2019 Annual Webinar for Participating Agencies New York State - - PowerPoint PPT Presentation
October 25, 2019 1 2019 Annual Webinar for Participating Agencies New York State Department of Civil Service Employee Benefits Division Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.
October 25, 2019 1 Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.
New York State Department of Civil Service Employee Benefits Division
October 25, 2019 2
518-473-1977 James.dewan@cs.ny.gov
October 25, 2019 3
October 25, 2019 4
Ron Kuiken – Assistant Director of Financial Management
October 25, 2019 5 Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.
Presenter- Ron Kuiken, Assistant Director, Financial Services New York State Department of Civil Service Employee Benefits Division
October 25, 2019 6
October 25, 2019 7
Blue Cross Hospital UHC Medical Beacon MHSA CVS Drug Total Premium $3,383,025 $3,440,819 $292,902 $1,883,182 $8,999,928 Incurred Claims $3,323,973 $3,262,291 $261,079 $1,701,271 $8,548,614 Administrative Expense $95,067 $199,671 $15,580 $27,835 $338,153 Gain/(Loss) ($36,015) ($21,143) $16,243 $154,076 $113,161 (1) 2020 Rate Renewal Submissions
October 25, 2019 8
October 25, 2019 9
Dividends Available as of 12/31/18 $261.5 2018/2019 Earned + $465.7 2019 Projected Applied
Projected Available 12/31/19 $577.2 2019/2020 Projected Earned + $144.2 2020 Projected Applied
Projected Available as of 12/31/20 $321.4
October 25, 2019 10
October 25, 2019 11
MaryEllen
October 25, 2019 12 Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.
Contract Manager, Vendor Management Unit New York State Department of Civil Service Employee Benefits Division
October 25, 2019 13
Agencies (PAs) will utilize the Empire Plan Advanced Flexible Formulary.
displays the most commonly utilized medications and displays excluded medications and preferred alternatives. This formulary will be used by almost 90% of The Empire Plan enrollees and dependents.
CVS Caremark.
✓ Drugs moving to the Excluded Drug List will affect approximately 1.74% of utilizers. ✓ Drugs moving to a higher tier will affect approximately .01% of utilizers. ✓ Drugs moving to a lower tier will affect approximately .46% of utilizers.
October 25, 2019 14
October 25, 2019 15
The Empire Plan Prescription Drug Copayments
Drug Category Up to a 30-Day Supply 31-to-90-Day Supply Network Retail Pharmacy, Mail Service Pharmacy or Specialty Pharmacy Network Retail Pharmacy Mail Service Pharmacy or Specialty Pharmacy Current Effective
Current Effective
Current Effective
Level 1 - Most Generic Drugs $5 $5 (no change) $10 $10 (no change) $5 $5 (no change) Level 2 - Preferred Drugs or Compound Drugs $25 $30 $50 $60 $50 $55 Level 3 - Non-Preferred Drugs $45 $60 $90 $120 $90 $110
October 25, 2019 16
October 25, 2019 17
Presenter – Lauren Leadley Policy Analysis and Strategic Planning Unit
October 25, 2019 18
employer reporting requirements remain in effect
“employer mandate”
employers must adhere
October 25, 2019 19
insurance benefits to 95% of full-time employees
criteria
employees who worked during the preceding calendar year
October 25, 2019 20
all full-time employees, retirees, vestees, dependent survivors, and COBRA enrollees
and to the IRS by 2/28/20 if filing on paper and 4/1/20 if filing electronically
October 25, 2019 21
1095-C to its employees and enrollees
enrollees
October 25, 2019 22
identify enrollees
dependent SSNs: 1. At the time of enrollment; 2. By December 31 of the year following enrollment; and 3. Once in the following year
enrollment
October 25, 2019 23
years and if they suspect non-compliance they will issue the employer a penalty notice
appears on the IRS Business Master File
department, so it is best to alert them to be on the look out
October 25, 2019 24
employers with these requirements
Part III of Form 1095-C or Part IV of Form 1095-B
information on how to access these reports
benefits/nyship/shared/publications/faq/2015/pa-pe-ppaca-faq.pdf
October 25, 2019 25
October 25, 2019 26
Presenters MaryEllen Brucculeri, Public Employer Liaison Unit Kara Hillicoss, Participating Agency Unit
October 25, 2019 27
Administrator (HBA)
October 25, 2019 28
Each Participating Agency must designate a Health Benefits Administrator (HBA) who is assigned the responsibility for the administration of the NYSHIP in that agency. HBA responsibilities include:
informed of the benefits and availability of NYSHIP
October 25, 2019 29
in NYSHIP
New York Benefits Eligibility and Accounting System (NYBEAS)
York State Department of Civil Service. Be sure to use the remittance included with the bill if you are mailing in your payment
October 25, 2019 30
issued copies of the General Information Book and Empire Plan Certificate and a Health Insurance Transaction form (PS503.1)
– Document that the enrollee was provided the material
– electing –
Maintain copies of form and dep proof (when applicable) in the enrollees’ personal files within your agency (Please note: the .1 was removed from the PS 503 form) It is still the same form)
October 25, 2019 31
MINIMUM EMPLOYER CONTRIBUTION RATE TOWARD NYSHIP PREMIUMS
Agencies that participate in NYSHIP are required to contribute a minimum of 50/35- 50% towards the cost of individual coverage and 35% towards the cost of dependent coverage FOR THEIR ACTIVE AND RETIRED ENROLLEES The minimum 50/35 requirement does not apply to: Dependent Survivors, Volunteer Firefighters and Ambulance Workers, Unpaid board members, unpaid publicly elected board members, unpaid local publicly elected officials, school board members, enrollees who are temporarily removed from the payroll (such as on leave), and enrollees who are covered under VESTEE or COBRA
October 25, 2019 32
Publications can be ordered through HBA Online.
(GIB/EP)-describes the benefits available under NYSHIP. This booklet also serves as the enrollee’s certificate under group contract
benefit information to enrollees
under NYSHIP and Medicare
October 25, 2019 33
and Monthly Billing Statements
agency’s administration of NYSHIP
– Agencies that participate in NYSHIP are required to notify EBD in writing, of any changes in agency policy as related to NYSHIP participation. Changes are made within an agency administratively or by resolution.
October 25, 2019 34
The Employee Benefits Division does not have access to claims information. Members with claims issues should call the Empire Plan at 1-877-769-7447.
October 25, 2019 35
dependents who become eligible for primary benefits under Medicare
– Agencies that participate in NYSHIP are required by § 167-a of New York State Civil Service Law to reimburse Medicare-primary enrollees/dependents for an amount equal to the Medicare Part B premium, including any income related monthly adjustment amount (IRMAA). Reimbursements can be sent at set intervals during the year and the timing is at agency discretion.
October 25, 2019 36
As an HBA, you can view your agency’s VDSA data in NYBEAS under Benefits > CMS/RDS Data > VDSA Query Only. (Voluntary Data Sharing agreement) You can use an enrollee’s or dependent’s Social Security Number (SSN), their Medicare Beneficiary Identifier (MBI) or an enrollee’s EmplID to search for someone’s VDSA information.
October 25, 2019 37
Once you access an enrollee’s information on VDSA Query Only, you will see two panels with blue headings:
October 25, 2019 38
Medicare Dates Tab
(e.g. Working Aged, Disability, or End Stage Renal Disease)
and D
October 25, 2019 39
Input/Response-Personal Data 2 Tab (Continuation of Input/Response-Personal Data 1)
Medicare ID
October 25, 2019 40
Health Benefits Administrators are responsible for providing enrollees with additional NYSHIP publications and forms that apply. (you may also refer employee to NYSHIP online where these forms are also available)
York State Department of Civil Service Website
– Form PS-503.1 Health Insurance Transaction Form – Form PS-451 Statement of Disability – Form PS-452 Application for Waiver of Premium – Form PS 452I Instructions for application of Waiver of Premium – Form PS-457 Statement of Dependence – Form PS-425 Domestic Partner Application
October 25, 2019 41
Health Benefits Administrators are responsible for providing enrollees with information regarding their eligibility for NYSHIP following their separation of employment. Determine if enrollee is eligible to continue NYSHIP under one of these 3 scenarios :
requirement and is eligible to receive their pension)
requirement but not yet eligible to receive their pension)
retiree or Vestee coverage. (May purchase NYSHIP up to 36 months under COBRA)
October 25, 2019 42
ENROLLING MEMBERS IN RETIREE COVERAGE
Agencies that offer retiree coverage (to a class or category of employees) Under NYSHIP, a retiree is defined as an enrollee who stops working and meets the three requirements below:
1. Is enrolled in NYSHIP at time of Separation 2. Is a member of a retirement system administered by the State of New York or one of its political subdivisions and has met the requirements for vesting receipt of a retirement allowance; and 3. has met the agency’s minimum service requirement for health insurance in retirement (minimum of 5 years) Note: Enrollment in a buyout, a PA’s alternate sponsored plan is considered Enrollment in NYSHIP.
October 25, 2019 43
ENROLLING MEMBERS IN VESTEE COVERAGE
Agencies that offer retiree coverage (to a class or category of employees) are also required to offer coverage to vestees. Under NYSHIP, a vestee is defined as an enrollee who terminates employment before pension eligibility. Vestees are eligible to continue coverage under NYSHIP if they: 1. Are enrolled in NYSHIP at time of separation 2. Are a member of a retirement system administered by the State of New York or
3. Met the agency’s minimum service requirement for health insurance in retirement
Note: An employer may adopt the additional policy that requires an employee to be within 5 years of pension eligibility to Vest.
October 25, 2019 44
ENROLLING MEMBERS IN VESTEE COVERAGE (Continued)
Important:
New York State Civil Service Law requires that a Vestee maintain continuous NYSHIP coverage until eligible for a NYS pension with no lapse. This can be done in one of three ways:
Coverage must be continuous from the first date of Vestee eligibility to the date eligible for a pension
October 25, 2019 45
COBRA NOTICES AND ENROLLMENTS Agency Health Benefit Administrators are responsible for notifying and enrolling persons eligible for COBRA by:
Dependents
elected it
October 25, 2019 46
Agencies that participate in NYSHIP are required to have access to the New York Benefits Eligibility and Accounting System (NYBEAS), to process enrollment transactions related to NYSHIP participation, and HBA Online, to receive important information and updates related to NYSHIP participation All NYBEAS users must be HIPAA trained and compliant Access to NYBEAS is only granted to users who have a business need to use NYBEAS The DAO must be the sole designated officer to permit and terminate NYBEAS access. However, the DAO will not be able to make changes to enrollee’s personal information in NYBEAS. That is the role of the HBA
October 25, 2019 47
Agencies that participate in NYSHIP are responsible for maintaining up-to-date agency contact information If the Chief Financial Officer, Data Access Officer, or Health Benefits Administrator changes, The Employee Benefits Division (EBD) must be notified by letter of such change. The letter must be signed by the agency official
October 25, 2019 48
The most important responsibility of the HBA is to ensure that NYBEAS Personal Information is accurate and up to date for all of their enrollees and dependents. NAMES ARE CORRECT; First and Last Name (should match what is on file with SSA) If you have the name as “Cindy” and SSA has the name as “Cynthia” you need to update your records to match SSA DATES OF BIRTH AND SSNS ARE CORRECT; this information in NYBEAS should match that on file with the SSA ADDRESSES ARE UPDATED; If enrollee has a P.O Box, a permanent/residential address must also be listed on NYBEAS
October 25, 2019 49
JOB INFORMATION IS CORRECT NYBEAS records for eligible employees, regardless of enrollment status, should have accurate Job information.
Administration
from Leave of Absence, Retirements, Rehires, and Job Terminations
October 25, 2019 50
MEDICARE PRIMACY IS UPDATED HBAs are responsible for updating Medicare ID Numbers and Medicare Primacy Indicators in NYBEAS for enrollees and dependents with Medicare-primary coverage To update Medicare primacy and Medicare primary billing, you must process a Medicare Change transaction. (If an employee or enrollees dependent is already 65 at retirement, you must process a Medicare transaction immediately following the retirement transaction)
October 25, 2019 51
When Is Medicare Primary for Members Ages 65 and over?
NYBEAS programming will attempt to automatically process a Medicare change for members who are already enrolled as a retiree, vestee or survivor when the auto meds are processed. (auto meds are processed 3-4 months prior to age 65), For the process to work, the following information must match:
match the information on file with the Centers of Medicare and Medicaid Services If the above information does not match, the enrollee or dependent’s Medicare will reject and not be updated programmatically. When this
by letter
October 25, 2019 52
When is Medicare is Primary for Members Ages 65 and over?
It is the Agency HBA’s responsibility to process Medicare for Retiree, Vestees and Survivors who are already Medicare eligible at time of being enrolled as Retired, Vested, or as a Survivor:
Retirement , Vestee enrollment, or Survivor enrollment transaction is done when the enrollee and/or dependent is eligible for Medicare
October 25, 2019 53
For Benefit Programs PR7, PF7, PV7, PR9, PS7, PS9, PV9 Medicare Part A Enrollment Date Medicare Primacy Date
Before Benefit Program Change Date Process Medicare Primary As Of The Benefit Program Change Date After Benefit Program Change Date Process Medicare Primary As Of The Medicare Part A Enrollment Date Equal to the Benefit Program Change Date Process Medicare Primary As Of The Benefit Program Change/Medicare Part A Enrollment Date
Medicare-eligible due to End-Stage Renal Disease are the exception to these rules.
October 25, 2019 54
Medicare Primacy and Active Enrollees and Dependents
Benefit Program Age Over 65 Under 65 Active Benefit Programs- PA7, PA9 Domestic Partners-First of the month when member turns age 65, or the first of the previous month if member is born on the first day of the month Domestic Partners under age 65 of Active enrollees are plan-primary Active Benefit Programs- PA7, PA9 All other enrollees and dependents are plan-primary, regardless of age, with the exception of members who are Medicare-primary due to End-Stage Renal Disease*
*If you have an enrollee who is becoming Medicare-eligible due to End-Stage Renal Disease, please call the HBA Helpline. Our representatives will review the member’s file with UnitedHealthCare to determine the member’s date of Medicare primacy.
October 25, 2019 55
October 25, 2019 56 Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.
Presenter- Kara Hillicoss New York State Department of Civil Service Employee Benefits Division
October 25, 2019 57
Agencies that participate in NYSHIP are sent a bill each month Bills are run on the first Friday of the Month Reconciliations should be run on the Monday following the first Friday
October 25, 2019 58
1. The Billing Statement – The Bill produced and mailed around the 15th of each month showing current charges and balances (if any) from a previous month. 2. The Transaction Listing – Mailed with the bill. A summary listing all transactions produced that were processed the previous month. 3. Reconciliation - A current summary of all enrollments ( Agency must run the report from NYBEAS, save to Excel)
October 25, 2019 59
October 25, 2019 60
October 25, 2019 61
October 25, 2019 62
62
October 25, 2019 63
October 25, 2019 64
64
October 25, 2019 65
65
October 25, 2019 66
66
October 25, 2019 67
67
October 25, 2019 68
October 25, 2019 69
69
October 25, 2019 70 70
October 25, 2019 71
71
October 25, 2019 72
October 25, 2019 73
Agencies need to run their reconciliations on the Monday following the First Friday (Date the bill is produced) This is the only way to ensure that no NYBEAS activity/transaction processing took place between the time the bill was run and the date the reconciliation was done. If you wait, transactions will show on the reconciliation that are not on the bill causing the information to not match. First Friday Monday Billing is run Run your Reconciliation
October 25, 2019 74
October 25, 2019 75
October 25, 2019 76
76
October 25, 2019 77
October 25, 2019 78 78
October 25, 2019 79
79
October 25, 2019 80
October 25, 2019 81
81
October 25, 2019 82
82
October 25, 2019 83
83
October 25, 2019 84
84
October 25, 2019 85
85
October 25, 2019 86
October 25, 2019 87
October 25, 2019 88
– On the Road with The Empire Plan for PAs, February 2019 – Medicare & NYSHIP for PAs, May 2019 – 2019 Participating Provider Postcard (to order a printed copy) – 2019 Participating Provider Directories – 2019 General Information Book for PAs – 2019 Creditable Coverage Notice – Child Health Insurance Program (CHIP) Notice for 2019
October 25, 2019 89
– October 2019 Empire Plan Reports for PA Empire Plan and Excelsior Plan Enrollee mailing will also include: 2020 copayment cards and the new publication Reporting On Mental Health and Substance Abuse Program. (Note: The 2020 SBC reminder is included in the EPRs so there will be no SBC postcards mailed this year.) – 2020 At A Glance for The Empire Plan and the Excelsior Plan Enrollee mailing will also include: 2020 versions of The Empire Plan Advanced Flexible Formulary or Excelsior Formulary, Out
Coverage Chart, and the Nondiscrimination Notice.
October 25, 2019 90
– Empire Plan Certificate for PA Empire Plan – Excelsior Plan Certificate
October 25, 2019 91
October 25, 2019 92
October 25, 2019 93
October 25, 2019 94
Before Calling EBD – Have NYBEAS open – Check NYBEAS Update History for recently processed transactions – Have SSN/Employee ID available Billing Inquiries – Be sure to run a reconciliation every Monday following the first Friday (billing is run the first Friday of every month) – Send full payment that is reflected on your billing statement. Don’t make adjustments even though changes may have been made resulting in a credit that would affect future bill. Credit adjustments will be reflected for transactions that were processed in the next billing cycle
October 25, 2019 95
When receiving inquiries from your employees and retirees; – Assist your enrollees
EBD
– If inquiry concerns a medical bill or problem receiving services, check NYBEAS for enrollment status
Plan 877-769-7447
– HBAs should be calling EBD on behalf of their enrollees; not referring them to EBD
October 25, 2019 96
Email requests for GASB and compliance information Pelu@cs.ny.gov
October 25, 2019 97
October 25, 2019 98
Tim’s reminder: when sending corrections, make sure you obtain and maintain the documentation required for the change and check your worklist to confirm what was done as further processing may be needed
October 25, 2019 99
Amanda’s reminder: Please be sure to periodically check for recently issued memo’s and updates on HBA
October 25, 2019 100
Remember to have your enrollee’s SSN or Alt ID ready to provide before calling ☺
October 25, 2019 101
Melissa wants to remind everyone to make sure you are signed into NYBEAS before calling for processing help
October 25, 2019 102
Remember to mark you calendars to run your agency reconciliation every month on Mondays following the first Friday ☺
October 25, 2019 103
October 25, 2019 104
EBD Contact for HBAs Phone: 518-474-2780 Address: NYS Department of Civil Service Employee Benefits Division Albany, NY 12239 Fax: 518-485-5590 Website: www.cs.ny.gov