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.
KATHY HOCHUL
Governor
TIMOTHY R. HOGUES
Commissioner
NY24-11
PE24-07
PA24-08
TO: Health Benefits Administrators of New York State Agencies, Participating Employers, and Participating Agencies with The Empire Plan
FROM: Employee Benefits Division
SUBJECT: Department of Civil Service Audit and Risk Management (ARM) Audit of Dependents Enrolled in The Empire Plan
DATE: June 28, 2024
The Department of Civil Service Audit and Risk Management team (ARM) is conducting an audit of the eligibility documentation for some New York State Health Insurance (NYSHIP) members enrolled in The Empire Plan and who cover dependents as domestic partners or as “other” children.
In the next week, you may receive an email from ARM requesting that you provide the most recent proof of eligibility for dependent coverage and the corresponding form (PS425 DP or PS457 Other) for no more than ten (10) Empire Plan enrollees. The email from ARM will come from DCSReports@cs.ny.gov. ARM will require the requested information be received by July 16, 2024. To safeguard Protected Health Information (PHI), the Empire Plan Alternate Identification (Alt ID) number and dependent demographics will be provided to you. Please refer to the attached instructions on how to search for the NYBEAS Employee ID (typically the enrollee’s SSN) with the Alt ID.
If you cannot locate the last provided proof of eligibility for the dependent (for example, it was provided to a former agency and did not get forwarded), you must request the enrollee submit current proof of eligibility that establishes the enrolled dependent continues to be eligible. Please refer to the applicable HBA Manual’s Dependent Eligibility Requirements sections for information on dependent eligibility and required documentation. If you do not receive the proof of eligibility from a member by July 16, please send what information you do have and notify ARM that additional documentation has been requested.
Questions regarding this audit should be directed to ARM at DCSReports@cs.ny.gov. If you have questions about dependent eligibility or proofs that cannot be answered using the HBA Manual, please contact the HBA Helpline at 518-474-2780. If you need help accessing HBA Online, contact the ITS Service Desk at 844-891-1786, fixit@its.ny.gov or via chat at https://chat.its.ny.gov.