December 01, 2009

NYSHIP dependent eligibility audit enters appeals phase

Source: NYSUT Program Services

The New York State Health Insurance Program (NYSHIP) dependent eligibility audit for participating agencies (schools and local governments) offering the Empire Plan is in the final phase, the appeals process.

In early December, enrollees with family coverage will receive a confirmation letter from Budco, the state's vendor for this project, listing eligible and ineligible dependents. Ineligible dependents will be removed retroactive to February 1, 2009. Participants can appeal the removal of dependents by providing Budco with the necessary documentation no later than January 15, 2010. If members have any questions concerning the NYSHIP eligibility project, they can call 1-888-358-2198.

The Budco appeals process for UUP members with ineligible dependents ended November 25, 2009. Any remaining appeals must be sent to the Department of Civil Service.

Additional information is available at:

About the Dependent Eligibility Project

"The Department of Civil Service (the Department), administrator of the New York State Health Insurance Program (NYSHIP), is conducting a project to verify the eligibility of every dependent covered by NYSHIP. The verification of eligibility will include all dependents, with the exception of Dependent Survivors, covered under NYSHIP health benefits through the Empire Plan, a NYSHIP HMO or the Student Employee Health Plan (SEHP).

"This project requires all enrollees with family coverage to provide proof that each of their dependents is eligible for coverage through NYSHIP. Failure to provide sufficient proof will result in the removal of the dependent from coverage. In addition, the Department reserves the right to recover from the enrollee claims paid on behalf of any dependent determined to be ineligible and to pursue civil/criminal action.

"The Department has contracted with Budco to conduct the eligibility audit project. Budco is a national leader in this field and is located in Highland Park, Michigan."


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