Department of Civil Service

PE08-30

TO: Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Option Transfer Period for 2009 Plan Year
DATE: December 5, 2008

This memo provides information about the annual Option Transfer Period for Participating Employers. As you know, each year agencies must conduct a transfer period to allow enrollees the opportunity to change health insurance options. This year’s Option Transfer Period began December 1, 2008 and will be extended to January 5, 2009. The effective date of benefit plan changes done during this period will be January 1, 2009. Rates for the 2009 plan year can be found in memo PE08-29.

Please note that NYBEAS now refers to health insurance “Option” as a “Benefit Plan.” You will see this term throughout the NYBEAS manual. To avoid confusion, we will continue to use “option” in the materials we prepare for enrollees for the Option Transfer Period.

BENEFIT PLAN TRANSFER PROCEDURES FOR PARTICIPATING EMPLOYERS

Changing Benefit Plans

Benefit Plan changes for active employees are directly entered by the agency HBA to the New York State Benefits Eligibility and Accounting System (NYBEAS) during the Option Transfer Period. A current list of the benefit plan codes is enclosed (Attachment A). Agencies that are not on NYBEAS must send a PS-404 or PS-404PE Health Insurance Transaction Form to the Employee Benefits Division for each change.

• Make sure the option code number for the option selected by the enrollee is correct - that the code is the same as that indicated on Attachment A (EXAMPLE: EMPIRE PLAN- 001; COMMUNITY BLUE - 067)
• If an enrollee requests a change of coverage (CCO/XXX) and an option transfer (PLN/CHG), a PS-404 or PS-404PE must be completed for each separate transaction. The transaction with the EARLIER transaction date must be entered first.
• Transactions which do not have a transaction date equal to or later than the most recent date on the NYBEAS benefit/billing inquire panel will not process. Therefore, to avoid enrollment, claim status and deduction adjustment problems, multiple transactions must be submitted in effective date sequence (chronological order).
• A PS-404 or PS-404PE MUST BE SIGNED AND DATED BY THE ENROLLEE FOR EACH TRANSACTION. Administrators cannot sign for the enrollee or process transactions indicating “signature on file”.
• Once the benefit plan change has been entered in the NYBEAS system, a subsequent benefit plan change can be made as long as it is requested during the Option Transfer Period.
• Enter the benefit plan change transactions as they are received during the Option Transfer Period. DO NOT HOLD transactions until the end of the option transfer period, as this may result in late notification to the carriers and problems with your employees receiving needed services.

HEALTH MAINTENANCE ORGANIZATIONS - CODES AND SERVICE AREAS

Not all enrollees are eligible to join every HMO. In order to be eligible for an HMO, an individual must live or work in the HMO's approved service area. If you have any questions regarding an HMO's approved service area, consult the 2009 Health Insurance Choices or contact the HMO.

Several HMOs with similar or duplicate names cover different regions. Enrollees may become confused about the correct Option Code. Verify that the enrollee’s service area and HMO Option Code match before processing a Benefit Plan Change on NYBEAS.

HMO Changes for 2009:

See Attachment A for a complete list of HMOs and Options for 2009.

For 2009: MVP Central Region (plan option 330 only) will offer a Medicare Advantage Plan for Medicare-primary enrollees. This means that Medicare primary enrollees in this plan must enroll in the advantage offering.

MVP is expanding to Franklin and St. Lawrence counties and establishing a new region for these two counties. The new NYSHIP number is 360.

MVP in Ulster County is changing from Central 330 to Mid Hudson 340.

For Assistance

Thank you for your cooperation in providing this information to your employees. Questions regarding any of this material may be referred to the PA/PE Operations Unit at the Employee Benefits Division at 518-474-2780.

Attachment A

BENEFIT PLAN CODES

Consult the 2009 Health Insurance CHOICES guide for further information on the specific service area for each HMO.

*For HMOs with more than one option code, please verify the correct service area.