Page 15 - Work Force June 2016

2016 NYSHIP Dependent Eligibility Verification now in 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.
Already completed:
The Phase 1 verification period for local government employees and retirees (county, municipal, 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)
• New York state 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 Jan. 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 Employer Solutions phone availability is Monday-Friday from 8 a.m. to 11 p.m. at 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 – Aug. 19, 2016 (dates to
submit proof of eligibility).
Important information about contract negotiations between Empire BlueCross/BlueShield and Health Alliance of the Hudson Valley
As this edition went to press, no agreement has been reached between Empire Blue Cross/Blue Shield (the Empire Plan’s hospital administrator) and the Health Alliance of the Hudson Valley, a hospital group that includes the following facilities in Ulster and Delaware counties: Health Alliance Hospital’s St. Mary’s Ave. and Broadway campuses in Kingston, and Margaretville Hospital in Margaretville.
If an agreement is not reached by May 31, 2016, Health Alliance hospitals will not be Empire Plan network providers. This means that most services, except in limited circumstances, will be covered on
an out-of-network basis. Empire Plan enrollees will be responsible for a coinsurance amount of 10 percent of billed charges for covered services, up to the annual coinsurance maximum.
Enrollees who are currently receiving services or are scheduled for treatment at a Health Alliance hospital are encouraged to call Empire BlueCross BlueShield toll free at 800-495-9323. Monday through Friday, between 7 a.m. and 8 p.m. or visit empireblue.com for updates. Representatives can also provide assistance in locating an alternative Empire Plan network hospital in the area.
June 2016
The Work Force 15