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.
TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Updating Employee Health Insurance Eligibility in PayServ
DATE: October 5, 2016
In accordance with the federal Patient Protection and Affordable Care Act (PPACA), the State of New York is required to capture and report health insurance eligibility data for all New York State employees. This information is captured and maintained using the Office of the State Comptroller’s (OSC) payroll system, PayServ. It is imperative that the data reflected in PayServ is up to date and accurate, and that it corresponds with the information in NYSHIP’s health benefit management system, NYBEAS. The Health Benefit Administrator (HBA) and Payroll Officer at each agency must coordinate their efforts to ensure this review is completed accurately. Agency payroll officers have been notified of this requirement in Payroll Bulletin #1506, which can be found here: http://www.osc.state.ny.us/agencies/pbull/agencies/2015_2016/bulet1506.htm.
On September 14, 2016, OSC populated the “Eligible for Health Insurance” and “Date Eligible for Health Insurance” fields in PayServ with information provided by the Department of Civil Service (Department).
Two groups of employees were pre-populated as “Yes” for the “Eligible for Health Insurance” field:
- All employees currently enrolled in the New York State Health Insurance Program (NYSHIP) or the Opt-out Program; and
- Employees not enrolled in NYSHIP who are paid on an ANN, CAL, CYF, or 21P payroll basis and whose FTE percentage in PayServ is 50 percent or higher.
Employees who did not meet the criteria for either group listed above will be pre-populated with “No” in the “Eligible for Health Insurance Coverage” field and the “Date Eligible for Health Insurance Coverage” will be blank.
For employees whose “Eligible for Health Insurance Coverage” was set to “Yes,” the “Date Eligible for Health Insurance Coverage” was pre-populated with the later of January 1, 2015 or the:
- Employees’ actual NYSHIP enrollment date (including Opt-out), or;
- 42 or 56 days after the date of first eligibility (based on bargaining unit) for employees not enrolled in NYSHIP, but paid on ANN, CAL, CYF, or 21P payroll basis with a FTE percentage in PayServ of 50 percent or higher.
January 1, 2015 is the placeholder date being used for employees who were first eligible or continuously enrolled in NYSHIP, prior to this date. This information is being used to ensure compliance with the PPACA “employer mandate” provisions which took effect January 1, 2015. As a result, actual dates of eligibility for these individuals are not required.
It is imperative that each agency review the information for all of their existing employees and make corrections, as needed. The State is required to submit this to information to the Internal Revenue Service to prove compliance with certain provisions of PPACA. Reporting inaccurate or incomplete information could result in major financial penalties to the State of New York.
Agency Action Required
Health Benefit Administrators and Payroll Officers must review their employees’ eligibility for health insurance. OSC has created a new query to allow agencies to evaluate the eligibility status of their employees so that updates or corrections can be made, if necessary. If an existing employee’s health insurance eligibility status needs to be changed after the initial load by the Department of Civil Service, those changes must be submitted through PayServ. Instructions can be found in Payroll Bulletin #1506. http://www.osc.state.ny.us/agencies/pbull/agencies/2015_2016/bulet1506.htm .
For employees not enrolled in NYSHIP but who are paid on an ANN, CAL, CYF, or 21P payroll basis with an FTE percentage in PayServ of 50 percent or higher, the Department of Civil Service made a reasonable assumption of health insurance eligibility. The Department only pre-populated health insurance eligibility information for certain state employees. No information has been provided for employees who do not meet the payroll criteria listed above and are not enrolled in NYSHIP. As a result, it is each agency’s responsibility to review the information available from the Locked Query #LQ_076_NEW_HIRE_ACA_INS_ELIG and provide corrections if changes need to be made.
Each agency’s HBA must coordinate with his or her payroll officer to ensure accurate information is provided in these fields. The “Eligible for Health Insurance Coverage” field must be correctly set to “Yes” or “No” for all existing employees.
For employees who were first eligible or continuously enrolled in NYSHIP prior to January 1, 2015, the “Eligible for Health Insurance Coverage” field must be “Yes” and the “Date Eligible for Health Insurance Coverage” should be populated with January 1, 2015.
For employees eligible for health insurance coverage after January 1, 2015, the “Date Eligible for Health Insurance Coverage” must reflect the employee’s first date of eligibility for health benefits. Refer to the following table to compute the date eligible for health insurance benefits.
|Group||Waiting Period||Date Eligible|
(*The 42-day waiting period for otherwise eligible newly hired academic employees will begin on the actual day of professional eligibility, but not earlier than August 15.)
(** GSEU employees are eligible for health insurance coverage on their appointment date.)
For example, if a CSEA employee is hired in a benefits eligible position on September 14, 2016, the “Date Eligible for Health Insurance Benefits” is October 26, 2016, the 43rd day of employment.
Agencies must review this report and provide any needed updates no later than October 31, 2016.
To be eligible for coverage, an employee must be appointed or elected to a position in State service and fulfill the specific eligibility requirements for his or her employee group.
Employees Working Half Time or More*
To be eligible for NYSHIP coverage, an employee must meet all of the following requirements:
- The employee must be appointed/elected to a position in State service.
- The employee must be working at least half time on a regular schedule.
- The employee is expected to work at least six continuous biweekly payroll periods.
(Note: This requirement does not apply to paid elected officials or members of the New York State Legislature).
- The employee must be on the payroll at the time he or she enrolls.
- The employee must not already be enrolled as an employee in NYSHIP. He or she can already be enrolled in NYSHIP as a dependent.
(* For employees represented by UUP, special eligibility rules apply. Please consult the current UUP contract for additional information.)
Employees Working Less Than Half Time
If an employee does not work at least half time on a regularly scheduled basis, he or she must meet one of the following requirements to be eligible for NYSHIP coverage:
- The employee is a paid elected official.
- The employee is a paid member of the New York State Legislature.
To be eligible for NYSHIP coverage, an employee is expected to work at least six months and meet all of the requirements outlined in the preceding section “Employees working half time or more.”
If an employee is a CSEA member who is off the payroll for less than six months, or a PEF member who is off the payroll for less than three months, he or she is eligible for health insurance when he or she returns to work. Coverage will begin on the first day of the second payroll period after the payroll period in which the employee returns to work. This date should be used when completing the “Date Eligible for Health Insurance” field.
Employees Who Return From a Full Share Leave of Absence
For employees placed on a full share leave of absence (where the employee is responsible for both the employee and State contribution towards the cost of health insurance), the “Date Eligible for Health Insurance Benefits” should be updated to the 1st day of the 2nd payroll period following their return to the payroll.
If an agency hires a State retiree who is eligible for retiree health insurance, the agency “Eligible for Health Insurance” field should be set to “Yes”. The “Date Eligible for Health Insurance” should be set to that employee’s first day of employment in his or her new position. Please note these guidelines should only be used for New York State retirees.
For retirees of other public employers or State retirees not eligible for retiree health insurance benefits, the guidelines above should be used.
If you have questions regarding the health insurance eligibility information in this memo, please contact the HBA Help Line at (518) 474-2780. If you have questions regarding Payroll Bulletin 1506 which discusses the new PayServ fields and Locked Query, you may e-mail the Payroll Earnings mailbox at firstname.lastname@example.org.