The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
DAVID A. PATERSON
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NANCY G. GROENWEGEN
COMMISSIONER
NY10-19
PE10-13
PA10-15
SEHP10-05
PAEX10-11
TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division (EBD)
SUBJECT: Policy on Proofs Required Establishing Dependents' Eligibility
DATE: June 22, 2010
This memo is to advise you of a change in the New York State Health Insurance Program's (NYSHIP) dependent proof policy and to clarify the types of dependent proofs required for dependents to be enrolled in NYSHIP. This policy is to ensure consistency with the proofs that were required for the Dependent Eligibility Project recently completed by the Employee Benefits Division (EBD). EBD determined that the same types of proofs of eligibility required for the Project will now be required before a dependent can be enrolled in NYSHIP.
In addition to clarifying the types of acceptable documentation to add a dependent, NYSHIP will now require documentation to verify a dependent's current eligibility before a previously covered dependent can be re-enrolled in NYSHIP. For example; a spouse was enrolled as a dependent in the past then disenrolled because other coverage was available and the enrollee requests that the spouse again be added as a covered dependent to their health insurance under NYSHIP. In this situation a marriage certificate will document that a marriage took place, but the enrollee would also need to document current eligibility through proof of current joint ownership/joint financial obligations such as the prior year's tax return. Both types of documentation are also required to add a new spouse to NYSHIP when the marriage took place over one year ago. Another example, a dependent child was covered as dependent in the past was disenrolled and the enrollee is now requesting that the child again be added on to their health insurance. In this situation the enrollee will need to supply the required documentation in the policy memo, even if they already submitted it in the past, such as a copy of the child's birth certificate and Social Security Card. This requirement is satisfied if the agency maintained and has access to copies of documents previously submitted.
Please refer to the attached policy memo for the types of acceptable forms of proof required for adding all dependents. This memo is also available on HBA Online.
Please note; if your enrollee states they do not have certain documentation that NYSHIP policy requires. you may contact your EBD processor for possible alternatives.
The attached policy is effective on the date of this letter and applies only to prospective enrollments, Questions concerning this letter and the attached policy should be directed to your EBD processor.
Employee Benefits Division Policy Memo
Number: Policy Memo #139
Date Issued: June 22, 2010
Policy File Ref: A330
Subject: Dependent Proof
ISSUE
Determine the documentation necessary to adequately establish dependent eligibility before adding a new dependent to NYSHIP and before adding a dependent who previously was enrolled in NYSHIP.
BACKGROUND
Prior to the issuance of this Policy Memo, the Employee Benefits Division (EBD) did not require current documentation to verify eligibility when adding a dependent to NYSHIP. In addition, EBD did not require current documentation to verify eligibility when adding a dependent who previously was enrolled in NYSHIP. The recently conducted Dependent Eligibility Verification project required that all dependents' eligibility be verified on a current basis with current documentation. As a result, NYSHIP dependent records presently show that only those currently eligible for coverage are enrolled. To prevent the extension of coverage to ineligible dependents going forward, the Department will establish a dependent eligibility documentation policy that is consistent with the documentation that was required during the Dependent Eligibility Project.
Require that all dependents' eligibility be verified on a current basis with current documentation before enrolling a dependent in NYSHIP, regardless of whether the dependent was covered previously under NYSHIP.
| Spouse | Domestic Partner | Child under age 19 (or 21 for PBA) | Child over age 19 (or 21 for PBA) |
|---|---|---|---|
| 1. Copy of Birth Certificate | 1. Copy of Birth Certificate | 1. Copy of Birth Certificate | 1. Copy of Birth Certificate |
| 2. Copy of Social Security Card (Copy of Medicare Card if applicable). | 2. Copy of Social Security Card (Copy of Medicare Card if applicable). | 2. Copy of Social Security Card | 2. Copy of Social Security Card (Copy of Medicare Card if applicable). |
| .3. Copy of Marriage Certificate (if rnarriage took place more than one year ago-see #4 below). | 3. Completed PS425 Domestic Partner application and acceptable proof as defined in the application. | 3. For Relationship of 'Other', a completed PS457 Statement of Dependence is required along with acceptable proof as defined in the PS 457. | 3. Proof of student's full time student status, or: Approved Medical Leave of Absence documentation Granted by the School or Doctor, or: Approved PS 451 Statement of Disability Form. |
| 4. For marriages that took place more than one year ago, Proof of current joint ownership/joint financial obligation is required (ie: prior year's tax return) If tax document is not provided. a current bank statement, mortgage statement or homeowners policy rnay be provided | 4. For Relationship of 'Other', a completed PS457 Statement of Dependence is required along with acceptable proof as defined in the PS 457. |
If any of the above documentation can not be provided or if you have questions concerning acceptable documentation, please contact your processor in the Ernployee Benefits Division for assistance.
This policy will be effective as of the issuance of this Policy Memo.