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
LOLA W. BRABHAM
TO: New York State Agency Health Benefit Administrators
FROM: Employee Benefits Division
SUBJECT: NYSHIP Dental and Vision Updates for Dependents
DATE: January 13, 2020
Effective immediately, Emblem Health, who is administering the dental program for enrollees under the New York State Health Insurance Program (NYSHIP), will begin a monthly systematic process of adding and removing dependents ages 19 through 25 based on their full-time student status. All information received from Emblem Health will also be used to update the dependent’s vision coverage under Davis Vision.
Removing Dependents (after 1st Friday of each month)
Dependents that have not confirmed as full-time student status, will be removed from NYBEAS accordingly:
• No response to Emblem Health Student Verification form 2 months prior to the 19th birthday: Dependent is removed the first of the month following their 19th birthday
• No response to Emblem Student Verification form for Current Semester: Dependent is removed the first of the month following a 3-month extension beyond the last semester full-time student status was confirmed
Re-adding Verified Dependents (after the 1st Friday of each month)
Dependents who have confirmed full-time student status with Emblem Health since the previous monthly update, will be re-added to NYBEAS accordingly:
• Retroactively: Dependent is re-added retroactive to the date they were originally removed with confirmation of continuous full-time student status.
• When Classes began: Dependent is re-added as of the first day of the month in which classes began. There will be a break in coverage when there is a break in between semesters. (Example: dependent attends Fall semester, but does not return to school again until the following Fall semester)
Age 25 Removals
EBD will continue the automated process of removing all children from NYSHIP dental and vision effective the first of the month following their 25th birthday.
Dependents being removed from the file will automatically receive a COBRA application. Deadlines as noted on the application must be adhered to. Please instruct enrollees and/or their dependents to contact EBD at 1-800-833-4344 and select menu options for COBRA.
Enrollees are to Contact Emblem Health
Enrollees should be informed that they are required to submit the requested “Dependent Student Certification Form” to Emblem Health each time it is requested. This form is located on Emblem Health’s website at: https://www.emblemhealth.com/resources/forms. Enrollee’s should select “Student Verification Form for NYS Enrollees Only – GHI”. Once the enrollee submits this form, Emblem Health will reinstate the coverage and begin processing claims again. Emblem Health will send the update to EBD and NYBEAS will be updated within 60 days of receiving the information was received from Emblem.
HBAs not Required to Process
Although HBAs are not prohibited from processing on NYBEAS, this is now an automated process for NYSHIP Dental and Vision coverages. Therefore, enrollees are still required to contact Emblem Health in order to submit the Student Verification form to ensure claims are processed.
HBAs Should Contact EBD when:
• Enrollee has submitted Student Verification form more than 2 weeks ago and Emblem is not honoring claims.
• Enrollee has submitted the Student Verification form more than 60 days ago, and NYBEAS has not been updated.
Enrollees who are enrolled in dental and vision coverage through an employee benefit fund such as CSEA and UUP, must contact that entity regarding their dependent’s coverage. For questions related to process noted above, please contact the HBA Helpline at 518-474-2780.