Department of Civil Service

PA95-16

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Option Transfer Period
DATE: November 30, 1995

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 PA 95-15), we recommend that Participating Agencies which offer the Empire Plan and one or more HMOs set a 30 day period, ending no later than December 29, 1995, 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 Option Transfer 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 a 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.

New Empire Plan flyer

We have enclosed a flyer about the Empire Plan your enrollees considering the Empire Plan may find helpful. If you would like additional flyers immediately, please complete and fax the attached form to the Communications Unit at (518) 457-2494. You will receive a standard order form with a future publication memo to order these flyers throughout 1996. If you have any questions about this publication, please call Communications at (518) 457-7577.

Thank you for your cooperation in providing this information to your employees.

VERY IMPORTANT

An employee or retiree is assigned to one of the three 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 offers an opportunity for a change between the Empire Plan and an HMO only.

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 (PS-503.1). Order additional transaction forms using the supply request form (PS-565). For coverage to be effective on January 1, 1996, the PS-503.1 must be signed within your 30 day open enrollment period, and that period must end by December 29, 1995. These changes are processed as a "NEW" transaction (see the Manual of Procedures - Section 351). Please complete the PS-503.1 as follows:

Item 9; Option: Check off the appropriate option.

The three Empire Plan Options are:

Item 20; Transaction Effective Date: Enter 01/01/96
Item 24; Date of First Eligibility: Enter 01/01/96

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

Retirees:

After the NEW effective 01/01/96 processes on the Central Enrollment file, prepare and submit an "RET" transaction effective 01/01/96 to report the retirement status and, if appropriate, initiate a pension deduction. If the Retiree or their dependent is Medicare eligible, you must also submit an "MED" transaction for each person who is eligible. 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 01/01/96 to the PA Operations 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. If the survivor is Medicare eligible, include a copy of their Medicare Identification Card. 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 have had no break in coverage while in dependent survivor status. Documentation of employment should be provided when submitting the transaction to the PA Operations Unit. For COBRA enrollees, include a note indicating status, i.e., Employee or Dependent, and the effective date COBRA began with the HMO.

Empire to HMO:

Enrollees who wish to change their coverage from the Empire Plan to coverage with an HMO effective January 1, 1996, must complete and sign a "CAN" (cancel) transaction during December 1995. The effective date of the "CAN" will be 12/31/95. (See the Manual of Procedures - section 356.)

Cancellations signed during any other month will be assigned an effective date of the last day of that month. For example: A "CAN" signed in November will be assigned a cancellation date of November 30, 1995.

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 the PA Operations Unit at (518) 457-5776, 457-5847 or 485-1186.