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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.

State Seal
GEORGE E. PATAKI
GOVERNOR
STATE OF NEW YORK
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
GEORGE C. SINNOTT
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER

PA99-02

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Option transfer period for HIP NJ
DATE: February 23, 1999

As you may have heard, HIP Health Plan of New Jersey (HIP NJ) has been experiencing severe financial difficulties. As a result, the New York State Health Insurance Program (NYSHIP) is establishing an open enrollment period for enrollees in HIP NJ effective immediately through March 31,1999, to allow employees to change their option. Participating Agencies who offer HIP NJ as an option are encouraged to conduct an open enrollment period for their affected enrollees.

Instructions for completing an option transfer to the Empire Plan follow.

Enrollees who wish to change their coverage from HIP NJ 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). Enrollment forms signed during February will have an effective date of March 1, 1999 and forms signed during March will have an effective date of April 1, 1999. 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:

Option Code Option Name
6
Core plus Medical Enhancements
7
Core plus Medical and Psychiatric Enhancements
8 Core Only

Item 20: Transaction Effective Date: Enter 03/01/99 or 04/01/99, whichever applies

Item 23: Date of Employment: Enter the employee's original date of hire

Item 24: Date of First Eligibility: Enter 03/01/99 or 04/01/99, whichever applies

Special Instructions for Retirees. Dependent Survivors and COBRA Enrollees Changing from HIP NJ to the Empire Plan:

Note: Since HIP NJ is a Medicare risk HMO, enrollees 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 coverage from the HMO by the option transfer date to insure full Empire Plan Benefits the option change effective date. Contact HIP NJ directly for their procedures.

Retirees:

After the NEW processes on the Central Enrollment file, prepare and submit an "RET" transaction effective the same date 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 with the appropriate effective date 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 the same date. 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.

For COBRA enrollees, include a note indicating status, i.e., Employee or Dependent, and the effective date COBRA began with the HMO.