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
PE12-22
PA12-17
TO: Chief Executive Officers and Health Benefits Administrators of Participating Agencies with The Empire Plan and Chief Executive Officers and Health Benefits Administrators of Participating Employers
FROM: Employee Benefits Division
SUBJECT: 2013 Empire Plan Medicare Rx Program for Medicare-Primary Enrollees and Dependents
DATE: August 31, 2012
Effective January 1, 2013, prescription drug coverage for Medicare-primary enrollees and dependents under The Empire Plan will include a Medicare Part D prescription drug program that has been expanded to provide a benefit level that is generally as good as, or better than, the benefits provided under The Empire Plan Flexible Formulary. The combination of these benefits is called Empire Plan Medicare Rx, which will continue to be administered by UnitedHealthcare in partnership with Medco. Enrollment in Empire Plan Medicare Rx will be automatic for Medicare-primary enrollees and dependents. This change only applies to prescription drug coverage under The Empire Plan. (NOTE: PA enrollees and dependents with The Excelsior Plan are not affected by this change.) Additionally, it does not impact other Empire Plan benefits (medical/surgical, hospital, mental health and substance abuse) or Medicare Part A or B coverage.
Beginning January 1, 2013, Medicare-primary enrollees and dependents will use a separate ID card to access prescription drug benefits. Because Medicare provides coverage on an individual level (there are no dependents under Medicare), each Medicare-primary enrollee and dependent will have his or her own Empire Plan Medicare Rx card. This card can only be used to access prescription drug benefits. Medicare-primary enrollees and dependents will continue to use their NYSHIP Empire Plan benefit card to access all other benefits under The Empire Plan. Enrollees and dependents who are not Medicare-primary will continue to use their NYSHIP Empire Plan benefit card to access all benefits, including prescription drugs.
Beginning in late August and through mid-September, the Employee Benefits Division will mail an introductory package (a sample is enclosed) to enrollees and dependents who are or will be Medicare-primary by January 1, 2013 (includes individuals turning 65 on or before February 1, 2013). The package includes:
- A personalized announcement letter, with a mandated Cancellation Form;
- An overview brochure titled Introducing Empire Plan Medicare Rx (PDP);
- A trifold brochure titled How to Use Your Empire Plan Medicare Rx (PDP) ID Cards; and
- A preaddressed courtesy reply envelope.
Please note that active enrollees who will turn 65 in this time frame and/or their dependents who will turn 65 are receiving this mailing also. This is informational material only for this group of enrollees. However, if the currently active enrollee retires before January 1, 2013, or the enrollee or dependent becomes Medicare-primary due to End-Stage Renal Disease (refer to the NYSHIP General Information Book for information regarding Medicare primacy), this information will apply. Because Medicare is a federal program that does not recognize domestic partners or same-sex spouses, Medicare becomes primary for these dependents at age 65 even if the enrollee is covered as an active employee. As a result, the domestic partner or same-sex spouse of an active enrollee who is 65 will be automatically enrolled in Empire Plan Medicare Rx. A follow-up letter will be sent to active enrollees shortly to explain this information.
Please review these materials; they include information that you will find helpful. The Cancellation Form is included because Medicare rules require us to provide Medicare-primary enrollees and dependents with the choice of not enrolling in Empire Plan Medicare Rx. Medicare-primary enrollees and dependents will be automatically enrolled in Empire Plan Medicare Rx unless they return a completed Cancellation Form by November 1, 2012.
IMPORTANT: If an enrollee or dependent submits a Cancellation Form, he or she will be disenrolled from all Empire Plan health insurance coverage effective January 1, 2013. If an enrollee submits a Cancellation Form, all covered dependents will also be disenrolled from all Empire Plan health insurance coverage effective January 1, 2013. It is very important that enrollees and dependents fully understand the ramifications of declining enrollment in Empire Plan Medicare Rx.
Cancellation Forms must be returned to the address on the return envelope provided in the package (The New York State Department of Civil Service, P.O. Box 13293, Albany, NY 12212-3193) and should not be returned to an employer or the Employee Benefits Division. We will be reaching out to those enrollees or dependents who return the Cancellation Form to ensure that they understand they will have no Empire Plan coverage beginning on January 1, 2013.
We are in the process of finalizing a presentation concerning Empire Plan Medicare Rx for enrollees and dependents who will be affected by this change. This presentation will be accessible on our web site by September 6, 2012. We will post this and other helpful information at the following URL: https://www.cs.ny.gov/empireplanmedicarerx/index.cfm. A NYBEAS System Announcement will be issued when it is available. The purpose of this presentation is to provide information about the change in prescription drug benefits.
We recommend that you review this information when it becomes available; it will provide additional information about Empire Plan Medicare Rx and assist you in responding to questions and concerns from enrollees. You may also use this presentation at meetings to inform your Medicare-primary population of this change. Implementation of Empire Plan Medicare Rx will be on the agenda for PA and PE regional meetings; a UnitedHealthcare representative from the Prescription Drug Program will be present to address questions.
Attachments:
Introducing EMPIRE PLAN MEDICARE RX (PDP)
How to use your Empire Plan medicare Rx (PDP) ID Cards
Empire Plan Medicare Rx Cancelation Form and Instructions