Department of Civil Service

PA98-16

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Option Transfer Period
DATE: November 23, 1998

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 1999 have been established (see memorandum PA 98-15 or if you have Internet access, www.cs.state.ny.us), we recommend that Participating Agencies which offer the Empire Plan and one or more HMOs set an option transfer period, ending no later than December 31,1998, for this year.

Enrollees in the Empire Plan who wish to change to HMO coverage and HMO enrollees who are eligible for enrollment in the State Program and 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, without Penalty, 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.

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 (P S-503. 1). Order additional transaction forms using the supply request form (PS-565). For coverage to be effective on January 1,1999, the PS-503. 1 must be signed within your open enrollment period, and that period must end by December 31,1998. 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:

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

Note: If your retired enrollees are in a Medicare risk HMO, they must provide the HMO with the appropriate forms necessary to disenroll their Medicare coverage from the HMO. These forms must be submitted by the HMO's deadline to release the Medicare from the HMO by December 31,1998 to insure full Empire Plan Benefits on January 1,1999. Contact the HMO directly for their procedures.

Retirees:

After the NEW effective 01/01/99 processes on the Central Enrollment file, Prepare and submit an "RET" transaction effective 01/01/99 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 01/01/99 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 and a completed PS-503.1 transaction form, with a Medicare transaction effective dated 01/01/99. 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 1,1999, must complete and sign a voluntary cancel lation transaction during December 1998. The effective date of the "CAN" will be 12/31/98. (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 30,1998.

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) 457-5847, 485-6619 or 485-1186.