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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
NY00-15
PA00-09
TO: Health Benefits Administrators
FROM: Employee Benefits Division (EBD)
SUBJECT: Automated Dependents Delete Report
DATE: May 15, 2000
At the end of April, we resumed running automated programming to remove dependents on file who had reached their 25th birthday and for dependents who reached their approved temporary disability date (report date 4/21/00). In the future "Other Dependents" who have reached the end of their two-year approval will also be automatically deleted. A dependent delete (DEP/DEL) transaction was processed for dependents age 25 or over and for dependents who had an approved temporary disability with an end date on file which was reached during this reporting period. These transactions processed automatically if the enrollee's coverage would not change (i.e. dependent is not the last dependent on file). If the deletion of the dependent would cause a change in coverage or the deletion date predates the last transaction on file, the automatic DEP/DEL will not process and a rejection is reported on the "Automated Dependent Delete Process" report.
Last Dependent on File
Contact the enrollee for the last date of the dependent's eligibility. The enrollee must complete and sign a PS-404 "Health Insurance Transaction Form". Process a Change of Coverage transaction using the last eligibility date as the date of event.
Insert Transaction Required
Determine the last date of the dependent's eligibility and complete a PS-404. Send the completed form with a letter of explanation to EBD for corrections processing.
Disabled Dependent
Determine if the dependent should be deleted, or if the dependent is entitled to additional coverage based on his/her disability and the existence of an approved PS-451 (Statement of Disability for Dependents 19 Years of Age and Over) with a date later than the date on file. If the dependent may be entitled to additional coverage, the enrollee must complete and submit a new PS-451. If there is no PS-451 with a later eligibility date, delete the dependent as of the last approval date. If the DEP/DEL predates another transaction on file, follow the instructions for inserting a transaction.
Coverage Ends
For dependents turning 25, coverage is not in effect beginning on the day of the 25th birthday. In the case of dependents with an approved temporary disability, coverage is not in effect the beginning of the day following the approved temporary disability date.
Monthly Processing
This process will be run monthly. Dependents who were automatically deleted will show on your activity report as a DEP/DEL transaction.
The report ("Automated Dependent Delete Process") listing rejections will be sent to agencies monthly. "Blank" reports will not be produced for agencies with no rejections.
If you have any questions regarding this information, please contact your EBD Processor.