Page 17 - Work Force June 2019

Important information: Deadline approaching for Westchester Medical Center Health Network Negotiations with Empire Blue Cross/Blue Shield
At press time, an agreement had not yet been reached between Empire Blue Cross/Blue Shield (the hospital administrator for the Empire Plan) and the Westchester Medical Center Health Network, a hospital group that comprises the following facilities:
• Westchester Medical Center
• Mid-Hudson Regional Hospital • Bon Secours – Good Samaritan
Hospital
• Bon Secours – Mercy
Community Hospital
• Bon Secours – St. Anthony’s Hospital
If an agreement is not reached
by May 31, 2019, Westchester Medical Center Health Network 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.
This could result in Empire Plan enrollees being 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 Westchester Medical Center Health Network hospital are encouraged to call Empire Blue Cross Blue Shield toll free at 1-800-495-9323 Monday through Friday, between 8:30 a.m. and 5:00 p.m. The customer service representatives can also provide assistance in locating an alternative
Empire Plan network hospital, if necessary.
Prescription Drug Co-Payment Reimbursement Benefit Enhanced for New York State Members
What is the Prescription Drug Co-payment Reimbursement Benefit?
The CSEA Employee Benefit
Fund (EBF) seeks to help members and their dependents defray some of their costs associated with prescription drugs. The most
recent state contract includes
an enhancement to the benefit beginning with the 2019 benefit year. Now up to $300 is reimbursable if you qualify for this benefit.
Who is eligible for this benefit?
CSEA members from the New York State bargaining units, including the Division of Military and Naval Affairs (DMNA),
who are enrolled in the New
York State Health Insurance Program (either the Empire
Plan or a health maintenance organization) are entitled to reimbursement once annually for prescription drug co-payments and covered prescriptions less than the co-payment. CSEA members employed by Roswell Park separately agreed to the newly enhanced co-payment
reimbursement in the most recent contract.
I am eligible. How do I qualify to receive the $300?
Once your family’s co-payments for prescription drugs for the year (January - December) reach $300, the next $300 in prescription drug co-payments is reimbursable. To get the maximum benefit of $300, wait until your co-payment expenses reach $600 before filing your claim. If you do not accumulate $600 before the end of the year, submit your claim after December 31 for what you did pay over $300. See the examples below on the chart.
What do I need to do to properly file a claim?
1. Get a Prescription Drug Co-payment Reimbursement Claim Form from an EBF representative,
by calling EBF at 800-323-2732 or by downloading the
form from our
website at
cseaebf.com.
Once you get the
form, fill it out completely and
2.
be sure to read the important information on the form. Submit your completed
form along with an itemized pharmacy printout clearly
indicating the patient’s name, dates
of service, co-payment amount and
prescription drug names. Cash
register receipts, original pharmacy receipts and cancelled checks
will not be accepted. Please do not use a highlighter on the printouts.
3. Mail your completed
claims to: CSEA Employee Benefit Fund, PO Box 516, Latham, NY 12110-0516.
Family
Family Prescription Co-payment Totals
Minimum Amount
Benefit Reimbursement
Notes
Andersons
$278
$300
$0
Do not meet minimum requirements
Smiths
$485
$300
$185
Not maximum benefit but some money is reimbursed
Williams
$687
$300
$300
Maximum benefit is reimbursed to member
June 2019
The Work Force 17