Update on Empire Plan program administrator change Effective Jan. 1, 2014, the Empire Plan Mental Health and Substance Abuse (MHSA) Program is administered by ValueOptions, Inc. The MHSA Program is self-insured by New York state, with ValueOptions providing administrative services such as claims processing and network management. The former administrator, OptumHealth, will assist with the transition. To ensure enrollees continue to receive the highest level of care, please refer to the Empire Plan Special Report sent to enrollees in January. If enrollees do not have the Special Report, please contact your agency health benefits administrator for a copy. On this page are some of the topics covered under the Special Report. Enrollees with questions regarding The Empire Plan MH/ SA program should contact the Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447), press 3 for the MH/SA Program and select the option for 2014 benefits. What is the transition of care benefit? To help ensure that Empire Plan enrollees have access to network benefits, a 90-day transition of care benefit is available for enrollees who received services from a participating provider in the OptumHealth network on or after July 1, 2013. The transition of care benefit allows enrollees to continue to receive network benefits for a period of time (after Jan. 1, 2014) even if their provider has not joined the ValueOptions network. Health insurance premium deduction: New York state quarterly review As an employee of New York state, the employer pays the majority of your health insurance premium. You are responsible for paying the remaining portion of your health insurance premium through biweekly payroll deductions. In accordance with the collective bargaining agreement effective October 2011, CSEA state members contribute toward health insurance premiums as follows: • An enrollee grade 9 and below contributes 12 percent of the individual premium and 27 percent of the dependent portion of the family premium. • An enrollee grade 10 and above contributes 16 percent of the individual premium and 31 percent of the dependent portion of the family premium. CSEA has recently experienced problems with enrollees who have had a promotion or demotion that results in a premium contribution change. If the premium contribution change is not noted until several months later, enrollees are being required to pay retroactive premiums or receive a retroactive refund of overpayment of health insurance premium. • If an enrollee experiences a promotion during the year (grade 9 and below to grade 10 and above), How do I find out if my provider is in the ValueOptions network? For the most up-to-date list of providers, go to the Department of Civil Service web site at https://www.cs.ny.gov. Click on Benefit Programs, then NYSHIP Online and follow the prompts to the NYSHIP Online homepage. Select Find a Provider, then scroll down to the Mental Health and Substance Abuse Program and click on the Achieve Solutions link. From the Achieve Solutions homepage, select Find Services, then Referral Connect and choose Find Now. Or, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447), press 3 for the Mental Health and Substance Abuse Program and select the 2014 benefits option. Provider network information will be updated regularly. What are my options if my provider is not currently in the ValueOptions network? The transition of care benefit allows you to continue to receive network benefits for a period of time, even if the provider you were seeing in 2013 is not part of the ValueOptions network. When the transition period ends on March 31, 2014, you must use a ValueOptions network provider to receive the highest level of benefits. For a list of network providers, call 1-877-7-NYSHIP (1-877-769- 7447). If you continue treatment with your provider after March 31, 2014 and your provider is not part of the ValueOptions network, in most cases your treatment will be covered at the non-network level of benefits and you will have higher out-of-pocket costs. In limited instances, if your former provider is not a covered provider type, such as a Licensed Mental Health Counselor or a Licensed Marriage and Family Therapist, no benefits will be covered after March 31, 2014. this would result in a premium contribution increase. • If an enrollee experiences a demotion during the year (grade 10 and above to grade 9 and below), this would result in a premium contribution decrease. To reduce the chances of retroactive health insurance premium changes, New York state agreed to perform quarterly reviews of eligibility files in an effort to ensure enrollees are at the correct health insurance premium contribution. The most recent quarterly review includes premium changes retroactive to Oct. 1, 2013. New York state will notify enrollees in writing if the most recent quarterly review impacts them. In the future, if an enrollee experiences a promotion/demotion that affects their health insurance premium contribution, enrollees can request the agency’s health benefits administrator submit a health insurance correction request to the state Department of Civil Service. Doing so will change the health insurance premium contribution to the correct level to coincide with the promotion/ demotion effective date to help avoid any retroactive premium changes. 16 The Work Force March 2014
March_14_WF
To see the actual publication please follow the link above