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NYSHIP dependent eligibility verification project During state fiscal year 2015-16, the New York State Department of Civil Service will conduct an audit of all dependents who have health insurance coverage through the New York State Health Insurance Program (NYSHIP). If you have family coverage, or have elected to opt out of family coverage through the Opt-out- Program, you will receive a packet of information in the mail about the audit. It will include a list of your dependents who are currently enrolled in NYSHIP (including the Opt-out Program), along with an eligibility worksheet and a list of required documents that must be provided. This fall, the Department of Civil Service will reach out to enrollee with information regarding the audit. You may be required to supply documentation for certain dependents, such as spouses, even if you have previously done so. You will NOT be required to submit documentation for dependent children who were verified during the 2009 audit. DO NOT submit documents now! Please wait for additional information from Civil Service. If required, you must provide the requested documentation to ensure that your enrolled dependents continue to be covered under NYSHIP. If you have elected the Opt-out Program for family coverage, you may also need to provide the required documentation to remain eligible for the family opt-out incentive payments. Ineligible or unverified dependents will have their coverage terminated, and you may be liable for any NYSHIP expenses paid on their behalf. The Department of Civil Service will be offering an amnesty period as part of the project, whereby enrollees may voluntarily remove ineligible dependents from coverage. Enrollees will NOT be liable for any NYSHIP expenses paid on behalf of dependents terminated during the amnesty period. Watch for the mailing over the next few months. It will include more details and specific instructions on the 2015-16 NYSHIP Dependent Eligibility Verification Project. Traveling this summer? Here’s some important Empire Plan information Summertime is the ideal time for families to take a getaway, send children to summer camp or begin preparing for dependents going to college or for themselves retiring and being able to spend winters in Florida. If you are planning to travel this summer, it is reassuring to know that the Empire Plan is there for you wherever your travels take you and/or your dependents. Empire Plan coverage is available worldwide and not just for emergencies. Most parts of The Empire Plan have two levels of benefits. If you use an Empire Plan participating provider, you will receive medically necessary covered services and supplies at little or no cost and have no claim forms to complete. If you use a non-participating provider, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply. It is important to note that The Empire Plan does not require that participating providers refer you to a network facility or participating laboratory, urgent care center, radiologist or medical specialist. It is the enrollee’s responsibility to request and verify if a network facility or participating provider is used. Explain to your physicians that your out-of-pocket expenses are usually lower when using Empire Plan participating providers. The Empire Plan Medical/ Surgical Program has participating providers in most states. Access to participating providers is best in areas where a significant number of Empire Plan enrollees reside. The Hospital Program, Prescription Drug Program and Medicare Rx (Empire Plan Medicare primary enrollees) have nationwide networks. The Empire Plan Mental Health and Substance Abuse Program, the Home Care Advocacy Program (HCAP) and the Managed Physical Medicine Program have guaranteed access to network benefits nationwide if you call to make the necessary arrangements before you receive services. It is important to be familiar with your health insurance plan and understand how it works, especially when you and/or your dependents are away from home. If you are traveling and anticipate that you or a family member may require medical services while you are away, prepare for out-of-town medical needs by consulting with your physician and locating network providers where you will be visiting by calling The Empire Plan before your travels. In many areas, you can now find network urgent care centers that have extended and weekend hours. When an Empire Plan enrollee or dependent travels to Arizona, Connecticut, Florida, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, Washington D.C., West Virginia or the greater Chicago area, access to Empire Plan network benefits are available by using a physician or center that is part of United Healthcare’s options preferred provider organization (PPO). For more information or to get a copy of The Empire Plan Participating Provider Directory, ask your agency health benefits administrator for a copy, or request one through the Empire Plan carriers at 1-877-769-7447. You may also find Empire Plan participating provider information online at https://www.cs.ny.gov. 16 The Work Force July-August 2015


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