Department of Civil Service

PE97-32

TO: Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Option Transfer Period
DATE: December 5, 1997

The purpose of this memo is to distribute information about the annual Option Transfer Period for Participating Employers and the 1998 Imputed Income Gross Rates. As you know, each year agencies must conduct an Option Transfer period to allow enrollees the opportunity to change Health Insurance Options. This year's Option Ttransfer period began on November 1,1997 and ends December 31,1997. The effective date of option changes done during this period will be January 1,1998. Rates for the 1998 plan year can be found in memo PE97-31. See memo PE97-30 for information on the PE Option Transfer Notice for employees and 1998 Health Insurance Choices for Retirees.

OPTION TRANSFER PROCEDURES FOR PARTICIPATING EMPLOYERS

Changing Options

Option changes are directly entered by the agency to the Enrollment Management System (EMS) during the Option Transfer period. Please refer to pages 9-32 to 9-34 of the HBA Handbook regarding the instruction for changing options. A current list of the option codes is enclosed (Attachment A). Agencies that are not connected to EMS must send a PS-404 (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 the enclosed option sheet. (EXAMPLE: EMPIRE - 001; COMMUNITY BLUE -067)
• If an enrollee requests a change of coverage (CCO) and an option transfer (OPT), a PS-404 must be completed for each separate transaction. The transaction with the EARLIEST 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 health account will not process. Therefore, to avoid enrollment, claim status and deduction adjustment problems, multiple transactions must be submitted in transaction date sequence (chronological order). If using the same effective date for more than one transaction, use the next sequence number.
• A PS-404 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 option change has been entered in the EMS system, a subsequent option change can be made as long as it occurs during the Option Transfer Period.
• Enter the option change transaction 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 1998 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, so make sure to verify that the enrollee's service area and HMO Option Code match before processing an Option Change.

HMO Expansions:

The following HMOs have been granted approval to expand their New York State Health Insurance Plan service areas into the counties indicated.

• HMO Blue (160)- to Jefferson County
• EBCBS-BIue Choice HMO (280) - to Clinton and Essex Counties

HMO Enrollment

An enrollee who wishes to enroll in an HMO must fill out both a PS-404, NYS Health Insurance Transaction Form, and an HMO enrollment form. Send the HMO enrollment form to the HMO, keep a copy for your file and give a copy to the enrollee to serve as identification until the enrollee receives his/her identification cards. Do not send the HMO enrollment form to the HMO Council or Civil Service. Within six weeks of receipt of the HMO enrollment form, each HMO will verify enrollment through the weekly transaction recaps.

The HMO enrollment form is unchanged. Additional copies of this form can be ordered through EBD by using the most recent Participating Employer Publications Supply Request Form.

The HMO enrollment form must be completed for initial enrollment in the HMO. ANY CHANGES IN THE EMPLOYEE'S ENROLLMENT STATUS (NAME, COVERAGE, DEPENDENTS, ETC.) MUST BE PROCESSED ON EMS.

MORE INFORMATION

Questions regarding submission of transaction to the EMS File should be directed to your Employee Benefits Division Processor.

Attachment B is a chart of gross premiums for the 1998 rate year. These rates should be used to calculate the Imputed Income for enrollees with Domestic Partners.

Thank you for your cooperation in providing this information to your employees.

Enclosures

OPTION CODES

Consult the 19987 Health insurance CHOICES guide or contact the HMO directly for further information on the specific service area for each HMO.

* For HMOs with more that one code, please verify the correct service area

001 - Empire Plan
210 - Aetna US Healthcare
066 - Blue Choice
280 - BlueChoice HMO of Empire BCBS
063 - Capital District Physicians' Health Plan
067 - Community Blue
053 - CHP Community Health Plan*
061 - CHP Community Health Plan - Hudson Valley Region*
068 - Elderplan, Inc.
050 - HIP Health Plan of New York
062 - HIP Health Plan of New Jersey
160 - HMO Blue
064 - HMO-CNY*
072 - HM0-CNY*
057 - HealthCarePlan
270 - Healthsource HMO of New York
120 - Independent Health - Hudson Valley Region
059 - Independent Health - Western New York Region
052 - Kaiser Permanente
060 - MVP Health Plan*
100 - MVP Health Plan*
230 - NYLCare Health Plans
055 - PHP / Prepaid Health Plan
058 - Preferred Care
260 - UnitedHealthcare (formerly MetraHealth)
070 - VYTRA Healthcare
220 - WellCare of New York

1998 GROSS PREMIUMS FOR INDIVIDUAL
HEALTH INSURANCE COVERAGE
MONTHLY