Department of Civil Service

NY01-27
PE01-23

TO: Health Benefits Administrators or State Agencies and Participating Employers
FROM: Employee Benefits Division
SUBJECT: Other Dependent Children Recertification
DATE: July 16, 2001

Eligibility of "other" children must be re-certified every two years starting two years from their date of first enrollment. The first two year end date for recertification under NYBEAS is August 31, 2001. Any enrollee who added a dependent defined as "other" children under NYSHIP effective September 1, 1999 or earlier will be receiving a letter from EBD advising that it is time to recertify his/her "other" child’s (children’s) eligibility no later than August 31, 2001. After that date, enrollees must recertify his/her "other" children status before their eligibility end date (two years from first certification or recertification). Failure to do so will result in the deletion of the dependent record from NYBEAS and loss of the child’s eligibility under NYSHIP. These requirements apply only to state-administered health benefits. Enrollments and terminations of dependents in union Employee Benefit Funds will continue to be handled in accordance with the procedures and eligibility rules established by the unions.

The number of "other" children with a dependent end date of August 31, 2001 is quite large. This is because this is the first time these records are being identified under NYBEAS. In addition to the letter being sent directly to the enrollee, the accounts with a child requiring recertificaiton will be reported to you on a worklist (see NYBEAS Instructions on page 3). Because of the large number of "other" children with an end date of August 31, 2001, we have also included a list of affected enrollees with this memo. If your agency does not receive a list, that means you have no enrollees who require a dependent to be recertified at this time. This can be verified on your worklist. This process will be run monthly, with new accounts added to your worklist. It is anticipated that the number of required recertifications per month, after this initial run, will be quite small. You will not receive a list of affected enrollees in subsequent months.

A copy of the letter sent to affected enrollees is attached.

PROCEDURE

Employee Benefits Division (EBD), Department of Civil Service

• EBD sends a letter to enrollee to notify him/her of his/her responsibility to recertify their "other" child dependent status before the end date. Form PS-457 Statement of Dependence is included. The letter and PS-457 are sent to the enrollee approximately two months before the end date.

• Any "other" child whose end date is not updated, will automatically be deleted from NYBEAS effective one day after the end date.

Enrollee

• Completes the PS-457 and returns the form with required dependent proof documentation to their agency health benefits administrator.

Health Benefits Administrator

• Reviews the PS-457 and required dependent proof documentation for completeness and accuracy. Contacts the enrollee if any information is missing or incomplete.

• Make sure you have a copy of the dependent social security number and birth certificate on file. If you do not, request this information from the enrollee. The dependent cannot be recertified without all documentation being submitted. Additional required documentation:

Legal Residence:
The dependent must reside permanently in the enrollee’s home. The completed PS-457 is proof of legal residence. No additional proof is required.

Support:
The dependent must receive more than 50 percent of their support from the enrollee, including medical expenses. The enrollee must provide documentation of this support. Acceptable documentation include

• Papers of legal guardianship

• Copy of enrollee’s Federal tax return listing the individual as a dependent

• Letter from a CPA or an attorney that the dependent meets the eligibility requirements to be claimed on the enrollee’s tax return under current IRS regulations if the enrollee chose to do so.

• If the dependent meets the criteria to be recertified as an "other" child, update NYBEAS end date. (See NYBEAS Instructions on next page).

• If the dependent does not meet the criteria to be recertified as an "other" child, notify the enrollee, and update comments on NYBEAS with the reason for the denial.

• If the dependent became ineligible prior to the end date on the file, the date of loss of eligibility should be used if that info is provided. You can update the correct end date if the record has not yet been deleted. If the dependent record has been deleted, contact your processor to update the end date.

NYBEAS Instructions

A worklist is produced of all enrollees with "other" children that need recertification. The enrollee record is added to the worklist once the end date of the dependent is less than two months away. For example, enrollee records with a dependent end date of 8/31/01 were added in July. Enrollee records with a dependent end date of 9/30/01 will be added to the worklist the beginning of August, and so on.

Access Worklist in NYBEAS

• Select Start, Administer NYBEAS Updates.
  Click the Worklist icon . A Worklist will display.

• Under the column labeled Activity Name, select NYBEAS Depend Recert Required and double click.

• Select the available transaction. Press the WorkIt! push button. You will automatically be brought to the Dependent/Beneficiary2 screen.

• Under Dependent End Information End Date field, enter the new end date. The new end date cannot be more than 2 years from the current end date. For example, for enrollees with a current end date of 083101, update the end dates with a date no later than 083103.
  

• Click the Save icon to save this transaction into the system. The Icon will change to gray when the save is complete.

NOTE: Saving the transaction automatically deletes the entry from the Depend Recert Required worklist.

Updating Records After the Current End Date has Expired.

If the End Date is not updated prior to its expiration, a DEP/DEL transaction will automatically be generated to delete the dependent record. If you update the end date on a record AFTER the current End Date:

• Check the EVENTS panel to see if the dependent has been deleted.

• If the dependent has not been deleted, you just need to change the End Date.

• If the dependent has been deleted, change the End Date then do a DEP/ADD transaction to re-enroll the dependent.

TO AVOID DEPENDENT RECORDS FROM DELETION IN ERROR, UPDATE THE DEPENDENT END DATE PRIOR TO ITS EXPIRATION.

Attachment

SAMPLE LETTER TO ENROLLEE

Dear Enrollee:

Our records indicate that you have a dependent enrolled in the New York State Health Insurance Program (NYSHIP) who is other than your own child, adopted child or dependent stepchild. For such a dependent to be eligible, the child must, among other things,

1. reside permanently in the enrollee’s home and

2. receive more than 50 percent of support from the enrollee, including medical expenses.

Eligibility of "other" children must be re-certified every two years, starting two years from their date of first enrollment. "Other" children who were on file when the Department converted its NYSHIP records to its current enrollment system in September, 1999 were given an end date of 8/31/01. In order for coverage under NYSHIP to be continued for the dependent listed below, you must complete form PS-457 Statement of Dependence (enclosed) and return it with required dependent proof documentation (include copy of dependent social security card and birth certificate) to your agency Health Benefits Administrator, located in your agency’s Personnel Office, by the End Date of Coverage. Failure to do so, will result in termination of coverage for your dependent.

Dependent Name: _____________________________________________

End Date of Coverage: __________________________________

Form PS-457 Statement of Dependence and required dependent proof documentation must be returned to your agency Health Benefits Administrator prior to the End Date of Coverage.

If you have any questions, please contact your agency Health Benefits Administrator.

Yours truly,

Pamela Fetcho
Manager, Operations
Employee Benefits Division

Cc: Agency Health Benefits Administrator