Benefits: Watch for option transfer period deadlines

The annual New York State Health Insurance Program (NYSHIP) option transfer period allows you to change your health insurance option for the next calendar year. You may change from: an HMO to the Empire Plan; the Empire Plan to an HMO; or one HMO to another HMO.

In November, your agency Health Benefits Administrator (HBA) received a supply of Choices for 2002, a guide to NYSHIP health insurance options. If you are thinking about changing your option, read the plan descriptions of the options available in your area and compare the coverage that is important to you and your family. Use the decision-making checklist in Choices as your guide. If you have specific questions, call the plan directly. Plan phone numbers are included in Choices.

Information about the cost of each option will be sent to your HBA and your home (or the address on record with your campus personnel office) when the rates are approved. At Voice press time, the premium rates had not yet been announced. When the rate information does become available, it will be posted on the Civil Service Web site at http://www.cs.state.ny.us. You will have 30 days from the date your agency receives the rates to change your option. If you wish to keep your current health insurance option, no action is required. If you wish to make a change, contact your HBA.

Through the NYS/UUP Joint Labor/Management Committee on Health, UUP has some input on which HMOs are approved. However, UUP does not negotiate directly with the HMOs. As a result, HMO benefits may change each Jan. 1. The HMOs decide what benefit and co-pay levels will attract enrollees to their plans and keep rates competitive with the Empire Plan. Review carefully the changes that your HMO is making for the new year to determine if that HMO is still the plan for you. Last year, many members didn’t notice until after the option transfer period deadline that their HMO had increased prescription and office visit co-pays. If you currently participate in an HMO, you will receive a letter from your plan outlining any benefit changes that will occur in the new year. Don’t miss the option transfer period deadline or the opportunity to make a change if you’re thinking about switching your health insurance option.

Empire Plan benefits will also see changes for 2002. Among the changes is an increase in the co-pay for hospital emergency room services from $25 to $35 per visit. The co-pay for other outpatient services covered by the Empire Blue Cross and Blue Shield hospital contract will remain at $25 per visit. There are no other co-pay changes for the Empire Plan for 2002.

There also is an increase in the Empire Plan deductible and an increase in the out-of-pocket maximum for 2002. These increases are tied to the Consumer Price Index, which increased by 4.5 percent.

The new deductible, effective Jan. 1, will go from $259 to $271. The new, out-of-pocket maximum will go from $1,670 to $1,745.

The Empire Plan deductible and out-of-pocket maximum are applied to the amount allowed (reasonable and customary) when you use a nonparticipating provider for services covered under the basic medical portion of your Empire Plan coverage through United HealthCare.

If you use an Empire Plan participating provider, you are charged a co-pay. Empire Plan participating providers can be found on the Web at http://www.cs.state.ny.us (click on Empire Plan Providers). Using Empire Plan participating providers can greatly reduce your out-of-pocket expense.

If you have any questions, don’t hesitate to contact UUP Member Benefits at (800) 887-3863 or e-mail us at benefits@uupmail.org.

— Gail Maloy, director of Member Benefits and Services