Page 18 - Work Force December_2019

Changing Your NYSHIP health insurance option for 2020
Empire Plan adds mental health, sTubstance abuse network providers
he Empire Plan’s Mental Health and applied behavioral analysts (ABAs) or Substance Abuse (MHSA) Program certified behavioral analysts (CBAs).
It’s that time of year to determine your 2020 health insurance options. The annual NYSHIP option transfer period will be held after the 2020 health insurance premiums are approved.
Changes allowed during the Option Transfer Period:
• Changing your Pre-Tax Contribution Program (PTCP) election;
• Changing your New York State Health Insurance Program (NYSHIP) option to one of the following:
• The Empire Plan • A NYSHIP Health
Maintenance Organization (HMO) where you live or work
• The Opt-Out Program
New in 2020:
• The PTCP election period will run concurrently with the Option Transfer Period. The dates will be announced once the rates have been approved.
• For State enrollees currently enrolled in the Opt-Out Program, no action is necessary if you are still eligible and wish to maintain your enrollment in the Opt-Out Program for the 2020 plan year.
• Contact your agency Health Benefits Administrator, located in your Personnel Office or the New York State Business Services Center, regarding any change which would impact your eligibility
to receive the Opt-Out incentive payments or
if you lose your other employer-sponsored health coverage.
Other changes permitted during the Option Transfer Period:
• Change from Family to Individual coverage (regardless of whether a qualifying event has affected your dependents’ eligibility)
• Change from Individual
to Family coverage (late enrollment provisions will apply)
• Voluntarily cancel your coverage (regardless of whether a qualifying event has affected your eligibility)
• Enroll in NYSHIP coverage (late enrollment provisions will apply)
Your agency has been sent Health Insurance Choices for 2020, your guide to NYSHIP options. If you are thinking about changing your option or newly enrolling in NYSHIP, ask your HBA for a copy or go to NYSHIP Online and read the descriptions of plans in your area to compare the benefits that are important to you and your family.
has added licensed mental health counselors (LMHCs), licensed marriage and family therapists (LMFTs) and physician assistants (PAs) to its network of providers.
When you use an MHSA Program network provider, you will be offered care at the highest benefit level under The Empire Plan. Network providers have been credentialed by the MHSA Program administrator to ensure
they meet the highest standards of education, training and experience.
By using a network provider, you will receive access to medically necessary services. The Program’s network gives you access to a
wide range of providers, including psychiatrists, psychologists, clinical social workers, nurse practitioners,
Network facilities include psychiatric hospitals, clinics, residential treatment centers, halfway houses, group
homes, intensive outpatient treatment programs (IOPs) and partial hospital programs (PHPs).
To find an MHSA Program network provider online, go to www.cs.ny.gov/ employee-benefits. Choose your group and plan, if prompted, and from the NYSHIP Online homepage, select Find a Provider. Scroll to the Mental Health and Substance Abuse Program and choose ReferralConnect. You can also call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 3 for the MHSA Program. From there you can reach the Clinical Referral Line, which is available 24 hours a day, seven days a week.
EImpire Plan Infertility Benefits in 2020
n accordance with New York State
law, effective Jan. 1, 2020, Empire Plan infertility benefits will include the following:
In Vitro Fertilization (IVF):
The new law requires that enrollees receive coverage for three IVF cycles per lifetime. Under The Empire Plan, in vitro fertilization is a Qualified Procedure (a specialized procedure that facilitates a pregnancy, but does not treat the cause of the infertility) for which you must receive prior authorization. Qualified Procedures are subject to a $50,000 lifetime maximum per covered individual; however, coverage will be provided for a minimum of three IVF cycles. The lifetime maximum applies to all covered hospital, medical, travel, lodging and meal expenses associated with the Qualified Procedure. If
the three IVF cycles have not been completed once the $50,000 lifetime maximum is reached, the Plan will cover the remaining IVF cycles and the associated travel, lodging and meal expenses.
Fertility Preservation:
Standard fertility preservation services are covered and not subject to the $50,000 lifetime maximum
when a medical treatment will
directly or indirectly lead to infertility. Treatments include, but are not
limited to, radiation therapy or chemotherapy for treatment of cancer. Fertility preservation is the process
of saving or protecting eggs or sperm so that a person can use them to have biological children in the future. The new coverage applies to all enrollees and dependents, regardless of age, sex, sexual orientation, marital status or gender identity.
Centers of Excellence:
While you have the freedom to choose a provider, the Centers of Excellence for Infertility are a select group of providers recognized
by the Medical/Surgical Program administrator as leaders in reproductive medical technology and infertility benefits. If the Program administrator preauthorizes treatment at a Center, benefits are payable in
full (subject to the maximum lifetime benefit). There is also a travel benefit available if the Center is more than 100 miles (200 for airfare) from the patient’s residence. For additional information, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical/Surgical Program.
18 The Work Force
December 2019