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While many CSEA state enrollees have probably seen an increase in their out-of-pocket expense for prescription drugs as a result of co-payments, your health insurance plan continues to pay most of the cost of your prescription drugs. To keep your out-of-pocket costs for prescription drugs as low as possible, let your doctor know that your co-payments are lower when you use generics and/or preferred brand-name drugs. Ask if there are alternative prescription drugs that may be right for you. New York State Alters Domestic Partner Policy The CSEA Health Benefits Department would like to inform enrollees of a recent change to the Department of Civil Service's policy regarding the eligibility of spouses for coverage under the New York State Health Insurance Program (NYSHIP). Effective May 1, 2007, the New York State Department of Civil Service will alter its prior policy and afford recognition to any same-sex marriage that is legal in the jurisdiction where it was performed, for purposes of providing spousal benefits eligibility in NYSHIP. At this time, a same-sex marriage from the following jurisdictions will be recognized if it is legal in the jurisdiction itself: The State of Massachusetts, Canada (including a11 of its provinces), Spain, South Africa, the Netherlands, and Belgium. Please note that the laws governing the legality of same-sex marriages in these jurisdictions vary. In general, NYSHIP will assume, absent any indication to the contrary, that the possession of a marriage certificate from the jurisdiction is proof that the marriage is legally recognized there. Civil unions continue to be acceptable as part of proof requirements for domestic partner coverage. The offering of coverage for domestic partners will continue to be discretionary for PAs and PEs. To help implement this change, there will be a special enrollment period from May 1, 2007 through May 31, 2007 during which enrollees may enroll same-sex spouses in NYSHIP without regard to the usual enrollment effective date rules. During the special enrollment period, the effective date of the spouse's coverage will be May 1, 2007 if a legal marriage took place prior to this date and the enrollee requests that effective date. Applications submitted during the special enrollment period for marriages that occur after May 1, 2007 will be effective on the date of the marriage. Applications signed after May 31, 2007 will be subject to the usual effective date rules used for spouse eligibility due to marriage. Although these dependents are recognized as spouses by NYSHIP, enrollees may still be subject to imputed income for the value of the benefits provided to the spouse, if the spouse does not meet the qualifications as a dependent under IRS Code Section 152. Any questions regarding this change in policy or the recognition of a marriage for NYSHIP purposes should be directed to your agency's Health Benefits Administrator, usually located in the personnel office. Attention Empire Plan Enrollees A Reminder About Mastectomy and Reconstructive 5 Surgery Benefits The CSEA Health Benefits Department would like to remind enrollees that The Empire Plan covers inpatient hospital care for lymph node dissection, lumpectomy and mastectomy for treatment of breast cancer for as long as the physician and patient determine hospitalization is medically necessary. The Plan covers all stages of reconstructive breast surgery following mastectomy, including surgery of the other breast to produce a symmetrical appearance. The Plan also covers treatment for complications of mastectomy, including lymphedema. Prostheses and mastectomy bras are covered. If you have questions about your coverage for implants, breast forms or other prostheses related to breast cancer treatment call United HealthCare, the Empire Plans medical/ surgical provider, toll free at 1-877-7-NYSHIP (1-877-769-7447) or you contact your agency health benefit administrator, usually located in the personnel office. Empire Plan Benefits Management Program requirements apply. See your Empire Plan Certificate and Empire Plan Reports. Attention Empire Plan Enrollees A Reminder about NurseLine Services The CSEA Health Benefits Department would like to remind enrollees that the Empire Plan NurseLine offers health and wellbeing information 24 hours a day. This service is provided to CSEA represented NYS Empire Plan enrollees and their eligible dependents. Nurses can help answer questions and provide education and support for a wide variety of health related concerns such as; managing diabetes, controlling high blood pressure, understanding cancer and living with asthma. , Get answers to health questions, learn about possible treatment options and even gain a better understanding of a medical diagnosis or health condition by contacting the Empire Plan NurseLine toll free at 1-877-7-NYSHIP (1-877-769-7447). |
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