Dispute arises over new Opt-out Program
By LORRAINE SIMPKINS
A disagreement has arisen between PEF and the state over a health-benefit enhancement in the recently ratified 2011-2015 PS&T Contract.
The Health Insurance Enrollment Opt-out Program is a new enrollment option for PEF-represented state employees who are eligible for coverage in the state Health Insurance Program (NYSHIP).
Effective January 1, 2012, eligible employees who have other health insurance coverage may opt out of their NYSHIP coverage in exchange for an annual incentive payment of $1,000 for individual coverage or $3,000 for family coverage.
To be eligible for the Opt-out Program: the employee must be enrolled in NYSHIP before April 1 of the previous plan year and throughout that plan year; and the employee must be able to demonstrate and attest to having other health insurance coverage.
During bargaining, PEF did not agree to any restrictions or limitations on what is meant by other coverage, including when the other coverage is NYSHIP coverage provided through a spouse’s state employment.
Dual NYSHIP coverage
For many years, all of the NYS labor agreements, including those with PEF, have prohibited couples who are both state employees from having two family enrollments.
Simply switching the family enrollment from one spouse to the other will not qualify either of them for the Opt-out Program.
However, PEF contends one of them could qualify for the individual opt-out incentive if: one of the spouses enrolls in individual coverage while the other enrolls in family coverage; and those coverages are effective before April 1 and continue into the December Option Transfer period when the employee opts out of individual coverage to be covered by the spouse’s family coverage.
How do you define ‘other?’
Based on the information in the November 2011 Planning for Option Transfer flyer, it appears the state is interpreting “other” coverage differently than PEF. The state contends the PEF-represented state employee’s other coverage cannot be NYSHIP coverage provided through their spouse’s employment with the state.
This interpretation effectively prohibits a PEF-represented state employee married to another state employee, both of whom may be enrolled in NYSHIP, from meeting the eligibility requirements for the Opt-out Program.
What now?
PEF intends to ensure the contract is implemented as it was negotiated. If PEF’s attempts to resolve this dispute informally are unsuccessful, the union’s Contract Administration Department will file a class-action contract grievance to challenge the state’s interpretation of Article 9.2(j).
As more information becomes available, it will be posted on the PEF website.
MORE HEALTH NOTES STORIES
State going back to Davis Vision
Federal health reform brings co-pay relief
Dispute arises over new Opt-out Program
It’s the law: Parity for mental health, substance abuse benefits
Negotiated Changes to Health Benefits
The Communicator Letters policy
We welcome letters to the editor about union issues and events relevant to PEF's diverse membership. All letters are subject to editing for space, fairness and good taste.
Please keep them brief (up to one page, double-spaced or a maximum of 250 words), and please include your name and phone number for verification.
Send letters to thecommunicator@pef.org:
The Communicator
Public Employees Federation
P.O. Box 12414
Albany, N.Y. 12212-2414
Email to Sherry Halbrook, Editor or Darcy Wells, Editor-In Chief