Department of Civil Service

NY08-20
PE08-16

TO: NY and PE Health Benefit Administrators
FROM: Employee Benefits Division (EBD)
SUBJECT: 2008 NYSHIP Benefit Changes
DATE: June 26, 2008

The State has reached contract agreements with CSEA, DC-37, PEF and UUP. The new contracts include numerous benefit changes that go into effect on July 1, 2008 and subsequent dates, with one change that is being implemented retroactive to January 1, 2008. Benefits for the “unrepresented cohorts” of NYSHIP are also being implemented as of these dates, pending final signing of a resolution by the Health Insurance Council. For the purposes of this memo, the “unrepresented cohorts” comprise the following groups: Executive and Legislative Branch M/C employees, Participating Employer (PE) employees & retirees, State retirees and miscellaneous direct pay status groups such as vestees and dependent survivors and preferred list employees. All employees of the Unified Court System (UCS), will get the benefits negotiated by the unions that represent UCS employees, which are the same as those of Executive Branch CSEA represented employees.

This memo provides a summary of the benefit changes that will take effect for the groups mentioned above as of January 1, 2008 and July 1, 2008. Information on benefit changes scheduled to occur as of January 2009 and later will be communicated separately.

Some unions do not yet have negotiated or arbitrated contract settlements. The benefits for these groups, including employees represented by Council 82, (Supervisors and ALES), NYSCOPBA, PBA, PIA and GSEU are therefore NOT affected by the changes described in this memo.

Please note these are summaries of the changes and are not intended to provide full information. Empire Plan Reports with full details on these changes are being mailed to affected enrollees and will be available online shortly. See HBA memo NY 08-18/PE 08-13 for further information regarding these publications.

If you have any questions about any of the information in this memo, please contact your agency processor for assistance.

CHANGE EFFECTIVE JANUARY 1, 2008

Empire Plan Medical Benefit (UHC) Change

Prosthetic Wig Benefit: Coverage for prosthetic wigs will change from one per lifetime to a maximum lifetime allowance of $1,500 per individual. This benefit is payable under the Basic Medical program, not subject to deductible or coinsurance and uses the same medical necessity criteria currently in place. UHC is reviewing claims history and will issue payments for any qualified claims occurring on or after January 1, 2008. Any employees incurring expenses since January 1, 2008 that have not yet been filed should file a claim with UHC directly as soon as possible. (See July 1, 2008 Empire Plan Report for more details on this benefit).

CHANGES EFFECTIVE JULY 1, 2008
Empire Plan Benefit Changes

Empire Plan Medical Benefit (UHC) Changes

Outpatient Surgery Locations Copayment Increase: The copayment for covered outpatient surgery performed at UHC participating freestanding outpatient surgical locations will increase to $30. The co-payment also covers any radiology and laboratory tests performed on the same day at the same center.

Managed Radiology Prospective Procedure Review Program: The Empire Plan Benefits Management Program’s Prospective Procedure Review requirements will expand to include pre-notification for MRA, CT, PET and Nuclear Medicine diagnostic procedures, along with MRIs that already require pre-notification when preformed on a non-emergency basis. An enrollee who does not notify UHC before having one of these procedures on or after July 1, 2008 will be subject to a payment of the lesser of 50% of the fee schedule amount or $250.00 under the Participating Provider Program. Failure to notify UHC under the basic medical program will result in payment of the lesser of 50% of the covered hospital or medical charge or $250.00. Enrollees will continue to be responsible for meeting their deductcompensation leave for up to 24 months as a result of assault, may remain covered under the State Health Insurance Plan for the same duration and will be responsible only for the employee share of premium. Dental and vision benefits will remain in effect for the same duration at no cost to the employee. Employees who began assault related workers’ compensation leaves on or after July 1, 2007 are eligible to receive the full 24 months of employee share LWOP.

WC/LWOP Deferred Premium Procedural Changes:

Employees on Workers’ Compensation LWOP continue to be eligible for employee share premium and to defer premiums owed during WC/ LWOP until their return to payroll or employment termination. But for leaves beginning on or after July 1, 2008, a written deferral must be provided. Enrollees will be notified by EBD in writing of their rights and choices for Continuing health insurance during Workers’ Compensation leave. This notice will include an Election of Deferral of Workers’ Compensation Health Insurance Premium Form. Written deferral will only be necessary for the Medical premium that will be due since there is no cost to the enrollee for dental and vision coverage while on workers compensation leave. Employees not providing a written deferral will be billed for health insurance premiums every 4 weeks, and will be cancelled for non-payment in accordance with usual LWOP billing procedures if bills are not paid. Cancellation will be retroactive to the date for which the enrollee last paid. Copies of the enrollee letter and the deferral election form are Included with this memo.

Special Option Transfer Period for CSEA-represented Employees and UCS Employees:

In compliance with the CSEA and UCS Collective Bargaining Agreements, a special Option Transfer Period will be conducted for CSEA and UCS employees only who wish to change from the Empire Plan to an HMO with lower co-payments for third tier Prescription Drugs or Outpatient Surgery. Employees must live or work in the service area of the HMO requested. The HMOs to which changes will be permitted are:

Aetna 210
Community Blue 67
Empire BlueCross BlueShield HMO 280, 290, 320
HIP 050
GHI HMO 220, 350
Independent Health 059
MVP 060, 330, 340
Univera 057

EBD will issue details and instructions for the special option transfer period separately.

New Employee Waiting Period Changes for M/C Employees:

The new employee waiting period for Health Plan benefits (currently 42 days) and Vision Plan benefits (currently 28 days) for M/C employees hired on or after July 1, 2008 will be 56 days

Attachments:
Workers Comp Premium Deferral Letter
Election of Deferral of Worker Compensation Health Insurance Premium Form
MC Booklet Insert
PEF Booklet Insert