10/7/2004
-SCHEDULE
OF PAYMENTS
The Office of the State Comptroller has
not yet finalized the schedule of payments for the new contract. Once this
information is available, details will be posted on the PEF website.
-
TUITION REIMBURSEMENT
The Article 15 Committee has established
an interim tuition reimbursement benefit for classes underway or commencing
September 14, 2004 through
March 31, 2005. Click here for more information.
http://www.pef.org/special_postings/tuition_reimbursement_memo.htm
-
PRODUCTIVITY ENHANCEMENT PROGRAM (PEP) BEGINS
The 2003-2007 Agreement provides that
employees working in positions allocated to SG-17 and below are eligible to
participate in PEP which allows them to trade 3 days of annual or personal leave
credits for a $400 credit toward the enrollee share of health insurance
premiums. (Details of the PEP program can be found on page 89 of the
Communicator Supplement sent to homes in August or on page 165 of the Electronic
Adobe version of the contract found here:
http://www.pef.org/pst2003/contractinfo/tentative_pst_contract.pdf)
The enrollment period for PEP
has begun and it will close on
OCTOBER 29, 2004. Employees interested in this benefit should
contact their personnel office for more information. Details of the program, as
well as enrollment forms, are be located here:
http://www.cs.state.ny.us/attendance_leave/PolBull04-03.htm
HEALTH
BENEFITS
-BASIC
MEDICAL DISCOUNT PROVIDER PROGRAM IMPLEMENTED EARLY
Members receive the best discounts and
benefits when they use Empire Plan participating providers. However, sometimes a
member cannot, or chooses not, to use an Empire Plan par provider. A new program
that became available on
10/1/04 gives Empire Plan members discounts from select providers who
don’t participate in the Empire Plan. (This program was not scheduled to become
effective until
1/1/05).
The Basic Medical Provider
Discount Program is 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 any
additional amounts.
Multiplan has more than
200,000 providers in their network. Please be sure to confirm the provider’s
participation before receiving services. You can access an online list of
Multiplan providers from the directory in the Civil Service web site at
www.cs.state.ny.us or at
www.myuhc.com. You can also call the Kingston
Service
Center at 1-877-7-NYSHIP and speak to
a United HealthCare representative.
EMPIRE
PLAN HOSPITAL NETWORK
-PINNACLE
HOSPITALS IN WESTCHESTER
COUNTY
There has been a good deal of media
coverage concerning a dispute between the 5 hospitals in
Westchester
County affiliated with Pinnacle
Health Care and the United Health Care Hospital Network. This has generated
some concern among our members since the new PEF Contract provides that the
Empire Plan Hospital Network will become effective
1/1/05.
Although United Health Care is
part of the Empire Plan, they DO NOT provide the hospitalization coverage.
United Health Care’s contract dispute with the Pinnacle Healthcare hospitals has
NOTHING to do with the Empire Plan Hospital Network to be implemented on
January 1, 2005. The Empire Plan Hospital Network will be
administered by Empire Blue Cross Blue Shield, not United Health Care, and we
have confirmed that all 5 of the hospitals involved with the dispute ARE network
hospitals in the Empire Plan Hospital Network.
-
IMPROVED BENEFITS FOR SERVICES PERFORMED BY RADIOLOGISTS, ANESTHESIOLOGISTS, AND
PATHOLOGISTS AT NETWORK HOSPITALS
Beginning
January 1, 2005, if you receive radiology, anesthesia or pathology
(RAP) services in connection with either INPATIENT OR OUTPATIENT hospital
services at an Empire Plan NETWORK hospital, covered charges billed separately
by the anesthesiologist, radiologist or pathologist will be PAID IN FULL.
During negotiations, GOER agreed to provide paid in full benefits for RAP
services on an inpatient basis only. Recently, GOER notified us that paid in
full benefits for RAP services would be expanded to include those performed on
an outpatient basis as well.
Currently, when a radiologist,
anesthesiologist or pathologist bills for services performed at a hospital,
benefits are provided under the Par Provider or Basic Medical portion of the
Empire Plan depending on the physician’s participation status. Often,
hospital-based physicians do not participate in the Empire Plan. In these
instances, the patient would have to pay any amounts applied to the annual Basic
Medical deductible, 20% of the covered expenses, and any non-covered expenses
such as amounts exceeding the Reasonable and Customary (R&C) charge. Since
these out-of-pocket expenses could be quite substantial, the new benefit for RAP
services is a significant enhancement to the Empire Plan.
-HEALTH
CARE SPENDING ACCOUNT
The Health Care Spending Account (HCSA) is
a program PEF and the state negotiated to help members save money on their taxes
by using pre-tax dollars to pay for non-reimbursed health care expenses (e.g.,
co-pays, deductibles, non-covered services). HCSA enrollment for 2005 ends on
November 10. (For more information on HCSA, check here:
http://www.pef.org/healthbenefits/newspromos.htm )
-HCSA:
OVER THE COUNTER MEDICATIONS
A new benefit negotiated in the 2003-07
PS&T contract allows over-the-counter drugs and supplies to be reimbursed
through the Health Care Spending Account. Current HCSA enrollees can begin using
this new benefit on
11/1/04. Reimbursable expenses include allergy remedies, antacids,
cold medicines and pain relievers. Visit the Flex Spending Account web site at
www.flexspend.state.ny.us for more information.
-EMPIRE
PLAN DEDUCTIBLE AND COINSURANCE MAXIMUM FOR 2005
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. Check here for information on the 2005
rates and more information:
http://www.pef.org/healthbenefits/newspromos.htm
-GET
READY FOR THE OPTION TRANSFER PERIOD
Later this fall, NYSHIP enrollees will
have the opportunity to change their health insurance enrollment during the
annual OPTION TRANSFER PERIOD. We have received some preliminary information
from the HMOs offered to state employees, and we can report that all of the
current HMOs will continue to be available in 2005. (MVP has also been approved
to offer services in Jefferson
County).
The 2005 premium rates for the HMOs and
the Empire Plan are still being reviewed by Civil Service and the Division of
Budget. Once the final rates have been approved, enrollees will be sent the
rate information. In November, HMO enrollees will receive a side by side
comparison showing any changes in benefits for 2005. The benefits offered by an
HMO can and do change over time, sometimes significantly. When enrollees
receive this information, they should evaluate the data carefully to determine
which health insurance coverage best suits their personal circumstance.
Continue to check the Health Benefits section of the PEF website for additional
information.
FULL CONTRACT TEXT and OTHER IMPORTANT
INFORMATION NOW ON-LINE! Just Click here to check
out these documents:
http://www.pef.org/pst2003/contractinfo/index.htm