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.
ELIOT SPITZER
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NANCY G. GROENWEGEN
COMMISSIONER
NY08-04
TO: New York State Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Reduced Empire Plan Basic Medical Co-insurance Maximum Reports
DATE: January 31, 2008
Executive Branch Empire Plan enrollees represented by CSEA and DC37 in or equated to salary grade 6 or below, and Judicial Branch employees in or equated to Judicial Grade 6 or below, are eligible for a reduced basic medical coinsurance maximum of $500.00 for 2008 CSEA This is also referred to as “OOP”.
Those employees who could not be systematically updated will be reported through Exception Reports. Below is the description of the reports for your review. In each of the situations, HBA’s will have to review the report(s), determine if the employee is eligible and if so, update the OOP Eligibility page in NYBEAS (see HBA memo NY08-03).
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NYBEAS/NYSTEP NON-MATCHING AGENCIES POTENTIAL OOP ELIGIBLE
This report includes employee records for which the agency code in NYBEAS did not match the agency code in NYSTEP.
Example: NYBEAS agency code - 01030 / NYSTEP agency code - 00640
Any employees on leave from a NYSTEP agency who are currently in a non-NYSTEP agency on NYBEAS will also show on the report.
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NYSTEP NON-GRADE POTENTIAL OOP ELIGIBLE
This report includes employees from NYSTEP who do not have a valid numeric grade level but may be eligible due to their equivalent salary and or hourly rate. These employees have not been enrolled in the OOP but instead have been reported in this exception report for HBA review of their eligibility. The report includes their compensation rate, pay basis, and job title to assist with determining eligibility.
Example: Grade - NS or OS
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NYBEAS NON-NYSTEP POTENTIAL OOP ELIGIBLE
This report contains the names of employees enrolled in medical benefits from your agency who are not found in NYSTEP. HBA’s must determine if the employee is eligible for OOP and if so, manually update the OOP Eligibility page in NYBEAS (see OOP HBA MEMO NY08-03).