Need help acclimating to new health plan? Don't sweat it
By LORRAINE SIMPKINS
The annual option-transfer period in which state employees can change their health plan
option ended December 31, 1998. If you changed to another health plan, your coverage with
the new plan began on that date for institutional-payroll employees, or January 7, 1999 if
you are on the state's administrative payroll.
During the option-transfer period, many PS&T employees contacted PEF's Health Benefits
staff with questions. Here are answers to some of the most frequently asked questions:
Q Why
didn't I receive the "Rates & Deadlines" flyer until December?
A The
state Division of Budget did not approve the rates until November 20. Printing of the
flyer did not begin until the week after Thanksgiving. The flyer was distributed to
state-agency personnel offices on December 1. The PS&T contract requires the state to
extend the option-transfer period a minimum of 30 calendar days beyond the date the rate
information is distributed to the agencies. The deadline was, therefore, set at December
31.
Q The
premium rates for my HMO went up significantly. Why?
A Two
factors contribute to higher premium contributions.
The first is the HMO increased its premium rate from 1998 to 1999. For the specific
reasons, contact your HMO directly. The reasons most frequently given are:
· HMOs want to stop financial losses or increase profits;
· The rising cost of prescription drugs; and
· Decreases in the reimbursement amounts received from Medicare.
The second factor is the formula used by the state to calculate your HMO premium
contribution. The state pays 90 percent of the cost of individual coverage, and 75 percent
of the additional cost for dependent coverage toward the non-prescription-drug components
of the premium, not to exceed 100 percent of its dollar contribution for those components
under the Empire Plan.
You must pay any portion of the premium that exceeds this cap.
Of the 24 HMO options available to PS&T employees, 13 HMOs exceeded the cap for
individual coverage and 21 HMOs exceeded the cap for family coverage. The amount over the
cap ranged from a low of 68 cents to a high of $55.75.
Q Why are
the rates for PS&T employees higher than for employees represented by the Civil
Service Employees Association?
A
PS&T rates are higher because you are contributing toward the cost of
prescription-drug coverage. You receive your prescription-drug coverage through your
health plan, and your benefits differ depending on which health plan you choose.
However, CSEA members receive their prescription-drug benefits through the CSEA Employee
Benefit Fund, which is a freestanding program separate and apart from their health plan.
Q I've
switched from an HMO to the Empire Plan. When I went to get a prescription filled, I was
told my cost would be more than the $8 copayment I expected. Why?
A There
is more than one reason why this could happen. You should contact ValueRx, the
administrator of the Empire Plan Prescription Drug Program, at 1-800-964-1888. When using
the program for the first time, be sure to advise your pharmacist that you are now in the
Empire Plan, and present your New York Government Employee Benefit Card.
PS&T employees who have changed plans should carefully read the informational
materials describing their new HMO or the Empire Plan. The HMOs will send this material
directly to you. You should contact your personnel office for the Empire Plan Certificate
and subsequent addenda.
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