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| Date Issued: | October 17, 2023 |
|---|---|
| Subject: | Minimum Time Frame to Join the New York State Health Insurance Program (NYSHIP) or Change NYSHIP Participation |
| Purpose: | Establish a minimum time frame in which Participating Agencies (PA) and Participating Employers (PE) must notify the Employee Benefits Division (EBD) when joining the New York State Health Insurance Program (NYSHIP) or making changes to their NYSHIP participation. |
| Date Issued: | February 10, 2023 |
|---|---|
| Subject: | Eligibility for Volunteer Ambulance and EMS Organizations to Join NYSHIP |
| Purpose: | To establish and clarify rules for eligibility of volunteer ambulance and Emergency Medical Services (EMS) organizations to participate in the New York State Health Insurance Program (NYSHIP). |
| Date Issued: | October 26, 2022 |
|---|---|
| Subject: | Documentation Required to Change a Gender Designation and/or Name in NYBEAS |
| Purpose: | Clarify the documentation required for an enrollee or dependent to change their gender designation and/or name in the New York Benefit Eligibility and Accounting System (NYBEAS |
| Date Issued: | January 11, 2022 |
|---|---|
| Subject: | Waiving Late Enrollment Waiting Periods When One or More Dependents Experiences a Qualifying Event |
| Purpose: | To clarify that Late Enrollment Waiting Periods are waived for an employee or retiree when they request to newly enroll in coverage or add previously eligible dependents to existing coverage coincident with a dependent becoming newly eligible. |
| Date Issued: | May 11, 2018 |
|---|---|
| Subject: | Offering Empire Plan and Excelsior Plan to the Same Class of Employee |
| Purpose: | Codify the New York State Health Insurance Program's (NYSHIP) policy of prohibiting participating agencies from offering the Empire Plan and the Excelsior Plan to the same class of employees. |
| Date Issued: | May 11, 2018 |
|---|---|
| Subject: | Adding Dependents to Existing Family Coverage |
| Purpose: | To establish the procedure for adding dependents to existing family coverage for New York State, Participating Employer, and Participating Agency enrollees. |
| Date Issued: | May 11, 2018 |
|---|---|
| Subject: | Effective Date of Coverage for Seasonal Employees Returning to Work |
| Purpose: | Determine the effective date of health, dental, and vision coverage for seasonal employees who leave the payroll and return to work. |
| Date Issued: | April 25, 2016 |
|---|---|
| Subject: | Pre-Tax Contribution Program (PTCP) |
| Issue: | Administration of PTCP for New York State employees |
| Date Issued: | February 8, 2011 |
|---|---|
| Subject: | Documentation of Paternity Establishment |
| Purpose: | To clarify the documentation necessary to establish paternity of NYSHIP enrollees' dependent children, particularly when the enrollee is not married to the child's mother and the enrollee-father's name is not on the child's birth certificate. |
| Date Issued: | August 23, 2010 |
|---|---|
| Date Revised: | November 14, 2017 |
| Subject: | M/C Life Insurance- Eligibility for Domestic Partners and their Children |
| Purpose: | To extend eligibility under the M/C Life Insurance Plan to include the enrollment of Domestic Partners and their children. |
| Date Issued: | June 29, 2010 |
|---|---|
| Subject: | Retroactive Premium Refunds for Participating Agencies |
| Purpose: | Codify the process of refunding retroactive premium to participating agencies. |
| Date Issued: | July 22, 2010 |
|---|---|
| Date Revised: | September 18, 2023 |
| Subject: | Required Dependent Proofs |
| Purpose: | Identify the documentation that must be collected as proof of eligibility before adding a dependent to NYSHIP. |
| Date Issued: | June 23, 2017 |
|---|---|
| Date Revised: | February 22, 2024 |
| Subject: | Student Eligibility for Dependent Children Receiving a Military Extension |
| Purpose: | Summarize the New York State Health Insurance Program's (NYSHIP) full-time student status requirements as they relate to dependents receiving a military extension. |
| Date Issued: | May 27, 2009 |
|---|---|
| Policy File Ref: | A1810 |
| Subject: | Eligibility -- HIPAA Policies and Administrative Requirements |
| Issue: | Breach Notification and Security |
| Date Issued: | May 27, 2009 |
|---|---|
| Policy File Ref: | A330 |
| Subject: | Eligibility -- Child Health Insurance Program Reauthorization Act of 2009 |
| Issue: | Child Health Insurance Program Reauthorization Act of 2009 - implementation |
| Date Issued: | March 17, 2009 |
|---|---|
| Policy File Ref: | A330 |
| Subject: | Dependent Eligibility Audit issues |
| Date Issued: | December 5, 2007 |
|---|---|
| Policy File Ref: | A110 |
| Subject: | Eligibility restriction based on spousal eligibility through another employer. |
| Date Issued: | November 15, 2007 |
|---|---|
| Policy File Ref: | A310 |
| Subject: | Employee Eligibility |
| Issue: | Determine EBD policy concerning the enrollment of unpaid board members by public authorities in the New York State Health Insurance Program. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Termination Date for Remarried Dependent Survivors |
| Purpose: | Determine the effective date of termination of coverage when it is discovered that a dependent survivor has newly married or entered into a new domestic partnership. |
| Date Issued: | March 10, 2005 |
|---|---|
| Policy File Ref: | A1100, A800 |
| Subject: | Retirement, Medicare |
| Issue: | Memorialize our existing policy that agencies may not withdraw only their Medicare eligible retirees from NYSHIP. |
| Date Issued: | June 15, 2004 |
|---|---|
| Policy File Ref: | A410 |
| Subject: | Internal Policies, Procedures |
| Issue: | Advise employees of the manner in which EBD will categorize and store e-mail documents which meet the definition of a record. |
| Date Issued: | May 6, 2004 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1320 |
| Subject: | Effect On Qualified Beneficiaries When Enrollee's COBRA Coverage Is Terminated Due To The Enrollee's Medicare Entitlement |
| Issue: | Determine how IRS Revenue Ruling 2004-22 applies to NYSHIP COBRA coverage for dependents of persons terminated from COBRA coverage due to eligibility to receive Medicare benefits. |
| Date Issued: | May 14, 2003 |
|---|---|
| Policy File Ref: | A320 |
| Subject: | Agency Eligibility |
| Issue: | Determine if an agency participating in NYSHIP may offer another indemnity plan as an alternative to the Empire Plan. |
| Date Issued: | May 14, 2003 |
|---|---|
| Date Revised: | September 28, 2011 |
| Policy File Ref: | A310 |
| Subject: | PA/PE Health Insurance Buyouts |
| Issue: | Determine when an employee who elects to participate in a Participating Agency (PA) or Participating Employer (PE) health insurance buyout program may enroll in NYSHIP. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1830 |
| Subject: | Restriction of Disclosures of PHI, Individual Rights |
| Purpose: | To issue instructions to EBD workforce members regarding the process for individuals to request a restriction of certain uses and disclosures of protected health information (PHI) that are for activities related to treatment, payment and health care operations (TPO), or to persons involved in the individual's care. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1830 |
| Subject: | Individual Rights |
| Issue: | Confidential Communications of PHI |
| Purpose: | To issue instructions to EBD workforce members regarding an individual's right to submit requests for communications of their protected health information (PHI) by alternative method or at alternative locations. Health plans may comply with such a request if the request meets the health plan's reasonable prerequisites for such requests. Health plans are required to comply with the individual's request if the individual states that disclosure of all or part of the PHI could endanger the individual. |
| Date Issued: | April 1, 2003 |
|---|---|
| Policy File Ref: | A1830 |
| Subject: | Access to and Amendment of PHI, Individual Rights |
| Purpose: | To issue instructions to EBD workforce members regarding an individual's right to access or request amendment of their protected health information maintained by EBD. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1830 |
| Subject: | Individual Rights |
| Issue: | Accounting of Disclosures of PHI |
| Purpose: | To issue instructions to EBD workforce members regarding the process for an individual to submit, and EBD's responsibility to respond to, requests for an accounting of certain disclosures or protected health information (PHI). Under HIPAA, individuals have the right to receive a written accounting of certain disclosures of their PHI made by a health plan or its business associates. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1820 |
| Subject: | Uses and Disclosures of PHI and Authorization Requirements |
| Issue: | Authorization for Use or Disclosure of PHI |
| Purpose: | To issue instructions to EBD workforce members regarding the 'Authorization for Release of Health Information' form for using and disclosing protected health information (PHI), and necessary documentation of authority for such use or disclosure, when use/disclosure is for purposes outside of those permitted or required by law relating to treatment, payment or health care operations, or public responsibilities. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1820 |
| Subject: | Uses and Disclosures of PHI and Authorization Requirements |
| Issue: | Uses and Disclosures of PHI |
| Purpose: | To issue instructions to EBD workforce members regarding permitted uses and disclosures of protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA). |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1810 |
| Subject: | HIPAA Privacy Policy and Administrative Requirements, Notice of Privacy Practices |
| Purpose: | To issue instructions to EBD workforce members regarding the division???s Notice(s) Of Privacy Practices. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1810 |
| Subject: | HIPAA Privacy Policy and Administrative Requirements |
| Purpose: | To issue instructions to EBD workforce members regarding the process for individuals to file complaints about EBD's privacy policies and procedures, its compliance with those policies and procedures, or its compliance with the HIPAA regulations. |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1810 |
| Subject: | HIPAA Privacy Policies and Administrative Requirements Topic: General Administrative Requirements |
| Purpose: | To establish policies to protect the confidentiality of protected health information (PHI) in compliance with the administrative and organizational requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). |
| Date Issued: | April 14, 2003 |
|---|---|
| Policy File Ref: | A1810 |
| Subject: | HIPAA Privacy Policies and Administrative Requirements |
| Purpose: | To define terms used throughout policies for compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification requirements. |
| Date Issued: | December 27, 2000 |
|---|---|
| Policy File Ref: | A330 |
| Subject: | Dependent Eligibility |
| Issue: | Determine if State agencies must accept Qualified Medical Child Support Orders (QMCSO) issued pursuant to ERISA. |
| Date Issued: | May 10, 1999 |
|---|---|
| Policy File Ref: | A830 |
| Subject: | Medicare Reimbursement |
| Issue: | Determine whether the current practice of withholding the Medicare credits of Medicare primary enrollees' dependents until receipt of the dependent's Medicare card should be replaced by automatic granting of the Medicare credit when the dependent reaches age 65. |
| Date Issued: | April 2, 1999 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1014 |
| Subject: | COBRA; Deletion from Coverage Prior to Divorce |
| Date Issued: | June 5, 1998 |
|---|---|
| Policy File Ref: | A1140 |
| Subject: | Retirement Sick Leave Credit |
| Issue: | Determine the correct method of calculating the sick leave credit. |
| Date Issued: | September 4, 1997 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A220, A510 |
| Subject: | Option Change Upon Return from Leave |
| Purpose: | Determine if State or Participating Employers' enrollees who have had health insurance canceled while on leave without pay (LWOP) may change options upon return to the payroll if they missed an option transfer period while on LWOP. |
| Date Issued: | July 18, 1997 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A1130 |
| Subject: | Reinstatement of Coverage After Disability Retirement has been Approved |
| Issue: | Determine if health insurance can be reinstated for individuals who lose coverage for non-payment of premiums during leave without pay (LWOP) or vestee status and who are subsequently granted a retroactive retirement by the New York State and Local Employee's Retirement System. |
| Purpose: | Determine if health insurance can be reinstated for individuals who lose coverage due to non-payment of premiums and are subsequently granted a retroactive disability retirement by the New York State and Local Retirement System (NYSLRS) or the New York State Teachers' Retirement System (NYSTRS). |
| Date Issued: | February 1, 2006 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | 330 |
| Subject: | Court Orders to Add Previously Eligible Dependents |
| Purpose: | Determine if NYSHIP must enroll previously eligible children without a late enrollment waiting period when an enrollee or the agency is ordered by a family court order to immediately enroll dependents and determine if such a change would be a qualifying event under the Pre-Tax Contribution Program (PTCP). |
| Date Issued: | April 4, 1997 |
|---|---|
| Policy File Ref: | A830, A1000 |
| Issue: | Determine the number of years payments and billings may be made retroactive under NYSHIP. |
| Date Issued: | January 29, 1997 |
|---|---|
| Policy File Ref: | A810 |
| Issue: | Determine Medicare Secondary Payer (MSP) status of domestic partners of active NYSHIP enrollees. |
| Date Issued: | December 20, 1999 |
|---|---|
| Policy File Ref: | A1150 |
| Subject: | Sick Leave Deferral |
| Issue: | Determine the status of individuals who chose the five year deferred sick leave calculation benefit, but who do not return to NYSHIP at the expiration of the five year period. |
| Date Issued: | September 24, 1996 |
|---|---|
| Policy File Ref: | A1020 |
| Issue: | Determine how many waivers of premium an enrollee is entitled to, and how soon after returning to the payroll may another waiver be applied for. |
| Date Issued: | September 10, 1996 |
|---|---|
| Policy File Ref: | A810 |
| Issue: | Determine if the Medicare Secondary Payer (MSP) rules increase skilled nursing facility benefits. |
| Date Issued: | January 9, 2003 |
|---|---|
| Policy File Ref: | A1130 |
| Subject: | Retirement Eligibility |
| Issue: | Determine if an enrollee eligible for a retirement incentive who had previously declined or cancelled NYSHIP coverage may reinstate or enroll for coverage without a waiting period in order to have health insurance as a retiree. |
| Date Issued: | June 28, 1996 |
|---|---|
| Date Revised: | September 28, 2023 |
| Policy File Ref: | A230 |
| Purpose: | Clarify application of the new employee waiting period before NYSHIP coverage begins. |
| Date Issued: | May 17, 1996 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1320 |
| Subject: | COBRA |
| Issue: | Determine if NYSHIP must grant all qualified beneficiaries the right to have individual coverage under COBRA. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | 'Other Child' Eligibility |
| Purpose: | Clarify the definition of 'chiefly dependent' for purposes of 'other child' eligibility for NYSHIP. |
| Date Issued: | April 16, 1996 |
|---|---|
| Policy File Ref: | A590 |
| Issue: | Determine EBD obligation to offer health insurance at enrollee share for enrollees covered by the Family Medical Leave Act (FMLA). |
| Date Issued: | April 16, 1996 |
|---|---|
| Policy File Ref: | A590 A1020 |
| Issue: | Determine if individuals absent under the Family Medical Leave Act (FMLA) are eligible for a waiver of premium. |
| Date Issued: | January 4, 1996 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1130 |
| Subject: | Continuing NYSHIP Coverage in Retirement as a Member of Another Retirement System |
| Purpose: | Determine which memberships in a local public retirement system satisfy the NYSHIP requirement that an employee be retired as "a member of a retirement system or pension plan or system administered and operated by the State of New York, or a civil division thereof..." at the time of retirement. |
| Date Issued: | February 1, 1996 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1320 |
| Subject: | Maximum Enrollment Period for COBRA Enrollees and Dependents of Incoming Participating Agencies and Employers |
| Date Issued: | January 30, 1996 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A830 |
| Subject: | Retroactive Medicare Part B Reimbursements for New York State and Participating Employers' Enrollees and their Dependents |
| Issue: | Determine the maximum period of retroactive reimbursement for Medicare Part B premiums when NYSHIP has been paying primary for a Medicare enrolled person. |
| Date Issued: | December 21, 1995 |
|---|---|
| Date Revised: | July 28, 2017 |
| Policy File Ref: | A600 |
| Subject: | PA and PE Claims Reports |
| Purpose: | Determine the minimum number of enrollees a PA or PE must have before EBD will release claims experience to the agency. |
| Date Issued: | March 24, 1995 |
|---|---|
| Policy File Ref: | A580 |
| Issue: | Clarification of eligibility for NYSHIP vested status. |
| Date Issued: | March 6, 1995 |
|---|---|
| Date Revised: | October 9, 1998 |
| Policy File Ref: | A230 |
| Subject: | Eligibility |
| Issue: | Determine if a new enrollee waiting period should apply to employees of local entities acquired by State agencies assuming the responsibilities of the local agency. |
| Date Issued: | September 2, 1994 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A1310 |
| Subject: | Partial Month Billing (15 Day Rule) |
| Issue: | Termination date for Dental and Vision coverages for COBRA billing purposes. |
| Purpose: | Codify the Employee Benefits Division's (EBD) partial month billing policy. |
| Date Issued: | August 19, 1994 |
|---|---|
| Date Revised: | October 6, 1997 |
| Policy File Ref: | A810 |
| Subject: | Medicare |
| Issue: | NYSHIP liability for End Stage Renal Disease (ESRD). |
| Date Issued: | July 20, 1994 |
|---|---|
| Policy File Ref: | A310 |
| Issue: | Retention of the "actively at work" provision for new enrollments. |
| Date Issued: | February 7, 1994 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A510 |
| Subject: | Continuing Dental and Vision Coverage in Leave Without Pay Status |
| Purpose: | Establish the process for continuing dental and vision coverage while in leave without pay status. |
| Date Issued: | December 31, 1993 |
|---|---|
| Date Revised: | January 26, 2023 |
| Policy File Ref: | A820 |
| Subject: | Medicare Hold Harmless Rules and Procedures |
| Purpose: | Determine when New York State Health Insurance Program (NYSHIP) members of a New York State Agency, Participating Agency, or Participating Employer may be held harmless for not enrolling in Medicare when first eligible for Medicare-primary coverage. |
| Date Issued: | July 28, 1993 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A1320 |
| Issue: | Eliminate the "gross misconduct" exception for COBRA coverage. |
| Date Issued: | July 16, 1993 |
|---|---|
| Policy File Ref: | A580 |
| Issue: | Reinstatement of coverage for former employees who did not make the required premium payments during vested status. |
| Date Issued: | June 8, 1993 |
|---|---|
| Date Revised: | September 28, 1993 |
| Policy File Ref: | A210 |
| Issue: | Resolution of different effective dates for changes of coverage for State retirees and State Participating Employer retirees. |
| Date Issued: | December 14, 1992 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A340 |
| Subject: | Dependent Survivors Who Are NYSHIP Benefits Eligible Through Employment |
| Purpose: | Determine if a dependent survivor who has NYSHIP benefits eligible employment can enroll in coverage as an active employee and resume dependent survivor coverage at a later date. |
| Date Issued: | October 30, 1992 |
|---|---|
| Date Revised: | November 16, 2017 |
| Policy File Ref: | A1320 |
| Subject: | COBRA Termination due to Medicare Entitlement for COBRA Coverage Administered by the Employee Benefits Division (EBD) |
| Issue: | What is the correct NYSHIP termination date for a COBRA enrollee who has become entitled to Medicare coverage |
| Date Issued: | January 1, 2000 |
|---|---|
| Issue: | Period of time in which a withdrawn agency has to file retroactive transactions. |
| Date Issued: | January 11, 1999 |
|---|---|
| Date Revised: | November 14, 2017 |
| Subject: | COBRA Eligibility Regarding Other Health Coverage |
| Issue: | Eligibility for COBRA coverage when other health coverage exists. |
| Date Issued: | June 5, 1992 |
|---|---|
| Date Revised: | March 4, 1999 |
| Policy File Ref: | A1130 |
| Subject: | Retirement |
| Issue: | Clarify the definition of "service-connected disability retirement" in Section 73.2 (a)(3)(vii) of the President's Regulations. |
| Date Issued: | April 21, 1992 |
|---|---|
| Date Revised: | September 28, 2023 |
| Policy File Ref: | A230 |
| Purpose: | Require a waiting period for employees who are terminated from a Participating Employer (PE) and are hired at a State agency. |
| Date Issued: | March 31, 1992 |
|---|---|
| Date Revised: | March 13, 1995 |
| Policy File Ref: | A1130 |
| Issue: | Changing the age at which Tier IV members of the retirement systems and TIAA-CREF can retire and be eligible to continue health insurance coverage in retirement. |
| Date Issued: | March 31, 1992 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A530 |
| Subject: | Employees Returning to Work from Preferred List |
| Issue: | Determine if persons returning to work from Preferred List status, or any reinstatement after an absence of one year or less for other than disciplinary reasons, should satisfy the waiting period for new employees for health and dental insurance. |
| Purpose: | Determine if persons returning to work from Preferred List status should satisfy the new employee waiting period. |
| Date Issued: | March 20, 1992 |
|---|---|
| Date Revised: | November 2, 1999 |
| Policy File Ref: | A410 |
| Subject: | Internal Policies |
| Issue: | Address the security and privacy implications of requests for enrollment file changes by telephone and other electronic methods. |
| Date Issued: | January 23, 2017 |
|---|---|
| Date Revised: | February 22, 2024 |
| Issue: | Regaining NYSHIP Dependent Eligibility |
| Purpose: | Determine if a dependent child who lost NYSHIP eligibility can regain coverage after a change in circumstance. This memo will address situations when a child loses eligibility due to marriage, loss of student status, or loss of disabled dependent status. |
| Date Issued: | January 17, 1992 |
|---|---|
| Policy File Ref: | A220 |
| Subject: | Approving an Option Change Outside of the Annual Option Change Period |
| Purpose: | Expand the reasons for approving an option change outside of the annual option change period. |
| Date Issued: | May 6, 1991 |
|---|---|
| Policy File Ref: | B220 |
| Subject: | Coordination of Benefit Procedures for the Empire Plan's Carriers |
| Purpose: | Determine the differences in coordination of benefit procedures for the Empire Plan's carriers. |
| Date Issued: | May 1, 1991 |
|---|---|
| Policy File Ref: | A530 |
| Issue: | Temporary employment during the preferred list coverage period. |
| Date Issued: | March 21, 1991 |
|---|---|
| Policy File Ref: | A410 |
| Issue: | Resolution of cases of fraud and benefit abuse. |
| Date Issued: | February 25, 1991 |
|---|---|
| Date Revised: | January 23, 2017 |
| Subject: | Retirement and Dependent Survivor Service Requirement |
| Purpose: | Recognize other public service for the purpose of meeting the NYSHIP retirement and dependent survivor eligibility requirements. |
| Date Issued: | January 14, 1991 |
|---|---|
| Date Revised: | January 23, 2017 |
| Subject: | Eligibility of Dependent Survivors of COBRA Enrollees |
| Purpose: | Determine if survivors of deceased COBRA enrollees are eligible for dependent survivor coverage. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Dependent Survivor Premium Rates |
| Purpose: | Confirm dependent survivors of unrepresented NYS employees are eligible for NYSHIP coverage at the same rate as other dependent survivors of New York State employees. |
| Date Issued: | January 2, 1991 |
|---|---|
| Date Revised: | January 23, 2017 |
| Subject: | Dependent Survivor Eligibility |
| Purpose: | Determine whether a dependent survivor is eligible to add a dependent to NYSHIP coverage. |
| Date Issued: | August 8, 1990 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A580 |
| Subject: | Vested Employees Working Less than Half Time |
| Purpose: | Determine if a vested employee who moves from a full-time to a less than half-time position can remain eligible for health insurance if not specified by a union agreement. |
| Date Issued: | December 13, 1998 |
|---|---|
| Policy File Ref: | B740 |
| Subject: | Experimental or Investigative Procedures/Medical Necessity |
| Purpose: | Determine the carrier differences in designating procedures as experimental, investigative, or medically necessary. |
| Date Issued: | July 13, 1990 |
|---|---|
| Date Revised: | September 28, 2023 |
| Policy File Ref: | A810 |
| Purpose: | Clarify the process of correcting an enrollment file and recovering Medicare reimbursement when a Medicare-primary retiree or a retiree covering a Medicare-primary dependent returns to work. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Medicare Reimbursement for Dependent Survivors During the Extended Benefit Period |
| Purpose: | Determine Medicare Part B premium reimbursement for dependent survivors during the Extended Benefit Period. |
| Date Issued: | March 31, 1998 |
|---|---|
| Date Revised: | November 14, 2017 |
| Subject: | Returning to Work After Retirement |
| Issue: | Proper application of sick leave credit for a retiree who returns to work and subsequently reretires. |
| Date Issued: | May 14, 1990 |
|---|---|
| Date Revised: | December 14, 1992 |
| Policy File Ref: | A830 |
| Issue: | Resolution of duplicate Medicare reimbursement situations. |
| Date Issued: | December 20, 1989 |
|---|---|
| Policy File Ref: | A1130 |
| Issue: | Counting "ineligible service" with a participating employer/agency toward the length of service requirement for retirement coverage. |
| Date Issued: | November 28, 1989 |
|---|---|
| Date Revised: | August 30, 2021 |
| Subject: | PA and PE Employees Enrolled in Non-NYSHIP Plans through their PA or PE at Retirement |
| Purpose: | To codify whether an employee who is enrolled in a non-New York State Health Insurance Program (NYSHIP) health plan through their Participating Agency (PA) or Participating Employer (PE) meets the NYSHIP retiree requirement to be enrolled in NYSHIP at the time of retirement. |
| Date Issued: | February 1, 1989 |
|---|---|
| Policy File Ref: | A320 |
| Issue: | Determine whether a participating agency can cancel the enrollment of all its employees and still remain in NYSHIP. |
| Date Issued: | November 10, 1989 |
|---|---|
| Date Revised: | July 28, 2017 |
| Policy File Ref: | A410 |
| Subject: | NYSHIP Administrative Charge |
| Issue: | Changing the participating agency administrative charge billing from an annual billing to a monthly billing. |
| Date Issued: | September 12, 1989 |
|---|---|
| Policy File Ref: | A1130 |
| Subject: | Withdrawing Retirees from NYSHIP |
| Purpose: | To determine if a participating employer can withdraw its retirees from NYSHIP and continue coverage only for active employees. |
| Date Issued: | June 30, 1989 |
|---|---|
| Policy File Ref: | A310 |
| Issue: | Application of waiting period for an employee whose employment is reinstated retroactive to the date of termination. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Coverage for Adopted Children |
| Purpose: | Determine eligibility for coverage of children who are in the process of being adopted. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Dual Annuitant Sick Leave Credit |
| Purpose: | Determine the procedure when an enrollee applies for dual annuitant sick leave credit and then dies after his or her retirement date, but before the effective date of retiree coverage. |
| Date Issued: | May 17, 1989 |
|---|---|
| Date Revised: | March 12, 1990 |
| Policy File Ref: | A410 |
| Subject: | Deficit Recoupment Charge for PAs and PEs |
| Purpose: | Clarify regulation change requiring former participating employers and participating agencies to pay a deficit recoupment charge upon reentering the Program. |
| Date Issued: | January 30, 1989 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A1020 |
| Subject: | Applying for Waivers of Premium |
| Purpose: | Clarify the timeframe in which an enrollee may apply for a waiver of premium under the Empire Plan. |
| Date Issued: | December 14, 1988 |
|---|---|
| Date Revised: | June 28, 2004 |
| Policy File Ref: | A410 |
| Subject: | Internal Policies, Procedures |
| Issue: | Determine the proper procedure when instances of enrollee health benefit fraud or abuse are suspected. |
| Date Issued: | February 5, 1988 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A-830 |
| Subject: | Medicare Reimbursement for Members Who Live Outside of the United States |
| Purpose: | Determine whether Medicare reimbursement should be paid to retirees and dependents who live outside the United States. |
| Date Issued: | January 15, 1988 |
|---|---|
| Date Revised: | November 14, 2017 |
| Subject: | M/C Life Insurance Coverage for Retiring Employees Age 70 or Older |
| Issue: | Procedure for continuing Management/Confidential Life Insurance coverage in amounts over $15,000 for the period(s) paid for by payroll deduction for enrollees age 70 or older who retire. |
| Date Issued: | January 16, 1990 |
|---|---|
| Issue: | When does NYSHIP coverage become effective for an otherwise eligible State employee if, after initial appointment, he/she is placed on leave without pay prior to satisfying the appropriate waiting period for the assigned bargaining unit while on the payroll? |
| Date Issued: | May 28, 1987 |
|---|---|
| Date Revised: | September 28, 2023 |
| Policy File Ref: | A200 |
| Subject: | Waiting Period for COBRA or Vested Enrollees Who Return to Active New York State Employment |
| Purpose: | Determine whether a NYSHIP COBRA or vested enrollee must satisfy the new employee waiting period when he or she becomes newly reemployed with an employer that participates in NYSHIP. |
| Date Issued: | February 26, 1987 |
|---|---|
| Date Revised: | November 14, 2017 |
| Policy File Ref: | A830 |
| Subject: | Recovery of Incorrectly Paid Medicare Reimbursements |
| Date Issued: | February 23, 1987 |
|---|---|
| Date Revised: | March 30, 1988 |
| Policy File Ref: | A330 |
| Subject: | If a dependent is granted a medical leave due to disability and subsequently returns to school in less than a full-time status, for what period of time is the dependent eligible for dependent student status while in less than full-time status. |
| Date Issued: | January 23, 2017 |
|---|---|
| Subject: | Retiree and Survivor Eligibility for Part-time Employees |
| Purpose: | Determine if part-time employees enrolled in NYSHIP through special plan provisions are eligible to continue health insurance in retirement and determine if their dependents can continue coverage as dependent survivors. |
| Date Issued: | November 4, 1986 |
|---|---|
| Date Revised: | May 11, 2018 |
| Policy File Ref: | A200 |
| Subject: | Agency Requests for Administrative Exceptions |
| Purpose: | Establish guidelines for the review of agency requests for exceptions to computer assigned effective dates. |