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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA95-17
TO: Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Cyclical Transaction Recaps and Information Listings
DATE: December 1, 1995
The Division is currently implementing MediPrime rates for Participating Agencies. With the implementation of Mediprime two of the computer reports you receive from the Employee Benefits Division will now look different:
- The Information Listings, that you receive during the month when you submit transactions, will now reflect every transaction that you do. They will appear in the same format as your monthly Health Insurance Billing. The Listings will now provide earlier confirmation that your transactions have been received and processed. Continue to resubmit any rejected transactions as you have in the past.
- The Cyclical Transaction Recaps (billings) will remain in the same format. You will see an increase in size due to the expansion of rate categories for each option. There are six possible rate categories for each option. Your billing will only show those rate categories for which you have enrollment.
At the present time there are separate rates for the following five categories: a) individual coverage, no Medicare; b) individual coverage with Medicare; c) family coverage, no Medicare; d) family coverage with one member eligible for Medicare; and e) family coverage with two members eligible for Medicare. Note: Family coverages with two or more members eligible for Medicare will be billed at the rate for family coverage with two eligible members.
The new "MED" or "RMD" transactions appear either under "Option/Coverage Change" or "Notes" in the processed transaction section of your billing. Each "MED" or "RMD" usually creates a rate category change and therefore will have billing units associated with it. In these cases the "MED" or "RMD" appears under "Option/Coverage Change." When the family coverage has three or more members already eligible for Medicare, the fourth "MED" does not create a rate category change and the "MED" appears under "Notes." When the family coverage has four or more members eligible for Medicare, the "RMD" will not create a rate category change and the "RMD" appears under "Notes."
The "DEL" transaction will have billing units associated with it when the dependent being deleted is Medicare primary. In this case the "DEL" appears under "Option/Coverage Change." When the "DEL" is for a non-Medicare primary dependent or a dependent on a family coverage with four or more Medicare eligibles, there will be no billing units associated with the transaction and it appears under "Notes."
We hope this information is helpful. If you have questions please call the PA Unit at 518-457-5766, 457-5847, or 485-1186.