affect their service to members, access to doctors, or current benefit levels,” said PEF health program analyst Deborah Stayman. She added, however, it’s not possible to predict how the conversion would affect future premiums.

State Insurance Superintendent Eric R. Dinallo, who will make the decision, held public hearings on the request in Albany and New York City in late January. That testimony is posted online at
www.ins.state.ny.us.

PEF, which has not taken a position on the application, will continue to monitor the conversion review process.

For more information about the conversion, call 1-877-444-6506, visit the GHI Web site at www.ghi.com or go to the Insurance Department Web site listed above.
                                      – Sherry Halbrook
Claims submitted after the deadline will be rejected. The carriers will only reconsider their denial of these claims if you provide documentation indicating it was not reasonably possible for you to meet the deadline (for example, due to illness).

Ask your agency Health Benefits Administrator for claim forms, or call the Empire Plan toll-free at 1-877-7NYSHIP (1-877-769-7447). Or just download the forms from the state Department of Civil Service Web site, http://www.cs.state.ny.us/ebd/. Click on “Using Your Benefits” then “Forms.”

Mail completed claim forms with supporting bills, receipts and, if applicable, a Medicare Summary Notice or statement from your other primary insurer to:
• United HealthCare
P.O. Box 1600
Kingston, New York 12402-1600;

• ValueOptions
P.O. Box 778
Troy, New York 12181-0778; or

• The Empire Plan Prescription
Drug Program
P.O. Box 52071
Phoenix, AZ 85072-2071

The Communicator Home Page
If you are in the Empire Plan and want to continue using these drugs, the less expensive option is to buy them over the counter in their generic form – cetirizine. If you are enrolled in the Health Care Spending Account, you can reimburse yourself for their purchase as over-the-counter drugs.
                                    – Deborah Stayman
Empire Plan enrollees take note: Time is running out for filing claims for covered medical services received in 2007.

March 31 is the last day to submit your 2007 claims to:

• United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;

• ValueOptions for non-network mental health and substance abuse services; and

• Caremark for prescriptions filled in 2007 at non-participating pharmacies or without using your Empire Plan Benefit Card.

If the Empire Plan is your secondary insurer, you must submit claims by March 31, or within 90 days after your primary health insurance plan processes your claim, whichever is later.

If you are covered under the Empire Plan as both an enrollee and as a dependent, you may submit secondary claims to the Empire Plan for expenses not reimbursed under your primary coverage – such as copayments (including prescription drug copayments), deductibles and coinsurance amounts.
Since the asthma drugs Zyrtec and Zyrtec-D (generic name cetirizine) became available January 24 without a prescription, they ceased to be covered as prescription drugs under the Empire Plan on January 25.
By SHERRY HALBROOK
If you get a letter from a company called Healthcare Recoveries Inc. (HRI) asking about a medical claim you have made for benefits under the Empire Plan, it’s OK to answer it.

Answering won’t delay or reduce the payment of your claim, and it might save the Empire Plan money and help reduce premiums for all Empire Plan enrollees.
Here’s how it works.

If you or one of your covered dependents is injured, another person or their insurance company may be legally responsible for your resulting medical expenses, not the Empire Plan. Common examples are a motor-vehicle accident or a medical-malpractice judgement that includes payment of an injured party’s medical expenses.

The Empire Plan is “subrogated” to your legal claims. That means the Empire Plan carriers go ahead and pay your claims, but  they also “stand in your shoes” and can
If you work for New York state, you may have received a letter in January notifying you that two not-for-profit HMOs offered through the NYS Health Insurance Program – HIP and GHI HMO – have applied to convert to for-profit status.

They applied through their new parent company, Emblem Health Inc., to the state Insurance Department for approval to convert, claiming it would enable them to raise capital for expansion and improvements they must make to remain competitive.

Empire Plan enrollees receive managed mental health and substance abuse benefits from GHI/Value Options. And all enrollees in the NYS Health Insurance Program receive dental benefits through the GHI Preferred Plan.

“We don’t expect the conversion of HIP and/or GHI to for-profit status to negatively
Empire Plan not covering Zyrtec (Story 3 of 4)
’07 Empire Plan claims due March 31 (Story 4)
Why is this ‘nosy’ company asking about my accident? (Story 2 of 4)
State Insurance Department weighs GHI/HIP conversion to for-profit (Story 1 of 4)
make claims against the third party.

The law requires the Empire Plan carriers to seek repayment for claims they have paid for treatment of your injuries, but that are more properly the responsibility of another carrier, such as an automobile insurer.

The Empire Plan hospital and medical carriers (Empire Blue Cross and Blue Shield and United HealthCare) contract with HRI to administer the Empire Plan’s subrogation provision, including certain recovery efforts.

So, if the Empire Plan has paid claims on your behalf that might be the liability of a third party, HRI may send you a letter asking for information about those claims.

“If you receive a letter from HRI, please answer its questions, even if you think no one else is responsible for your claim,” said PEF health benefit specialist Lorraine Simpkins. “It won’t cost you anything, and it helps hold Empire Plan premiums down for everyone.