Health Benefits

Latest News from Health Benefits Dept.

IMPORTANT: Open Enrollment for the following plans will begin on October 2, 2023- November 30,
2023: 2024 MEDICAL /CALENDAR YEAR FSA/AFLAC
You will or should have receive(d) an open enrollment email in October.

Please note that the medical open enrollment will also include the option to enroll in the calendar
year FSA plan and calendar year AFLAC. Our medical open enrollment period is the time where you can
make changes to your existing health insurance plan. You must complete the open enrollment process
through INAVIGATOR, even if you are not making changes to renew your medical insurance for the
upcoming 2024 calendar year. All insurance changes will go into effect on January 1, 2024. If you
participate in the Health Insurance Buy-Out you will need to log in to INAVIGATOR then decline the
insurance coverage to complete the open enrollment. (The medical open enrollment must be
completed and is not optional)

If you are interested in enrolling in the Flex FSA plan for the calendar year, Jan - Dec 2024, then you
must enroll and make your annual elections. The deductions will be withheld starting with the Jan 19,
2024 payroll and will be withheld over the course of 19 pay periods from Jan 24- Dec 24. No deduction
is withheld over the summer. Enrollment in the FSA/DCA plan is optional)

If you are interested in enrolling in AFLAC, contact information for our AFLAC representative, Jennifer
Boulle will be provided. Please be sure to contact her before the open enrollment deadline 11/30/2023.
There is an Interest Form for AFLAC, that must also be completed through INAVIGATOR if you are
interested in enrolling in AFLAC. The form will be located under Required Tasks and will be used to help
expedite the enrollment process with the AFLAC representative. Deductions will begin Jan 19, 2024.
(Enrollment in AFLAC is optional).

2023-2024 Open Enrollment Period for Health Insurance Buy-Out:

*** Important: If you do not participate in the Health Insurance Buy-Out and you are already enrolled in a district insurance plan, then there is nothing that you need to do during this open enrollment period.****

Open enrollment for the 23-24 Health Insurance Buy-Out will begin on Monday, May 1, 2023 and run through Wednesday, May 31, 2023. If you currently participate in the Health Insurance Buy-Out and you would like to re-enroll in the Buy-Out for the 23-24 school year, then you must complete the Buy-Out open enrollment through INAVIGATOR. Once completed, a required task will generate. You must click on the Required task and there will be a link to upload proof of other insurance coverage. You are required to upload a copy of your current health insurance ID card to the portal each year you participate in the Health Insurance Buy-Out. If you do not see a Required task generated to upload proof of insurance, then the Buy-Out enrollment was not completed correctly and you will need to log back into INAVIGATOR and redo it. Please make sure you have enrolled in the Buy-Out and do not decline it of you are enrolling in the Buy-Out for the 23-24 school year.

Please note the 23-24 Buy-Out year runs from September 1, 2023- August 31, 2024. If you were previously enrolled in the Buy-Out for the 22-23 school year and now wish to enroll in insurance effective September 1, 2023, then you must log into INAVIGATOR and decline the Buy-Out. You will need to complete an insurance enrollment form for the plan you are enrolling in. You can contact Health Benefits for an insurance enrollment form and we will send it to you. If you are enrolling in a family plan, then in addition to the enrollment form, you must also provide copies of your marriage certificate (if applicable) and copies of birth certificates and social security cards for everyone who will be enrolled on your insurance plan, with the exception of yourself. All enrollment forms and required documents must be submitted to my attention before May 31^st, 2023.

The Health Insurance Buy-Out open enrollment must be completed by May 31st, 2023. If you do not enroll and upload a copy of your insurance ID card at this time, then you will not receive the Buy-Out payment in October 2023. If you are no longer interested in enrollment in the Buy-Out and are opting for insurance, then you must decline the Buy-Out on INAVIGATOR and submit the completed enrollment form and documents before the May 31, 2023 deadline. If you have any questions, please email kmartinez@necsd.net or dperez@necsd.net or call 845-563-3467 or 845-563-3489.

Important Benefit Plan Changes for NYSHIP Enrollees effective July 1, 2023: NYSHIP will be sending out information about their plan changes shortly. Please see the summary of changes below:

Only one $25.00 copay for services in a single visit on the same day to a network provider will be charged. This includes visits to network Managed Physical Medicine Providers (Physical therapists, Chiropractors and Occupational therapists)

No copayments for virtual visits using LiveHealth Online.

Covered in full benefit for mastectomy bras in or out of network.

July 1, 2023 reduced in- network maximum out of pocket limits. (* Does not apply to Medicare primary enrollees)

Hospital/Medical/MHSU      $2600 ind annual limit      $ 5200 fam annual limit
*Prescription Drug-               $1400 ind annual limit      $ 2800 fam annual limit
Total Limit: $4000 ind annual limit      $ 8000 fam annual limit

New Center of Excellence (COE) for Substance Use Disorder: COE is in partnership with the Hazelden Betty Ford Foundation. Paid in full, high quality treatment services throughout the United States. Empire Plan must be the primary coverage.

New Site of Care Program for Infusions- Anyone impacted by this change will receive a letter from Empire Blue Cross Blue Shield and will receive assistance in coordinating the transition.

Visit Limit for Out of Network Acupuncture Services: Out of Network will be subject to a maximum of 20 visits per calendar year. No annual visit limit for acupuncture received form a participating provider- this has not changed. Visits prior to July 1, 2023 do not count toward the 2023 maximum.

Visit Limit for Massage Therapy Services: Coverage will be available for up to 20 massage therapy visits per calendar year. Visits to a network Managed Physical Medicine Provider generally will not count toward the 20 visit limit. A script is still required from your medical provider. Visits prior to July 1, 2023, do not count toward the 2023 maximum.

New Reimbursement Method for Non- Network Claims: Out of Network providers will be paid at rated equivalent to those Medicare pays which could result in larger out of pocket cost for the enrollee. As a reminder, out of network providers can balance bill enrollees for their costs. Enrollees are still protected under state and federal law for emergency care and surprise bills.

Empire Plan ID Card Re- Issue: Benefit Cards are scheduled to be reissued again. Your ID number will remain the same. Enrollees can use their new card immediately and there is no requirement to call The Empire Plan or to register the card.

Covid- 19 Update: End of the Public Health Emergency Period is May 11, 2023. The Empire Plan will no longer be required to provide cost share waivers for testing and diagnosing COVID- 19 upon expiration of the public health emergency.

Health Equity Flexible Spending Accounts: Health Care FSA (HCFSA) and Dependent Care FSA (DCFSA)

We are happy to announce we will be moving from a plan year set up to a calendar year set up for our Health Equity Flexible Spending Accounts (HCFSA & DCFSA).

In order to accomplish this change, we will be renewing our Health Equity Flexible Spending Accounts: for a short plan year: 10/1/22 to 12/31/22 then for a full calendar year plan: 1/1/23 to 12/31/23.

You will have the opportunity during these two open enrollment periods, one for each plan year, to enroll and choose your election amount for that plan year. Your contribution will be pre-tax through payroll – having equal amounts taken from each paycheck.

Health Care FSA (HCFSA) and Dependent Care FSA (DCFSA) for a short plan year: 10/1/22 to 12/31/22: The 2022 IRS Contribution limits: Health Care FSA (HCFSA) is $2850 and Dependent Care FSA (DCFSA) is $5000.

*Please note: If you elected the max of 2750 in our plan year Oct 21- Sept 22 – you will then only be allowed to elect the difference between what you have already contributed during the period Jan 22- June 22, since that is within the same 2022 calendar year.

For the short plan year (10/1 to 12/31/22) your elections must be pro-rated, as follows:

*How to Prorate max FSA election*: 2022 FSA Contribution limit is $2,850 divided by 12 = $237.50 per month x3 months (Oct-Nov-Dec) is $712.50. Meaning the participant can elect up to maximum of $712.50 for the medical FSA for the short plan year 10/1/22 to 12/31/22.

*How to Prorate max DCA election*: The dependent care Contribution limit for 2022 is $5,000 divided by 12 = $416.67 per month x 3 months (Oct-Nov-Dec) is $1,250. Meaning the participant can elect up to maximum of $1,250 for the DCA for the short plan year 10/1/22 to 12/31/22.

OPEN ENROLLMENT:

1) For the short plan year (10/1 to 12/31/22):

The iNavigator portal will be open from Monday 8/22/22 to Wednesday 9/7/22 – you must log onto the iNavigator portal to enroll and make your election(s). Payroll deductions for the short plan year will be withheld from Oct- Dec 2022 and must be expended within that time frame.

2) For the full calendar year plan: (1/1/23 to 12/31/23):

The iNavigator portal will be open from Friday 10/7/22 to Wednesday 11/30/22 – you must log onto the iNavigator portal to enroll and make your election(s). This open enrollment will coincide with our medical open enrollment period. Health Care FSA (HCFSA) and Dependent Care FSA (DCFSA) for a full calendar year plan: 1/1/23 to 12/31/23:

Health Care FSA( HCFSA) and Dependent Care FSA ( DCFSA) for a full calendar year plan: 1/1/2023- 12/31/2023:

We will keep the FSA deductions based on 19 pay periods as it is currently. For the 2023 calendar year, you will be able to elect the max for the 2023 calendar year. Payroll deductions will be withheld from Jan-June 2023 and Sept- Dec 2023. There will be no withholding during the summer months.

The 2023 IRS Contribution limits are still to be determined by IRS, but are expected by November 2022.

The open enrollment for Aflac will occur at the same time as the full calendar year election from Friday 10/7/22 to Wednesday 11/30/2022 and will also transition from a plan year set up to a full calendar year set up. The contribution arrangement will be based on 19 pay periods, the same as the flex plan.

August EAP Newsletter

The August EAP Newsletter is now available.

NEW Vesting Requirement for Tier 5 and Tier 6 ERS Memberships

Are You Vested?
Being vested means that you have earned enough service credit to qualify for a pension benefit once you meet the minimum age requirements established by your retirement plan. Vesting is automatic; you do not have to fill out any paperwork to become vested.

Tier 1, 2, 3 or 4 members who have at least five years of credited service are vested.

As of April 9, 2022, Tier 5 and 6 members also only need five years of service credit to be vested. This newly enacted vesting requirement change affects members of both the Employees’ Retirement System (ERS) and the Police and Fire Retirement System (PFRS). Previously, Tier 5 and 6 members needed ten years of service to be eligible for a service retirement benefit.

Effective immediately, if you are a Tier 5 or 6 member with five or more years of service and you meet the minimum age requirements for your retirement plan, you can apply for a service retirement benefit if you wish. If you have between five and ten years of service credit and you have questions about filing for retirement, please contact us.

Tier 5 and 6 members who left public employment with five or more years of service and did not withdraw their membership are now considered to be vested.

Tier 5 and 6 members who leave public employment with more than five years of service but less than ten years, as of April 9, 2022, now have the option to either apply for a retirement benefit once you reach retirement age or withdraw your contributions. You cannot withdraw your contributions once you have ten years of service. As a reminder, once you withdraw your contributions, you end your membership with NYSLRS and are no longer eligible for a retirement benefit.

The new legislation does not change eligibility for disability retirement benefits that are established by your retirement plan. This legislation also did not change Tier 6 benefit rules such as how long you must contribute, your pension benefit calculation, your full retirement age, reductions to retire early or the cost to purchase previous service.

If you were a Tier 5 or 6 member and have been off the payroll for more than seven years prior to April 9, 2022, your membership is considered withdrawn and terminated. You would need to return to payroll and reinstate your withdrawn membership in order to be eligible for five-year vesting.

Covid Test Kit Reimbursement Information

MVP Covid-19 Test Reimbursement

Effective January 15, 2022 for MVP HMO and PPO enrollees members can submit to the insurance plan for reimbursement for up to 8 covid tests per month:

Commercial, self-funded, and Essential Plan members can submit requests for reimbursement using the Claim Reimbursement Request Form, or the CVS Caremark Prescription Reimbursement Claim Form. Members will need to attach receipts with the specific test noted and UPC codes from the test box. For more information on OTC at-home test reimbursement, member’s can contact the MVP Customer Care Center at the phone number on the back of their MVP Member ID card. Please download and complete the claim form and return it to MVP at the address provided on the form. Please be sure to attach the receipt as specified with the test detail and upc codes from the test box.

NYSHIP Covid-19 Test Reimbursement

Effective January 15, 2022, under direction from the federal government, the Empire Plan will cover FDA-authorized at-home COVID-19 Over the Counter (OTC) diagnostic tests. A doctor’s order or prescription is not needed. Members should go to the pharmacy counter with the COVID-19 test(s) so that the tests can be processed and covered through your insurance.

All enrollees and dependents are eligible for this benefit. OTC diagnostic tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan, Excelsior, or SEHP ID Card. If you are charged for a test at a participating network pharmacy, submit for reimbursement through Caremark.com or through the paper claim process. If you need assistance, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program, 24 hours a day, 7 days a week.

Coverage includes up to eight (8) at-home COVID-19 tests, per covered member, per month. Tests are covered at no cost or are fully-reimbursed at participating network pharmacies. If you purchase a test outside of a participating network pharmacy (such as Amazon), the maximum allowable reimbursement is $12 per test ($24 for a box that contains two tests). Save your receipts to submit for reimbursement.

As of January 18, 2022, the list of OTC FDA-authorized tests* are:
BinaxNOW COVID-19 Antigen Self Test
COVID-19 At-Home Test (SD Biosensor, Inc.)
CLINITEST Rapid COVID-19 Antigen Self-Test
iHealth COVID-19 Antigen Rapid Test
CareStart COVID-19 Antigen Home Test
BD Veritor At-Home COVID-19 Test
SCoV-2 Ag Detect Rapid Self-Test
InteliSwab COVID-19 Rapid Test
Celltrion DiaTrust COVID-19 Ag Home Test
QuickVue At-Home OTC COVID-19 Test
Flowflex COVID-19 Antigen Home Test
Ellume COVID-19 Home Test

*The list of FDA-authorized tests is subject to change.

Claims / Receipt Submission Information

If you are charged for a test at a participating network pharmacy, submit for reimbursement through Caremark.com or through the paper claim process.

If a test is paid for out-of-pocket at a non-participating network pharmacy (e.g., Amazon or other online retailer), then Empire Plan members can submit for the maximum reimbursement through UnitedHealthcare (UHC) online at www.myuhc.com. There will be information about OTC test reimbursement highlighted in a banner at the top of the website.

Plan members can also mail or fax a claim form to UHC, using the OTC At-home COVID-19 Test Kit Reimbursement Form which will be available on www.myuhc.com beginning January 15, 2022. The claim form and proof of payment must be mailed to UnitedHealthcare P.O. Box 1600, Kingston, NY 12402-1600 or faxed to (845) 336-7716.
Questions

If you have any questions, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program. Representatives for the Medical Program (UHC) are available Monday-Friday, from 8:00a.m. to 4:30p.m., ET. Representatives for the Prescription Drug Program (CVS Caremark) are available 24 hours a day, 7 days a week.

Emblem Health Covid-19 Test Reimbursement

Please see our enclosed Q&As with regard to COVID 19 testing and instructions for reimbursement of FDA approved in-home testing kits. Please note that at this time, members will need to submit a reimbursement form, along with itemized receipts to have their claims reviewed for reimbursement.

We will pass along additional information as it is made available to us.

Please note the following:

In the future, EmblemHealth is working on a program where you can purchase a covered COVID-19 at-home, rapid test at an in-network pharmacy with zero out-of-pocket cost by presenting your member ID card at the time of purchase.
In the meantime, when members pay out-of-pocket for tests at a retail store, online, or a pharmacy, they will have to send in some information to be reimbursed for each test. This includes a completedclaim form and the itemized receipt. (EmblemHealth may require an attestation that this test is for the member only, and not for a non-covered purposes, as part of the claim process.)
For more specific details, go to COVID-19 testing on emblemhealth.comor connecticare.com. There members can learn how to find a participating in-network pharmacy, or get instructions about how to fill out the claim form. Members may also call the phone number on their member ID card and speak with a representative who will help.

For your convenience, I have included here a copy of the reimbursement claim form, as well as copy of our current Q&As on testing from our www.emblemhealth.com which can be found under our COVID 19 section. The first attachment provides instructions on how to complete the form.

If members do have any questions, as per above, we encourage them to contact the member services number on the back of their ID cards for further assistance. I also attached a copy of the claim form for download.

CDPHP Covid-19 Test Reimbursement

Coverage of At-Home COVID-19 Test Kits

Please be advised that effective January 15, 2022, and due to a directive from the federal government, CDPHP is covering at-home COVID-19 test kits that are FDA-approved or issued an EUA by the FDA.

At this time, for all commercial members (including self-funded), we will be reimbursing for kits purchased out of pocket (up to $12 per test or $24 for a kit containing two tests).

The test kits will be covered under a group’s pharmacy benefit. For groups that carve out their pharmacy benefits, any questions should be directed to their PBM.

Members may obtain up to eight tests (or four kits containing two tests) per covered family member, per calendar month. For example, if the first test kit is purchased on January 15, a maximum of eight tests can be purchased by February 14.

To avoid an upfront cost, members will need to purchase the test kit at a pharmacy window or pharmacy counter of a pharmacy in the CDPHP network.

If members choose to purchase a test kit at a non-participating pharmacy or other retailer, there would be an upfront cost with reimbursement; reimbursement will require this form.

This directive currently does not include Medicare Advantage (MA) members. CDPHP will alert MA members as soon as we have updated guidance and direction from the government.

At this time, MA members who purchase test kits with a provider order can receive reimbursement as a medical claim by submitting both the script and their receipt either via paper claim or in their online member account.

Please note that effective January 19, 2022, all Americans will be able to order free rapid coronavirus tests online at COVIDtests.gov.

Additional detail is forthcoming, and we will be issuing updated guidance as often as it is received. We thank you for your cooperation.

January 2022 EAP Newsletter
Here is January 2022 EAP Newsletter

Contact Health Benefits

Keisha Martinez, Health Benefits Specialist
BOE/ Library Complex
124 Grand Street

Phone: 845-563-3467

Important Phone Numbers

Service	Phone
Empire	1-877-769-7447
MVP	1-888-687-6277
CDPHP	1-800-777-2273
GHI	1-877-244-4466
CSEA Dental/Vision	1-800-323-2732
Marshall & Sterling	1-914-962-1188 ext 2481 or 2489
NYSLRS osc.state.ny.us	1-866-805-0990 1-518-474-7736
NYSTRS www.nystrs.org	1-800-348-7298
Health Equity formerly WageWorks (Flex/FSA /DCA) my.healthequity.com	1-877-924-3967
Aflac Jennifer Boulle	845-337-2134
Educators' EAP	1-800-252-4555 or 1-800-225-2527