Yes, NYSHIP requires retirees to enroll in Medicare Parts A and B. Once you are both retired and eligible for Medicare (ie. at age 65), Medicare becomes your primary insurance (Medicare pays first). Your covered dependents must also enroll when eligible. NYSHIP will not provide any benefits for coverage available under Medicare. If you/a dependent are eligible for Medicare coverage that is primary but fail to enroll when eligible, you will be responsible for the full cost of services that Medicare would have covered.
How will my Medicare benefits work with my nyship coverage?
This page has information about how your Medicare benefits will work with your NYSHIP coverage.* Medicare becomes your primary insurer when you are eligible for Medicare and enrolled in NYSHIP as a retiree, vestee, dependent survivor, or are covered under Preferred List provisions.
Does nyship require Medicare enrollment during the waiting period?
Since Medicare will provide only secondary benefits during the waiting period, NYSHIP does not require Medicare enrollment during this time and will not provide reimbursement for the Part B premium. At the end of the waiting period, when Medicare becomes the primary insurer, NYSHIP requires the patient to have Medicare in effect.
What is the difference between nyship and primary Medicare coverage?
When you become eligible for primary Medicare coverage (“primary” means Medicare pays health insurance claims first, before NYSHIP), you must be enrolled in Medicare Parts A and B. NYSHIP also requires your dependents to be enrolled in Medicare Parts A and B when they are first eligible for primary Medicare coverage.
Will nyship reimburse my Medicare Part B premium if I move?
If you reside outside the United States, NYSHIP will reimburse your Medicare Part B premium if you remain enrolled in Medicare Part B. If you did not remain enrolled in Medicare, and are moving permanently back to the United States, contact Social Security to reenroll in Medicare. In addition, contact EBD about resuming your Medicare reimbursement.
Is Empire Nyship Medicare?
Effective January 1, 2013, NYSHIP replaced the Empire Plan Prescription Drug Program coverage for Medicare-primary enrollees and dependents with Empire Plan Medicare Rx (PDP), a Medicare Part D prescription drug program with expanded coverage designed especially for NYSHIP.
Is Nyship a Medicare Advantage Plan?
NYSHIP Medicare Advantage Plans include Medicare Parts A, B and D coverage. dependent. There is usually no cost for Part A. Premium costs may be found on the Medicare web site (www.medicare.gov) or you may call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week for assistance.
Is the Empire Plan Nyship Medicaid?
For retirees and their dependents, NYSHIP requires enrollment in Medicare Parts A and B when first eligible. NYSHIP's Empire Plan pays secondary to Medicare.
Is United Healthcare Nyship?
Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).
Does Nyship cover Medicare deductible?
Your NYSHIP plan covers much of the Medicare Part A and Part B deductible and coinsurance amounts if you use the NYSHIP plan provider network and may cover some other medical expenses Medicare does not cover.
Does Empire Plan pay Medicare deductible?
The Empire Plan pays for much of the Medicare Part A and B deductible and coinsurance amounts if you use The Empire Plan provider network, and may pay for some other medical expenses not paid by Medicare.
What is Empire Medicare?
Empire Medicare-related coverage offers Medicare-eligible retirees protection from costly health care by filling the gaps in Medicare coverage. At a Glance. Plan Type: Medicare Supplemental Plan. Geographic Service Area.
Is the Empire Plan the same as Empire Blue Cross Blue Shield?
Empire BlueCross BlueShield is a plan (HMO and LPPO) with a Medicare contract. Empire BlueCross is an HMO DSNP plan with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health.
Does Nyship have a deductible?
What is the overall deductible? $1,250($625 for enrollees in positions at or equated to Grade 6 or below or earning less than $38,651 for UUP) per enrollee, per spouse/domestic partner, and per all dependent children combined. The deductible only applies when you seek out-of-network services.
Is Nyship Empire Plan a PPO?
SUNY participates in the New York State Health Insurance Program (NYSHIP). This program offers a PPO, known as the Empire Plan, and several different HMOs, varying by geographic region around the State. Specific coverage provisions and plan design vary by health insurance plan and by employee bargaining unit.
What is the Nyship Empire Plan group number?
1-877-769-7447For more information, call The Empire Plan toll free number at 1-877-7-NYSHIP (1-877-769-7447) and press 1 for the Medical Program.
Does Nyship Empire Plan cover massage therapy?
We now accept NYSHIP through the empire plan for Massage Therapy! Massage is restorative for your body, but also provides time to relax and unwind in this stressful time. Come take a break at our Medical Massage Facility.
Who is required to submit Medicare claims?
Providers (such as hospitals, doctors and laboratories) who accept Medicare are required by federal law to submit claims to Medicare for Medicare-primary patients. After Medicare processes the claim, The Empire Plan considers the balance for secondary (supplemental) coverage.
When does Medicare become primary for spouse?
Since you are no longer actively employed, Medicare becomes primary to NYSHIP for your spouse at age 65. Medicare does not become primary for you until you reach age 65 or otherwise become eligible for Medicare.
What is a MAP plan?
Medicare Advantage plans (MAPs) replace your original fee-for-service Medicare Parts A and B coverage. The benefits offered by the plan and all of your medical care (except for emergency or out-of-area urgently needed care) must be provided, arranged or authorized by the MAP. Most NYSHIP HMOs provide Medicare Advantage coverage to Medicare-primary enrollees and dependents. Check the current NYSHIP Health Insurance Choices publication to see if any are offered in your area. If you are enrolled in a NYSHIP HMO that offers a MAP, you receive both your Medicare and NYSHIP benefits from that plan when you become Medicare-primary.
What is Medicare Part A and B?
Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care.
Is Empire Plan covered by Medicare?
If you receive services from a provider who does not participate in The Empire Plan, and these services are covered under The Empire Plan but not under Medicare, it is your responsibility to file a claim or have the provider file a claim with the appropriate Empire Plan administrator for Basic Medical or non-network benefits.
Does Medicare send an EOMB?
Medicare will send you an Explanation of Medicare Benefits (EOMB) that will note whether your claim was sent to The Empire Plan. This process, known as Medicare Crossover, is automatic for the medical program, hospital program and outpatient mental health and substance abuse program; however, inpatient mental health and substance abuse services are not crossed over directly from Medicare to Beacon Health Options. For these services, you will need to submit your EOMB to Beacon Health Options if you receive a bill.
Is NYSHIP a dependent?
If you return to work for New York State (or if you worked for a Participating Employer and you return to work for the same employer) in a benefits-eligible position after retiring, NYSHIP is primary for you as an active employee and, in most cases, for your Medicare-eligible dependents .
Who is required to submit a claim to Medicare?
Providers (such as hospitals, doctors and laboratories ) who accept Medicare are required by federal law to submit claims to Medicare for Medicare-primary patients. After Medicare processes the claim, NYSHIP considers the balance for secondary (supplemental) coverage.
What is Medicare Part A and B?
Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care.
How to contact Empire Plan?
If you have questions about your NYSHIP coverage, call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the program you need. If you have questions about Empire Plan Medicare Rx,
Does Medicare send out EOMB?
Medicare will send you an Explanation of Medicare Benefits (EOMB) that will note whether your claim was sent to NYSHIP. This process, known as Medicare Crossover, is automatic for the medical program, hospital program and outpatient mental health and substance use program; however, inpatient mental health and substance use services are not crossed over directly from Medicare to Beacon Health Options. For these services, you will need to submit your EOMB to Beacon Health Options if you receive a bill.
Does Medicare Part A cost?
There is usually no cost for Medicare Part A. If there is a charge for Medicare Part A coverage because the Social Security eligibility requirements were not met, send your HBA a copy of your statement from Social Security confirming your ineligibility for Part A at no cost. NYSHIP will provide primary coverage for Medicare Part A expenses and there will be no need to enroll in Medicare Part A unless eligibility for no-cost Part A coverage is attained. However, enrollment in Medicare Part B is still required. If you receive a statement from Social Security confirming your ineligibility for Medicare Part A at no cost, please send a copy to your HBA. Your former employer will not reimburse for the Medicare Part A cost.
Is NYSHIP primary for Medicare dependents?
After retiring, if you return to work in a benefits-eligible position for your former employer who is providing your health benefits, in most cases NYSHIP is primary for you and your Medicare-eligible dependents. Ask your HBA if you will be in a benefits-eligible position.
Does Medicare pay for Social Security?
Social Security deducts the Medicare Part B premium from your monthly Social Security benefit. If you don’t receive Social Security benefits , you pay the Medicare Part B premium directly to the Centers for Medicare and Medicaid services (CMS).
Medicare: A Federal Program
Medicare is a federal health insurance program for people who are age 65 or older, or have been entitled to Social Security disability benefits for 24 months, or have end stage renal disease (permanent kidney failure). Medicare is directed by the federal Centers for Medicare and Medicaid services (formerly Health Care Financing Administration).
NYSHIP is primary for most active employees
NYSHIP (Empire Plan or HMO) provides primary coverage for you, your enrolled spouse and other covered dependents while you are an active employee, regardless of age or disability.
You and your dependents must have Medicare in effect
As soon as you or your covered dependent becomes eligible for Medicare coverage that pays primary to NYSHIP (because of end stage renal disease or domestic partner status), you or your covered dependent must be enrolled in Medicare Parts A and B.
When you are no longer an "active employee"
When you are no longer an active employee of the State or a Participating Employer, NYSHIP or Medicare will be primary as follows:
If you are also covered by another employer's group plan
If you are no longer an active employee of the State or a Participating Employer and you have coverage under another employer's group plan, the order of claims payment is 1) current employer plan; 2) Medicare; and 3) NYSHIP.
When to enroll in Medicare
As an active employee, contact Medicare immediately if you, your spouse or enrolled dependent is eligible for primary Medicare coverage due to end stage renal disease. Also, the domestic partner of an active employee must have Medicare Part A and Part B in effect by the first of the month in which the domestic partner reaches age 65.
Planning to retire: Avoid a gap in coverage
If you are planning to retire or otherwise leave service with your employer and are under 65, Medicare becomes primary to NYSHIP on the first day of the month in which you reach age 65. Contact Social Security three months before you reach age 65 to be sure of having Medicare in effect at that time.
How does Medicare work with other insurance?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) ...
How many employees does a spouse have to have to be on Medicare?
Your spouse’s employer must have 20 or more employees, unless the employer has less than 20 employees, but is part of a multi-employer plan or multiple employer plan. If the group health plan didn’t pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.
How long does it take for Medicare to pay a claim?
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. If Medicare makes a. conditional payment.
When does Medicare pay for COBRA?
When you’re eligible for or entitled to Medicare due to End-Stage Renal Disease (ESRD), during a coordination period of up to 30 months, COBRA pays first. Medicare pays second, to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.
What is the phone number for Medicare?
It may include the rules about who pays first. You can also call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).
What happens when there is more than one payer?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) to pay. In some rare cases, there may also be a third payer.
What is a health care provider?
Tell your doctor and other. health care provider. A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. about any changes in your insurance or coverage when you get care.
New York State Health Insurance Program
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