Department of Civil Service

NY01-28

TO: SUNY Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: SUNY Graduate Students Dental Enrollment
DATE: July 23, 2001

As you are aware SUNY Graduate Students covered under the Student Employee Health Plan (SEHP) are covered under a Group Health Incorporated (GHI) dental plan effective July 1, 2001. Enrollment and eligibility will be administered through NYBEAS effective that date. This requires you to process HIRE and ENROLL transactions on NYBEAS for each eligible employee.

You should begin to process NYBEAS transactions as soon as possible for enrollees who were eligible for Dental coverage as of July 1, 2001. Do not process transactions for enrollees eligible for coverage as of July 2, 2001 or later. Further instructions will be forthcoming. In addition, please note that GHI will not be able to process claims until the enrollment record is updated on their system.

• If an enrollee needs services prior to the record being updated by GHI, you should instruct them to select a participating provider from the "Preferred" Dental Plan provider list on the GHI Web-site at www.ghi.com. The GHI dental claim form is also available on the website. Any problems experienced by enrollees prior to the completion of the enrollment process should be outlined in a letter to your processor.

NYBEAS Processing Instructions

SUNY Graduate Students do not appear on NYSTEP, therefore, it is necessary to process a HIRE transaction, prior to enrolling them in the Dental program.

Refer to the HBA Handbook Chapter 1 – Enrollment and Eligibility for detailed instructions on how to process the HIRE and ENROLL transactions.

Important Processing Notes

For the HIRE transaction, use your agency code with a "9" at the end to complete the Department field. For example, if your agency code is 28170, the agency code you use for SUNY GSEU is 28179. Enter the enrollee’s actual hire date as the effective date in Job Data 1.

For the ENROLL transaction, use 070101 as the Event Dt for any enrollee eligible for coverage as of July 1st. This will give the enrollee an Effective Date of 070101 for GHI dental coverage. GSEU enrollees cannot have an Effective Date prior to 070101 on NYBEAS.

Codes Used for SUNY GSEU

COBRA Enrollees

All current COBRA enrollees, who have continued SEHP coverage, are eligible to continue coverage under the GHI dental program for the remainder of their COBRA period. SUNY System Administration and EBD will be working with Univera to update NYBEAS with these enrollments. SEHP enrollees currently in COBRA who have enrollment and billing questions should be directed to contact the EBD COBRA Unit at 1-800-833-4344 between the hours of 9:00 and 3:00 Monday through Friday.

Additional Information

The purpose of this memo is to allow you to enroll current GSEU-represented enrollees who are covered as of July 1st. Further instructions concerning NYBEAS transaction processing, and SEHP dental benefits, will be sent by the Department of Civil Service and GHI respectively, in the coming weeks. A short fact sheet has been provided by GHI as an attachment.

HBAs may contact Carol Wittman at 518-485-1243 with general questions about the dental benefits. If you have any other questions, please contact your processor.

Attachment

Graduate Student Employees Health Plan
Effective July, 2001

DENTAL BENEFITS

subject to a $20.00 co-payment per visit
maximum 2 visits per year
only when you visit a participating provider in the GSEU Dental Program

Examinations

• Initial examination, including charting
  
• Periodic examination
  
• Cleaning

Bitewing X-Rays:

• Maximum 4 x-rays per year

Other Services

• You will be enrolled in GHI’s Discounted Access Program. When you use a GHI Participating Provider that accepts this Program, your out-of-pocket expense will be limited to the GHI Schedule of Allowance.
  
• For Eligibility questions, please contact your Heath Benefits Administrator at your Campus.
  
• For Customer Service, Please call GHI’s Dedicated Customer Service Center at 1-800-947-0101 after you have enrolled.
  
• Correspondence: Please direct your correspondence to: GHI, Attn: NYS Dental Customer Service, P.O.Box 12365, Albany, New York 12212-2365 . Please be sure to include your identification number on all correspondence.
  
• You can access the GHI Web-site at www.ghi.com to find a participating provider
  Retroactive Coverage:
  
• Your coverage will begin on July 1, 2001. If you receive care for examinations, cleanings and/or bitewing x-rays by a participating provider, please send GHI itemized bills (at the above address) and we will process your claim according to your available benefits. Payment will be made directly to the provider. The Provider will reimburse you for any overpayment.