2016 NYSHIP Dependent Eligibility Verification Enters Phase 2

This project impacts all NYSHIP enrollees with family health insurance (The Empire Plan and NYSHIP HMOs).  The verification of dependents is being performed in three separate phases.

Already Completed

Phase 1 verification period for Local Government employees and retirees, (counties, cities, towns, villages, school districts, libraries, etc.) ended on May 4.  HMS Employer Solutions will continue to accept appeals until August 2016.  Call (855) 884-9475 for more information related to verifications covered under Phase 1.

Current Step:

Phase 2 Verification Period (5/02/16- 6/17/16)

NY Retirees and Participating Employers (Authorities, etc.) employees/retirees must provide proof (verification) of ALL dependents

Verification of Dependents

  • Requires all enrollees with family coverage to provide proof that each spouse/dependent is eligible for coverage under NYSHIP.
  • Failure to provide proof could result in losing dependent coverage effective January 1, 2016 and being held responsible for repaying claims paid under NYSHIP for those dependents as early as the date the dependent was first added to coverage.  Other penalties could also be imposed.

The verification process can be completed in these steps:

  • Collect copies of all required documents for each enrolled dependent
  • Sign and date the Verification Form
  • Submit the Verification Form with copies of all required documents to HMS Employer Solutions no later than June 17, 2016. Please ensure a copy of the Verification Form is included with all documents submitted.
  • HMS Solutions phone availability; Monday-Friday 8am to 11pm 1-866-252-0527
  • For faster processing, please submit required documents by uploading them via the web portal, VerifyOS.com, or by faxing them to 1-877-223-8478. Documents may also be mailed to HMS Employer Solutions, P.O. Box 165308, Irving, TX 75016-9923.  Please do not mail original documents.

Next Step:

Phase 3 Verification Period (7/5/16 – 8/19/16)

  • Active New York State employees must provide proof (verification) of ALL dependents
    • July 5 – August 19, 2016 (dates to submit proof of eligibility)

    2016 NYSHIP Dependent Eligibility Verification Enters Phase 2

    Previous Work Force articles have discussed NYSHIP’s dependent eligibility verification project for those enrollees with family health insurance.  This project impacts all NYSHIP enrollees with family health insurance (The Empire Plan and NYSHIP HMOs).  The verification of dependents is being performed in three separate phases.

    Phase 1 verification period ended on April 15, 2016.  Please note:  NYSHIP has allowed a brief grace period for enrollees to submit the required documentation to HMS Employer Solutions (until 5/04/16)

    Phase 1 included the Verification Period for Local Government employees and retirees, (counties, cities, towns, villages, school districts, libraries, etc.)

    Due to time restraints, it is encouraged to submit documentation by electronic web upload at www.VerifyOS.com or fax the documentation to (877) 223-8478.  Documentation must be received by May 4, 2016.

    Current Step:

    Phase 2 Verification Period (5/02/16- 6/17/16)

    NY Retirees and Participating Employers (Authorities, etc.) employees/retirees must provide proof (verification) of ALL dependents.

    Verification of Dependents

    • Requires all enrollees with family coverage to provide proof that each spouse/dependent is eligible for coverage under NYSHIP.
    • Failure to provide proof could result in losing dependent coverage effective January 1, 2016 and being held responsible for repaying claims paid under NYSHIP for those dependents as early as the date the dependent was first added to coverage.  Other penalties could also be imposed.

    The verification process can be completed in these steps:

    • Collect copies of all required documents for each enrolled dependent
    • Sign and date the Verification Form
    • Submit the Verification Form with copies of all required documents to HMS Employer Solutions no later than June 17, 2016. Please ensure a copy of the Verification Form is included with all documents submitted.
    • HMS Solutions phone availability at 1-866-252-0527 , Monday-Friday 8am to 11pm
    • For faster processing, please submit required documents by uploading them via the web portal, VerifyOS.com, or by faxing to 1-877-223-8478. Documents may also be mailed to: HMS Employer Solutions, P.O. Box 165308, Irving, TX 75016-9923.  Please do not mail original documents.

    NEXT STEP: 

    Phase 3 Verification Period (7/5/16 – 8/19/16)

    • Active New York State employees must provide proof (verification) of ALL dependents
      • July 5 – August 19, 2016 (dates to submit proof of eligibility)

      2016 NYSHIP Dependent Eligibility Verification

      Previous Workforce articles have announced that New York State will be performing a dependent eligibility verification project in 2016 for all NYSHIP enrollees (The Empire Plan and NYSHIP HMOs) with family health insurance coverage.  The verification of dependents will be done in three separate phases.

      Verification of Dependents

      • Requires all enrollees with family coverage to provide proof that each spouse/dependent is eligible for coverage under NYSHIP.
      • Failure to provide proof could result in losing dependent coverage effective January 1, 2016 and being held responsible for repaying claims paid under NYSHIP for those dependents as early as the date the dependent was first added to coverage.  Other penalties could also be imposed.

      CURRENT STEP (2/29/16 – 4/15/16): 

      Phase 1 Verification Period for Local Government employees, including counties, cities, towns, villages, school districts, libraries, etc. Employees/retirees of Local Governments (Participating Agencies) with family coverage must provide proof that each spouse/dependent is eligible for coverage under the Empire Plan.

      The verification process can be completed in these steps:

      • Collect copies of all required documents for each enrolled dependent
      • Sign and date the Verification Form
      • Submit the Verification Form with copies of all required documents to HMS Employer Solutions no later than April 15, 2016. Please ensure a copy of the Verification Form is included with all documents submitted.
      • HMS Solutions phone availability; Monday-Friday 8am to 11pm 1-855-893-8477 for phase one only.
      • For faster processing, please submit required documents by uploading them via the web portal, VerifyOS.com, or by faxing them to 1-877-223-8478. Documents may also be mailed to HMS Employer Solutions, P.O. Box 165308, Irving, TX 75016-9923.  Please do not mail original documents.
      • See article for Frequently Asked Questions

      NEXT STEPS: 

      Phase 2 Verification Period (5/2/16- 6/17/16)

      • NY Retirees and Participating Employers (Authorities, etc.) employees/retirees must provide proof (verification) of ALL dependents
        • May 2 – June 17, 2016 (dates to submit proof of eligibility)

      Phase 3 Verification Period (7/5/16 – 8/19/16)

      • Active New York State employees must provide proof (verification) of ALL dependents
        • July 5 – August 19, 2016 (dates to submit proof of eligibility)

        2016 NYSHIP Dependent Eligibility Verification

         

        The Special Amnesty Period, which allowed NYSHIP enrollees a specified period of time to remove ineligible dependents (without penalty) has ended.

        The Next Step: Verification of Dependents

        • Requires all enrollees with family coverage to provide proof that each spouse/dependent is eligible for coverage under NYSHIP.
        • Failure to provide proof could result in losing dependent coverage effective January 1, 2016 and being held responsible for repaying claims paid under NYSHIP for those dependents as early as the date the dependent was first added to coverage.  Other penalties could also be imposed.

        Verification of Dependents will be conducted in three phases:

         The first phase will be for dependents of Participating Agencies (Local Government) enrollees.

        Phase 1 Verification Period

        • Employees of Participating Agencies (Local Government) must provide proof (verification) of ALL dependents
        • Submission of proof beginning February 29 – April 15, 2016

        The second phase will be for dependents of Retirees and Participating Employers (Authorities, etc.) enrollees.

         Phase 2 Verification Period

        • Retirees and Participating Employers (Authorities, etc.) employees must provide proof (verification) of ALL dependents
        • Submission of proof beginning May 2 – June 17, 2016

        The third phase will be for dependents of Active New York State enrollees.

        Phase 3 Verification Period

        • Active New York State employees must provide proof (verification) of ALL dependents
        • Submission of proof beginning July 5 – August 19, 2016

         

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            EMPIRE PLAN CLAIMS DEADLINES FOR CALENDAR YEAR 2015

            Empire Plan enrollees have until April 30, 2016 (120 days after the end of the calendar year) in which to submit medical expenses which were incurred during the 2015 plan year to:


            United HealthCare Service Corp.
            P.O. Box 1600
            Kingston, N.Y. 12402-1600

            For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services.


            Empire Blue Cross and Blue Shield
            NYS Service Center (Code YLS)
            P.O. Box 1407 – Church Street Station
            New York, NY 10008-1407

            For Empire Plan and non-network Inpatient or Outpatient hospital services.


            Value Options
            P.O. Box 1800
            Latham, NY 12110

            For non-network mental health and substance abuse services.


            The Empire Plan Prescription Drug Program c/o CVS Caremark
            P.O. Box 52136
            Phoenix, AZ 85072-2136

            For prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.


            Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to obtain claim forms. As a reminder, when using the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system.

            Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information.  If you have a non-network claim submission, make sure you complete the requested subscriber information on the claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form.

              Dependent Eligibility Verification

              Dependent Eligibility Verification for Enrollees with Family Coverage under NYSHIP

              What to do Right Now!

              As noted in previous Workforce articles, the Dependent Eligibility Verification Project administrator, HMS, sent NYSHIP enrollees an information packet in early December describing the Special Amnesty Period.  If you currently have a dependent covered under your policy that does not meet the NYSHIP eligibility criteria, make sure that you request to remove the ineligible dependent during the Special Amnesty Period.  The Special Amnesty Period will end on January 29, 2016.  If you remove an ineligible dependent during the Amnesty Period, the dependent will be removed from coverage effective February 1, 2016 and no repercussions will be applicable beyond that action.  Please submit the form included in the Special Amnesty Period information packet directly to HMS.

              What Happens Next?

              New York State will hold three separate Dependent Eligibility Verification phases.  Eligibility verification packets will be mailed to enrollees after the plan-wide Special Amnesty Period ends.   The Verification Packet will include a list of the enrollee’s dependents, an eligibility worksheet to help determine whether dependents meet NYSHIP’s eligibility requirements, a list of eligible proofs and instructions/deadlines to submit required documentation.

              When will the Verification Packet Arrive?

              Within the months following the completion of the Amnesty Phase, you will receive a letter from HMS that will detail the next steps in the process, the Verification Phase.  Phase and date of verification letter are as follows:

              • Enrollees of NYSHIP Participating Agencies (PAs) will receive letters
                dated February 29, 2016
              • Enrollees who are NYS retired will receive letters dated May 2, 2016
              • Enrollees of NYSHIP Participating Employers (PEs) will receive letters
                dated May 2, 2016
              • Enrollees who are NYS active will receive letters dated July 5, 2016

              HMS has a secure online Web Portal that contains information about the project and real-time information on verification of dependent eligibility and status updates. The Web Portal can be accessed online at www.VerifyOS.com

              Please feel free to call HMS Employer Solutions at 1-855-884-9475 from 8 am to 11 pm, Monday through Friday, if you have questions regarding phase 1 of this project.

              Look for additional information in future posts.

                Important Announcement: NYS Flex Spending Account 2016 Open Enrollment Deadline Extended Through November 24, 2015

                The 2016 Open Enrollment deadline for the Flex Spending Account has been extended. The online enrollment application was suspended beginning midnight, November 9, 2015, but will become available again on Thursday, November 19, 2015 at 12:01 a.m., ET.

                How to Enroll

                Eligible employees who wish to enroll for 2016 may do so by enrolling online at www.flexspend.ny.gov or calling the FSA hotline at (800) 358-7202, Option 1. Make sure you have your most recent pay stub available since you will need your Department ID and Negotiating Unit code to apply. You have from November 19, 2015 at 12:01 a.m., ET through 10:00 p.m. on November 24, 2015 to apply for enrollment for 2016. If you wish to change your 2016 election amounts after you submit your application, simply submit a new application by November 24. Be sure to complete both the DCAAccount and HCSAccount sections of the application, if applicable, since the new application will replace your original application.

                Confirmation Letter

                If you enroll after November 9, 2015 a confirmation notice will be sent to you in late December. However, you will not have an opportunity to change your annual election after November 24, 2015 unless you have an eligible change in status so select your election amount carefully.

                  NYSHIP Enrollees…. Dependent Eligibility Audit Information….. coming soon!

                  As required by the 2015/2016 enacted NYS Budget, the New York State Department of Civil Service will be conducting an eligibility audit of dependents under NYSHIP (the New York State Health Insurance Program). This dependent eligibility verification project will be similar to the audit conducted in 2009. Health Management Systems, Inc. (HMS) has been selected to administer all aspects of this dependent eligibility verification project. If eligibility was verified for a natural child, a stepchild or a child of a domestic partner in the 2009 audit, you will not be asked to verify their status during the current audit. Other dependents, such as spouses and domestic partners, will be required to submit documents even if they were verified in the previous audit.

                  Beginning in December 2015, a Special Amnesty Period will be offered to enrollees to allow for the removal of ineligible dependents before the verification project begins. Enrollees who voluntarily remove ineligible dependents from coverage during this period will be held harmless and will not be liable for repayment of claims paid on behalf of these reported dependents.

                  Watch your mail for additional information regarding the Special Amnesty Period. Please review all information closely and report any ineligible dependents directly to HMS no later than January 29, 2016. This is the ONLY opportunity to remove ineligible dependents without possible penalty.

                  NO ACTION is necessary during the Amnesty Period if all listed dependents are eligible for coverage. At no point should enrollees send original documentation to HMS, as this information will NOT be returned.

                  What Happens Next……?

                  New York State will hold three separate Dependent Eligibility Verification phases. Eligibility verification packets will be mailed to enrollees after the plan-wide Special Amnesty Period ends. The Verification Packet will include a list of the enrollee’s dependents, an eligibility worksheet to help determine whether dependents meet NYSHIP’s eligibility requirements, a list of eligible proofs and instructions/deadlines to submit required documentation. Look for additional information in future Workforce publications.

                    IMPORTANT DATES TO REMEMBER FOR 2016 Health Programs:

                    Now is the time for New York State employees (including the Unified Court System) to think about health insurance options for 2016. Watch your mailbox for important information, including the 2016 health insurance premium rates, option transfer information and deadlines. Other important benefits and dates to remember are:

                     Pre-Tax Contribution Program (PTCP) – Open Enrollment November 1st through November 30, 2015

                    Your share of health insurance premium is deducted from wages before taxes are withheld, which may lower your taxes. Under Internal Revenue Service (IRS) rules, if you are enrolled in PTCP, you may change your health insurance deduction during the tax year ONLY after a qualifying PTCP event. If you wish to change your pre-tax selection for 2016, see your agency Health Benefits Administrator and complete a health insurance transaction form (PS-404) by November 30, 2015.

                     Productivity Enhancement Program – Open Enrollment Ends November 27, 2015

                    Exchange previously accrued annual and/or personal leave in return for a credit to be applied toward the employee share of your New York State Health Insurance Program (NYSHIP) premium. The credit will be included in biweekly paychecks and divided evenly during the plan year. To elect PEP for 2016, you must apply between October 26, 2015 and November 27, 2015. Please see your Agency Health Benefits Administrator for additional information and an application. If you are currently enrolled in PEP, you must re-enroll to continue your benefits in 2016.

                    NYSHIP Annual Option Transfer Period – Dates to be determined

                    The annual Option Transfer Period will begin once the 2016 New York State Health Insurance Program (NYSHIP) premium rates are approved. During the Option Transfer Period, you may change your health insurance option for the next plan year;

                    • from a NYSHIP HMO to The Empire Plan
                    • from The Empire Plan to a NYSHIP HMO
                    • from one NYSHIP HMO to another NYSHIP HMO that has a NYSHIP service area where you live or work
                    • from a NYSHIP health plan to the Opt-out Program, or
                    • from the Opt-out Program to a NYSHIP health plan

                    NYSHIP Health Insurance Opt Out – Dates to be determined

                    NYSHIP will continue to offer the Opt-out Program, which allows eligible employees who have other employer-sponsored group health insurance to opt out of their NYSHIP coverage in exchange for an incentive payment. If you currently participate in the Opt-out Program for 2015 and wish to continue to receive incentive payments, you MUST elect to opt out for 2016 by submitting a completed Opt-Out Attestation Form (PS-409) during the Option Transfer Period.

                    We anticipate that the open enrollment dates for the opt-out will coincide with the Annual Option Transfer Period (dates not yet available). Please watch your mail and the Work Force for additional information.