The Employee Benefits Division is required to send a Medicare Part D Prescription Drug Program notice annually to all active and retired NYSHIP enrollees and dependents who are 65 or older, or eligible for Medicare due to disability. The notice attests to the creditable coverage status of the NYSHIP prescription drug program.
What is a Medicare Part D prescription drug program notice?
The Employee Benefits Division is required to send a Medicare Part D Prescription Drug Program notice annually to all active and retired NYSHIP enrollees and dependents who are 65 or older, or eligible for Medicare due to disability. The notice attests to the creditable coverage status of the NYSHIP prescription drug program.
How does nyship work with Medicare?
NYSHIP supplements this coverage and requires you and your eligible dependents to be enrolled in both Part A and Part B when Medicare is primary to NYSHIP. Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care.
When does Medicare become primary to nyship for dependents?
When you are no longer actively employed, Medicare will become primary to NYSHIP for any Medicare-eligible dependents as of their initial eligibility date. Enrollment in Parts A and B is required to maintain coverage under NYSHIP for anyone who is eligible for primary coverage under Medicare.
What medical expenses does my nyship plan cover?
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 it may cover some other medical expenses Medicare does not cover. For example, hearing aids are not covered under Medicare Parts A and B, but The Empire Plan offers an allowance for hearing aids.
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.
Does Nyship cover Medicare deductible?
NYSHIP automatically begins reimbursement for the standard cost of original Medicare Part B when Medicare becomes primary to NYSHIP coverage at age 65 for retirees, vestees, dependent survivors, and enrollees covered under Preferred List provisions, and their dependents who turn 65.
Does Nyship cover Medicare Part B deductible?
As the secondary payer, your NYSHIP plan will not cover expenses that Medicare would cover. 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.
How is Medicare Part D reimbursed?
Medicaid beneficiaries also typically receive covered drugs through pharmacies, which are reimbursed for these drugs by State Medicaid agencies. Most States typically calculate reimbursement based upon the AWP discounted by a specified percentage plus a dispensing fee.
What insurance carrier is 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 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 $40,210 for UUP) per enrollee, per spouse/domestic partner, and per all dependent children combined. The deductibleonly applies when you seek out-of-network services.
What is the difference between the Empire plan and the Excelsior plan?
"What is the difference between The Excelsior Plan and The Empire Plan?" The Excelsior Plan is a more affordable alternative to The Empire Plan. It offers many of the same features and benefits of The Empire Plan, with a higher degree of cost sharing between the employer and plan participants.
Is Nyship private insurance?
Now, more than 55 years later, NYSHIP is one of the largest public employer health insurance programs in the nation, protecting over 1.2 million State and local government employees, retirees and their families. Over 800 local government employers offer NYSHIP.
Is Nyship a PPO or HMO?
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.
Is Medicare Part D optional or mandatory?
Medicare drug coverage helps pay for prescription drugs you need. Even if you don't take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare.
When did Medicare Part D become mandatory?
The MMA also expanded Medicare to include an optional prescription drug benefit, “Part D,” which went into effect in 2006.
Who is responsible for Medicare Part D?
Unlike Parts A and B, which are administered by Medicare itself, Part D is “privatized.”[3] That is, Medicare contracts with private companies that are authorized to sell Part D insurance coverage. These companies are both regulated and subsidized by Medicare, pursuant to one-year, annually renewable contracts.
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 Empire Plan RX?
Medicare-primary enrollees and dependents enrolled in The Empire Plan have prescription drug coverage under Empire Plan Medicare Rx, a Medicare Part D Prescription Drug Plan with expanded coverage designed especially for NYSHIP. If you or any of your dependents are Medicare primary and enrolled in The Empire Plan, you will be automatically enrolled in Empire Plan Rx.You and each of your Medicare-primary dependents will receive a separate benefit card that you must use to access your Empire Plan Medicare Rx prescription drug benefits. You also will receive additional plan documents that explain your Empire Plan Medicare Rx benefits, as well as your rights and responsibilities.
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,
Can you opt out of Medicare if you are not covered?
If you are eligible for Medicare-primary coverage and you receive covered services from a provider who has elected to opt out of Medicare, or whose services are otherwise not covered due to failure to follow applicable Medicare program guidelines, your benefits may be drastically reduced.
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.
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 that 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).
When will Medicare remove Social Security numbers?
In an ongoing effort to fight medical identity theft and fraud, the Centers for Medicare and Medicaid Services (CMS) has been mandated to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.
Does NYShip pay for Medicare?
When Medicare is primary to NYSHIP coverage, NYSHIP reimburses you for the standard Medicare Part B premium you pay to SSA, excluding any penalty you may pay for late enrollment.
How to disenroll from Medicare?
If an enrollee has received this letter, they may disenroll from the Medicare Prescription Drug program by calling 1-800-MEDICARE (1-800-633-4227). They must also give a copy of this letter to their Medicaid worker in order to continue receiving Medicaid benefits.
What information is needed for Medicare?
This includes: name, DOB, effective dates of Medicare Part A & B and the beneficiary's Medicare ID #. Pharmacies may also be able to help.
What happens if you don't enroll in Medicare?
If enrollees do not participate in a Medicare prescription drug plan, they may lose all their Medicaid benefits. However, some people on Medicare and Medicaid may receive a letter from their employer or union stating that if they enroll in Medicare Part D they will lose the health care benefits provided by the union or employer.
What supplies are covered by Medicare?
Insulin-related supplies defined as syringes and needles, gauze and swabs should be billed to the Part D plan. Other supplies covered by Medicare Part B can be billed to Medicare. Supplies not covered by Medicare can be billed to Medicaid.
How to contact Medicare by phone?
You can obtain assistance in finding a plan to better match your needs by calling 1-800 -MEDICARE (1-800-633-4227) or by going to the CMS website at https://www.medicare.gov/find-a-plan/questions/home.aspx or by contacting HIICAP at 1-800-701-0501.
What to do if you haven't received your Medicare card?
If you haven't received your card, you can use the letter from your plan that states you are enrolled in their plan until you receive your new card. Your pharmacist may also be able to get the necessary information in order to bill your Part D plan from Medicare.
How long does it take for a prescription to change?
The plan must let you know if the drug is covered or there is a change in your quantity of pills/month within 72 hours. If your doctor believes there is a risk waiting for 72 hours , the plan must let you know in 24 hours or sooner if your health requires you have the medication sooner.
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.
Who does NYSHIP cover?
NYSHIP provides health insurance benefits to Participating Agency employees and retirees and their eligible dependents and to other former employees or dependents who are eligible for coverage through The Empire Plan or The Excelsior Plan.
How long after 65 can you enroll in Medicare?
Although Medicare allows you to enroll up to three months after your 65thbirthday, NYSHIP requires you to have Medicare Parts A and B coverage in effect when you are first eligible for Medicare coverage that is primary to NYSHIP. 3Medicar YSHI o etirees/Februar 2017 .
How to contact Social Security for Medicare?
Visit your local Social Security office or call Social Security at 1-800-772-1213. Medicare accepts applications online under certain circumstances. Teletypewriter (TTY) is available for callers using a TTY device because of a hearing or speech disability: 1-800-325-0778. Late enrollment in Medicare.
What is Medicare for seniors?
Medicare is the federal health insurance program for people age 65 and older, and for those under age 65, including those who have disabilities. It is administered by the Social Security Administration and the Centers for Medicare and Medicaid Services (CMS).
Can you file a mental health claim with NYShip?
Medical/Surgical and Outpatient Mental Health Claims. For medical/surgical or mental health/substance abuse expenses, you and your enrolled dependents age 65 and over generally have no claims to file because you are automatically enrolled in NYSHIP’s Medicare Crossover Program in the state where you reside.
Is Medicare primary for a domestic partner?
Regardless of the enrollee’s employment status, Medicare is primary for a domestic partner who is age 65 or older. If you have a domestic partner under the age of 65 who is Medicare- eligible due to disability, NYSHIP is primary while you have coverage as an active employee.
Is NYSHIP primary for end stage renal disease?
Regardless of the enrollee’s employment status, when Medicare eligibility is solely due to end- stage renal disease, NYSHIP remains primary during the 30-month coordination period. If you or your enrolled dependent is eligible for Medicare because of ESRD, contact Medicare at the time of diagnosis.
How to coordinate Medicare with NYShip?
To coordinate Medicare with your NYSHIP benefits, you should make sure that you: Contact the Social Security Administration (SSA) to enroll in Medicare three months before your birthday month. Visit https://www.ssa.gov/onlineservices or call 1-800-772-1213.
Who is required to send a notice of creditable coverage for Medicare Part D?
The Employee Benefits Division is required to send an annual notice of Creditable Coverage for the Medicare Part D Prescription Drug Program to all active and retired NYSHIP enrollees and dependents who are 65 or older, or are eligible for Medicare due to disability.
How to contact Empire Plan?
Empire Plan Medicare Rx: 1-877-769-7449, Option 4. New York State Employee Retirement System: 1-866-805-0990, https://www.osc.state.ny.us/retire. Click here to order a printed copy of the Medicare and NYSHIP booklet with DVD.
When will Medicare cards be mailed?
New Medicare cards will be mailed to all Medicare enrollees beginning in April 2018.
Can Medicare Part D be cancelled?
Be aware that enrolling in a Medicare Part D plan, a Medicare Advantage Plan, or other Medicare product in addition to your NYSHIP coverage may drastically reduce your benefits overall and could lead to the cancellation of your coverage.
Does Medicare work with NYShip?
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.
When will Medicare remove Social Security numbers?
In an ongoing effort to fight medical identity theft and fraud, the Centers for Medicare and Medicaid Services (CMS) has been mandated to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.