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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NY11-17
TO: New York State Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Retroactive Transaction Processing
DATE: July 14, 2011
The purpose of this memo is to inform you of a change with regard to the processing of certain retroactive transactions in the New York State Health Insurance Program (NYSHIP) enrollment system (NYBEAS).
Commencing with transactions processed on or after August 1, 2011, there will be a maximum six-month retroactivity period. Certain transactions with an effective date greater than six months from the date processed will result in the following error message and you will not be able to save the transaction:
"This transaction exceeds the six-month retroactivity limit, please contact EBD to process."
For example, if a transaction which affects an enrollee’s enrollment record is processed on August 1, 2011, the effective date of the transaction can be no earlier than February 1, 2011, as this is the six-month maximum retroactivity period.
The retroactivity limit applies to both credits and charges that impact an enrollee’s enrollment record and NYSHIP account. The following HBA processed transactions are subject to the retroactivity period:
- Terminations
- Enrollment
- Medicare
- Cancellations
- Changes of Coverage
- Dependent Deletes
Now that the Dependent Eligibility Audit is complete, EBD will resume the annual production of Enrollee Benefits Statements, notifying enrollees of their current benefits/coverage levels, as well as their dependent information. The allowance for six months retroactivity should be sufficient to process transactions in a timely manner.
If you have questions or concerns regarding this memo, please contact your EBD processor.