Federal and State Mandates

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Producer Transparency in Compensation  
The Producer Transparency in Compensation mandate requires producers and Empire sales associates to provide disclosure notification regarding sales compensation to customers during the sales process. The attachments below satisfy Empire's sales associates' disclosure notification requirement under the mandate.  
Downstate
Upstate
 
Federal Mental Health Parity: An Overview and FAQs  
Mental Health Parity
 
Health Care Reform Law and Small Groups  
Downstate
Upstate
 
2012 Preventive Care Coverage Update 
Downstate 
Preventive Care Coverage without Contraceptive
Preventive Care Coverage with Contraceptive
 
Upstate  
Preventive Care Coverage without Contraceptive
Preventive Care Coverage with Contraceptive
 
Reminder: Timothy's Law Rider is Available 
Upon inception or renewal of your Empire small group health insurance policy you have the right to purchase optional coverage for Biologically-Based Mental Illness (for dependant children and covered adults) and Children with Serious Emotional Disorders (for dependants under the age of 18) through a rider that is available at an additional cost. Please note that Empire's base benefits do not cover these conditions. Contact your broker or Empire representative to learn more. 
New Insurance Laws Adopted in New York State 
Two laws were signed into effect in New York on July 29, 2009. The first extends dependent coverage through age 29 under certain circumstances and the second extends state continuation coverage from 18 to 36 months. 
Extended dependent coverage through age 29:

This law has two components:

The first provides for a “make available” option that permits the policyholder to increase the coverage age for eligible dependents through 29.

The second applies if the group policyholder does not choose this option and instead allows group subscribers to buy continued coverage through age 29 on an individual basis for their eligible dependents who have “aged out” under the policy.

 
Extension of Cobra Benefits New York State Continuation of Coverage to 36 Months: This law extends state continuation coverage from 18 to 36 months when an employee, member or dependent that is eligible for NYS “mini-COBRA”, i.e., an insured group of fewer than 20, loses coverage. It also allows members who have exhausted federal COBRA coverage to buy an additional 18 months of coverage under NY “mini-COBRA.”
 
The Federal Mental Health Parity and Addiction Equity Act (referred to herein as Mental Health Parity or MHPA), which becomes effective October 3, 2009, requires "parity" between the financial requirements and treatment limitations applied to medical and/or surgical benefits and mental health and substance use disorder benefits. This law affects all fully insured and self-insured plans covering 51 or more employees, regardless of the number of eligible employees or actual enrolled employees. Small groups -- those with fewer than 51 eligible employees -- are required to comply with MHPA if they have 51 or more total employees. More 
 
Beginning this year, Empire, as well as all group health plan insurers or third party administrators, is required to provide reports to CMS1 about plan participants on behalf of group health plans. The collected data enables CMS to identify Medicare beneficiaries who are covered by group health plans and accurately pay claims by determining primary versus secondary payer responsibilities. More  
 
The American Recovery and Reinvestment Act ("ARRA" or the "Act") was enacted on February 17, 2009 (the "Enactment Date"). The Act provides COBRA health insurance premium assistance for eligible employees whose employment is involuntarily terminated between September 1, 2008, and December 31, 2009. The Act introduced a 65 percent federal subsidy of COBRA continuation coverage premiums for up to nine months. Please consult the links above for complete details relating to this federal law. More  
 

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