Department of Civil Service

PA99-14

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Communications Update and the Annual Option Transfer Period
DATE: November 12, 1999

At this time of year we know your employees may call you with questions about their health insurance for next year. Empire Plan benefits for the year-2000 have just been established. On the back of this memo is a short description of Empire Plan changes. We will send you rates as soon as they are approved. In the meantime, here is a summary of information currently available and planned for November-December 1999:

The Empire Plan at a Glance

We are preparing the year-2000 Empire Plan at a Glance and will mail it to Participating Agency HBAs at the end of November, earlier if possible. In the meantime, please continue to use the 1999 Empire Plan at a Glance together with the attached Empire Plan changes for your employees who ask about the Empire Plan. Please note that the following change is needed on the 1999 copy: Prior authorization is required to receive Empire Plan Prescription Drug Program benefits for Lamisil and Sporanox in addition to those prescription drugs already listed.

December Empire Plan Reports

December Empire Plan Reports will explain changes in benefits for 2000. We will mail these to homes of current Empire Plan enrollees (both active and retired) in early December. We will also ship a supply to each agency. Reports will also be posted on the Web site as soon as they begin printing.

Employee Benefits Division Web site

Our Web site at http://www.cs.state.ny.us has up-to-date Empire Plan information. We are updating the site with year-2000 benefits. The site also links to the Empire Plan Participating Provider Directory.

Participating Provider Directories

New provider directories are being printed and will be mailed to agencies and current Empire Plan enrollees at the end of November. In addition, the Department's Web site has the most up-to-date information on providers.

If you have any questions about publications, please call the Communications Unit at (518) 457-7577.

New York State Health Insurance Program (NYSHIP) BENEFIT CHANGES FOR PARTICIPATING AGENCIES

The following changes are effective January 1, 2000 unless otherwise noted. Changes will be announced in the December Empire Plan Reports and in the Empire Plan at a Glance, 2000.

1. Empire Plan Hospital Benefits

Inpatient: Pre-admission certification required before admission to a Skilled Nursing Facility when the Empire Plan is primary. Admissions include transfers into Skilled Nursing Facility.

Outpatient Physical Therapy: Same $10 copayment in outpatient hospital setting as in freestanding facility

PPR (Prospective Procedure Review): Penalties now also apply to Blue Cross coverage - enrollees must call for elective, non-emergency MRI in any outpatient setting, including a hospital outpatient department. Enrollees were told they had to call, but the Blue Cross certificate did not include the penalty language.

Emergency Room: $35 copayment

2. Empire Plan Medical Benefits

Benefits after termination of coverage for total disability: Up to 90 days for Medical and for Mental Health/Substance Abuse

Implement Centers of Excellence Program for infertility. Pre-authorized qualified procedures covered up to lifetime maximum of $25,000.

Cover pediatric influenza vaccine (No copayment with Participating Provider. Deductible and coinsurance apply under Basic Medical.)

Implement The Empire Plan NurseLine Program (Demand Management Program) February 1, 2000

Cover adult immunizations for influenza, pneumonia, MMR, Varicella, tetanus (under participating provider program only)

Basic Medical

• Increase newborn care allowance to $150 for Core Plus Medical and Core Plus Med/Psych enhancements, and to $100 for Core only.
• For Core Plus Medical and Core Plus Med/Psych enhancements: Increase hearing aid allowance to $800: Every 4 years for adult. Every 2 years for child when medically necessary. No change for Core Only.
• Basic Medical Deductible increases from $250 to $300 for Core Plus Medical and Core Plus Med/Psych enhancements. Remains $500 for Core Only.
• Increase out-of-pocket maximum from $1250 to $1500 for Core Plus Medical and Core Plus Med/Psych enhancements. Remains $2500 for Core Only.

HCAP: Reimbursement for non-network care is up to 50% of the network allowance. Non-network level of benefits apply if you don't call, or call but don't use an HCAP provider.

3. Empire Plan Prescription Drug Coverage

Copayment: $5.00 generic, $15.00 for brand name with no generic. Brand name with a generic is $15 plus the difference between the brand name and generic.