Empire Plan changes coming January 1, 2006

If you’re in the state’s Empire Plan, look for several benefit changes, authorized in the 2003-2007 PS&T contract, to start January 1, 2007.

In addition to changes in some co-payment amounts (See chart at right). the following two changes will be made to the Basic Medical Program:

• The annual deductible for medical services performed and supplies prescribed by non-participating providers will increase from $322 to $335; and

• If your expenses under the Basic Medical Program exceed $1,610 (up from $1,548), the plan will pay 100 percent of the total charge or the “reasonable and customary” charge, whichever is less.

These changes result from a 4 percent hike in the medical component of the Consumer Price Index for Workers (CPI-W) for the period July 1, 2005, through June 30, 2006.
— Lorraine Simpkins

New Empire Plan program offers info, screening for depression

A new program was launched in October to help Empire Plan members who are being treated for or are experiencing signs of depression.

ValueOptions, which manages the Empire Plan Mental Health and Substance Abuse Program, began offering “Depression Identification and Management,” which provides educational information on depression, including a workbook, information about medications, and help accessing treatment options.

The program also offers free depression screening.

To learn more about the program visit www.valueoptions.co online, click on “For Members” and then on “Education.” Or you may call ValueOptions toll-free at 877-7NYSHIP (877-769-7447) and choose option 3. The program is confidential and participation is voluntary.
— Lorraine Simpkins

Nov. deadlines for ’07 benefits decisions

• November 10 — Deadline for enrolling in the Health Care Spending Account (HCSAccount). The HCSAccount saves you money by allowing you to set aside up to $4,000 ($100 minimum) in pre-tax salary to pay for health care expenses that are not reimbursed by health insurance or other benefit plans. Apply for enrollment online at www.flexspend.state.ny.us or by phone at 1-800-358-7202.

• November 24 — Deadline for electing to participate in the Productivity Enhancement Program (PEP) for 2007. Eligible full- and part-time employees may exchange previously accrued vacation credits and/or personal leave for a credit of up to $400 to be applied toward their health insurance premium.

• November 30 — Deadline to change your Pre-Tax Contribution Program (PTCP) status. The PTCP allows you to have your health insurance premiums deducted from your pay before taxes are withheld. This lowers your taxable income and gives you more spendable income. If you participate in the PTCP, you may not make the following changes during the year without a qualifying event: change from family to individual coverage while at least one dependent remains eligible; and voluntarily cancel your coverage.

• To be announced — Deadline for changing your health plan option. Rates for 2007 have not been set. PS&T employees are entitled to 30 days from the date rates are delivered to the agencies to change their health plan option. No action is required if you do not wish to change health plans.
— Lorraine Simpkins

HMO options narrowed for 2007

By LORRAINE SIMPKINS
A few changes are in store next year for HMO enrollees, including some retirees.

After reviewing the HMOs’ proposals for participation in the NYS Health Insurance Program next year, the NYS Joint Labor-Management Committees on Health Benefits (JLMC) announced the following changes:

• Aetna will not be permitted to enroll state employees or retirees as new members or transfers in 2007 because for the second consecutive year, Aetna failed to submit a proposal that satisfied the specified requirements for HMOs participating in NYSHIP.

The restriction on enrollment affects only new employees, those who were not eligible in 2006 and those who wish to transfer from another plan. Most current Aetna members may continue with it or switch plans. The exception will be members living in Pennsylvania and currently enrolled in Aetna there;

• The NYSHIP-approved service area for Aetna will no longer include any of Pennsylvania; and

• The merger of Vytra with HIP means Vytra members also must choose a different option for 2007. The state Department of Civil Service will notify current Vytra members of that need. If they don’t choose another HMO, they will automatically be enrolled in the Empire Plan.

Watch your mail for information on any changes to HMO benefits or premium contributions.

If you are enrolled in an HMO that will be making a benefit change for the year 2007, you will be sent a side-by-side benefit comparison. HMOs making benefit changes are: Aetna, Blue Choice, CDPHP, HMO Blue, Preferred Care and Univera.

Premium rate information for the year 2007 should become available in November. When you receive it, carefully review the rate flyer because HMO premium contributions may increase significantly from one year to the next.