2018 General Information Book - New York

[Pages:56]2018 General Information Book

New York State Retirees

New York State Health Insurance Program General Information Book for New York State Retirees, Vestees, Dependent Survivors and Preferred List enrollees and their eligible dependents. Also includes information regarding COBRA continuation coverage and the Young Adult Option.

New York State Department of Civil Service, Employee Benefits Division ? cs.retirees

TABLE OF CONTENTS

Introduction.......................................................................................1

When You Need Assistance.........................................1 When You Must Contact EBD............................................1 Tips for calling EBD....................................................................... 3 Benefits on the Web.................................................................3 Other Resources..........................................................................3

Your Options Under NYSHIP.....................................3 The Empire Plan or a NYSHIP HMO............................4 Changing Options.......................................................................4 Qualifying Events: Changing Your NYSHIP Option More Than Once During a 12-Month Period....................................................4 Consider Carefully......................................................................5

Retiree Coverage.......................................................................5 Eligibility Requirements..........................................................5 Disability Retirement................................................................6 Maintain coverage while your disability retirement is being decided..........................7 If you experience an interruption in coverage........ 7 Denial of a disability retirement..........................................7 What You Pay.................................................................................7 How You Pay .................................................................................8 Deductions from your pension........................................... 8 Bills from EBD..................................................................................... 8 Sick leave credit.............................................................................. 8 Reinstating Your Coverage as a Retiree.............. 10 After deferring coverage....................................................... 10 After canceling coverage...................................................... 10 After being covered as a dependent in NYSHIP.............................................................. 10

Vestee Coverage.....................................................................10 Continuing NYSHIP Coverage as a Vestee........ 10 Enrollment........................................................................................11 Cost........................................................................................................11 Sick leave credit does not apply......................................11 Continuing Your NYSHIP Coverage as a Dependent..................................................11 Canceling Enrollment..............................................................11

Preferred List Coverage..................................................11 Enrollment........................................................................................11 Enrollment is automatic........................................................... 12 Waiver of Premium.................................................................. 12 Waiver is not automatic........................................................... 12 How to apply for a waiver of premium...................... 12 Additional waiver of premium.............................................13 Waiver ends........................................................................................13 Retiring from Preferred List..............................................13

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Dependent Survivor Coverage..............................13 Extended Benefits Period at No Cost......................14 Eligibility for Dependent Survivor Coverage After the Extended Benefits Period Ends.............14 Eligible Dependents................................................................14 Eligibility and Cost Vary.......................................................14 Dual Annuitant Sick Leave Credit option................ 15

Benefit Cards............................................................................... 15 Dependent Survivor Eligible for NYSHIP as a Result of Employment......................... 15 Loss of Eligibility for Dependent Survivor Coverage..................................... 15

Dependent Eligibility..........................................................16 Your Spouse................................................................................. 16 Your Domestic Partner........................................................ 16 Your Children................................................................................17 Your "other" child..........................................................................17 Your disabled child......................................................................17 Your child who is a full-time student with military service.................................................17

Proof of Eligibility...................................................................18 Required Proofs......................................................................... 18 Spouse................................................................................................... 18 Domestic partner........................................................................... 18 Natural-born children, stepchildren and children of a domestic partner.............................. 18 Adopted children.......................................................................... 18 Your disabled child over age 26.................................... 19 "Other" children.............................................................................. 19 Your child who is a full-time student over age 26 with military service................................... 19

Coverage: Individual or Family.............................19 Individual Coverage............................................................... 19 Family Coverage....................................................................... 19

Changing Coverage............................................................20 Changing From Individual to Family Coverage................................................................ 20 First date of eligibility...............................................................20

Adding a Previously Eligible Dependent to Existing Family Coverage.............. 21 Changing From Family to Individual Coverage............................................................... 21 Enrollment Considered Late if Previously Eligible............................................................... 21 Exception: Dependent(s) affected by a National Medical Support Order........................ 21 Exception: Changes in Children's Health Insurance Program (CHIP) or Medicaid eligibility................................................................ 21

When Coverage Ends.......................................................... 22

Your Share of the Premium.....................................22 What You Pay............................................................................. 22

Contribution Rates.................................................................. 22 Rate Information............................................................................23

Military Active Duty................................................................ 24

Identification Cards............................................................24 Empire Plan Enrollees.......................................................... 24 Your Empire Plan Medicare Rx card..........................24 Ordering a card.............................................................................24

HMO Enrollees........................................................................... 24

Possession of a Card Does Not Guarantee Eligibility..................................... 24

End Dates for Coverage................................................25 You, the Enrollee..................................................................... 25 Loss of eligibility...........................................................................25 Suspending retiree coverage...........................................25 Consequences...............................................................................25

Dependent Loss of Eligibility......................................... 25 Children................................................................................................25 Spouse..................................................................................................25 Domestic partner..........................................................................25

Medicare and NYSHIP.....................................................25 Medicare: A Federal Program....................................... 26

Medicare and NYSHIP Together Provide Maximum Benefits............................................. 26 Empire Plan enrollees..............................................................26 HMO enrollees............................................................................... 27

When Medicare Eligibility Begins...............................27

When Medicare Becomes Primary to NYSHIP..................................................................27

When You Are Required to Have Medicare Parts A and B in Effect.................27 When you are Medicare eligible due to age (65)..............................................................................28 When you are Medicare eligible due to disability.............................................................................28

How to Apply for Medicare Parts A and B......... 29

Enrollment in Additional Medicare Plans............ 29

Empire Plan Medicare Rx-- A Medicare Part D Prescription Drug Plan for Empire Plan Enrollees....................... 29 Prescription drug coverage for Medicare-primary Empire Plan enrollees and dependents..................................................29 Other Medicare prescription drug plans................30 Empire Plan Medicare Rx ID card.................................30

Medicare Costs, Payment and Reimbursement of Certain Premiums.................... 30 Medicare Part A.............................................................................30 Medicare Part B.............................................................................30 How you pay......................................................................................31

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Medicare Part B premium reimbursement..............31 Medicare Part D............................................................................32

Your Claims When Medicare Is Primary............... 32 When Medicare and NYSHIP are your only coverage..........................................................32 When you have coverage in addition to Medicare and NYSHIP.........................32

Expenses Incurred Outside the United States................................................ 32 Traveling outside the United States...........................32 Residing outside the United States............................. 33 Returning permanently to the United States...... 33

Provide Notice if Medicare Eligibility Ends........ 33 You must refund Medicare premium reimbursement you were not eligible to receive............................................................................................ 33

Questions....................................................................................... 33

Reemployment..........................................................................34 With the Employer You Retired From.................... 34 With an Employer that Participates in NYSHIP....................................................... 34 With a Non-NYSHIP Employer...................................... 34

COBRA: Continuation of Coverage...............35 Federal and State Laws..................................................... 35 Benefits Under COBRA...................................................... 35 Eligibility.......................................................................................... 35 Enrollee................................................................................................. 35 Dependents who are qualified beneficiaries........35 Dependents who are not qualified beneficiaries.............................................................36

Medicare and COBRA.......................................................... 36 Choice of Option...................................................................... 36 Deadlines Apply........................................................................37 60-day deadline to elect COBRA................................. 37 Notification of dependent's loss of eligibility.........37

Costs Under COBRA..............................................................37 45-day grace period to submit initial payment....................................................... 37 30-day grace period................................................................. 37

Continuation of Coverage Period...............................37 Survivors of COBRA enrollees......................................... 38

When You No Longer Qualify for COBRA Coverage........................................ 38 To Cancel COBRA................................................................... 38 Conversion Rights After COBRA Coverage Ends...................................................... 38 Other Coverage Options................................................... 38 Contact Information............................................................... 38

Young Adult Option...........................................................38 Eligibility.......................................................................................... 38 Cost..................................................................................................... 39 Coverage........................................................................................ 39 Enrollment Rules...................................................................... 39 When Young Adult Option Coverage Ends...... 39 Questions....................................................................................... 39

Direct-Pay Conversion Contracts.....................40 Eligibility.......................................................................................... 40 Deadlines Apply....................................................................... 40 No Notice for Certain Dependents........................... 40 How to Request Direct-Pay Conversion Contracts.......................................................... 40

Appendix............................................................................................41 Empire Plan Benefit Card...................................................41 Empire Plan Medicare Rx Card......................................41 Model Letter for Contacting the Employee Benefits Division.................................. 42 Forms Available Online and From EBD................ 43

Contact Information...........................................................44 Employee Benefits Division............................................ 44 Empire Plan.................................................................................. 44 Direct-Pay Conversion Contracts............................... 45 NYSHIP HMOs........................................................................... 45 Other Agencies and Programs..................................... 45

Index................................................................................................ 46

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Introduction

This is the New York State Health Insurance Program (NYSHIP) General Information Book for former employees of New York State and their covered dependents, including retirees, vestees, dependent survivors and enrollees covered under Preferred List provisions. This book explains your rights and responsibilities as an enrollee in NYSHIP. Receipt of this book does not guarantee you are eligible for or enrolled in coverage.

This book provides general information about eligibility, enrollment and other NYSHIP rules. Special rules apply to continuation coverage under COBRA and the Young Adult Option. For specific information regarding COBRA coverage, see page 35. For information about the Young Adult Option, see page 38.

NYSHIP is established under New York State Civil Service law. The New York State Department of Civil Service is responsible for administering NYSHIP and determines NYSHIP's administrative policies, practices and procedures. NYSHIP rules, requirements and benefits are established in accordance with applicable federal and State laws, as well as through negotiations with State employee unions and extended administratively for groups not subject to those negotiations. NYSHIP rules, requirements and benefits also may be affected by court decisions.

Therefore, the information in this book is subject to change, and you will be notified of changes through mailings to your address as it appears on your NYSHIP record. Please make sure that the Employee Benefits Division (EBD) has your most current address. Amendments and notification of changes can also be found on NYSHIP Online. Visit cs.retirees and select Health Benefits. Then select the group from which you retired and your plan type, if prompted.

When You Need Assistance

The Employee Benefits Division (EBD) serves as the Health Benefits Administrator for retirees, vestees, dependent survivors, enrollees covered under Preferred List provisions, COBRA enrollees and Young Adult Option enrollees. For information about your enrollment, eligibility, Medicare coordination or any other aspect of NYSHIP, contact EBD, Monday through Friday, 9 a.m. to 4 p.m. Eastern time, at 518-457-5754 or 1-800-833-4344 or by writing to:

New York State Department of Civil Service Employee Benefits Division Program Administration Unit Albany, NY 12239

Empire Plan inquiries: For questions about specific benefits or claims or to locate a provider, call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program.

Health Maintenance Organization (HMO) inquiries: For questions about specific benefits or HMO services or to locate a provider, call your HMO.

When You Must Contact EBD

EBD and your retirement system are separate entities and do not share information. You must contact EBD to update your health benefits information and contact your retirement system to update your record for retirement or pension purposes.

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You are responsible for letting EBD know of any changes that may affect your NYSHIP coverage.

To keep your enrollment up to date, you must notify EBD in writing (with supporting documentation) in the following situations:

Your mailing address or home address changes. (If you or a dependent is Medicare primary and your mailing address is a P.O. Box, EBD will need your residential street address as well.)

Your phone number changes.

Your name changes.

You need to correct your enrollment record.

Your family unit changes. (See Dependent Eligibility, page 16, and First Date of Eligibility, page 20, for details.)

? You want to add or remove a covered dependent or change your type of coverage (Individual/Family).

? Your covered dependent loses eligibility.

? Your covered dependent child becomes disabled.

? You get divorced (a copy of the divorce decree must be submitted).

? The enrollee or a dependent dies (a copy of the death certificate must be submitted).

Your employment status is changing.

? You are returning to work for the same employer that provides your NYSHIP benefits as a retiree.

? You are awarded a disability retirement benefit.

Your Medicare status is changing.

? You or a covered dependent becomes eligible for primary Medicare benefits (see Medicare and NYSHIP, page 25).

? You or a covered dependent loses eligibility for primary Medicare benefits (see Medicare and NYSHIP, page 25).

Other reasons to contact EBD:

? You need to order a replacement or an additional Empire Plan card. (HMO enrollees must contact their HMO to order benefit cards.)

? You have questions about the amount of your premium or your bill for NYSHIP coverage.

? You want to cancel or reinstate your coverage.

? You have questions about Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation of coverage (see page 35) or Young Adult Option coverage (see page 38).

? You have questions about your sick leave credit or the Dual Annuitant Sick Leave Credit option.

For any of the reasons listed above, write to:

New York State Department of Civil Service Employee Benefits Division Program Administration Unit Albany, NY 12239

Be sure to sign your request and include your name, address and Social Security number or Empire Plan identification number.

You may use the Model Letter for Contacting the Employee Benefits Division on page 42 to request changes to your NYSHIP option, enrollment or address. Most changes to your enrollment record cannot be made over the telephone because EBD needs your written authorization and signature. However, certain enrollment transactions and address changes can be made online through MyNYSHIP enrollee self service at cs.mynyship.

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