Page 18 - Work Force November 2016

Don’t miss the co-payment rTeimbursement deadline
he CSEA Employee Benefit Fund over $300. The deadline for the 2016 offers different prescription calendar year is March 31, 2017.
Think about 2017 health program options
Now is the time for New York state employees (including Unified Court System employees) to think about health insurance options
for 2017. Watch your mailbox for important information, including the 2017 health insurance premium rates, option transfer information and other important benefit dates.
Important Dates to Remember: Pre-Tax Contribution Program (PTCP): Open Enrollment: Nov. 1 - Nov. 30, 2016
Your share of the health insurance premium is deducted from wages before taxes are withheld, which
may lower your taxes. Under IRS rules, if you are enrolled in PTCP, you may change your health insurance deduction during the tax year ONLY after a qualifying PTCP event. If
you wish to change your pre-tax contribution for 2017, see your agency health benefits administrator and complete a health insurance transaction form (PS-404) by Nov. 30, 2016.
Option Transfer Information Availability:* The Option Transfer Period is the time of year when you are able to change your NYSHIP option for
the next plan year. To assist
you with this decision, the following information will be made available:
• The option transfer period will be announced once NYSHIP 2017 rates are released.
• NYSHIP Rates & Deadlines will be mailed to enrollees’ homes when rates are approved and posted online.
Productivity Enhancement Program:
Open Enrollment: Nov. 1 - Dec. 2, 2016 Exchange previously accrued
annual and/or personal leave in return for a credit to be applied toward the employee share of your New York State Health Insurance Program (NYSHIP) premium. The credit will be included in biweekly paychecks and divided evenly during the plan year. To elect PEP for 2017, you must apply between Nov. 1, 2016 and Dec. 2, 2016. Please see your Agency Health Benefits Administrator for additional information and an application. If you are currently enrolled in PEP, you must re-enroll to continue your benefits in 2017.
*More detailed information about New York state active employees’ option transfer period dates and deadlines will be provided when rates are available.
drug and/or physician co-payment reimbursements that may have been negotiated into your collective bargaining agreement.
These benefits reimburse you
once annually for co-payments spent per calendar year. If you’ve already reached the plan limit, you can
submit now! The deadline for the 2016 calendar year is March 31, 2017. Here is an overview of the plans:
Prescription Drug Co-Payment Reimbursement
for New York State Employees
Members 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 NYSHIP prescription drug co-payments
and covered prescriptions less than the co-payment for themselves
and their eligible dependents.
Once
co-payments reach
$300, the next $150
in prescription drug co-payments is reimbursable. If you still have not accumulated $450 by Dec. 31, 2016, submit your claim for what you did pay over $300. The deadline for the 2016 calendar year is March 31, 2017.
Prescription Drug Co-Payment Reimbursement for state Liquidation Bureau Employees
Members 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 NYSHIP prescription
drug co-payments and covered prescriptions less than the co-payment for themselves and their eligible dependents.
Once co-payments reach $300, the next $100 in prescription drug co-payments is reimbursable. If you did not accumulate $400 by Dec. 31 2016, submit your claim for what you did pay
Unified Court System Combined Co-Payment Benefit
Reimburses prescription drug co-payments and co-payments for physician office visits. The claim can be made up of both types of co-payments for a combined maximum reimbursement of $325. The deadline for the 2016 calendar year is March 31, 2017.
Unified Court System Retiree Co-Payment Benefit
Reimburses prescription drug co-payments only up to a maximum of $100. Physician co-payments for office visits are reimbursed up to a maximum of $125. The deadline for the 2016 calendar year is March 31, 2017.
Local Government Co-Payment
For local government employees who
have a negotiated prescription drug co-payment or physician co-payment reimbursement
benefit. Please contact either our Member Services Department at 800-323-2732 or refer to your collective bargaining agreement to verify the level and type of reimbursement available for you. The deadline for the 2016 calendar year is March 31, 2017.
How to submit a claim
Forms are available in the “Download Forms” section of our website at cseaebf.com. If you are eligible, please submit the applicable claim form along with supporting documentation by March 31, 2017. For prescription drug co-payment reimbursements, attach a complete, itemized pharmacy printout.
For physician co-payment reimbursements, attach Explanation
of Benefits (EOBs) from your health insurance carrier. If you have questions about these benefits, please contact our Member Services Department at 800-323-2732.
NYSHIP Dependent Eligibility Audit final phase: Removal of non-verified dependents
NYSHIP’s dependent eligibility verification project impacts all NYSHIP enrollees with family health insurance (the Empire Plan and NYSHIP HMOs). The audit helps to ensure that every participant who receives
NYSHIP health benefits is
entitled to those benefits. Health Management
Systems, Inc. (HMS) has
completed the NYSHIP
Dependent Eligibility
Verification Audit (DEVA)
for active New York state
agency enrollees and their
covered dependents. Enrollees
were required to provide proof of eligibility for their covered dependents by Aug. 19, 2016 and were notified of
a grace period which extended their reporting deadline to Sept. 7, 2016.
On Oct. 2, 2016, New York state
initiated the removal of unverified dependents from NYSHIP coverage retroactive to Jan. 1, 2016. Medicare primary dependents will be terminated in accordance with CMS guidelines.
NOTE: There will be a 90-day reinstatement period available
through Dec. 6, 2016. Enrollees in receipt of a “Notice of
Cancellation of Coverage” from NYSHIP who wish to appeal should contact HMS directly
at 1-866-252-0635 Monday through Friday 8 a.m. to 11 p.m.
(this number will no longer be available after Dec. 6, 2016). Appeals
for reinstatement must be received by HMS no later than Dec. 6, 2016; you may fax documentation to 1-877-223-8478 or upload documentation via VerifyOS.com. The HMS reference number from correspondence will be required.
18 The Work Force
November 2016