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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.

New York State of Opportunity


TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Enhancement to ACA Enrollment Report
DATE: December 20, 2016

The Employee Benefits Division (EBD) has enhanced the offer of coverage information contained in the Affordable Care Act (ACA) Enrollment Report. For each month in a Plan Year, the ACA Enrollment Report shows if coverage was offered and what kind of coverage was offered.

As you may be aware, Medicare primary enrollees and dependents do not need to be reported when filing ACA information with the IRS. Therefore, in order to better assist agencies to identify these individuals, the ACA Enrollment Report will now include a “M” indicator for each month the enrollee was considered Medicare Primary. If the individual was Medicare Primary for the whole year, each month will have a “M”.

A few examples are below to help you read this information using the updated ACA Enrollment Report.

Eaxmple 1:

 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
 1 1 1 1 1 1 1 M M M M M

This individual was enrolled in Empire Plan (“1”) coverage from January through July, and then became Medicare primary beginning in August.

 Eaxmple 2:

 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Example 3:

 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
M M M M M M 0 0 0 0 0 0


This individual was Medicare primary from January through June, and then was not enrolled from July through December.

In addition to the Medicare Primary update to the Report, when agencies run Plan Year 2016 information, it has been refreshed to include all enrollment information through November 30, 2016. On January 3, 2017, Plan Year information for 2016 will be through December 31, 2016 and can be used for ACA report.