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.
DAVID A. PATERSON
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NANCY G. GROENWEGEN
COMMISSIONER
NY10-32
TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Changes in Procedures for Dependent Eligibility Audit
DATE: August 23, 2010
Verification of dependent eligibility for ACTIVE employees, under the Dependent Eligibility Verification Project will no longer be performed by the NYS Department of Civil Service (DCS) after August 27, 2010. After that date, the toll free telephone line established for the DEA project will no longer be in service. Active enrollees who request reinstatement of eligible dependents will be directed to submit all required documentation to their agency health benefits administrator (HBA). HBAs will now review the documentation submitted by enrollees to determine dependent eligibility as of 2/1/09, in accordance with the enclosed checklists. Please do not refer ACTIVE enrollees to DCS. Note: DCS will continue to process requests from retirees and other inactive enrollees.
For the purposes of this project only, you must use the attached checklists to approve the submitted eligibility documentation. While reviewing documentation, please refer to the checklist and note the items received. Please keep the checklist and documentation in the enrollee’s health insurance file and send a copy of the checklist and documentation to the Employee Benefits Division.
Once you have verified that the employee has submitted the proper proofs and the checklist is complete, process the appropriate transaction to re-add the dependent(s) retroactive to 02/01/09. In order to achieve an effective date of 02/01/09, please use the following chart when processing the transaction on NYBEAS:
|
Current Coverage |
Action/Reason Code |
Date of Event |
Date of Request |
|
Individual |
CCO/PCT |
01/31/09 |
01/31/09 |
|
Family |
DEP/ADD |
02/01/09 |
N/A |
Please note this process should not be used to reinstate coverage for dependents with an effective date subsequent to 2/1/09. Refer to memo NY10-19 dated June 22, 2010, for more details.
Domestic Partners
Due to a recent change in NYBEAS programming, transactions for enrollees in the Pre-Tax Contribution Program (PTCP) requesting reinstatement of a non-federally qualified Domestic Partner must be sent to EBD for processing. Please send these transactions to EBD, along with a copy of the completed checklist and proofs. Please inform enrollees who re-add non-federally qualified domestic partners to their coverage that they will be subject to Imputed Income adjustments retroactive to 02/01/09. These employees may want to consider re-adding the domestic partner on a current basis.
Correction Requests
You may find that another transaction prohibits you from processing the dependent’s reinstatement. In this situation, submit a "Correction Request" to EBD. Your "Correction Request" comment, in addition to the general Comments panel, must indicate that you have received the proper documentation
Comments
Upon completing the appropriate transaction, you must place a comment in NYBEAS. In your comment, please reference the dependent that was reinstated, indicating that proper documentation was received. See following examples:
a) Re-adding Spouse
"Dependent #02, Jane (spouse) re-added effective 02/01/09 upon EE supplying copy of 2008 Tax return, "married filing jointly" checked and showing both Enrollee and spouse’s name."
"Dependent #02, Jane (spouse) re-added effective 02/01/09 upon EE supplying marriage certificate and mortgage statement dated 12/01/08."
b) Re-adding Children Under Age 19
"Dependent #04, John (son) re-added effective 02/01/09 upon EE supplying birth certificate listing enrollee as parent."
"Dependent #04, John (son) re-added effective 02/01/09 upon EE supplying birth certificate listing enrollee’s approved spouse as parent."
c) Re-adding Children Over Age 19
"Dependent #04, John (son) re-added effective 02/01/09 upon EE supplying birth certificate listing enrollee as parent and proof of full-time student status dated 01/01/09."
d) Re-adding Domestic Partner (Federally qualified)
Checklist indicating eligible proofs submitted to EBD to process addition of Dependent #06, Sue (domestic partner) effective 02/01/09."
Please allow ten business days from the time you enter the transaction/Correction Request for the dependent’s reinstatement to be fully updated by EBD and at the carriers. If you have any further questions, please call your processor or refer to our website, https://www.cs.ny.gov.