April 20, 2012 NYSHIP Buyouts
KEEPING YOU INFORMED…
The New York State Department of Civil Service, Employee Benefits Division has issued a policy memorandum that “clarifies” the circumstances pursuant to which employees who drop their employer-sponsored coverage in the New York State Health Insurance plan NYSHIP,) to participate in a health insurance buyout program may enroll in a NYSHIP plan before the end of the buyout period. Specifically, the new policy expressly prevents * taking a buyout from a NYSHIP plan from obtaining health insurance coverage pursuant to NYSHIP; e.g., through a spouse’s family plan, during the buyout period. This change was made effective March 7, 2012.
This policy applies to employees of all agencies and employers, including school districts and local governments, which offer an employee health insurance buyout program. (These programs permit an employee to decline health insurance enrollment in exchange fora cash payment or other benefit, while eliminating the employer’s obligation to pay health insurance premiums for a plan the employee is not using).
The purpose of the new policy, as articulated in the memorandum, is to protect the plan from the adverse selection of those who would take the buyout while health and seek to immediately enter the Plan when benefits would be advantageous to them.” Thus, the State is seeking to maximize NYSHIP revenues while minimizing projected increases in NYSHIP costs. However, by discouraging buyouts, this policy will generate significant additional insurance contribution costs for participating employers who will now have to pay for unneeded and unwanted Plan memberships.
NYSHIP Buyout Policy Requirements
A policy memorandum issued in September 2011 required that any health insurance buyout offered by an employer or agency participating in NYSHIP had to be implemented on an annual basis and for only those employees having “other employer-sponsored health insurance coverage.” The new memorandum “replaces” the September 2011policy guidance and now explicitly explains that “other employer sponsored coverage” refers to coverage in a plan other than NYSHIP. Accordingly, an employee will not be permitted to take a buyout from a NYSHIP plan and yet continue to participate in NYSHIP through a second job or as a dependent through coverage held by a family member or domestic partner.
NYSHIP continues to require that the end of the buyout period must coincide with the annual health insurance option transfer period so that employees who choose to participate in a buyout may enroll in a NYSHIP plan or another employer-sponsored plan at the end of the buyout period. However, employees cannot enroll in NYSHIP before the end of the buyout period unless they experience a “qualifying event” such as marriage, divorce, the birth of a child or death of a spouse. The policy memorandum also reiterates previous guidance that an employee who seeks to enroll in NYSHIP before the end of the buyout period must provide the employer with adequate documentation in order to show that a qualifying event actually occurred.
In addition, the memorandum reaffirms the September 2011 policy that retirement during the buyout period will be considered a qualifying event for NYSHIP purposes. Accordingly, as before, an otherwise eligible employee who took a buyout may either immediately enroll in NYSHIP upon retirement or defer enrollment in NYSHIP as a retiree until a later date, subject to normal late enrollment waiting periods and any applicable buyout program rules.
It should also be noted that the memorandum reiterates the existing requirement that “[e]mployers must ensure that adequate documentation is maintained for those who participate in the buyout program and establish eligibility to continue coverage in retirement.” In this regard, employers should document that buyout participants have other employer-sponsored health insurance, what it is and the source of that information.
In order to offset the potential adverse financial impact of the policy change, employers may consider changing their buyout provisions to eliminate dual family health insurance coverage; i.e., only permitting one dependent and one individual coverage per eligible family unit. Employers may also wish to explore the feasibility of offering new or additional non-NYSHIP health insurance options. If employees enrolled in non-NYSHIP plans participate in future buyouts, they would not be affected by the new NYSHIP policy.
If you have any questions regarding this new policy or methods to ensure compliance, please do not hesitate to contact us.
THIS MEMORANDUM IS MEANT TO ASSIST IN GENERAL UNDERSTANDING OF CURRENT LAW AND POLICY. IT IS NOT TO BE REGARDED AS LEGAL ADVICE. THOSE WITH PARTICULAR QUESTIONS SHOULD SEEK THE ADVICE OF COUNSEL.
© Lamb & Barnosky, LLP, 2012