When an enrollee first adds a dependent to coverage, the enrollee is required to provide proof that the dependent is eligible for coverage. A dependent’s eligibility for coverage may change over time.  In addition, the rules for providing proof of coverage have changed over the years.  This project will help improve our current process and ensure that all dependents are subject to the same requirements.

Paying for the healthcare of individuals that are not eligible for coverage under NYSHIP has increased the cost of healthcare for all plan participants.  Removing ineligible dependents from coverage will result in lower increases in health insurance premiums in the future for everyone, including enrollees

At the conclusion of this project, we will analyze the results and decide on how frequently a full verification of dependent eligibility should be performed.  It is the enrollee’s responsibility to report any changes in the eligibility of their dependents to their health benefits administrator immediately.  In addition, enrollees receive a benefit statement on an annual basis.  It is important for enrollees to review the information contained in the benefit statement and to report any inaccuracies to their health benefits administrator.

Documentation that is submitted to Budco is immediately scanned into a secure computer system.  The paper documentation is then destroyed.  Enrollees should not send in original documentation – send in photocopies.  A secure electronic copy of all documentation will be provided to the NYS Department of Civil Service, which maintains all enrollment records for NYSHIP enrollees.  The only people that will have access to the documentation enrollees submit are individuals that are directly involved in verifying the eligibility of enrollees’ dependents.

Budco staff does not have access to your full social security. When calling Budco, you will be asked for your last name and zip/postal code. If further information is needed to locate your record, you will be asked for the last four digits of your social security number.

The documentation will only be used to verify the eligibility of enrollees’ dependents.

No.

No.  All documentation must be submitted directly to Budco.  Failure to do so will delay the review of the dependent’s eligibility and may result in a temporary lapse in coverage for the dependent.

Yes.  Original documents should not be submitted.  Upon receipt, documents will be scanned and then destroyed.  Documents submitted for verification will not be returned.

Closer to the Verification phase, enrollees will receive a full verification packet that will include a full list of Required Documentation.  That packet will outline next steps and will also provide enrollees with additional documentation options that may be submitted, specific for each dependent type.  If enrollees have any questions after receiving that packet, they can call the telephone number provided in that packet and a representative will assist them.

If the enrollee does not remove an ineligible dependent during amnesty, the enrollee will be required to submit documentation to support the eligibility of the dependent.  If the required documentation is not provided, the dependent will be removed from coverage and any claims paid on behalf of the dependent while they were ineligible will be the enrollee’s responsibility to pay.

Yes.  If a dependent becomes newly eligible after the conclusion of this project, the enrollee should provide the required proof of eligibility to their health benefits administrator.

If the enrollee is unable or unwilling to provide the required documentation to verify the eligibility of a dependent, the dependent will be removed from coverage and the enrollee may be required to repay health insurance claims paid on behalf of that dependent.

Budco will send the enrollee a letter to confirm the dependent(s) that were removed during the Amnesty Period.  The letter will contain instructions on how to report dependents that were removed in error.

When the ineligible dependent is removed from coverage, the enrollee will receive a confirmation letter from Budco.  If the enrollee believes the dependent is eligible, they should follow the instructions contained in the letter. 

Yes.  If an enrollee calls Budco and needs the services of an interpreter, the Budco representative will contact Language Line to solicit the services of an interpreter.  All conversations are strictly confidential.

Yes.  If an enrollee is in need of services for the hearing impaired, they should dial “711” on their telephone.  They will be connected to their state’s Relay center.  Enrollees should have Budco’s toll free number ready to give to the Relay center.  All conversations are strictly confidential.

COBRA benefits are available to NYS/PE dependents that are removed from the coverage during this project.  An application and monthly premium amount will be sent by the NYS Department of Civil Service within approximately two weeks after Budco notifies the enrollee that the dependent(s) has been removed from coverage.  COBRA coverage will be effective 6/13/09, for those dependents removed during the Special Amnesty Period, and 2/1/09, for those dependents removed during the Dependent Verification Phase. 

Dependents of PA enrollees will have to check with their agency for the individual agency’s policy for offering COBRA for this project, application procedures and effective dates.

• NYS Active employees – the health benefits administrator is usually located in the agency’s human resources department.
• NYS Inactive employees (for example, those enrollees on leave, retirees, vestees and COBRA enrollees) – the NYS Department of Civil Service acts as the health benefits administrator for all NYS inactive employees.  Enrollees may contact them at 518-457-5754.
• All others – contact the current or former agency’s human resources department of the enrollee.

Budco is the company that the State has contracted with to administer the Amnesty Period and the Verification of Dependent Eligibility.  Budco is a national leader in their field and are located in Highland Park, Michigan.