2019 Annual Webinar for Participating Agencies€¦ · Role of the Health Benefits Administrator...

October 25, 2019 1

Prepared for use by the Department of Civil Service, Employee Benefits Division representatives only.

2019 Annual Webinar for

Participating Agencies

New York State Department of Civil Service

Employee Benefits Division

October 25, 2019 2

Welcome to the 2019 PA Annual Webinar For Participating Agencies

Message from Director;

James DeWan518-473-1977

[email protected]

2

Thank you!Please Review HBA Online for

Information

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• Financial Update

• Benefit Changes

• Federal Health Care Reform Update

• Benefit Administration

• Questions & Answers

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Agenda

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Ron Kuiken – Assistant Director of Financial Management

Financial Update

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Financial Update

Presenter- Ron Kuiken, Assistant Director, Financial Services



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Topics

• Projected 2019 Empire Plan Experience

• Projected 2020 Rate Renewal Information

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Projected Year 2019 Empire Plan

Experience1 (000’s)

Blue Cross

Hospital

UHC

Medical

Beacon

MHSA

CVS

Drug Total

Premium $3,383,025 $3,440,819 $292,902 $1,883,182 $8,999,928

Incurred Claims $3,323,973 $3,262,291 $261,079 $1,701,271 $8,548,614

Administrative

Expense $95,067 $199,671 $15,580 $27,835 $338,153

Gain/(Loss) ($36,015) ($21,143) $16,243 $154,076 $113,161

(1) 2020 Rate Renewal Submissions

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2020 Rate Renewal

• Projected Net Premium increase: 1.5%

• Empire Plan Program Trends:

• Hospital Program – 7.4%

• Medical Program – 5.4%

• Mental Health & Substance Abuse Program – 10.9%

• Prescription Drug Program – 8.9%

• Rate Includes 0% margin

• $400 Million Dividend Application

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Projected Dividends

All Payors (in Millions)

Dividends

Available as of 12/31/18 $261.5

2018/2019 Earned + $465.7

2019 Projected Applied - $150.0

Projected Available 12/31/19 $577.2

2019/2020 Projected Earned + $144.2

2020 Projected Applied - $400.0

Projected Available as of 12/31/20 $321.4

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Questions?

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MaryEllen

Benefit Changes for 2020

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Benefit Update

Presenter: Diana ValenchisContract Manager, Vendor Management Unit



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The Empire Plan Rx ProgramBenefit Changes for 2020

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• Effective January 1, 2020, enrollees and dependents of NYS Participating

Agencies (PAs) will utilize the Empire Plan Advanced Flexible Formulary.

• Like the Flexible Formulary used now, the Advanced Flexible Formulary

displays the most commonly utilized medications and displays excluded

medications and preferred alternatives. This formulary will be used by almost

90% of The Empire Plan enrollees and dependents.

• The Formulary is reviewed annually with The Empire Plan Rx administrator,

CVS Caremark.

• Formulary changes will impact approximately 2.21% of utilizers:

✓ Drugs moving to the Excluded Drug List will affect approximately 1.74% of

utilizers.

✓ Drugs moving to a higher tier will affect approximately .01% of utilizers.

✓ Drugs moving to a lower tier will affect approximately .46% of utilizers.

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The Empire Plan Rx ProgramCopayment Changes

• Copayment amounts for Level 1 drugs

(most Generic drugs) will remain the same.

• Copayment increases for Level 2

(Preferred) and Level 3 (Non- Preferred)

drugs will occur.

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Prescription Drug Copayments

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The Empire Plan Prescription Drug Copayments

Drug Category

Up to a 30-Day Supply 31-to-90-Day Supply

Network Retail Pharmacy,

Mail Service Pharmacy or Specialty Pharmacy

Network Retail PharmacyMail Service Pharmacy or

Specialty Pharmacy

Current Effective

Jan. 1, 2020Current

Effective

Jan. 1, 2020Current

Effective

Jan. 1, 2020

Level 1 -

Most Generic Drugs$5

$5

(no change)$10

$10

(no change)$5

$5

(no change)

Level 2 -

Preferred Drugs or

Compound Drugs

$25 $30 $50 $60 $50 $55

Level 3 -

Non-Preferred Drugs$45 $60 $90 $120 $90 $110

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Questions?

October 25, 2019 17

Federal Health Care Reform Update

Presenter – Lauren Leadley

Policy Analysis and Strategic Planning Unit

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PA & PE PPACA Requirements

• The "individual mandate" penalty was reduced to $0 for 2019, but

employer reporting requirements remain in effect

• Employer Shared Responsibility provisions, commonly known as the

“employer mandate”

• Reporting Requirements to which Empire and Excelsior Plan

employers must adhere

• Dependent Social Security Number solicitation

• IRS Penalty Letters regarding compliance with the employer mandate

• Each employer is responsible for their own compliance!

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Employer Shared Responsibility Provisions

• “Employer Mandate”

• Large employers must offer affordable and comprehensive health

insurance benefits to 95% of full-time employees

• Failure to comply could result in severe federal penalties

• Who is a “large employer”?

• Employers with 50 or more employees meeting PPACA's full-time

criteria

• For reporting purposes, employee count is the number of full-time

employees who worked during the preceding calendar year

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Reporting Requirements

• All NYSHIP employers are subject to PPACA reporting requirements

• Including those not designated as “Large Employers”

• Employers must provide a form, known as Form 1095-B or 1095-C, to

all full-time employees, retirees, vestees, dependent survivors, and

COBRA enrollees

• Employers do not have to provide forms to Medicare-primary enrollees

• These forms must be provided to employees and enrollees by 1/31/20

and to the IRS by 2/28/20 if filing on paper and 4/1/20 if filing

electronically

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What Form Should My Employer Use?

• Employers designated as “Large Employers” should provide Form

1095-C to its employees and enrollees

• All other employers should provide Form 1095-B to its Empire Plan

enrollees

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Dependent SSN Solicitation

• Form 1095-B and Form 1095-C use Social Security numbers to

identify enrollees

• Employers must make three “good faith efforts” to solicit missing

dependent SSNs:

1. At the time of enrollment;

2. By December 31 of the year following enrollment; and

3. Once in the following year

• NYSHIP employers still must ask for dependent SSNs upon

enrollment

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Penalty Letters

• IRS is sending penalty notices to employers

• The IRS reviews employer mandate data submitted for prior tax

years and if they suspect non-compliance they will issue the

employer a penalty notice

• Penalty letters will be addressed to the individual whose name

appears on the IRS Business Master File

• It is possible that a penalty notice will be sent to your tax and finance

department, so it is best to alert them to be on the look out

• Responses are time sensitive!

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EBD Assistance

• EBD has two downloadable reports available to assist NYSHIP

employers with these requirements

• The first report shows all enrolled dependents with a missing SSN

• The second report provides all of the information to be included in

Part III of Form 1095-C or Part IV of Form 1095-B

• HBA Memos PA15-23, PAEX15-21, PA 16-02, PA EX 16-02 provide

information on how to access these reports

• EBD FAQ: http://www.cs.ny.gov/employee-

benefits/nyship/shared/publications/faq/2015/pa-pe-ppaca-faq.pdf

http://www.cs.ny.gov/employee-benefits/nyship/shared/publications/faq/2015/pa-pe-ppaca-faq.pdf

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Questions?

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Benefits Administration

Presenters

MaryEllen Brucculeri, Public Employer Liaison Unit

Kara Hillicoss, Participating Agency Unit

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Benefits Administration Topics

• The Role and Responsibilities of the Agency Health Benefit

Administrator (HBA)

• How to Reconcile Your Bill

• Communications and Publications Update

• EBD Contacts

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Role of the Health Benefits Administrator

Each Participating Agency must designate a Health Benefits

Administrator (HBA) who is assigned the responsibility for the

administration of the NYSHIP in that agency. HBA responsibilities

include:

• Maintaining up-to-date files of health insurance records

• Ensuring that all eligible employees and retirees are properly

informed of the benefits and availability of NYSHIP

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• Determine the eligibility of employees and retirees for enrollment

in NYSHIP

• Enrolling employees and eligible dependents in NYSHIP using the

New York Benefits Eligibility and Accounting System (NYBEAS)

• Transmit timely premium payments on a monthly basis to the New

York State Department of Civil Service. Be sure to use the

remittance included with the bill if you are mailing in your payment

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• Each new employee who is eligible to enroll in NYSHIP must be

issued copies of the General Information Book and Empire Plan

Certificate and a Health Insurance Transaction form (PS503.1)

– Document that the enrollee was provided the material

• PS 503 should be returned to the HBA when:

– electing

– or declining coverage

Maintain copies of form and dep proof (when applicable) in the

enrollees’ personal files within your agency

(Please note: the .1 was removed from the PS 503 form) It is

still the same form)

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MINIMUM EMPLOYER CONTRIBUTION RATE TOWARD NYSHIP

PREMIUMS

Agencies that participate in NYSHIP are required to contribute a minimum of

50/35- 50% towards the cost of individual coverage and 35% towards the

cost of dependent coverage FOR THEIR ACTIVE AND RETIRED

ENROLLEES

The minimum 50/35 requirement does not apply to:

Dependent Survivors, Volunteer Firefighters and Ambulance Workers,

Unpaid board members, unpaid publicly elected board members, unpaid

local publicly elected officials, school board members, enrollees who are

temporarily removed from the payroll (such as on leave), and enrollees who

are covered under VESTEE or COBRA


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Publications can be ordered through HBA Online.

• General Information Book and Empire Plan Certificate

(GIB/EP)-describes the benefits available under NYSHIP. This

booklet also serves as the enrollee’s certificate under group

contract

• Participating Provider Directories

• At A Glance Booklets- provides Empire Plan and Excelsior Plan

benefit information to enrollees

• Medicare and NYSHIP- provides information to members covered

under NYSHIP and Medicare

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• Verifying the accuracy of the Health Insurance Transaction Listing

and Monthly Billing Statements

• Notifying the Employee Benefits Division of any changes to your

agency’s administration of NYSHIP

– Agencies that participate in NYSHIP are required to notify EBD in writing, of

any changes in agency policy as related to NYSHIP participation. Changes are

made within an agency administratively or by resolution.

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• Providing assistance to enrollees who have problems with claims

or other aspects of their health insurance coverage

The Employee Benefits Division does not have access to claims information.

Members with claims issues should call the Empire Plan at 1-877-769-7447.

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• Initiating/Issuing Medicare reimbursements to enrollees and

dependents who become eligible for primary benefits under

Medicare

– Agencies that participate in NYSHIP are required by § 167-a of New York

State Civil Service Law to reimburse Medicare-primary enrollees/dependents

for an amount equal to the Medicare Part B premium, including any income

related monthly adjustment amount (IRMAA).

Reimbursements can be sent at set intervals during the year and the timing is at

agency discretion.

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As an HBA, you can view your agency’s VDSA data in NYBEAS

under Benefits > CMS/RDS Data > VDSA Query Only. (Voluntary

Data Sharing agreement) You can use an enrollee’s or dependent’s

Social Security Number (SSN), their Medicare Beneficiary Identifier

(MBI) or an enrollee’s EmplID to search for someone’s VDSA

information.

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Once you access an enrollee’s information on VDSA Query Only, you

will see two panels with blue headings:

• Input/Response Data

• Input/Response Archive Data

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Medicare Dates Tab

• Displays the reason that the individual was enrolled in Medicare

(e.g. Working Aged, Disability, or End Stage Renal Disease)

• Shows Medicare Effective and Termination Dates for Parts A, B,

and D

• Includes Part D Medicare Number

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Role of the Health Benefits AdministratorInput/Response-Personal Data 2 Tab (Continuation of

Input/Response-Personal Data 1)

• Gender – I is the gender reflected in NYBEAS

• Gender – R is the gender on record from CMS

• This tab also shows the NYBEAS and CMS data for Birthdate and

Medicare ID

• CMS Date of Death reflects a reported date of death

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Health Benefits Administrators are responsible for providing enrollees

with additional NYSHIP publications and forms that apply. (you may

also refer employee to NYSHIP online where these forms are also

available)

• All Forms (listed below) and publications are available on the New

York State Department of Civil Service Website

– Form PS-503.1 Health Insurance Transaction Form

– Form PS-451 Statement of Disability

– Form PS-452 Application for Waiver of Premium

– Form PS 452I Instructions for application of Waiver of Premium

– Form PS-457 Statement of Dependence

– Form PS-425 Domestic Partner Application

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Health Benefits Administrators are responsible for providing enrollees with

information regarding their eligibility for NYSHIP following their separation of

employment.

Determine if enrollee is eligible to continue NYSHIP under one of these 3

scenarios :

1. Retired (enrolled in NYSHIP, meets employer’s minimum service

requirement and is eligible to receive their pension)

2. Vested (Enrolled in NYSHIP, meets employer’s minimum service

requirement but not yet eligible to receive their pension)

3. COBRA- Does not meet the employer’s minimum service requirement for

retiree or Vestee coverage. (May purchase NYSHIP up to 36 months under

COBRA)

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ENROLLING MEMBERS IN RETIREE COVERAGE

Agencies that offer retiree coverage (to a class or category of employees)

Under NYSHIP, a retiree is defined as an enrollee who stops working and meets the

three requirements below:

1. Is enrolled in NYSHIP at time of Separation

2. Is a member of a retirement system administered by the State of New York or one of its political

subdivisions and has met the requirements for vesting receipt of a retirement allowance;

and

3. has met the agency’s minimum service requirement for health insurance in retirement

(minimum of 5 years)

Note: Enrollment in a buyout, a PA’s alternate sponsored plan is considered Enrollment in

NYSHIP.

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ENROLLING MEMBERS IN VESTEE COVERAGE

Agencies that offer retiree coverage (to a class or category of employees) are also

required to offer coverage to vestees.

Under NYSHIP, a vestee is defined as an enrollee who terminates employment

before pension eligibility. Vestees are eligible to continue coverage under NYSHIP if

they:

1. Are enrolled in NYSHIP at time of separation

2. Are a member of a retirement system administered by the State of New York or

one of its political subdivisions

3. Met the agency’s minimum service requirement for health insurance in retirement

Note: An employer may adopt the additional policy that requires an employee to be within 5 years of

pension eligibility to Vest.

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ENROLLING MEMBERS IN VESTEE COVERAGE (Continued)

Important:

New York State Civil Service Law requires that a Vestee maintain continuous

NYSHIP coverage until eligible for a NYS pension with no lapse. This can be

done in one of three ways:

• Paying their former employer the full NYSHIP premium

• Being covered as a dependent on another NYSHIP policy;

• As an enrollee of a NYSHIP agency

Coverage must be continuous from the first date of Vestee eligibility to the

date eligible for a pension

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COBRA NOTICES AND ENROLLMENTS

Agency Health Benefit Administrators are responsible for notifying and

enrolling persons eligible for COBRA by:

1. Sending COBRA application to terminated enrollees and their

Dependents

2. Provide enrollee with a minimum of 60 days to elect COBRA

3. Process COBRA enrollment for enrollees and dependents who have

elected it

4. Collect the full NYSHIP premium (may add 2% admin fee)

October 25, 2019 46

Role of the Health Benefits AdministratorACCESSING HBA ONLINE AND NYBEAS

Agencies that participate in NYSHIP are required to have access to the New

York Benefits Eligibility and Accounting System (NYBEAS), to process

enrollment transactions related to NYSHIP participation, and HBA Online, to

receive important information and updates related to NYSHIP participation

All NYBEAS users must be HIPAA trained and compliant

Access to NYBEAS is only granted to users who have a business need to

use NYBEAS

The DAO must be the sole designated officer to permit and terminate

NYBEAS access. However, the DAO will not be able to make changes to

enrollee’s personal information in NYBEAS. That is the role of the HBA

October 25, 2019 47

UPDATING AGENCY CONTACT INFORMATION

Agencies that participate in NYSHIP are responsible for maintaining

up-to-date agency contact information

If the Chief Financial Officer, Data Access Officer, or Health Benefits

Administrator changes, The Employee Benefits Division (EBD) must

be notified by letter of such change. The letter must be signed by the

agency official


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Role of the Health Benefits AdministratorThe most important responsibility of the HBA is to ensure that

NYBEAS Personal Information is accurate and up to date for all of

their enrollees and dependents.

NAMES ARE CORRECT; First and Last Name (should match what

is on file with SSA) If you have the name as “Cindy” and SSA has the

name as “Cynthia” you need to update your records to match SSA

DATES OF BIRTH AND SSNS ARE CORRECT; this information in

NYBEAS should match that on file with the SSA

ADDRESSES ARE UPDATED; If enrollee has a P.O Box, a

permanent/residential address must also be listed on NYBEAS

October 25, 2019 49

Role of the Health Benefits AdministratorJOB INFORMATION IS CORRECT

NYBEAS records for eligible employees, regardless of enrollment

status, should have accurate Job information.

• Job information is updated in NYBEAS Workforce

Administration

• Job Information includes Hires, Leaves of Absence, Returns

from Leave of Absence, Retirements, Rehires, and Job

Terminations

October 25, 2019 50

Role of the Health Benefits AdministratorMEDICARE PRIMACY IS UPDATED

HBAs are responsible for updating Medicare ID Numbers and

Medicare Primacy Indicators in NYBEAS for enrollees and

dependents with Medicare-primary coverage

To update Medicare primacy and Medicare primary billing, you must

process a Medicare Change transaction. (If an employee or

enrollees dependent is already 65 at retirement, you must process a

Medicare transaction immediately following the retirement

transaction)

October 25, 2019 51

Role of the Health Benefits AdministratorWhen Is Medicare Primary for Members Ages 65 and over?

NYBEAS programming will attempt to automatically process a Medicare

change for members who are already enrolled as a retiree, vestee or

survivor when the auto meds are processed. (auto meds are

processed 3-4 months prior to age 65), For the process to work, the

following information must match:

• The Medicare ID number, name, SSN and date of birth in NYBEAS

match the information on file with the Centers of Medicare and

Medicaid Services

If the above information does not match, the enrollee or dependent’s

Medicare will reject and not be updated programmatically. When this

occurs, enrollees and/or dependents will be notified of action needed

by letter

October 25, 2019 52

Role of the Health Benefits AdministratorWhen is Medicare is Primary for Members Ages 65 and over?

It is the Agency HBA’s responsibility to process Medicare for Retiree,

Vestees and Survivors who are already Medicare eligible at time of

being enrolled as Retired, Vested, or as a Survivor:

• The HBA must process Medicare immediately following when the

Retirement , Vestee enrollment, or Survivor enrollment transaction

is done when the enrollee and/or dependent is eligible for

Medicare

October 25, 2019 53

Role of the Health Benefits AdministratorWhen is Medicare primary for Members under Age 65?

For Benefit Programs PR7, PF7, PV7, PR9, PS7,

PS9, PV9

Medicare Part A

Enrollment Date

Medicare Primacy Date

Before Benefit Program

Change Date

Process Medicare Primary As Of

The Benefit Program Change

Date

After Benefit Program Change

Date


The Medicare Part A Enrollment

Date

Equal to the Benefit Program

Change Date


The Benefit Program

Change/Medicare Part A

Enrollment Date

• Members who are

Medicare-eligible due to

End-Stage Renal Disease

are the exception to these

rules.

October 25, 2019 54

Role of the Health Benefits AdministratorWhen is Medicare Primary for Active members?

Medicare Primacy and Active Enrollees and DependentsBenefit Program Age

Over 65 Under 65

Active Benefit Programs-

PA7, PA9

Domestic Partners-First of

the month when member

turns age 65, or the first of

the previous month if

member is born on the first

day of the month

Domestic Partners under

age 65 of Active enrollees

are plan-primary

Active Benefit Programs-

PA7, PA9

All other enrollees and dependents are plan-primary,

regardless of age, with the exception of members who are

Medicare-primary due to End-Stage Renal Disease*

*If you have an enrollee who is becoming Medicare-eligible due to End-Stage Renal Disease,

please call the HBA Helpline. Our representatives will review the member’s file with

UnitedHealthCare to determine the member’s date of Medicare primacy.

October 25, 2019 55

Questions?

October 25, 2019 56


RECONCILING YOUR NYSHIP BILL

Presenter- Kara Hillicoss



October 25, 2019 57


Agencies that participate in NYSHIP are sent a bill each month

Bills are run on the first Friday of the Month

Reconciliations should be run on the Monday following the first Friday

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Documents Needed

1. The Billing Statement – The Bill produced and mailed around the

15th of each month showing current charges and balances (if any)

from a previous month.

2. The Transaction Listing – Mailed with the bill. A summary listing all

transactions produced that were processed the previous month.

3. Reconciliation - A current summary of all enrollments ( Agency

must run the report from NYBEAS, save to Excel)

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1. The Billing Statement

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How Do You Read The NYSHIP Billing

Statement?

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Coverage Begin

Date

Coverage End

Date

As you can see

there are two

months on this

bill

Rate Effective

Date

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Benefit Plan001 = Empire

009 = Excelsior

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Coverage Code

1= Individual

4= Family

A= Ind. with Medicare

B = Family w/1 Medicare

C = Family w/2 Medicare

D= Family w/3 or more Medicare

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Benefit Program

A = Active

R = RetireeS = SurvivorC = CobraV=Vestee

D = YAD

F = Firefighter

The last number will be a 7 for Empire plan

Or a 9 for Excelsior Plan

Second letter (Job Status) will be:

64

The first letter will always be a P

October 25, 2019 65

The count of

Employees per

Coverage

Code in that

Benefit

Program

When a SSN appears in the Emplid column, the BU

column changes to indicate months of retroactivity

(credit or charge)

For this example 123456789 has 8 months of

retroactive credit

BU = Billing Units

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Coverage Rate, the monthly rate for coverage

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Transaction listing

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How Do You Read The NYSHIP

Transaction Listing?

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Transaction listing

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In this example the enrollee passed away on

1/25/2019 (Event Dt). Benefits were canceled on

1/26/2019 (Effective Dt), and this was processed on

NYBEAS as a CAN/DEC on 9/3/2019

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3. The Reconciliation

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When to Run Your Agency Reconciliation

Agencies need to run their reconciliations on the Monday following the

First Friday (Date the bill is produced) This is the only way to ensure

that no NYBEAS activity/transaction processing took place between the

time the bill was run and the date the reconciliation was done. If you

wait, transactions will show on the reconciliation that are not on the bill

causing the information to not match.

First Friday

Monday Billing is run

Run your

Reconciliation

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How to Run a Reconciliation

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On NYBEAS – Go to NYBEAS REPORTS –

Agency Reconciliation Report

Enter your Agency code

here and Click on SearchMEMO PA 11-08

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You have a choice of how the report will look –

HTM – Hyper Text Markup (web based)

PDF – Portable Document Format

XLS – Excel Spreadsheet

We recommend you choosing XLS, in order to sort

and filter your employees 76

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How to Read Your Reconciliation Report

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Rate Qualifier

E = 100% of the cost to the agency.

If there is a different letter in the

column the enrollee has a pay

method of EPEN or TPEN.

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How to Read the Reconciliation Report

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Marital StatS = Single

M = Married

D = Divorce

W = Widow

UNIONPA = Employee

SP = Spouse

D = Daughter

S = Son

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The reconciliation reflects the billing

status for each employee

• Regular (R)

• Waiver of Premium (W)

• Extended Benefits (E)

Memo PA14-19

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Take all the tools that I have gone over and

see if they match, For example if you have

4 – PA7 (1) Individuals on the bill

make sure there are 4 individual actives on

your reconciliation –

And so forth

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Reminder # 1

If you want a transaction to reflect on

the next bill, the transaction must be processed in

NYBEAS before COB on the first Friday of the

month.

For example you would have to process the

transaction by 11/1/2019 to have it reflect on the next

billing statement

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Reminder # 2

If you process any transaction after the first Friday

of the month, it will not be reflected on the bill.

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Paying your bill on time, avoids multiple

billing months on one statement, making it easier to

reconcile

Reminder # 3

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Questions?

October 25, 2019 87

Publications and Enrollee Notices

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Recent publications:

– On the Road with The Empire Plan for PAs, February 2019

– Medicare & NYSHIP for PAs, May 2019

– 2019 Participating Provider Postcard (to order a printed copy)

– 2019 Participating Provider Directories

– 2019 General Information Book for PAs

– 2019 Creditable Coverage Notice

– Child Health Insurance Program (CHIP) Notice for 2019

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Communications Update

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Fall 2019– October 2019 Empire Plan Reports for PA Empire Plan and

Excelsior Plan

Enrollee mailing will also include: 2020 copayment cards and the

new publication Reporting On Mental Health and Substance

Abuse Program. (Note: The 2020 SBC reminder is included in the

EPRs so there will be no SBC postcards mailed this year.)

– 2020 At A Glance for The Empire Plan and the Excelsior Plan

Enrollee mailing will also include: 2020 versions of The Empire

Plan Advanced Flexible Formulary or Excelsior Formulary, Out

of Network Reimbursement Disclosure, Preventive Care

Coverage Chart, and the Nondiscrimination Notice.

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Upcoming Publications

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2020– Empire Plan Certificate for PA Empire Plan

– Excelsior Plan Certificate

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Upcoming Publications

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Be sure to check HBA online at a minimum

of once a week to stay informed

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Before Calling EBD

– Have NYBEAS open

– Check NYBEAS Update History for recently processed

transactions

– Have SSN/Employee ID available

Billing Inquiries

– Be sure to run a reconciliation every Monday following the first

Friday (billing is run the first Friday of every month)

– Send full payment that is reflected on your billing statement.

Don’t make adjustments even though changes may have been

made resulting in a credit that would affect future bill. Credit

adjustments will be reflected for transactions that were

processed in the next billing cycle

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General Reminders

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When receiving inquiries from your employees and retirees;

– Assist your enrollees

• If you need assistance please call the HBA Helpline. Do not refer caller to

EBD

– If inquiry concerns a medical bill or problem receiving services,

check NYBEAS for enrollment status

• If enrollee is covered and services were denied, refer caller to the Empire

Plan 877-769-7447

– HBAs should be calling EBD on behalf of their enrollees; not

referring them to EBD

95

General Reminders

October 25, 2019 96

How To Reach Us

HBA Line PA/PE Unit

(518) 474-2780 Press 1

for Participating Agency

and then 1,2 or 3

Responds to questions about:

• NYBEAS Processing (1)

• Enrollment Issues (2)

• Agency Bill Questions (3)

96

Public Employer Liaison Unit

(Press 4)

Responds to questions about:

• Compliance with Civil Service Law

• Agency Resolution Changes

• GASB 45

• Agency Participation

• NYSHIP Policies

Email requests for GASB and

compliance information

[email protected]

mailto:[email protected]

mailto:[email protected]

October 25, 2019 97

EBD Contacts

October 25, 2019 98

PA/PE Unit StaffTim

PA/PE call center staff

98

Tim’s reminder: when sending corrections, make

sure you obtain and maintain the

documentation required for the change and check your worklist to confirm

what was done as further processing may be needed

October 25, 2019 99

PA/PE Unit Staff

Amanda


99

Amanda’s reminder: Please be sure to

periodically check for recently issued memo’s

and updates on HBA online

October 25, 2019 100

PA/PE Unit Staff

MikePA/PE Call Center Staff

100

Remember to have your enrollee’s SSN or Alt ID ready to provide before

calling ☺

October 25, 2019 101

PA/PE Unit Staff

Melissa


101

Melissa wants to remind everyone to make sure

you are signed into NYBEAS before calling for

processing help

October 25, 2019 102

PA/PE Unit Staff

KaraPA/PE Unit Manager

102

Remember to mark you calendars to run your agency reconciliation

every month on Mondays following the first Friday

☺

October 25, 2019 103

PA/PE & PELU Staff

MaryEllen

Policy, PA/PE and

Participating Employer

Liaison Unit (PELU)

Supervisor

103

October 25, 2019 104

Thank you for joining us today!

EBD Contact for HBAs

Phone: 518-474-2780

Address: NYS Department of Civil Service


Albany, NY 12239

Fax: 518-485-5590

Website: www.cs.ny.gov

2019 Annual Webinar for Participating Agencies€¦ · Role of the Health Benefits Administrator...

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