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.
ANDREW M. CUOMO
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
PE11-12
PA11-11
PAEX11-08
TO: Participating Agency and Participating Employer CEOs/CFOs
FROM: Employee Benefits Division
SUBJECT: Reconciliation Listing
DATE: May 13, 2011
On May 2, the Employee Benefits Division issued Memo PA11-08/PAEX11-05/PE11-08, which notified your agency Health Benefits Administrator of the automation of the process to generate the reconciliation listing that was previously sent to your agency on a quarterly basis. Your agency Health Benefits Administrator now has the ability to run/print the reconciliation listing at any time. Detailed instructions on the procedure to run the reconciliation listing were provided to your agency Health Benefits Administrator, as well as directions on how to reconcile the listing with your monthly billing statement.
In order to facilitate movement to the automated process, it is now mandatory that all Participating Employers and Participating Agencies have access to the New York State Benefits Eligibility and Accounting System (NYBEAS). If your agency does not currently have access to NYBEAS, your agency Health Benefits Administrator will receive a letter with the information necessary to gain access.
Section 73.4(a)(3) of the Regulations of the President of the Civil Service Commission requires that NYSHIP employers are responsible for “maintenance of enrollment and up-to-date eligibility records for covered employees and retired employees,” and “prompt certification to the insurers of eligibility or non-eligibility for benefits for the employees and retired employees, and their dependents, claiming benefits and prompt notification to the carriers, as necessary, of the enrollment, change in status and termination of coverage of its covered employees.”
A In order to comply with this requirement it is necessary that you ensure periodic reconciliation, at a minimum on a quarterly basis, of your agency’s enrollment records. The Employee Benefits Division will continue to enforce the retroactive limitation on premium refunds and transaction processing that is currently in place.
If your agency has any questions concerning the reconciliation process, please have your Health Benefits Administrator contact their processor.