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.
ANDREW M. CUOMO
Governor
LOLA W. BRABHAM
Acting Commissioner
NY17-24
PE17-21
PA17-18
SEHP17-12
PAEX17-17
TO: Health Benefit Administrators
FROM: Employee Benefits Division
SUBJECT: Revised Medicare/Retirement, COBRA, and M/C Life Policy Memos
DATE: December 8, 2017
The Employee Benefits Division (EBD) is in the process of reviewing and revising all New York State Health Insurance Program (NYSHIP) Policy Memos. The goal of this project is to make NYSHIP Policy Memos easier to understand while updating them to meet current legislative standards. Changes include revising language for clarity, withdrawing memos that have been rendered obsolete, consolidating memos that cover the same topic, and amending policy where necessary.
The language in all revised memos has been updated to make them easier to read. We have replaced jargon and outdated terminology with more understandable language.
EBD has divided the memos into categories and is reviewing them in phases. Updated Medicare/Retirement, COBRA, and M/C Life Insurance Policy Memos are now available to view online. https://www.cs.ny.gov/employee-benefits/hba/shared/apps/policymemos/
The tables below outline all the Policy Memos that were revised in this phase of the project, as well as a brief description of the change:
| Summary of Medicare/Retirement Policy Memo Actions | |||
| Previous PM | Action | New PM | Changes |
| 5 | Updated | 5r2 | Policy memo was updated to reflect current practice. |
| 8 | Withdrawn | 39r2 | Policy memo merged with PM-39r2. No change in policy. |
| 9 | Withdrawn | None | Policy was duplicative of Medicare’s coordination of benefits rules and was withdrawn. Policy was duplicative of Medicare’s coordination of benefits rules and was withdrawn. |
| 11 | Updated | 11r3 | Change in policy. EBD or employer will provide Medicare Part B reimbursement for Medicare primary enrollees who live outside the country. |
| 33 | Withdrawn | None | Policy was duplicative of Medicare’s coordination of benefits rules and was withdrawn. |
| 37r1 | Updated | 37r2 | PM-96 was merged with this memo. Rewritten for clarity. Added a chart for reference. No change in policy. |
| 39r1 | Updated | 39r2 | PM-8 was merged with this memo. Rewritten for clarity. No change in policy. Added detail, if an enrollee retires from one NYSHIP employer and returns to work for a different NYSHIP employer, the enrollee remains Medicare-primary. |
| 70r1 | Updated | 70r2 | PM-75r1 was merged with this memo. Rewritten for clarity. |
| 75r1 | Withdrawn | 70r2 | Duplicative of PM-70r1. Merged with PM-70r1 and withdrawn. |
| 82r1 | Updated | 82r2 | Rewritten for clarity. No change in policy. |
| 85 | Updated | 85r1 | Policy memo updated to include additional retirement systems that were not previously mentioned. |
| 96 | Withdrawn | 37r2 | Duplicative of PM-37r1. Merged with PM-37r2 and withdrawn. |
| 99r2 | Withdrawn | None | Policy withdrawn because Medicare primary Empire Plan enrollees can no longer be enrolled in non-NYSHIP HMOs. |
| 105 | Withdrawn | None | Policy memo was withdrawn. Memo was unnecessary because retiree eligibility criteria is addressed in NYS Regulations. |
| 108 | Withdrawn | None | Policy memo was withdrawn because it was duplicative of Section 167-a of Civil Service Law. |
| 122r3 | Withdrawn | 122r1 | Due to litigation, PM-122r3 and PM-122r2 are null and void. Therefore, PM-122r1 stands. |
| Summary of COBRA Policy Memo Actions | |||
| Previous PM | Action | New PM | Changes |
| 19 | Withdrawn | 65r4 | Memo was merged with PM-65r4. No policy change. |
| 44 | Withdrawn | None | Memo was withdrawn because policy is already covered under NYS COBRA extension (“mini-COBRA”). |
| 51 | Withdrawn | None | Memo withdrawn because the policy appears in federal COBRA law and does not need clarification. |
| 63r1 | Updated | 63r2 | Policy memo rewritten for clarity. |
| 65r3 | Updated | 65r4 | PM-19 was merged with PM-65r3. Change in policy. NYSHIP COBRA coverage will not be terminated for COBRA enrollees who become entitled to Medicare and are in a coordination period due to End Stage Renal Disease (ESRD). COBRA coverage will be terminated when such individuals become Medicare primary. Also, the three-year maximum retroactive payment for Medicare Part B premium is now noted. |
| 69 | Updated | 69r1 | Policy memo rewritten for clarity. |
| 76 | Updated | 76r1 | Updated memo to codify the "15-day rule" for monthly premium payments. |
| 83 | Updated | 83r1 | Change in policy. Employees of Participating Agencies and Participating Employers are no longer given a three-month extension of COBRA coverage if they have already surpassed the 36 months of coverage allowed under NYS COBRA law. |
| 90r1 | Updated | 90r2 | Change in policy. All qualified beneficiaries may have the option to elect individual COBRA coverage when first eligible for COBRA. |
| 109 | Updated | 109r1 | Change in policy. List of examples was updated. |
| 124 | Updated | 124r1 | Memo was updated to reflect time frame stated under NYS COBRA extension (“mini-COBRA”). |
| Summary of M/C Life Insurance Policy Memo Actions | |||
| Previous PM | Action | New PM | Changes |
| 10r1 | Updated | 10r2 | Changed policy to reflect current practice of reducing enrollee’s M/C Life Insurance coverage to $15,000 when they retire at age 70 or older. The reduction of coverage is effective the September 1 coincident with, or next following, their retirement. |
| 25 | Withdrawn | None | Memo was withdrawn because eligibility criteria for M/C Life Insurance and Dental Insurance are stated in NYS Regulations. |
| 91 | Withdrawn | None | Policy memo was withdrawn because “13 pay period” policy does not exist in NYS Regulations, CS Law, or contract agreements. |
| 141 | Updated | 141r1 | Replaced "dependent stepchildren" with "stepchildren" because the term "dependent stepchildren" is no longer applicable per change in DFS Laws. |