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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.

New York State of Opportunity

ANDREW M. CUOMO
Governor
LOLA W. BRABHAM
Acting Commissioner

PE19-17

TO: Participating Employer (PE) Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: NYSHIP Retiree Health Benefits Eligibility and the Qualification Process
DATE: September 19, 2019

As the result of a change in policy, the Employee Benefits Division (EBD) will no longer review a PE enrollee’s file to determine retirement eligibility when a retirement transaction (RET/RET) is processed. When a RET/RET is processed by the agency, it will be considered the agency’s acknowledgement that the enrollee is eligible for retiree benefits in the New Your State Health Insurance Program (NYSHIP).

To assist agencies with understanding the process they should use to qualify a retiree for retiree health insurance, there will be a ‘retiree eligibility’ training webinar for HBAs on October 1, 2019, from 1:00 PM – 2:00 PM. During this time, EBD staff will review NYSHIP retiree eligibility requirements, educate on how to update NYBEAS with the correct transactions, and be available to answer any questions related to this new process. Agency HBAs can register for the webinar through the following link: Processing NYSHIP PE Retirees in NYBEAS. Note: this training webinar is separate from the annual PE webinar held in the fall each year.

When a retirement transaction (RET/RET) is processed, enrollees will be immediately placed in retiree coverage and billed accordingly. When a termination transaction (TER/TER) is processed, EBD will send the enrollee an application to enroll in Vestee coverage or COBRA coverage, as appropriate. It is the agency’s responsibility to determine if their enrollees meet the eligibility requirements for NYSHIP retiree coverage and then process the correct retirement or termination transaction.

Enrollees who are qualified for retiree benefits are moved to retiree billing status and will appear in a retiree benefit program on their agency reconciliation. Agencies should verify the accuracy of the enrollment status of each of their enrollees through their reconciliation, and it should be matched with the agency billing statement each month. For additional information and instructions regarding the reconciliation process, see Memo PE 11-08 dated May 2, 2011.

For questions on registering for the webinar, please contact the HBA Help Line at (518) 474-2780.