a number of complaints about the GHI dental plan’s out-of-network differential,” said PEF health benefits specialist Lorraine Simpkins. When basic and major restorative services are performed by a non-participating dentist, the GHI plan has been paying 80 percent of the allowable charge.

Empire Plan Prescription Drug Program Vendor to Change (9/20/05)

The state has awarded the contract to manage Empire Plan prescription drug benefits to Empire Blue Cross Blue Shield (BCBS) and Caremark Rx.  The three-year contract will be effective January 1, 2006.  The contract is currently held by CIGNA and Express Scripts, Inc.  This change in vendor does not affect members enrolled in an HMO.  

Use the Flex Spending Account to Save $$$ (9/15/05)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

Make the Most of Your Vision Care Benefits (8/24/05)

The State of New York provides vision care benefits to PEF-represented state employees.  The Vision Plan is administered and fully paid for by the state.  It offers quality eyewear services at little or no cost to eligible employees and their dependents who obtain covered services from a participating optometrist (Panel Provider).  For those who obtain services from a non-participating optometrist (Non-Panel Provider), reimbursement is available based on a fixed payment schedule.  

Do you have health benefits questions or complaints? Speak up! (8/22/05)   

 Don’t know where to turn for help with health-benefit questions or problems? Not satisfied with your health plan or the service you are receiving?  Have suggestions for improving health benefits?  The PEF  Joint Labor/Management Committee on  Health Benefits (JCHB) wants to hear from you.

Achieve Solutions Web Site (8/2/05)

Value Options, the Empire Plan managed mental health and substance abuse program, has a free web site with information about behavioral health issues. In order to use the Achieve Solutions web site the employee/dependent must be enrolled in the Empire Plan. However, employee names are not associated with either the username or password.

Is your freshman ready for college? (6/8/05) 

  Do you have a son or daughter getting ready to start college in August? If the answer is yes, chances are you already have a to-do list of things to buy and errands to run before the big day when you load up the car and make the trip to campus. There are some important health benefits matters to take care of before sending your son or daughter to college miles from home.

Meningitis vaccine now covered by the Empire Plan (6/8/05) 

  Effective July 1, 2005, the meningitis vaccine will be considered a covered pediatric vaccine for dependent children up to age 19, under both the participating provider and basic medical components of the Empire Plan. Full-time dependent students age 19 and over will be eligible for vaccine coverage under the adult immunization benefit, which is through a participating provider only.

Express Scripts, Inc. (ESI), which administers the Empire Plan Prescription Drug Program, has announced that their mail service fulfillment functions are moving from Troy, New York to Bensalem, Pennsylvania. Fulfillment functions include receipt, opening and scanning of prescription orders, dispensing the actual medication, and packaging and mailing the final order.

Continuing Coverage for Dependent Students  (5/16/05)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage.

Laser Vision Correction Program (3/18/05)   

 The Laser Vision Correction Program, a new benefit in the ’03-’07 PS&T Contract, will be implemented on April 1, 2005. The benefit provides a discount to members who have laser vision correction surgery performed by a provider in the Davis Vision Laser Vision Network. Members can save up to 25% off the provider’s usual and customary fees, or receive an additional 5% discount.

Important Claim Deadlines  (2/15/05) 

March 31, 2005 (90 days after the end of the calendar year) is the last day to submit your 2004 claims to:        United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;      ValueOptions for non-network mental health and substance abuse services.

Highlights of Empire Plan Changes (11/1/04)

The following new Empire Plan benefits became effective on October 1, 2004:

Basic Medical Provider Discount Program - Offered through Multiplan. When you use non-par physicians who are affiliated with Multiplan, you will receive discounts on the provider’s usual fees. You still must satisfy the annual deductible and 20 percent coinsurance required by Basic Medical, but you cannot be balance billed for amounts exceeding the discounted fee. Plus, the provider submits the claim for you.

Time for Annual Health Plan Check Up (10/15/04)

The annual window for changing your health plan option has been extended through December 24, 2004.  If you don’t request a change now, you will automatically remain enrolled with the same health plan you are in. Not all health plans are alike, and the one that was the best for you this year may no longer be your best choice. It’s well worth your effort to compare them.  

Empire Plan 2005 Preferred Drug List (12/23/04)

Express Scripts has released the Empire Plan Preferred Drug List (PDL) for 2005. As of 1/1/05, benefits provided will depend on whether a drug is generic (Tier 1), preferred brand name (Tier 2), or non-preferred brand name (Tier 3). Copayments will be based on the drug, the days' supply, and whether the prescription is filled at a retail pharmacy or the mail service pharmacy. 

Using Mail Service Pharmacy Saves $$ (1/13/05)

Recent negotiated changes in the Empire Plan Prescription Drug program have motivated many enrollees to consider using the Express Scripts mail service pharmacy for long-term medications. The following are frequently asked questions about the mail service pharmacy. Click on any question below and you will immediately see the answer.

HMO Changes for 2005   (9/28/04)

 The   Jo int Labor/Management Committees on   Health Benefits  (JLMC) have completed reviewing proposals submitted by HMOs for inclusion or continued participation in the New York State Health Insurance Program (NYSHIP). The JLMC limited new HMO requests for inclusion in NYSHIP, as well as expansion requests from those already participating, to seven (7) counties deemed underserved. 

Use the Flex Spending Account to Save $$$   (10/1/04) 

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.  

Empire Plan Deductible and Coinsurance Maximum for '05  (10/5/04)

If you’re in the Empire Plan, you know that, with a few exceptions, you must first satisfy an annual deductible before you receive reimbursement for services performed by a non-participating (par) provider. You are also responsible for 20 percent of covered charges until you reach the annual coinsurance maximum.

Annual Vision Benefit Extended (4/20/04)

PEF and the state have signed a Memorandum of Agreement extending the annual vision benefit for adults with certain medical conditions through April 1, 2005, pending the outcome of the current collective bargaining negotiations. Article 9.25(b) of the 1999-2003 PEF/NYS contract includes an annual vision benefit for adults with certain documented medical conditions that may affect their vision.

Use It or Lose It!  (3/22/04)

If you participated in the NYS Flex Spending Account Program in 2003 and still have a balance in your Health Care Spending Account or Dependent Care Advantage Account, it's not too late to get your money. The deadline to submit claims for the 2003 Plan Year is March 31, 2004

New Option Transfer Policy for Retirees (4/14/04)

The Department of Civil Service has announced a more flexible health insurance option transfer policy for NYSHIP enrollees with retiree benefits. NYSHIP retirees  are now permitted to change health insurance options at any time during the year; however, once an option change is made, another one may not be made until twelve months later. 

E-Healthbeat: Help for the Seriously Ill (3/29/04)

The NYS Insurance Department has a new web site designed as a comprehensive information center for people who are seriously ill and their caregivers. The new web site at www.insurancehelpny.com provides quick and reliable access to insurance information and other useful resources.

Empire Plan Benefits to Change on January 1, 2004 (12/5/03)

If you’re in the state’s Empire Plan, look for these benefit changes, authorized in the 1999-2003 PS&T contract, to start January 1, 2004. These changes are: Basic Medical Deductible:  The Empire Plan Basic Medical Program annual deductible for medical services performed and supplies prescribed by non-participating providers increases from $283 to $295.  

March 31, 2004 (90 days after the end of the ca len dar year) is the last day to submit your 2003 claims to United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services; ValueOptions for non-network mental health and substance abuse services...

OncoLink is a multi-media resource about cancer from the Abramson Cancer Center of the University of Pennsylvania. The web site provides information about specific types of cancer, news about research advances, and updates on cancer treatment and clinical trials. OncoLink offers up-to-date information on quality of life issues of relevance to cancer survivors and their families.

Use the Flex Spending Account to Save $$$ (9/23/03)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that 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.

New York Online Access to Health (NOAH) at www.noah-health.org is a web site with a unique collection of state, local and federal resources for consumers. NOAH's mission is to "... provide access to high quality full-text consumer health information in English and Spanish that is accurate, timely, relevant and unbiased."

How to Change Your FSA Withholding $$$ (11/18/03)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that help you pay for health care or dependent care with pre-tax dollars. 

Time to Make Important Decisions about Your Benefits  (10/16/03)

The annual Option Transfer Period, which begins on November 1, is the time for you to make important decisions about your health benefits. During the Option Transfer Period, you may change your health insurance option for the next calendar year, as well as change your Pre-Tax Contribution Program (PTCP) enrollment.  

Enjoy Good Health on Vacation: Plan Ahead to Travel (6/15/03)

Summer is traditionally the time when most of us take that much-needed vacation. But when you're planning a trip, don't overlook the health care needs of you and your family. Here are some things to consider:

Continuing Coverage for Student Dependents (5/2/03)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage.

Attention: Parents of Disabled Children (8/20/03)

The Empire Plan insurers and HMOs participating in the New York State Health Insurance Program (NYSHIP) must accept all individuals determined by the NYS Department of Civil Service (Civil Service) to be eligible. It recently came to our attention that one HMO, CDPHP, has not been complying with the NYSHIP eligibility requirements for disabled children. 

Diabetes Management Program (4/1/03)

The Empire Plan is introducing a  Diabetes Management Program to help individuals living with diabetes or high blood sugar. Enrollees who recently received treatment for diabetes or a diabetes-related problem may receive a letter inviting them to participate in the program. Participation is voluntary, free of charge,  confidential and will not affect coverage in any way.

e-HealthBeat: Quackwatch (3/20/03)

Quackwatch is an independently operated web site containing useful information about health fraud and quackery. There are hundreds of original articles in categories such as "Questionable Products, Services and Theories," "Non-recommended Sources of Health Advice," "Consumer Strategy: Tips for Provider Selection," plus a lengthy selection of links to related sites. 

Important Claim Deadlines  (2/25/03)

March 31, 2003 (90 days after the end of the calendar year) is the last day to submit your 2002 claims to: United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services; ValueOptions for non-network mental health and substance abuse services.

What is HIPAA? (4/25/03)

If you have seen a doctor or filled a prescription since April 14, 2003, you probably were asked to read and sign some new, confusing forms. Your doctor's office staff may have grumbled something about "HIPAA" requirements if you asked for an explanation. You probably also received at least one Notice of Privacy Practices from your health insurance company. If you're still wondering what HIPAA is all about, read on.

Women’s Health & Wellness Act (2/10/03)

New York State employers who provide prescription drug coverage to employees must now offer insurance coverage for contraceptive drugs and devices. A new law, called the Women’s Health & Wellness Act, also requires employers to expand coverage for prevention, early detection and treatment of breast and cervical cancer and the bone density-thinning condition called osteoporosis. 

The National Women's Health Information Center (NWHIC) web site at www.4woman.gov is the federal government's clearinghouse for women's health information. It offers information on all major health concerns for women, prevention topics, frequently asked questions about women's health.

Empire Plan Changes Start January 1 (12/6/02)

If you’re enrolled in the Empire Plan, look for these benefit changes, authorized in the 1999-2003 PS&T contract, to start January 1, 2003: copayment increases from $10 to $12 for services by Empire Plan participating providers, Managed Physical Network (MPN) providers, ValueOptions network providers.

Annual Vision Benefit for Certain Medical Conditions  (2/14/03)

UPDATE: PEF and the State have agreed to extend this benefit until April 1, 2004. Article 9.25(b) of the 1999-2003 PS&T contract includes an annual vision benefit for adults with certain documented medical conditions that may affect their vision. These medical conditions include diabetes, developing cataracts, taking a prescription drug which could cause vision changes, or any other medical condition which could cause a change in vision.

2003 Health Plan Rates (12/4/02)

The 2003 Empire Plan and HMO premium rates have been approved and were distributed to state agencies on November 27, 2002. Click here to see the rates. Empire Plan premiums are adjusted annually based on plan experience. The PEF/NYS contract does not give PEF authority to negotiate premium rates

Time for Annual Health Plan Checkup (9/30/02)

The annual window for changing your health plan option will open as soon as the premium rates for 2003 are set. This is likely to take place in November. Not all health plans are alike, and the one that was the best for you this year may no longer be your best choice. It’s well worth your effort to compare them.

Use the Flex Spending Account to Save $$$ (9/20/02)

The Flex Spending Account (FSA) is a program PEF and the state negotiated to help members save money on their taxes. The FSA has two benefits, the Health Care Spending Account (HCSAccount) and the Dependent Care Advantage Account (DCAAccount)--that help you pay for health care or dependent care with pre-tax dollars. 

The Empire Plan now has a single toll-free number to reach United HealthCare, Empire Blue Cross and Blue Shield, ValueOptions, Express Scripts and Empire Plan Nurseline: 1-877-7NYSHIP or 1-877-769-7447.

NYSOnLine is the web site of the Department of Civil Service/Employee Benefits Division. It is the most comprehensive source of health benefits information available to state employees, and it can be accessed from the privacy of your own home, 24 hours a day.

Davis Vision began sending updated Vision Care Program Books to enrollees’ homes on August 2, 2002. In addition to the updated vision benefit book, members enrolled in the Empire Plan will receive the June 1, 2002 NYSHIP General Information Book and Empire Plan Certificate (benefit book).

Where would you turn to find information if you or a family member received a diagnosis of cancer? Many people would begin by searching the Internet. Cancerlinks is specially designed to make on-line searches for information about cancer faster and easier.

Community Blue Members to Pay More for Prescriptions (11/15/02)

Members enrolled in Community Blue will have to pay significantly more for their prescriptions beginning in January 2003. A comparison of the current copay amounts to the new copay amounts explains the details.

The American Academy of Child & Adolescent Psychiatry is composed of over 6,500 child and adolescent psychiatrists who research, evaluate, diagnose, and treat psychiatric disorders. Their web site contains a wealth of information provided as a public service to aid in the understanding and treatment of the developmental, behavioral, and mental disorders among children and adolescents.

Most Empire Plan enrollees know that surgery is covered by the plan when it’s medically necessary. You may not know, however, that there are limitations to what the plan will pay if your doctor does more than one surgical procedure during the same operation.

Enjoy Good Health on Vacation: Plan Ahead to Travel (6/22/02)

Summer is traditionally the time when most of us take that much-needed vacation. But when you're planning a trip, don't overlook the health care needs of you and your family. Here are some things to consider:

More and more people are using online resources to make important medical decisions for themselves and family members. According to a recent survey of Internet users, only one-quarter thoroughly check the source and date of information they find online. Do you know how to evaluate the reliability of health information on the Internet?

New Feature: e-HealthBeat (7/1/02)

This is the first in a series of articles about web sites that provide reliable, up-to-date information on health-related topics. If you use the Internet to find health information, you have access to literally millions of web pages. The challenge is to find web sites that provide accurate, objective information. 

New Allergy Serum Benefit (3/20/02)

The Empire Plan provides a paid-in-full benefit for the administration of an allergy injection, including the cost of the serum, when billed by a participating provider. But, what happens when the serum is dispensed by one participating physician and is administered by another participating physician or, in some cases, by the patient or the patient’s family? As of January 1, 2002, the “take-away” serum will be paid in full under the Participating Provider Program.

Empire Plan Chemotherapy Benefits (6/3/02)

As if having cancer isn’t bad enough, several Empire Plan enrollees have learned too late that their out-of-pocket expenses for chemotherapy will be much higher than expected. These enrollees weren’t aware that the benefits for chemotherapy differ significantly depending on the provider they use.  

Empire Plan Par Radiologists (2/20/02)

Associated Radiologists of the Finger Lakes re-joined the panel of Empire Plan participating providers effective January 10, 2002.This is welcome news for PEF members who live in Chemung, Schuyler, and Steuben counties. 

March 31, 2002 (90 days after the end of the calendar year) is the last day to submit your 2001 claims to: United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services.

Continuing Coverage for Dependent Students (5/10/02)

May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage.

For the first time the state is offering long-term care insurance to active and retired employees and their eligible dependents. This is an employee-pay-all program available at discounted group rates from MedAmerica of New York.

If you’re in the state’s Empire Plan, look for the following benefit changes, authorized in the 1999-2003 PS&T contract, to start January 1, 2002.

Which ID Card Are You Using?(11/21/01)
When you go to a doctor or other provider, do you know which card identifies you as an Empire Plan enrollee? It’s the one that says "New York Government Employee Benefit Card." Unfortunately, the card doesn’t have the Empire Plan name, logo or telephone numbers on it so some enrollees forget it’s their Empire Plan card.

Health Benefits While on Military Leave (10/5/01)
PEF and GOER have reached an agreement to provide health benefit protections to State employees who have been activated for military duty as a result of the September 11, 2001 attack on the United States.

Get Ready to Choose Health Benefits for 2002 (11/1/01)
The annual Option Transfer Period begins on November 1st. Option Transfer Period is the time for you to make important decisions about your health care benefits. In addition to changing your health plan, you are allowed to make certain changes in the month of November:

Reminder: HCSAccount Enrollment Ends Soon (10/24/01)
If you've put off enrolling in the Health Care Spending Account (HCSAccount) for 2002, be aware that the deadline for enrollment is November 9, 2001.

Achieving exceptionally high recognition for quality in virtually all areas of its operations, Davis Vision has become the first vision care Preferred Provider Organization (PPO) in the country to receive full accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).