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.
ANDREW M. CUOMO
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
SEHP11-01
TO: SEHP Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Action/Reason Codes for Disabled Dependent and Other Children Recertification End Dates
DATE: March 11, 2011
New NYBEAS action/reason codes have been created to address disability end dates for temporarily disabled dependents and certification end dates for other children. The new action/reason codes will be made available mid-March.
Action Reason Codes for Disabled Dependents
Disabled dependents are certified as having a permanent disability or a temporary disability. All dependent children certified with a temporary disability have a disability end date in NYBEAS that reflects the end date of the certification of the temporary disability. If the temporary disability end date is not extended then the dependent will be removed from NYSHIP coverage the first day of the following month following the disability end date. Once the disability end date is reached the new action/reason codes can be used to delete the dependent as of their disability end date (DEP/DIS) or if the disabled dependent is the last dependent then a new change of coverage transaction (CCO/DIS) can be processed. The new action/reasons are as follows:
|
NYBEAS Panel |
Action / Reason |
Description |
Date of Event/Request |
Effective Date Rules |
|
Benefits > |
DEP/DIS |
Medical/Dental/Vision - Dependent child is 26 or older: Dependent child's disability end date has been reached and is no longer eligible to continue coverage as a dependent |
Date of event = end of month of temporary disability end date |
Medical/ Dental/Vision: Effective date = 1st day of the month following the date of event |
|
Benefits > |
CCO/DIS |
Medical/Dental/Vision - Dependent child is 26 or older: Dependent child's disability end date has been reached and is no longer eligible to continue coverage as a dependent |
Date of event = end of month of temporary disability end date |
Medical/ Dental/Vision: Effective date = 1st day of the month following the date of event |
Action Reason Codes for Other Children
An other child's status must be recertified before the end date is reached for the other child to continue to be eligible for NYSHIP coverage. If it is not reestablished the other child will be removed from NYSHIP coverage effective the next day following the recertification end date. Once the recertification end date is reached the new action/reason codes can be used to delete the dependent as of their recertification end date (DEP/RCT) or if the dependent is the last dependent then a new change of coverage transaction (CCO/RCT) can be processed. The new action/reasons are as follows:
|
NYBEAS Panel |
Action / Reason |
Description |
Date of Event/Request |
Effective Date Rules |
|
Benefits > |
DEP/RCT |
Medical/Dental/Vision |
Date of event = date of recertification end date |
Medical/ Dental/Vision: Effective date = 1st day following the date of event |
|
Benefits > |
CCO/RCT |
Medical/Dental/Vision |
Date of event = date of recertification end date |
Medical/ Dental/Vision: Effective date = 1st day following the date of event |
SEHP coverage for a dependent child will be deleted at the end of the month in which a dependent child turns 26.
If you have any questions regarding the new action reason codes, please contact your EBD processor.