Department of Civil Service

PA98-17

TO: All Participating Agency Health Benefit Administrators
FROM: Employee Benefits Division
SUBJECT: Enclosed Listing of PA Active Enrollees with Medicare Credits
DATE: November 30, 1998

In anticipation of converting the PA enrollment files to the new New York Benefits Eligibility and Accounting System, (NYBEAS), we have been sending agencies various printouts in an attempt to clean up the enrollment files.

The enclosed printout lists all of the employees in your agency who are enrolled in NYSHIP with an employment status of ACTIVE and showing the enrollee and/or the dependent(s) of the enrollee as MEDICARE PRIMARY (part B). The printout reports the agency code, the enrollee's social security number, the enrolle' s name, if there is an enrollee Medicare indicator (yes or no), how many people on the enrollee's policy are Medicare primary, and the most recent transaction effective date of a change in Medicare status. We have looked up all of the enrollee's files listed on your printout to determine the Medicare transaction effective dates for each person who is noted as Medicare primary. This information is handwritten on the printout below the computer-generated information. We are also enclosing a recent PA Reconciliation Statement to assist you in completing any necessary PS 503.1 transaction form.

As you know, the ACTIVE status category (translates to EMPLOYEE status on the reconciliation statement) does not necessarily mean that the enrollee is Actively employed. Enrollees who are on a Leave Without Pay, a Long Term Disability, a Preferred List, or Vested also show on our files as ACTIVE employees.

We need you to review the listing and determine each enrollee's employment status. If an enrollee is actually on a Long Term Disability, a Preferred List or is Vested, he/she, as well as his/her dependent(s), would be eligible to be Medicare Primary. Section 610, pages 1-7, of your Manual for Participating Subdivisions outlines some of the eligibility criteria for Medicare. If an enrollee or his/her dependent(s) has End Stage Renal Disease, he/she would be eligible for Medicare primacy for a specific period of time. If the enrollee and/or dependent(s) listed on the printout falls under one of these situations, no further action is required by you other than to notify the PA Unit, in writing, of your determination.

An enrollee who is Actively employed, on a Leave Without Pay or on Workers Compensation is not eligible to be Medicare Primary. The dependent(s) of an enrollee
who falls under one of these situations is also not eligible to be Medicare primary. If you have an enrollee and/or a dependent(s) of an enrollee on your printout that falls under one of these situations, you must complete a PS 503.1 transaction form with an RMD (Remove Medicare Credit) transaction code. Please follow the directions in section 364, page 2, of your Manual for Participating Subdivisions on how to complete an RMD transaction. For these cases, the effective date (#20) will be the same effective date as the Medicare transaction effective date. Mail all completed RMD transactions, with a note referring to this project, to:

The New York State Department of Civil Service
The State Office Building Campus
Employee Benefits Division - PA Unit
Albany, NY 12239

If the enrollee shows as an Active employee and is actually a Retiree, complete a PS 503.1 transaction form with an RET transaction code. Please follow the directions in Section 359, pages 1 - 4, of your Manual for Participating Subdivisions on how to complete an RET transaction. Mail all completed RET transactions, with a note referring to this project, to the address noted above.

Your continued cooperation in correcting your enrollee's files is appreciated. If you have any questions, please do not hesitate to contact our office. In two months, our Unit will follow-up with those Agencys who have failed to respond to this memo.