Click on the categories below to view our responses to questions of general interest.
Have a question for OMCE?  Email us: nysomce@gmail.com.

● How does the Empire Plan Hospital Network that became effective January 1, 2005, work?

As a condition laid down by Blue Cross of getting a preferred rate, major employers across the country, including New York State, have moved to a hospital network provider model, according to the Department of Civil Service. Every hospital currently operating in New York State is included in the Empire Plan Hospital Network. Nationwide, about 94% of hospitals currently participate. Here's how it works: Covered inpatient services received at a network hospital will be paid-in-full; covered network outpatient services will be subject to a copayment. Covered inpatient services received at a non-network hospital will be reimbursed at 90% of charges; covered outpatient services will be reimbursed at 90% of charges or a $75 copayment, whichever is higher. There will be a $1,500 annual coinsurance maximum for non-network inpatient and outpatient services combined, but once an enrollee, enrolled spouse/domestic partner or all dependent children combined have incurred $500 in out-of-pocket non-network expenses, expenses in excess of the $500 will be reimbursed up to the $1,500 coinsurance maximum. There are exceptions: Inpatient and outpatient services received at a non-network hospital will be reimbursed at the network benefit level for emergency treatment, where a non-network hospital is an exclusive provider of the needed services, or where there is no reasonable access to a network hospital. The hospital network provider requirement does not apply to enrollees who are Medicare primary.

● The Federal guidelines for Health Savings Plans were changed as a result of new legislation. One of the benefits is that the money contributed which is tax deferred is not lost if not used and can accumulate similar to an IRA. The info on the state website still lists the old provisions. Can you check to see if the State plans to or must change the guidelines? I have tried to with my agency, but as usual no one has a clue. Thanks for your help.

The federal changes to which you refer are in connection with the new Health Savings Plans (HAS) authorized by Congress in the 2003 Medicare bill. The changes are not applicable to the State's Health Care Spending Account, so the "use it or lose it" requirement of the State's pre-tax program will continue unchanged. There is some good news to report, however. Over-the-counter (OTC) drug expenses are now reimbursable through the Health Care Spending Account. Reimbursable expenses include allergy remedies, antacids, cold medicines and pain relievers. A more complete list is available on the State's Flex Spending web site at: http://flexspend.state.ny.us/otc.asp. As for the new HSAs, they are designed principally for self-employed persons and others who are paying high health insurance premiums. In order to participate in an HSA, you would need to be insured in an HSA qualifying high-deductible health insurance plan, not a traditional health plan like NYSHIP. The higher the deductible, the less the premiums cost. The idea is to invest the dollars saved on premiums in an IRA-like account where they can grow and be available for future medical-related expenses or be withdrawn for medical expenses not covered by the high deductibles. Relatively healthy persons with low medical expenses can realize a long-term IRA-like benefit with an HSA, but an HSA is not a good idea for those who regularly incur significant medical expenses.

● When I became an M/C employee in 1991, I foolishly opted for the M/C IPP (Income Protection Plan). I am told that this choice is irrevocable. Is this truly the case, and I'm stuck losing 5 sick days per year until I retire?

We believe the IPP is a good program, especially should anyone ever suffer the misfortune of a long-term disability, but we don't believe it should cost M/C employees five days of sick leave annually. We have pressed for restoration of the five days, particularly in light of the Governor's action restoring lost sick days to PEF-represented employees in 2003, and we will continue to do so. You were advised correctly-the choice is irrevocable.

● When I joined the State, I was told I had to join the IPP program, that it was 'mandatory'. I would rather not have joined but did not have a choice. Can anything be done about this?

A solution we have sought for several years (so far, unsuccessfully) is for the State to restore the sick leave accrual rate for all M/C employees to thirteen days annually, as was the case before the IPP was introduced in January 1986. We are convinced that M/C employees should be earning sick leave at a rate comparable to negotiating unit employees and, to that end, we will continue to seek restoration of a higher sick leave accrual rate for M/C employees. Another approach we have been pursuing (so far, unsuccessfully) would provide IPP-covered employees a one-time opportunity to opt out of the IPP.

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