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10/22/2019
Time to Make Benefits Choices for 2020

It’s that time of year again when you have the opportunity to continue or change your health benefit choices for 2020. In late September, the Planning for Option Transfer flyer was mailed to active employees enrolled in the New York State Health Insurance Program (NYSHIP). This flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Productivity Enhancement Program (PEP), the Pre-Tax Contribution Program (PTCP), and the Opt-Out Program. Watch your mailbox for the Rates & Deadlines for 2020 flyer, which will provide the biweekly premium rates, the deadline for changing health plan options, and other important dates, such as payroll deduction dates.

If you are considering changing your health insurance option for 2020 or wish to review your current option, ask your health benefits administrator usually located in your personnel office or the New York State Business Services Center for a copy of Health Insurance Choices for 2020, your guide to NYSHIP options. Or, find Choices and other option transfer publications on NYSHIP Online at www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted. On the NYSHIP Online home page, select “Health Benefits & Option Transfer” and then “Rates and Health Plan Choices” for the most up-to-date Option Transfer Period information.

Missing the Option Transfer Period deadlines can be very costly. Mark your calendars or set reminders for these important deadlines.

November 8 – Health Care Spending Account (HCSAccount). The HCSAccount could reduce your 2020 income taxes (payable in 2021) by allowing you to set aside pre-tax salary earned in 2020 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 2020.

November 19 – Productivity Enhancement Program (PEP). PEP allows eligible full- and part-time employees in a job title at or below grade 24 to exchange previously accrued annual leave and/or personal leave in return for a credit which reduces their share of the NYSHIP premium on a biweekly basis. If you are currently enrolled in PEP, you must re-enroll to continue in 2020

Deadline date to be announced – Option Transfer Period. Dates will be announced once the 2020 premium rates have been approved. During the Option Transfer Period, you may change your NYSHIP health plan option, including enrolling in the Opt-out Program if eligible. If you are currently enrolled in the Opt-out Program, you will be pleased to know that it is no longer necessary to re-enroll in the Opt-out Program each year. No action is required for current Opt-out enrollees who are still eligible and wish to remain in the Program for 2020.

Deadline date to be announced – Pre-Tax Contribution Program (PTCP). The PTCP Election Period will now run concurrently with the Option Transfer Period. Under the PTCP, your share of the health insurance premium is deducted from your wages before taxes are withheld, which may lower your tax liability. In exchange for this reduction in your tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you provide timely notification (within 30 days) of a qualifying event, which would allow you to make a change or cancel your coverage.

If you are enrolled in PTCP, you can make the following changes during the Option Transfer Period: 1) Change your PTCP election; 2) Change from Family to Individual coverage, while your dependents are still eligible, when there is no qualifying event; 3) Change from Individual to Family coverage without a qualifying event (late enrollment provisions will apply); and 4) Voluntarily cancel your coverage, while you are still eligible for coverage, when there is no qualifying event. Requests made during the PTCP Election Period are effective beginning the 2020 plan year.

Deadline date to be announced – Young Adult Option (YAO) Enrollment. The YAO provides coverage to children of NYSHIP enrollees up to age 30. The open enrollment period for the YAO will run concurrently with the Option Transfer Period. During this time, eligible adult children of NYSHIP enrollees can enroll or switch plans. For more information, visit www.cs.ny.gov/employee-benefits/young-adult-option.

10/2/2019

Flex Spending Account Helps You Save $

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 2020 open enrollment period for the FSA is 10/7-11/8/19. 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.y1576329457n.reo1576329457g@asf1576329457

The HCSAccount now has a debit card called WageWorks® Healthcare Card, which enables enrollees to pay for copayments and other out-of-pocket costs at the time of service. When you use the debit card to pay for eligible expenses, funds are electronically deducted from your Health Care Spending Account. There is no annual fee for the card. Each enrollee will be issued two cards initially. If you need a third card you may request one from WageWorks Customer Service 1-800-358-7202.

How the Health Care Spending Account worksIf eligible, you may contribute any amount from $100 to $2,700 annually in pre-tax dollars to pay for out-of-pocket medical, dental, vision, or hearing costs not reimbursed by health insurance. The new maximum of $2,700 is the maximum annual election allowed by the federal government. Some examples of allowable costs are office visit and prescription drug copayments, dental implants, and orthodontia fees paid to non-participating providers, deductibles, laser eye surgery and contact lenses.

Federal law limits OTC drug reimbursement. Over-the-counter drugs, medicines, and biologicals require a doctor’s prescription to be eligible for reimbursement under the HCSAccount. Other OTC products (e.g., hearing aid batteries, band-aids and contact lens solution) are not affected by the law.

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 use the smartphone app (see box below) mail or fax claims, then receive reimbursement by check or direct deposit.

An 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.

Also new for 2020 is the WageWorks EZ Receipts app, which you can download to your smartphone. The app allows you to file and manage your reimbursement claims and debit card usage paperwork on the spot, with a click of your smartphone or mobile device camera, from anywhere

The enrollment deadline is early, before 2020 health plan rates may be released Although next year’s health plan rates may not be available by the FSA enrollment deadline of 11/8/19, there is an opportunity to make changes in your withholding for the HCSAccount. After enrolling, you will receive a confirmation notice in the mail that allows you to change your withholding amount. The deadline to submit changes is 12/9/19. participating providers, deductibles, laser eye surgery and contact lenses.

Federal law limits OTC drug reimbursement. Over-the-counter drugs, medicines, and biologicals require a doctor’s prescription to be eligible for reimbursement under the HCSAccount. Other OTC products (e.g., hearing aid batteries, band-aids and contact lens solution) are not affected by the law.

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 use the smartphone app (see box below) mail or fax claims, then receive reimbursement by check or direct deposit.

An 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.

Also new for 2020 is the WageWorks EZ Receipts app, which you can download to your smartphone. The app allows you to file and manage your reimbursement claims and debit card usage paperwork on the spot, with a click of your smartphone or mobile device camera, from anywhere.

The enrollment deadline is early, before 2020 health plan rates may be released. Although next year’s health plan rates may not be available by the FSA enrollment deadline of 11/8/19, there is an opportunity to make changes in your withholding for the HCSAccount. After enrolling, you will receive a confirmation notice in the mail that allows you to change your withholding amount. The deadline to submit changes is 12/9/19.

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).

You must pay the expenses first and then submit claims for reimbursement from your DCAAccount.

The state confirmed that PEF-represented employees will receive employer contributions to their DCAAccounts in 2020. The Schedule of Employer Contributions for 2020 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

Employees who have not enrolled in the 2020 plan year will be eligible for the employer contribution if they enroll with an eligible change in status (CIS) within 60 days of the eligible CIS event, and will have the employer contribution applied to their DCAAccount for the remainder of the plan year.

Remember, the 2020 open enrollment period for the FSA is 10/7-11/8/19. You may enroll on-line at www.flexspend.ny.gov or by calling 1-800-358-7202. A customer service representative will take your application. If you have additional questions you may email them to vog.y1576329457n.reo1576329457g@asf1576329457

10/2/2019
New Empire Plan benefits

  • Effective 10/1/19, the Empire Plan will be extending the age range for coverage of the Gardasil 9 Human Papilloma Virus (HPV) vaccine as a preventive care service for men and women through age 45. The Plan has been covering the Gardasil 9 vaccine as a preventive care service for enrollees ages 9-26. In October 2018, the FDA approved the Gardasil 9 vaccine for expanded use by men and women ages 27–45 years old. Consequently, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended extending the age range for coverage of the Gardasil 9 vaccine as a preventive service through age 45. This age range extension applies only to the Gardasil 9 vaccine, not to any of the other HPV vaccines. The CDC adopted the ACIP recommendation in June 2019, to be effective by October 1, 2019.

    Preventive care services required under the Affordable Care Act, which includes the Gardasil 9 HPV vaccine, are covered at no cost share to enrollees when a network provider is used.

  • Effective 9/16/19, gender reassignment surgery and any other surgeries, services and procedures associated with gender reassignment (including those performed to change an enrollee’s physical appearance to more closely conform secondary sex characteristics to their identified gender) are now covered if a behavioral health provider determines the surgery or procedure is medically necessary.

    A behavioral health provider, who must be licensed by the state in which they practice and experienced in treating gender dysphoria, must provide a written assessment documenting that the enrollee has a diagnosis of gender dysphoria, the capacity to make a fully informed decision and to consent for treatment, and is 18 years of age or older.

    Benefits are available under the Participating Provider and Basic Medical programs. While not required, a predetermination review, also known as a preservice claim determination, is available.

    Coverage for gender dysphoria treatment also includes cross-sex hormone therapy, puberty- suppressing medications and laboratory testing to monitor the safety of hormone therapy.

    More information is provided in the Empire Plan Certificate Amendment dated 9/16/19: Gender Dysphoria Amendment

7/10/2018
Westchester Medical Center Update

We are pleased to advise you that the Westchester Medical Center Health Network (WMCHN) and Empire BlueCross (the administrator for the Empire Plan Hospital Program) have reached a contract agreement that reinstates the hospital system’s network status retroactive to June 1, 2019. WMCHN includes the following facilities: Bon Secours—Good Samaritan Hospital; Bon Secours—Mercy Community Hospital; Bon Secours—St. Anthony’s Hospital; Mid-Hudson Regional Hospital and Westchester Medical Center.

This means that claims for covered services received at these facilities on or after June 1, 2019, will be processed at the in-network level of benefits subject to any applicable in-network copayment.

Empire Plan enrollees who have any questions should be advised to call The Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447) and select option 2 for the Hospital Program.

6/20/2019
Security Incidents Involving Quest Diagnostics and LabCorp

Quest Diagnostics (Quest) and LabCorp recently reported two separate security incidents involving their debt collection vendor, American Medical Collection Agency (AMCA). AMCA, a third-party vendor used for patient debt collection, may have been the victim of a malware-attack, resulting in exposure of certain personal information. This information is reported to include social security numbers and financial data, such as credit card information. Laboratory test results were not included. This issue is limited to only those Quest and LabCorp patients who had a past due balance for lab services that were sent to the collections vendor, AMCA, where the security incident occurred.

Quest and LabCorp have stated they are working closely with AMCA to determine the facts and understand which health plan members are affected. Although these two incidents did not directly involve NYSHIP, the Department of Civil Service will continue to provide updates as additional information becomes available.

06/06/2019
Update – Westchester Medical Center Health Network
As of May 31, 2019, the contract between Empire BlueCross BlueShield (the hospital administrator for The Empire Plan) and Westchester Medical Center Health Network (WMC) expired. Effective June 1, 2019, the following WMC facilities are no longer in The Empire Plan network:

    • Bon Secours – Good Samaritan Hospital (Suffern, NY)
    • Bon Secours – Mercy Community Hospital (Port Jervis, NY)
    • Bon Secours – St. Anthony’s Hospital (Warwick, NY)
    • Mid- Hudson Regional Hospital (Poughkeepsie, NY)
    • Westchester Medical Center (Valhalla, N.Y)

Impact on Empire Plan Enrollees – Most Coverage Is Now On a Non-Network Basis
Except for the special circumstances listed below, all other services provided by WMC facilities will now be covered on a non-network basis:

    • If no in-network hospital is available within 30 miles of your residence
    • If no in-network hospital within 30 miles of your residence can provide the covered services you require
    • If you need emergency care
    • 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
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.
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.
Emergency Services $70 copay; copay waived if patient admitted directly from ER.

 

Radiology, Anesthesiology and Pathology Physician Services (UnitedHealthcare)

If an enrollee receives radiology, anesthesiology or pathology services from a physician in connection with inpatient or outpatient hospital services at one of the non-network WMC facilities, his or her out-of-pocket costs for these services may be higher as well. United Healthcare (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 have questions or need assistance in identifying an alternative facility should be advised to call Empire BCBS toll-free at 1-800-495-9323, Monday through Friday, between the hours of 8:30am and 5:00pm

05/22/2019
Westchester Medical Center Health Network Termination

If an agreement with Empire Blue Cross Blue Shield is not reached by June 1, 2019, the Westchester Medical Center Health Network will no longer be in-network.
Westchester Medical Center Health Network consists of the following facilities: Bon Secours – Good Samaritan Hospital; Bon Secours – Mercy Community Hospital; Bon Secours – St. Anthony’s Hospital; Mid- Hudson Regional Hospital; and Westchester Medical Center.
Under these circumstances, Westchester Medical Center Health Network will only provide the following in-network services:

    1) Cases of emergency;
    2) If no in-network hospital exists that can provide the services required;
    3) If a network hospital is not available within a 30-mile radius from your home;
    4) For continuation of care for pregnancy or health risk;
    5) For any services that were previously preauthorized.

If you choose to use Westchester Medical Center Health Network, all other services will be covered on an out-of-network basis. You will be responsible for paying ten percent (10%) of the billed charges for covered services, up to the annual coinsurance maximum amount.
To find an alternate network hospital or learn more, call 1-877-7-NYSHIP (1-877-769-7447) and select option 2.

05/20/2019
Revised Empire Plan Certificate Books\
The NYS Department of Civil Service recently mailed the January 1, 2018 Empire Plan Certificate book to the homes of all active PEF-represented state employees enrolled in the Empire Plan. The updated Certificate book, which describes the coverage provided by the Empire Plan, is also posted on the Civil Service Employee Benefits Division website, NYSHIP Online. Go to www.cs.ny.gov/employee-benefits, select your group (PEF) and plan, if prompted, and then select Health Benefits & Option Transfer.

The 2018 Certificate book replaces your 2014 Empire Plan Certificate book and all Empire Plan Reports/Certificate Amendments updating the 2014 book. The 2018 Certificate includes all of the changes to the Empire Plan since publication of the 2014 Empire Plan Certificate book and January 1, 2018. When PEF ratifies a successor contract, Civil Service will update the Certificate book to include any negotiated benefit changes.

Civil Service will also be mailing a revised Empire Plan Certificate for New York State Retirees to retirees in the near future. The retiree Certificate book will be dated January 1, 2019.

You should save this book and all subsequent Empire Plan Reports/Certificate Amendments you receive in the mail. New Certificate books are not issued every year. It is important that you read and keep this book and any future Empire Plan Reports/Certificate Amendments that update this book and inform you of important changes to your Empire Plan coverage.

05/13/2019
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. The toll-free number is 1-877-7-NYSHIP or 1-877-769-7447.

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. Select Using Your Benefits and then Publications.

04/18/2019
College-age Students’ Dental, Vision Coverage May End with School Year

If your child is age 19 or older, but under age 25, and is completing his or her studies in May or June, then he or she may lose eligibility for coverage as a dependent child under your dental and vision plans.

You must notify your state agency’s health benefits administrator of your child’s change in student status, and you should request information about how to continue their dental and vision coverage.

The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26, but that only applies to medical care, not dental or vision care.

When coverage ends

Under the EmblemHealth (formerly GHI) Preferred Dental Plan and the NYS Vision Plan, your unmarried dependent children age 19 or older, but under age 25, are eligible for coverage if they are full-time students. They continue to be eligible until the first of the following dates:

    • The end of the third month following the month in which they completed the semester as a full-time student;

    • The end of the month in which attendance at school ends, if the semester is not completed and proof of the last day of attendance for the semester is provided, or the end of the third month following the month that the last semester was completed, whichever is later;

    • The starting date of the semester if the semester is not completed and no proof of attendance is provided, or the end of the third month following the month that the last semester was completed, whichever is later;

    • The end of the third month following the month in which they complete course requirements for graduation; or

    • The end of the month in which they reach age 25.

How to extend coverage

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) requires most employers sponsoring group health plans to offer employees and their covered dependents the opportunity for temporary “continuation coverage” at group rates in certain instances where coverage under the employer-sponsored plan would otherwise end.

The dental and vision care benefits your dependent may continue are the same benefits you receive as an active employee. COBRA requires that your child have the opportunity to continue coverage for up to 36 months. The cost of COBRA coverage is the full premium (both the employer and employee shares) plus a 2 percent administrative fee. The 2019 monthly COBRA rates for individual coverage are: $23.41 for dental and $3.16 for vision.

Under COBRA, the employee or dependent is responsible for informing the Employee Benefits Division (EBD) of the state Department of Civil Service (DCS) within 60 days of when the dependent loses eligibility. If you do not notify EBD within that time, regardless of the reason, the dependent will not be entitled to COBRA continuation coverage.

For more information about COBRA continuation coverage, visit the DCS web site at www.cs.ny.gov/employee-benefits.. Follow the prompts to NYSHIP Online, and then select Other Benefits to access the Dental Plan Certificate Book and NYS Vision Plan Book, or you may call the DCS at 518-457-5754 or 1-800-833-4344.

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