The Empire Plan Covers Shingrix Vaccine for Prevention of Shingles

The Centers for Disease Control (CDC) recently approved Shingrix as a recommended vaccine for (Shingles) herpes zoster.  The Shingrix vaccine has also been recommended by the Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster and related complications for those age 50 and older and is therefore required to be covered as a preventive service for this age group.

 

Effective April 1, 2018, the Shingrix vaccine will be covered by both the Empire Plan Medical/Surgical Program and by the Prescription Drug Program through the CVS Caremark Vaccine Network. There will be no enrollee cost share for the Shingrix vaccine for enrollees age 50 and older when administered by an in-network provider.  Any Shingrix vaccine that was administered prior to April 1, 2018 will be a covered service but will have enrollee cost share applied.

 

Please be aware that the Shingrix vaccine requires two shots to be administered and both Shingrix shots will be covered as described above.

    Assignment of Benefits for Non-Network MHSA Services

    Beacon Health Options (Beacon) is the administrator for The Empire Plan’s Mental Health and Substance Abuse Program (MHSA).  Until recently, the Empire Plan prohibited claim payments for non-network MHSA from being sent directly to a provider.  All non-network claim payments were paid directly to the member and the member was required to send payment to the provider of service.  This resulted in numerous problems for enrollees and providers of service.  The NYS Department of Civil Service recently reviewed and revised this policy and will allow assignment of benefits to non-network MHSA claims processed on or after March 1, 2018.  Beacon Health sent a letter explaining this change to enrollees who obtained services under the non-network portion of the MHSA Program.

     

    If you have already paid a non-network provider for a date of service and have not submitted a claim form to Beacon yet, do not indicate an assignment of benefits on the claim form. This will result in the provider being paid twice for the same date of service. If this does occur it will be your responsibility to recoup money owed to you from the non-network provider.

     

    By receiving MHSA Program services from a non-network provider your out-of-pocket costs are much higher.  If you have any questions or would like to discuss transitioning to a network provider, please contact Beacon’s Customer Service at 1-877-7-NYSHIP (877-769-7447), Option 3 between 8 AM and 8 PM (EST).

     

     

      EMPIRE PLAN CLAIMS DEADLINES FOR CALENDAR YEAR 2017

      Empire Plan enrollees have until April 30, 2018 (120 days after the end of the calendar year) in which to submit medical expenses which were incurred during the 2017 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

      P.O. Box 1407 – Church Street Station

      New York, NY 10008-1407

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

       

      Beacon Health Options

      P.O. Box 1850

      Hicksville, NY 11802

      For non-network mental health and substance abuse services

       

      CVS Caremark

      P.O. Box 6590

      Lee’s Summit, MO 64064-6590

      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.

       

        New Medicare Cards Coming Soon

        To help protect your identity, Medicare will begin mailing new cards to everyone who receives Medicare benefits.  Medicare and Medicaid Services (CMS) has been directed to remove Social Security Numbers (SSN) from all Medicare cards by April 2019.  A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on new Medicare cards.  Beginning in April 2018, CMS will start mailing the replacement Medicare cards with the MBI to existing Medicare enrollees.

         

        Each MBI is a unique, randomly-generated, 11-character number made up only of numbers and uppercase letters.  The characters are “non-intelligent,” which means they don’t have any hidden or special meaning.  The new MBI will help protect private health care and financial information and will be coordinated with the Social Security administration and health care providers.  The Department of Civil Service, administrator of the New York State Health Insurance Program, is looking at any impact the new MBI numbers will have for NYSHIP enrollees and will communicate any new information in future periodicals.

         

        Medicare enrollees may start using their new Medicare cards and MBIs as soon as they get them.

         

        For additional information call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.  You can also visit the CMS website for additional information on the distribution of new cards; https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html

         

         

          Update to Free Identity Protection Services for Empire Plan Enrollees

          As noted in previous articles in the Workforce, Anthem BlueCross BlueShield, the parent company of The Empire Plan Hospital Program administrator, offers free identity protection services to all current Empire Plan enrollees through AllClear ID.    For more information, call 1-855-227-9830 or go to https://anthemcares.allclearid.com.

          The National Association of Insurance Commissioners (NAIC) has also asked Anthem to provide additional credit protection to minors under the age of 18 as of January 27, 2015 in the form of credit freezes.

          Credit Freeze for Minors

          Anthem has partnered with the three major credit bureaus (Equifax, Experian, and Transunion) and will cover the cost of a one-time freeze and one-time removal at each of these credit bureaus.

          Highlights:  The Program offers a one-time credit freeze and one-time credit freeze removal at each of the three major credit reporting bureaus for children affected by the cyber-attack to:

          • Parents or legal guardians of children under the age of 18 as of January 27, 2015 who are not yet 18 as of February 24, 2017
          • Minors who are now adults – children under 18 on January 27, 2015 who are 18 or older as of February 24, 2017

          Anthem will begin mailing letters to parents or legal guardians and adult children on February 24, 2017 and expects all letters to be mailed by the end of May.

            2017 New York State Health Insurance plan rates for CSEA active state employees and Unified Court System employees

            The NYS Division of Budget has approved the Empire Plan’s premium rates for the year 2017.  The approval of the rates signals the beginning of the option transfer period for the New York State Health Insurance Program.

            New York State active employees have until December 16, 2016 to change their health insurance option or to submit/resubmit documentation to participate in the Opt-Out Program for 2017.  Enrollees wishing to change options or participate in the Opt-Out Program should complete the necessary transaction forms and return them to their Health Benefits Administrator no later than December 16, 2016.

            Opt Out Program for 2017:

            NYSHIP will again offer the Opt-Out Program in 2017, which will allow eligible employees who have employer sponsored group health insurance, to opt out of their NYSHIP coverage in exchange for an incentive payment.  NYS employees who currently participate in the Opt-Out Program will receive a notice from the NYS Department of Civil Service advising that the PS-404 and PS-409 forms MUST be submitted during the Annual Option Transfer Period in order to continue participation in 2017.

            In 2012 and 2013, CSEA had a special arrangement with New York State which allowed a CSEA enrollee covered as a dependent through their spouse/domestic partner, who is also a State employee, to opt out of their coverage in return for a $1,000 payment.  This arrangement was not made available to CSEA since 2013.  CSEA’s ongoing grievance regarding the “State on State” Opt-Out Program continues to move forward in arbitration.  We will keep you advised of any developments.

            The following are the 2017 biweekly rates for CSEA active State Executive Branch and Unified Court System employees.  Please note there are two sets of rates.  The first set reflects 2017 biweekly rates for CSEA represented state employees who are Grade 9 and below.  The second set reflects 2017 biweekly rates for CSEA represented state employees who are Grade 10 and above.

            Please note some of the HMOs saw a significant change in health insurance premiums for 2017.

            2017 State NYSHIP Enrollee Biweekly Premium Contributions
            The following represents the 2017 biweekly premium contributions for CSEA active State employees (and Unified Court System). Please note there are two sets of rates. The first set reflects 2017 biweekly rates for CSEA represented employees who are Grade 9 and below. The second set reflects 2017 biweekly rates for CSEA represented State employees who are Grade 10 and above.
            Grade 9 and below:   Individual Change Family Change
            The Empire Plan 001 $39.91 $2.41 $175.53 $13.91
            Blue Choice 066 $34.49 -$8.62 $148.86 $4.06
            Blue Cross Blue Shield (WNY) 067 $36.12 $2.18 $155.52 $9.27
            CDPHP (Capital) 063 $40.10 -$12.19 $160.71 -$2.07
            CDPHP (Central) 300 $75.92 -$13.17 $218.90 -$52.60
            CDPHP (Hudson Valley) 310 $132.47 $9.89 $362.62 $20.61
            Empire BC/BS HMO (Upstate) 280 $137.08 $31.79 $418.99 $85.53
            Empire BC/BS HMO (Downstate) 290 $238.10 $30.31 $684.44 $81.11
            Empire BC/BS HMO (Mid-Hudson) 320 $229.22 $30.52 $660.70 $81.77
            HIP (Downstate) 050 $97.55 -$2.00 $262.16 -$6.87
            HIP (Capital) 220 $112.54 $6.66 $299.93 $14.88
            HIP (Hudson Valley) 350 $112.54 $6.66 $299.93 $14.88
            HMO Blue (Central NY ) 072 $87.11 -$15.05 $241.67 -$40.11
            HMO Blue (Utica Region) 160 $107.49 -$14.93 $328.05 -$39.08
            Independent Health 059 $36.33 -$2.10 $155.04 $7.97
            MVP (Rochester) 058 $37.21 $2.54 $144.40 $13.83
            MVP (East) 060 $58.56 $9.82 $149.49 $17.09
            MVP (Central) 330 $87.33 $5.99 $202.12 $10.19
            MVP (Mid-Hudson) 340 $100.95 $11.48 $232.12 $22.05
            MVP North 360 $155.56 $11.73 $364.27 $22.95
             
            Grade 10 and above: Individual Change Family Change
            The Empire Plan 001 $53.21 $3.20 $208.92 $16.40
            Blue Choice 066 $45.99 -$7.86 $177.31 $4.85
            Blue Cross Blue Shield (WNY) 067 $48.16 $2.90 $185.25 $11.04
            CDPHP (Capital) 063 $52.55 -$10.93 $191.50 -$0.17
            CDPHP (Central) 300 $88.36 -$12.21 $251.26 -$49.92
            CDPHP (Hudson Valley) 310 $145.01 $10.62 $395.28 $22.83
            Empire BC/BS HMO (Upstate) 280 $150.53 $33.25 $454.26 $89.60
            Empire BC/BS HMO (Downstate) 290 $251.79 $31.67 $720.35 $84.94
            Empire BC/BS HMO (Mid-Hudson) 320 $242.83 $31.91 $696.39 $85.66
            HIP (Downstate) 050 $110.53 -$0.69 $295.77 -$3.24
            HIP (Capital) 220 $125.71 $8.06 $334.00 $18.74
            HIP (Hudson Valley) 350 $125.71 $8.06 $334.00 $18.74
            HMO Blue (Central NY ) 072 $99.48 -$14.00 $273.63 -$37.10
            HMO Blue (Utica Region) 160 $119.78 -$13.87 $360.05 -$36.06
            Independent Health 059 $48.44 -$1.29 $184.73 $9.49
            MVP (Rochester) 058 $49.39 $3.75 $172.58 $16.53
            MVP (East) 060 $70.27 $11.04 $178.66 $20.44
            MVP (Central) 330 $99.32 $7.20 $233.14 $13.57
            MVP (Mid-Hudson) 340 $112.53 $12.75 $262.19 $25.45
            MVP North 360 $167.96 $12.94 $396.22 $26.34

             

              Empire Plan Enrollees Receive Letter of Explanation Regarding Excellus BlueCross BlueShield Cyber-Attack

              Anthem (the parent company of Empire BlueCross Blue Shield) is currently in the process of mailing letters of explanation to Empire Plan members whose personal information may have been accessed during a sophisticated cyber-attack, against Excellus BlueCross BlueShield, which was previously reported to media outlets on September 9, 2015.

              These letters will help to explain Anthem’s relationship with Excellus and why your data may have been in Excellus’s system.

              It is important to note that Anthem is neither owned nor operated by Excellus. Excellus is a separate company with which Anthem works to administer certain parts of your health care plan when you receive health care services in upstate New York. This affiliation enables BlueCross and BlueShield members to receive the high-quality, affordable health care they need, wherever they are. Your information may have been in Excellus’s information technology systems because you received health care services in the Excellus service area.

              It is also important to note that the Excellus cyber-attack is not the same as the cyber-attack against Anthem (the parent company of Empire BlueCross BlueShield), about which you may have been notified earlier this year.

              For more information about the sophisticated cyber-attack against Excellus BlueCross BlueShield, please visit www.excellusfacts.com or call 877-589-3331, Monday – Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.