Latest News from Health Benefits Dept.
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.
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
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
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 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.
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.
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
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Keisha Martinez, Health Benefits Specialist
BOE/ Library Complex
124 Grand Street
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