THE TRUSTEE: April 2009: KINGSTON TRUST FUND
PO Box 4461, Kingston, NY 12402, 307 Wall St., 3rd fl., Kingston, NY 12401
Phone:(845)338-5422, Fax:(845)338-039 Email:Kathy@kingstontrustfund.com
‘Thank You’ for all of your efforts in meeting the requirement for electronic enrollment. The electronic enrollment web site is encrypted; safe and secure. Remember, the deadline is April 30.
As detailed in the March Torch, as well as noted in the NYSUT Leader, the MVP newsletter, and other publications, a new federal law requires that group health plan insurers report specific information about their group members to the Center for Medicaid and Medicare Services(CMS). NHAI must provide enrollment information to CMS for every policy holder covered through the Trust. Medicare will use this information, both retrospectively and prospectively, to ensure that payment of medical expenses is coordinated with other health insurance and coverage payers. Examples of other payers may include liability insurers, no-fault insurance, and workman’s compensation insurance. It would seem that the federal government would like to tighten Medicare oversight prior to any introduction of a national health plan.
As the federal government moves toward greater accountability of Medicare records, it is also gathering information on the health insurance status of all citizens Families may have spouses and dependents, all with different surnames and living at different locations. Divorce and separation decrees may impact dependent and primary and secondary coverage. And, Medicare is dependent on the several factors already mentioned. It is a challenge to provide a software application that addresses and handles all of these variables. In meeting the reporting requirements, there are many variables when addressing the enrollment needs of our 1500 plus policy holders. There are always unanticipated situations that occur. Any time the on-line enrollment encounters a conflict, it is immediately addressed by NHAI’s internet technician.
Knowing there are software limitations, we are aware of the concerns that may require perseverance through the on-line enrollment process. Once you do move ahead… click, save, and print a copy of the form. You can always use your assigned number and password to go back in and correct any submission. Here are some frequent concerns.
As I now have NHAI, am I a new or an existing enrollee?
-Until you electronically enroll, you should indicate new enrollee. Obviously, you need a login ID and password for existing status and you won’t have that until you have electronically enrolled.
Is this an Update for me?
-For those with no current changes, this is an Update. If there are changes, the date of change must be noted. For example, several members have not kept their information current on marital status and this creates a fraudulent event where coverage was extended to an ineligible person. Now, electronically, the member can enter the change on their form.
Does spousal coverage under NHAI count as other coverage?
-No. Other coverage would mean another health plan, including Medicare.
Do Retirees who have two individual policies both have to enroll ?
-Not necessarily. Retirees with two individual policies should complete ONE member enrollment form with their spouse’s information regarding any other health coverage they have, including Medicare UNLESS both are retired from the district and have dual coverage. In that case, Then, the individual with dual coverage would report the NHAI coverage as “other health coverage.”
What is the effective date of Medicare coverage?
-Use the effective date printed on your Medicare ID card.
If I have other health coverage with the Trust (Kingston Schools), such as any of the HMO’s, but have Trust Dental, do I complete the form?
-Yes. If you elect “other health coverage” select Option ‘O’ and complete the form as it applies to your dental coverage. If you have ‘other’ and no dental, you do not have to do an NHAI enrollment. Your ‘other’ health insurer will contact you for information they need.
Do I have to report spousal information if I’m not covering my spouse?
-CMS requires any married member to report spousal information, even if they are not covered.
Can I note any unusual circumstances on the form?
-There is a space on the signature/acceptance page to add any special items.
How will I know if my form is acceptable as presented?
-You will receive an email, confirming your ID# and your Password. Any statements that need clarification will be noted.
As a retiree with no computer, I filed a hard copy enrollment. Will I be electronically enrolled?
-You will be electronically enrolled and will be given an ID# and a password. In the future, NHAI can update any information you need.
Be sure to list ALL dependents, including spouse. For some members, current information indicates a spouse and the Updated electronic form omits them. Did you forget? Is this a change as opposed to an Update?
Sign the electronic enrollment by writing forward slash, full name, forward slash. (/ your name /)
REMINDERS-- Any benefit where there is a maximum benefit per visit, such as Massage Therapy, Chiropractic, and Acupuncture, members are responsible for any charges in excess of the allowable. For example, if the allowable is $50 and the charge is $70, the member is responsible for the excess of $20 plus the co-pay of $15, or a total of $35 for the visit.
COMMUNICATION -- When a member emails or faxes an appeal or a request for additional information to any of the NHAI Offices, please be sure to include in the Subject Line the group name (KTF) and your member number(153……). It will avoid any communications being missed as computers distinguish between legitimate email and spam.
The NHAI plan book includes Medical and Dental information and schedules and is available on-line at www.nhai.net.
As always, if there are concerns, contact Kathy Hyatt at the Trust office.