Department of Civil Service

PA94-15

TO: Participating Agency Chief Executive Officers and Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Health Insurance Option Transfer Period
DATE: November 21, 1994

Participating Agencies which offer employees a choice between the Empire Plan and one or more Health Maintenance Organizations (HMOs) must conduct an annual option transfer period.

Now that Empire Plan rates for 1995 have been established (see memorandum PA94-14), we recommend that Participating Agencies which offer the Empire Plan and one or more HMOs set a 30-day period that must end by December 30, 1994, for this year's Option Transfer Period.

Enrollees in the Empire Plan who wish to change to HMO coverage and HMO enrollees who are eligible for enrollment in the State Program who wish to change to the Empire Plan may request a transfer during the November/December period by following the procedures outlined below. Enrollees may transfer options between the Empire Plan and an HMO only during the Option Transfer Period (except for a transfer based on permanent change of residence - see Section 205 of the Manual of Procedures.) This is not an opportunity to waive late enrollment periods for an otherwise eligible employee or retiree who presently has no coverage.

VERY IMPORTANT

An employee or retiree is assigned to one of the four Empire Plan Options based on his or her being in a particular class or category. The annual Option Transfer Period will not be an opportunity for an enrollee to elect to transfer from one Empire Plan Option to another Empire Plan Option. The annual Option Transfer Period will continue to be an opportunity for a change between the Empire Plan and an HMO.

HMO to Empire

Enrollees who wish to change their coverage from an HMO to the Empire Plan must complete and sign a Health Insurance Transaction Form PS503.1. For coverage to be effective January 1, 1995, the P5503.1 must be signed within your 30- day open enrollment, and that period must end by December 30, 1994. These changes are processed as a "NEW" transaction (See Manual of Procedures - Section 351.) Please complete the PS503.1 as follows:

Item 9, Option: Check off the appropriate option. Note: You should be using the P5503.1 (Rev. 11/88); earlier versions should be destroyed. Order new transaction forms using the Supply Request Form PS565.

The four Empire Plan Options are as follows:

Item 20, Transaction Effective Date: Enter 01/01/95
Item 24, Date of First Eligibility: Enter 01/01/95

Special Instructions for Retirees. Dependent Survivors and COBRA Enrollees Changing Options from a HMO to the Empire Plan:

Retirees:

After the NEW effective 01/01/95 processes on the Central File, prepare and submit a RET transaction effective 01/01/95 to report the retirement status and, if appropriate, initiate a pension deduction. A retiree must still meet the eligibility requirements outlined in Section 245 of the Manual of Procedures, including enrollment in the Empire Plan or HMO at the time of retirement.

Dependent Survivors and COBRA Enrollees:

Mail a completed NEW transaction effective 01/01/95 to the PA Agency Services Unit at the Employee Benefits Division at the address provided in the letterhead of this memorandum. For dependent survivors, include a note requesting that the individual be enrolled as a dependent survivor. When enrolling a dependent survivor, you must use the identification number of the deceased enrollee. A dependent survivor must meet the eligibility requirements outlined in Section 252 of the Manual of Procedures and had no break in coverage while in dependent survivor status. Documentation of employment should be provided when submitting the transaction to the PA Agency Services Unit. For COBRA enrollees, include a note indicating status, i.e., Employee or Dependent and the effective date COBRA began with the HMO.

Empire Plan to HMO

Enrollees who wish to change their coverage from the Empire Plan to coverage with an HMO effective January 1, 1995, must complete and sign a "CAN" (cancel) transaction during December 1994. The effective date of the "CAN" will be 12/31/94. (See Manual of Procedures - Section 356.)

Cancellations signed during any other month will be assigned an effective date of the last day of such month. For example, CAN's signed in November will be assigned a cancellation date of November 30, 1994.

Notice to Employees

Agencies that offer a choice between the Empire Plan and one or more HMO's should notify employees and retirees of the Annual Option Transfer Period.

For Assistance

If you have any questions regarding the Option Transfer Period, please contact our Processing Unit at (518) 457-5766 or 457-5847.