NYSHIP enrollees: GHI HMO no longer offered in 2015 The following information is intended for CSEA represented Executive Branch enrollees - enrollees employed by the State of New York covered by one of the following CSEA collective bargaining agreements; Administrative Services Unit, Institutional Services Unit, Operational Services Unit or the Division of Military and Naval Affairs. Effective Jan. 1, 2015, GHI HMO will no longer be offered as an option, under the New York State Health Insurance Program (NYSHIP). This change is a result of the merger between Health Insurance Plan of New York (HIP) and Group Health Incorporated (GHI). Members will receive from New York state a copy of the “Planning for Option Transfer” document. Additionally, members who are currently enrolled in GHI HMO will receive information from HIP inviting them to consider choosing their HMO for next year’s coverage option. Current GHI HMO enrollees are encouraged to contact their agency’s health benefits administrator to obtain a copy of the “2015 Health Insurance Choices.” This booklet explains the options available to you under NYSHIP and is a helpful resource in making an informed decision about your health insurance plan for 2015. If no action is taken during this year’s annual option transfer period, current GHI HMO enrollees will be automatically enrolled in the Empire Plan for the 2015 plan year. For additional information and to change your health insurance option for the 2015 plan year, please contact your agency’s health benefits administrator (usually located in the personnel office). CSEA Health Benefits Department staff members get certification The CSEA Health Benefits Department’s Local Government and Private Sector Division staff has completed the training to become certified application counselors for the New York State of Health Marketplace. This could be especially helpful for CSEA members who are active employees and are not eligible for employer sponsored health insurance (i.e. part-time, seasonal, per diem, etc.), or if employer sponsored health insurance is unaffordable as per the Affordable Care Act. (Note: Most CSEA members are eligible for employer-sponsored coverage that meets or exceeds the guidelines for minimum value and affordability as defined by the Affordable Care Act. This service will only benefit members who are not eligible for employer-sponsored coverage). As certified application counselors, a health benefits specialist will: • Provide an overview of the New York State of Health Marketplace and how it works. • Discuss qualified health insurance plan options that include available health insurance carriers, premiums, networks and prescription drug formularies. • Find out if a member(s) qualifies for an advance premium tax credit (subsidy) or cost sharing reduction based on family size and household income. Based on demand in a particular area, a health benefits specialist will set up individual appointments or educational sessions in a group setting. If there is not enough demand to travel to a location in person, a CSEA health benefits specialist may provide assistance to members over the phone. The open enrollment period for the New York State of Health Marketplace will be Nov. 15, 2014 through Feb. 15, 2015. For more information, contact the CSEA Health Benefits Department, Local Government and Private Sector division at 1-800-286-5242. Empire Plan coverage for adult vaccinations at network retail pharmacies Under the Empire Plan, there are currently paid-infull benefits for covered adult immunizations, as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention when received from an Empire Plan participating provider. In order to broaden the availability of coverage, effective Oct. 1, 2014, the Empire Plan extended paid-in-full vaccination coverage for Empire Plan primary enrollees/dependents to include select preventive adult vaccinations when administered by a licensed pharmacist at a pharmacy that participates in CVS Caremark’s national vaccine network. The specific vaccinations covered under this expansion of coverage include: • Influenza • Pneumonia • Meningitis • Herpes Zoster (shingles) Please note there is no copayment for Herpes Zoster vaccine for individuals age 60 and older. Enrollees between the ages of 55-59 who receive the Herpes Zoster vaccine at one of CVS Caremark’s national vaccine network pharmacies will be responsible for a $5 level one copayment. Empire Plan enrollees will have access to a national contracted network of chain and independent pharmacies administered through CVS/Caremark, the Empire Plan Prescription Drug Program administrator. Please note that in New York state, certified licensed pharmacists only administer vaccines to enrollees age 18 and older (other states age may vary). Additional information regarding participating pharmacies under the Empire Plan pharmacy vaccination program for non-Medicare primary enrollees/dependents can be obtained by contacting the Empire Plan at 1-877-769-7447. November 2014 The Work Force 11
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