Page 17 - Work Force March 2016

2016 NYSHIP Dependent Eligibility Verification
Empire Plan claims deadlines for calendar year 2015
The Special Amnesty Period, which allowed NYSHIP enrollees a specified period of time to remove ineligible dependents (without penalty) has ended.
The Next Step: 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.
Verification of Dependents will be conducted in three phases:
The first phase will be for dependents of Participating Agencies (local government) enrollees.
Phase 1 Verification Period
• Employees of Participating Agencies (Local Government) must provide proof
(verification) of ALL dependents • Submission of proof beginning
Feb. 29 – April 15, 2016
The second phase will be for dependents of New York State Retirees and Participating Employers (Authorities, etc.) enrollees.
Phase 2 Verification Period
• NYS Retirees and
Participating Employers (Authorities,
etc.)
employees
must provide proof (verification) of ALL dependents
• Submission of proof
beginning May 2 - June 17, 2016
The third phase will be for dependents of Active New York State enrollees.
Phase 3 Verification Period
• Active New York State employees must provide proof (verification) of ALL dependents
• Submission of proof beginning July 5 – Aug. 19, 2016
Empire Plan enrollees have until April 30, 2016, 120 days after the end of the calendar year, to submit medical expenses incurred during the 2015 plan year to:
United Health Care Service Corp. P.O. Box 1600
Kingston, N.Y. 12402-1600
For the Empire Plan Basic Medical
Program, the Home Care Advocacy Program (HCAP) and for non-network
physical therapy or chiropractic services.
Empire Blue Cross and Blue Shield
NYS Service Center (Code YLS) P.O. Box 1407 – Church Street Station New York, N.Y. 10008-1407
For Empire Plan and non-network Inpatient or Outpatient hospital services.
Treasurer at AFSCME Headquarters, 1625 L
St., N.W., Washington, D.C. 20036-5687; and CSEA Statewide Treasurer, Empire State Plaza Station, P.O. Box 2611, Albany, N.Y. 12220-0611. Requests for more than one person may not be sent in the same envelope. Each request must be sent individually. Requests must be renewed in writing every year the member wishes a rebate.
Upon receipt by the International of a valid rebate request, an application for partisan political or ideological rebate will be sent to the objecting member. The objecting member will be required to complete and return the application within 30 days of its issuance. In accordance with the constitutional amendment adopted at the 1998 International Convention, the application will require the objecting member to identify those partisan or political or ideological activities to which objection is being made, and no rebate will be made to any member who fails to complete that portion
of the application. In determining the amount of the rebate to be paid to any member, the International Union and each subordinate body
Value Options
P.O. Box 1800
Latham, N.Y. 12110
For non-network mental health and substance abuse services.
The Empire Plan Prescription Drug Program c/o CVS Caremark
P.O. Box 52136
Phoenix, A.Z. 85072-2136
For prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.
Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to get claim forms.
Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information.
If you have a non-network claim submission, make sure you complete the requested subscriber information on the claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form.
shall have the option of limiting the rebate to the member’s pro-rata share of the expenses for those activities specifically identified in the application.
Upon receipt by CSEA of the valid, certified request, the constitutional maximum of 3 percent rebate will be processed. No phone calls or e-mail correspondence will be accepted.
Any member who is dissatisfied with the amount of the rebate paid by the International Union may object by filing a written appeal with the AFSCME Judicial Panel within 15 days after the rebate check has been received. Appeals should be sent to the Judicial Panel Chairperson at the AFSCME International Headquarters at the address listed above.
The Judicial Panel will conduct a hearing and issue a written decision on such appeals, subject to an appeal to the full Judicial Panel. If dissatisfied with the Judicial Panel’s ruling, a member can appeal to the next International Convention.
Procedure protects rights
AFSCME’s constitution includes a rebate procedure to protect the rights of members who disagree with how the union spends money for partisan political or ideological purposes.
Article IX, Section 14 of the International Constitution, which establishes the procedure for dues rebates for members who object to AFSCME’s partisan political or ideological expenditures, was amended at AFSCME’s 33rd International Convention.
The amended language requires those persons who object to the expenditure of dues for political or ideological purposes to submit their objection in writing to both the International Union and CSEA Local 1000 by certified mail between April 1 and April 16 (dates inclusive) each year for the prior year ending Dec. 31.
The timing of the steps in the procedure is tied to the International’s fiscal year. The procedure, including the requirements for
March 2016
submitting a proper rebate request, is spelled out in Article IX, Section 14 of the International Constitution. THESE REQUIREMENTS WILL BE STRICTLY ENFORCED.
Here’s how it works. Members who object to the expenditure of a portion of their dues
for partisan political or ideological purposes and want to request a rebate must do so individually in writing. Written requests
must be postmarked between April 1 and
April 16, 2016. That request must be timely filed by registered or certified mail with: the International Secretary-Treasurer and the
CSEA Statewide Treasurer. The requests must contain the following information: name, CSEA ID number, home address, email address, if available, and the AFSCME local (CSEA Local 1000) to which dues were paid during the preceding year. This information must be typed or legibly printed. The individual request must be signed by the member and sent by the individual member to: International Secretary-
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