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
REBECCA A. CORSO
Acting Commissioner
PE21-11
TO: Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: NYSHIP Retiree Health Benefits Eligibility and the Qualification Process
DATE: July 20, 2021
Update
This memo replaces HBA Memo PE19-17 that was published on September 19, 2019.
The Employee Benefits Division (EBD) conducted the Processing NYSHIP PE Retirees in NYBEAS webinar on October 1, 2019 to train Participating Employer (PE) Health Benefits Administrators (HBAs) on their responsibilities for when an employee retires or separates from service. The training has been revised and re-recorded to provide HBAs with the latest processing information. A recording of the updated training has replaced the October 1, 2019 recording and can be found on the E-Learning page of HBA Online at https://www.cs.ny.gov/employee-benefits/hba/shared/e-learning/index.cfm.
A PDF document of the PowerPoint used during the Processing NYSHIP PE Retirees in NYBEAS webinar is enclosed at the bottom of this memo for your reference.
Processing NYSHIP PE Retirees in NYBEAS Summary
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.
When a PE agency processes a retirement transaction (RET/RET), EBD will consider it as the agency’s acknowledgement that the enrollee is eligible for retiree benefits under the New York State Health Insurance Program (NYSHIP) and the enrollee will be placed in retiree coverage and billed accordingly. Furthermore, EBD will not review a PE enrollee’s NYBEAS record to determine retirement eligibility when a RET/RET is processed in NYBEAS.
When a termination transaction (TER/TER) is processed, the HBA must put a comment in NYBEAS to advise EBD if the enrollee is eligible to continue NYSHIP coverage as a Vestee or only eligible to continue through COBRA. If the enrollee is eligible for Vestee coverage, your comment must also confirm when they are eligible to transfer into the retirement program, in many cases this will be when the enrollee reaches age 55. Your comment will be used to ensure that EBD places the enrollee in the appropriate coverage.
Agencies should verify the accuracy of the enrollment status of each of their enrollees through their reconciliation reports, and match it against the agency billing statement each month. For additional information and instructions regarding the reconciliation reporting process, see HBA Memo PE11-08 dated May 2, 2011. If you require further assistance, please contact the HBA Help Line at 518-474-2780.