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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA02-15
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2002 NYSHIP Empire Plan PA Benefit Statements Transaction Processing Instructions
DATE: October 7, 2002
You received with memo PA 02-14 a sample of the PA Benefit Statement being sent to your enrollees in the New York State Health Insurance Program (NYSHIP). Benefit statements will be sent to all active and non-active enrollees of your agency beginning on or about October 7, 2002. This memo will address your responsibility in processing those forms returned to your agency with corrections and general questions you may receive from your enrollees.
Enrollees Who Do Not Receive Statements
You received with memo PA02-14 a blank benefit statement form. Additionally, you will receive a printout of all of your agency’s benefit statement records. If you have an enrollee who does not receive a benefit statement, you may use your blank statement as a duplicating master and produce a statement for them using the information on the master printout.
Remember that the information on the printout is confidential and should be kept in a secure manner. Provide each enrollee only the information that pertains to his/her own coverage.
Benefit Statement Mail Dates and Deadlines
As noted above, 2002 NYSHIP Benefit Statements are being mailed to all active and non-active employees (retirees, dependent survivors, etc.) beginning on or about October 7, 2002. The statement shows the enrollee’s NYBEAS information as of September 5, 2002. Any transaction entered on NYBEAS after September 5, 2002 will not be reflected on the enrollee’s statement.
Transaction Priorities
Our experience with the Benefit Statements project has shown that, although this is not the first year we are sending statements, you are likely to receive a high volume of corrections. The number of benefit statements you receive may require you to prioritize your work and handle the most critical transactions first. We have developed a suggested prioritization list to help you.
The following are priority transactions and should be processed as soon as possible:
Dependent Adds and Deletes
Changes in Coverage
Changes in Address
Incorrect Enrollee Status (i.e.; retirements, terminations, dependent survivors)
Incorrect Enrollee or Dependent Name (misspelled or changed)
Incorrect Enrollee or Dependent Date of Birth
Incorrect Marital Status (the marital status date is now required to change status)
If you are a NYBEAS agency, transactions may be processed directly into the NYBEAS enrollment system. Non-NYBEAS agencies should complete a PS-503.1 for each transaction, and send them with a completed PS-516 to: NYS Department of Civil Service, Employee Benefits Division, The State Campus, Albany, NY 12239
In some cases, a letter to EBD may be required to make the correction. This will occur if a transaction date has to be changed or needs to be inserted before a transaction already on the file.
Name Changes and Identification Cards
Due to the anticipated high volume of name changes (adding full first names to the NYBEAS files) card production continues to be suspended for name change transactions. If the change made is significant (i.e. changing from Smith to Johnson), a new benefit card should be ordered for the enrollee or dependent. Changes of just a first name (i.e. changing from R Smith to Robert Smith) do not require a new benefit identification card.
Although addition of an enrollee’s full first name should not be treated as a priority change, these changes need to be processed. NYSHIP will be required to carry the full first name of all enrollees in NYBEAS to comply with HIPAA regulations. The deadline for this portion of HIPAA compliance has been extended to 2003.
Social Security Numbers and Phone Numbers
Dependent social security numbers and enrollee telephone numbers should be updated after priority transactions are completed. If dependent social security numbers are missing, we are printing “please provide” on the enrollee’s statement to encourage the enrollee to provide this information to you.
Process Transactions in Order
In NYBEAS you can process all changes the enrollee needs at one time. However, you must process all transactions in chronological order (oldest one first) to insure all transactions will process correctly.
Questions?
Questions regarding transaction processing should be referred to the PA unit processors at EBD:
Gail Schultz (518) 485-6619
Theresa Bartlett (518) 457-5847
Darci Jo Riddle (518) 485-6618
Jessica Dougrey (518) 457-5766
Marc Barre (518) 485-1186
Thank you for your assistance with this project!