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Grievance
focuses on vision care By SHERRY HALBROOK In response to complaints from its members, PEF filed a grievance asserting that the state has diminished PS&T members’ vision care benefits by changing the paid-in-full benefit for eyeglass frames from a collection of frames to an allowance of $100. On March 27, the Governor’s Office of Employee Relations denied the grievance. PEF responded that it will take the case to arbitration. Meanwhile, members are advised to consider how their benefit has changed and adapt their strategy for using it. Last year, the state Department of Civil Service awarded EyeMed Vision Care the contract for vision care effective January 1, 2007. The contract was previously held for decades by Davis Vision, which also operates Empire Vision Centers. Shortly after the new arrangement took effect, PEF members began reporting that their choice of paid-in-full frames was narrower at an EyeMed in-network provider than it had previously been under Davis Vision. Members said it cost them more out-of-pocket to purchase eyeglasses that met their expectations. Davis Vision offered a collection of frames for which there was a paid-in-full benefit. Or, you could choose from a collection of higher priced frames and pay a fixed, reduced fee, which was $22.74 last year. If you selected a frame that was not from either of these collections, your allowance was reduced to $16 and you paid the remaining retail cost. However, EyeMed allows you a $100 allowance to apply to the retail cost of any frame offered by an in-network provider. If you choose a frame that costs more than $100, you receive a 20 percent discount on the balance. So, you pay 80 percent of the retail cost exceeding $100. Davis Vision required all in-network providers to offer the same collections of frames. EyeMed, on the other hand, allows its in-network providers to decide which frames to offer. The selection of frames varies from one in-network provider location to another, as does the number of frames that cost $100 or less. Return policies and eyeglass warranties also differ between Davis Vision and EyeMed. Davis Vision provided a 30-day return policy on all plan-covered eyeglasses purchased at an in-network provider location, and a one-year unconditional warranty against defect or breakage. Return policies and eyeglass warranties vary among EyeMed in-network providers. “Because, for years, our members had no incentive to shop around, these changes have been a shock,” said PEF health benefits specialist Lorraine Simpkins. “Now, given the differences in the selection of frames and the return policies and eyeglass warranties, we encourage you to shop around before scheduling an appointment with an in-network vision care provider. Visit the different stores in the EyeMed network to see which ones offer frames that you like and that are within your budget. Ask about the store’s return policy and eyewear warranties. By comparison shopping, you are likely to be more satisfied with your eyewear purchase and may save yourself some money in the process.” Through the Upgrade Program, you may upgrade certain eyeglass lens options and coatings at fixed, reduced prices at in-network vision care providers. For most of these enhancements, the EyeMed discounted fee is lower than the Davis Vision fee. However, “premium” coatings or options that are not covered in the Upgrade Program can add considerable cost. Immunizations up to date? Are your child’s immunizations, including HPV, meningitis and hepatitis, up-to-date? The Empire Plan covers Gardasil and the meningitis vaccine as pediatric vaccines for dependents up to age 19. Full-time dependent students ages 19 to 25 are eligible for vaccine coverage only through participating providers. |
Act now to keep students
covered By LORRAINE SIMPKINS If you have a child who is age 19 or older enrolled in the NYS Health Insurance Program (NYSHIP), you may need to act quickly to ensure he or she remains eligible for coverage. If you are a NYSHIP enrollee, your unmarried dependent children who are 19 or older, but less than 25, are eligible for coverage if they are full-time students at an accredited educational institution and are otherwise not eligible for employer group or military health care coverage (e.g., cadets at U.S. military academies). They continue to be eligible until the earlier of the following dates: the end of the third month following the month in which they complete course requirements for graduation; or they reach age 25. Students who want to continue health insurance coverage during the summer must have been enrolled in the previous spring semester and must be enrolled as full-time students for the fall semester. If a dependent child who was a full-time student in the spring semester does not enroll as a full-time student for the fall semester, coverage under the parent’s policy will end on the last day of the month in which the student was a full-time student attending classes. If you want your child to continue to be covered without interruption, you must act quickly in one of two ways: • Continue coverage in NYSHIP under COBRA (federal Consolidated Omnibus Budget Reconciliation Act); or • Convert to a direct-pay contract. Get covered under COBRA Under COBRA, you have 60 days after coverage ends to notify the Employee Benefits Division of the state Department of Civil Service of a child losing NYSHIP eligibility. To obtain a COBRA election form, send a written request to: NYS Dept. of Civil Service Employee Benefits Division Attn.: COBRA Unit Alfred E. Smith State Office Building 80 South Swan Street Albany, NY 12239 Include your Social Security number, the dependent’s name, the reason for the request, the date coverage ended, and a telephone number where you can be reached during the workday. Your child may continue under COBRA the same benefits you receive as an active employee enrolled in NYSHIP for up to 36 months. The cost of COBRA coverage is the full premium (both the employer and employee share) plus a 2 percent administrative fee. If your child is seeking admission to a school over the summer, but has not yet been accepted, coverage should be continued through COBRA. Once your child’s enrolled for the fall semester, his or her dependent student status will be reinstated back to the date he or she lost eligibility and the COBRA premium you paid during the interim will be refunded. Or pay directly for coverage Children losing eligibility under their parent’s NYSHIP coverage can convert to direct-pay contracts. Notification procedures and application deadlines vary among the NYSHIP health care plans. The benefit package for direct-pay conversion contracts may differ from what your child had under NYSHIP. To obtain premium information, contact the carrier or HMO directly. Additional information concerning COBRA and direct-pay conversion contracts is in the NYSHIP General Information Book for Empire Plan enrollees dated June 1, 2002, and in the NYSHIP General Information Book for HMO Enrollees dated March 1, 2002, as well as in documents communicating changes made since then. You may also contact your agency health benefits administrator, who is usually located in your personnel office, for assistance. |
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