Insurance carriers require proof of full time student status before they will pay the claim. The Special Amnesty Period protects enrollees against repaying claims already paid by the insurance carrier; it does
not apply to claims not yet paid.

Yes. The enrollee must submit the documentation to the insurance carrier in order for the claim to be paid. The enrollee must also submit the required documentation to Budco as part of the Dependent Eligibility Verification Project.

HBAs should explain that 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 to ensure that
only eligible dependents are receiving benefits.

The HBA should not accept dependent eligibility proofs in connection with this project. The enrollee must submit the proofs directly to Budco. This will eliminate delays in Budco receiving the information.

The enrollee will have to resubmit the documentation to Budco.

The dependent will be removed from coverage, effective 2/1/09. If, at a later date, the enrollee can prove the eligibility of the dependent, the dependent can be added back. HBAs will receive further direction from the Department on this issue in the future.

Dependents who are enrolled in the NYS Dental and/or Vision plans and are removed from medical coverage, will be removed from dental/vision coverage. This does not apply to dependents coverage under
other Dental/Vision plans (for example a union employee benefit fund).

Enrollees should continue to report all qualifying events that occur 2/1/09 or later to their HBA. The HBA should process the transaction as normal. For example, removal of a recently divorced spouse.

Enrollees requesting to remove ineligible dependents where there is no current qualifying event (occurred prior to 2/1/09) should be referred to Budco to remove the dependent using the Dependent Eligibility
Confirmation Form.

Instruct the enrollee to contact Budco to see if there is alternative acceptable documentation. In rare circumstances, Budco will refer the case to the Department of Civil Service for a final determination.

The enrollee should call Budco directly to confirm if his request to remove the ineligible dependent was received and processed. If Budco has no record of receiving the request and the enrollee insists the request was submitted timely, the case will be referred to the Department of Civil Service for a determination.

Yes. In this case, the employer will receive a refund in the difference between Family and Individual coverage, retroactive to 2/1/09.

No this information will not show on a worklist. It will go on the Activity list.

A passport is not an acceptable proof in lieu of a birth certificate for dependent children as it does not prove the parent/child relationship.

The enrollee should contact Budco to see if there are alternative documents that the enrollee can provide to prove the marital relationship.

No, the enrollee will be advised on their Dependent Eligibility Confirmation Form that the dependent is covered under a NMSO and cannot be voluntarily removed from coverage and is not subject to dependent eligibility verification.

DCS will periodically advise Budco of dependents who are removed from the Project based on losing eligibility through a qualifying event that occurred after 2/1/09. The dependent still may appear on the confirmation form. An enrollee can also call Budco to verify whether or not that dependent has been removed from the Dependent Eligibility Verification Project. Depending on the timing of the qualifying event, the enrollee should still submit that required documentation for that dependent to prove eligibility as
of 2/1/09.

For the purpose of this project the enrollee is asked to provide proof of their dependent’s eligibility effective 2/1/09. DCS has determined that we can accept documentation dated anytime within the quarter prior to 2/1/09 to prove eligibility for all dependent types. If an enrollee does not have documentation dated between 11/1/08 and 2/1/09 the enrollee should call Budco to see if there is acceptable alternative documentation which can be provided.

DCS will receive electronic copies of all proofs of eligibility submitted to Budco by the enrollee. DCS is exploring the feasibility of making this information available to HBAs.

Yes, joint ownership in a Time Share qualifies as proof of financial interdependence from List A.

Yes, the enrollee will be subject to imputed income for the period of time the dependent was a domestic partner.

Same sex marriage performed in a state that allows such a marriage is recognized as any other marriage for NYSHIP eligibility purposes. The enrollee must submit proof of the spousal relationship.

No. This project is to prove eligibility of a dependent covered under NYSHIP Medical coverage. However, if it is determined that a dependent is ineligible for Medical, DCS will also have the dependent removed for NYSHIP Dental and Vision coverage.

At the conclusion of this Project DCS will be reviewing its policies and procedures regarding dependent eligibility. In the mean time, HBAs should follow existing guidelines.

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.

Enrollees should continue to report all qualifying events that occur 2/1/09 or later to their HBA.  The HBA should process the transaction as normal. For example, removal of a recently divorced spouse.  Removal of ineligible dependents where there is no current qualifying event (occurred prior to 2/1/09) should be reported by the enrollee to Budco during the Special Amnesty Period.

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

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.

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.

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. 

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.

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.

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. 

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 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.

For up to date information HBA's should consult the dedicated website at www.cs.state.ny.us/nyshipeligibilityproject; or call BUDCO beginning April 6, 2009 at 888-358-2196, 12:00 p.m. to 8:00 p.m., Monday through Friday

HBAs will be notified of dependents removed during either the Amnesty Period or the Verification Period on the worklist generated through NYBEAS.  They will be identified separately from dependents removed outside of this project.