You have a lot on the line if you are in the state Health Insurance Program (NYSHIP) and have covered dependents.
You soon will receive two mailings from the program, which is conducting a two-part audit to ensure only eligible dependents are covered.
“It’s very important for you to carefully read and respond to these mailings as requested in a timely manner,” said PEF Director of Contract Administration Robert Carrothers.
The audit will cover all enrollees in NYSHIP who have covered dependents, including both those with coverage through the Empire Plan and those covered by HMOs.
“When ineligible dependents are covered, that needlessly drives up the cost of coverage and the premiums for everyone,” Carrothers said. “Costs escalate fast enough. Our members cannot and should not pay increased costs because ineligible people are enrolled in the health insurance plan.”
The state has contracted with Budco, a Michigan-based firm, to perform this audit. Budco expects to identify and remove about 40,000 ineligible covered dependents.
The audit, called the Dependent Eligibility Verification Project, will have two phases.
The first is a “Special Amnesty Period” from April 14 to June 12.
“This is your chance to voluntarily identify without penalty any ineligible dependents you have who are covered,” Carrothers said.
During the Special Amnesty Period, any dependents you voluntarily identify as ineligible will be removed from coverage effective June 13, 2009, and NYSHIP is barred by state Civil Service Law from demanding that you repay any benefits received inappropriately. You will also be protected from lawsuit, prosecution or discipline as a result of this improper coverage.
NYSHIP is sending you the list of your covered dependents and a worksheet to help you verify if they are eligible for coverage.
“Be sure to read the material and respond carefully before June 12 if you find any of your covered dependents are ineligible,” Carrothers said.
The second phase of the audit begins July 6 and ends August 28. During this “Eligibility Verification Period,” you will be asked to submit documentation to verify the continuing eligibility of all your covered dependents who were not removed during the amnesty period.
You will receive a list of your remaining covered dependents and another worksheet along with a full list of documents you must provide that are sufficient to establish each dependent’s eligibility.
“Again, it is extremely important that all enrollees with family coverage respond fully and accurately during this final verification phase,” Carrothers said. “If you fail to fully document a dependent’s eligibility by August 28, that dependent will likely lose coverage, you may be required to repay any claims that were paid for them (possibly going back to when they were first covered), and you could face lawsuit, prosecution and/or discipline.”
For more information, go online to www.cs.state.ny.us/nyshipeligibility project/overview.cfm or call Budco at 1-888-358-2196 weekdays between noon and 8 p.m.
