Department of Civil Service

NY06-33

TO: New York State Health Benefits Administrators
FROM: Robert W. DuBois, Director of the Employee Benefits Division
SUBJECT: New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL) and Employee Notice and Fact Sheet
DATE: September 6, 2006

This is a reminder that the attached form EBD 542.1, entitled Employee Notice and Fact Sheet With Instructions on Enrolling, is to be provided to new employees in accordance with the “Procedure for Agency” section on form EBD 542, Instruction Sheet, also attached. 

Completed and signed EBD 542.1 forms must be retained in the employee’s personnel folder.  Appropriate use of this form is critical to the proper administration of this employee benefit since it serves to document that eligible new employees have been informed about NYPERL and open enrollment.

If you failed to complete this form in the past, begin to complete this form for any eligible employee hired on or after September 1, 2006.

Forms EBD 542 and 542.1 are available at HBA Online by clicking on the NYPERL logo or you may reproduce the attached EBD 542.1, as needed.  If you need help accessing HBA Online, please call the Help Desk or your processor.

Special Open Enrollment

Because some employees were not provided with proper notice in the past, MedAmerica has agreed to offer a special open enrollment opportunity to affected employees to correct this situation. In the near future, we will contact affected employees by mail and tell them about this special open enrollment opportunity and how to get more information on NYPERL or apply for coverage. The open enrollment period will be a fixed 60-day period that we anticipate will start in October. Eligibility for the special open enrollment opportunity will be determined by MedAmerica based on their records.

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