HMO
applied wrong rule for covering disabled kids
If you have a disabled child and you are enrolled in the
Capital District Physicians’ Health Plan, also
called CDPHP, you may have been improperly required to
submit proof of your child’s financial dependence on
you.
Empire Plan insurers and HMOs participating in the New
York State Health Insurance Program (NYSHIP) must accept
all individuals determined by the NYS Department of Civil
Service to be eligible.
The enrollee’s own, legally adopted, or dependent
stepchildren who are unmarried, age 19 or older, who are
incapable of self-support because of a mental or physical
disability incurred before termination of enrollment in
NYSHIP are eligible.
However, CDPHP was requiring all NYSHIP enrollees with
disabled children to provide documentation — such as
a copy of the enrollee’s federal income tax return
listing the child as a dependent — that these
children were dependent on the enrollees for support and
maintenance.
CDPHP should not have required proof of financial
dependency for an enrollee’s own, legally adopted,
or dependent stepchildren. CDPHP should have requested
this documentation only for “other” children,
such as foster children or grandchildren living with the
enrollee.
The state Department of Civil Service has asked CDPHP to
identify any disabled child who may have been denied
coverage in error.
If you are enrolled in CDPHP or other HMO and believe you
have been incorrectly denied coverage for your disabled
child, you may call PEF health benefits specialist Lorraine Simpkins at (518) 785-1900 or 1-800-342-4306, ext.
283 for help clarifying this issue. — Sherry
Halbrook
Meningitis vaccine recommended for
college students in dorms
Hefty fines, prison time for
violators
New federal law aims to guard your privacy
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Lawmakers override all 119
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Set state safety, security
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Thank your legislators
Departments
President's Message:Our work
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You Said It: Member's
letters this month
PS&T Contract Update:
Pay hikes hot topic
Member Highlights;Keeping up
the good fight
Retirees In Action: New
officers take the reins
PEF Membership Benefits
Program & Travel Corp
Nurses' Station:
- Derail unsafe staffing, put
laws on the fast track
- Roswell Park honors nurses
- Nurses conference addresses
timely topics
Legislative Action:
- Union presses lawmakers on
contracting out
- Legislature passes 11 bills
PEF supports
- Don’t let feds
shortchange NY
Health Benefits:
- Feds aim to guard your
privacy
- College students need shot
in arm
- HMO applied wrong rule for
disabled kids
Union Matters
PEF, OASAS train workers for
emergencies
EAP Coordinator earns
Quality Service Award
Making state park system a
summer delight
Pre-Tax Transit pilot put on
hold
Balloting brings 13
newcomers to E-Board
Convention 2003: Delegate
preview
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