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Paying forHealth InsuranceAs an active employee, your share of the NYSHIPpremium is deducted from your paycheck. When youretire, you pay through deductions from your monthlyretirement check or you make monthly paymentsdirectly to the Employee Benefits Division. Your HBAcan answer your questions and help you determinethe cost of your health insurance option in retirement.What portion of the cost of health insurancewill I pay as a retiree?The amount you must contribute toward the costof your health insurance coverage as a retireewill be based on your salary grade (or equivalent)at the time of retirement. Ask your HBA what yourpremium will be. You may be able to use your sickleave credit to reduce your cost. See pages 5–7.Although health insurance premiums generallyincrease annually, your sick leave credit is afixed monthly amount that will not change.How will I pay for my health insurance asa retiree?When you retire, you will pay your share of theNYSHIP premium through deductions from yourmonthly retirement check or by making monthlypayments directly to the Employee Benefits Division.Once your eligibility for retiree benefits has beenconfirmed, the Employee Benefits Division will begintaking monthly health insurance deductions fromyour pension. In the interim, if you owe premiums,you will be billed directly each month. You must paythe monthly bills or risk having your health insurancecanceled for nonpayment. If your coverage iscanceled for nonpayment, you can later reenroll.However, in most cases, you will be subject to athree-month waiting period before your coveragebecomes effective.It may take several months for billing to begin.At that point, you will be billed from the date yourretiree health benefits went into effect through thecurrent billing period. Typically, retroactive premiumdeductions will be recouped in increments of upto 750, if applicable.5PLANNING FOR RETIREMENT/April 2021Sick Leave CreditWhat is sick leave credit?Sick leave credit is the actuarial value of your unusedsick leave calculated at the time you retire.* It is thenapplied as a credit to reduce the cost of your NYSHIPpremium — either The Empire Plan or a NYSHIP HMO.Sick leave credit can be applied toward your NYSHIPpremium only if you retire directly from activeemployment, Leave Without Pay status, PreferredList coverage or if you are approved for disabilityretirement retroactive to your last date of employment.Sick leave credit may not be applied toward healthinsurance premium costs while you are in vestedstatus or after retiring from vested status.To estimate the value of your sick leave credit,see the following or visit NYSHIP Online atwww.cs.ny.gov/employee-benefits. Choose yourgroup and plan, if prompted. From the NYSHIPOnline homepage, select Planning to Retire?and click on the Sick Leave Credit Calculator.Employees earn sick leave each biweekly payperiod if they are in full-pay status for seven outof 10 days in a biweekly pay period.** The rate atwhich employees earn sick leave depends on thepercentage of time they work, their bargaining unit,date of hire and whether or not the employeeparticipates in the Income Protection Plan (IPP).* Your age on your actual retirement date is used to calculate sickleave credit.** Judges, justices and certain M/C employees do not earn sickleave credit.

After you retire, sick leave credit benefits you in two ways:1. Reduces the cost of your NYSHIP premium.2. Increases your pension as service credit.Having a monthly sick leave value that covers the premium in full when you retiredoes not guarantee free health insurance for life. While your sick leave creditremains unchanged, your NYSHIP premium will most likely increase each year.Most employees can use a maximum of 200 days ofunused sick leave to calculate sick leave credit. Seeyour HBA for details. Using your sick leave creditfor health insurance will not affect the value ofyour sick leave for pension purposes.If you earn sick leave credit, you may be able to usethe value of your unused sick leave to pay for all orpart of the cost of your health insurance duringretirement. The actuarial value of your sick leavehours is converted to a monthly dollar value.The result is a lifetime monthly sick leave creditused to reduce your share of the monthly NYSHIPpremium for as long as you are enrolled in NYSHIP.If the NYSHIP premium rises, the monthly premiumyou pay also may rise. Each year you can calculatethe amount you will pay in the new calendar year bysubtracting your monthly sick leave credit from thenew monthly premium.When you retire, if you are eligible to use sick leavecredit, your agency will report your hourly rate of payand accumulated sick leave hours to the EmployeeBenefits Division. You will receive a letter verifyingyour monthly sick leave credit and the current costof retiree health insurance coverage. Keep thisletter for your records.If you do not receive this information, write to theEmployee Benefits Division (see page 23) or call518-457-5754 or 1-800-833-4344 (U.S., Canada,Puerto Rico, Virgin Islands).How do I estimate the value of my sickleave credit?To estimate the value of your sick leave credit,use the following formula.Hours ofUnusedSick LeaveHourly Rateof PayTotal DollarValue ofSick LeaveTotal DollarValue ofSick LeaveLifeExpectancyin MonthsYour MonthlySick LeaveCreditYour monthly credit ends when you die and maynot be used by your surviving dependents unlessyou choose the dual annuitant sick leave optionon or before your retirement date.Your HBA can help you with sick leave creditcalculations, or you can access the online sick leavecalculator at www.cs.ny.gov/employee-benefits.Choosing How to Use YourSick Leave CreditWhen you retire, you may choose to use thefull value of your sick leave credit to reduce yourmonthly premium. This is called the single annuitantsick leave option. If you choose this option thefull actuarial value (100%) of your monthly sickleave credit will be applied to your monthly healthinsurance premium until either you cancel yourretiree health coverage or you die. Your singleannuitant sick leave is NOT transferable to yoursurviving dependent(s) to offset the cost of theirNYSHIP premiums for dependent survivor coverage.PLANNING FOR RETIREMENT/April 20216

Choosing the dual annuitant sick leave option is not a requirement fordependent survivor coverage.If you are deferring your coverage prior to retirement, ask your HBA tocomplete Form PS-410, NYSHIP Sick Leave Credit Preservation, and keep itin a safe place. This form will document your accumulated sick leave credit.When you start your retiree coverage, this form will be used to calculate yourmonthly sick leave credit that will be applied toward the cost of yourNYSHIP premium.The dual annuitant sick leave option is also available.This option allows your dependent survivors tocontinue to use your monthly sick leave credit toreduce their monthly NYSHIP premium if you die.If you choose this option, you must do so beforeyour retirement date. This option is only availableprior to your retirement.If you choose the dual annuitant sick leave option,your sick leave credit is reduced to 70 percent ofits full actuarial value for as long as you live andcontinues as long as your covered dependentsare eligible for dependent survivor coverage. Youreligible enrolled dependents who outlive you maycontinue to use the same 70 percent monthlycredit to reduce their NYSHIP premium.If you do not elect dual annuitant sick leave creditbefore your retirement becomes effective, the singleannuitant option will automatically be applied to yourpremium. Your dependent survivors will not be ableto use your sick leave credit to offset the cost oftheir NYSHIP premiums.How do I choose dual annuitant sickleave credit?To choose dual annuitant sick leave credit, contactyour HBA before you retire.You may choose dual annuitant sick leave creditwhether you have Individual or Family coverage atthe time you retire. To make this choice, you mustcomplete Form PS-405, NYSHIP Sick Leave CreditOption Election Form before your retirement date.7PLANNING FOR RETIREMENT/April 2021Once you elect dual annuitant sick leave credit, theelection is permanent. If your dependents shouldlose eligibility or die before you, you will continueto receive 70 percent (reduced) sick leave credit.If I don’t choose dual annuitant sick leavecredit, can my dependent survivors stillhave health insurance?Yes. Your dependent survivors will be able tocontinue their health insurance if they meet NYSHIPeligibility requirements (see pages 2–3). However,without dual annuitant sick leave credit, yourdependent survivors will not have your sick leavecredit available to reduce their NYSHIP premium.How will I decide whether to choose dual orsingle annuitant sick leave credit?Circumstances such as your age, your spouse/domestic partner’s age, eligibility for retireecoverage in their own right and the amountof sick leave credit are different for each retireeand may affect this decision. You may want toconsult with your financial advisor.Keep in mind that choosing dual annuitant sickleave credit is not required for dependent survivorcoverage, but the initial decision is irrevocable(cannot be changed).If you have questions about the dual annuitantsick leave option, your HBA can help or you maycall the Employee Benefits Division at 518-457-5754or 1-800-833-4344 (U.S., Canada, Puerto Rico,Virgin Islands).

Deferring Your Health InsuranceIf I have met the requirements to continue mycoverage as a retiree, can I defer the start ofmy retiree health coverage and use of sickleave credit until after I retire?If you are enrolled in health coverage and have metthe minimum service requirement at the time youretire, you may defer (delay) the start of your retireehealth coverage and the use of your sick leave creditonly if you have other health coverage. If you wantto defer health coverage, you must make this choicebefore your retirement date. Contact your HBA todefer coverage.There may be advantages to delaying the startof your NYSHIP coverage. During the period ofdeferment, you do not have to pay the NYSHIPpremium. The monthly credit for your sick leavemay be higher when you begin your retireecoverage because it will be calculated when youare older. The actuarial table in effect at the timeyou defer your retiree health coverage will beused to determine your sick leave credit.You may reenroll for NYSHIP coverage at anytime by contacting the Employee Benefits Division.A waiting period will not apply if you defer yourcoverage prior to leaving the payroll.If you die while your coverage is deferred and youhad NYSHIP Family coverage in effect at the timeof retirement, your eligible dependents may beeligible to continue NYSHIP coverage as dependentsurvivors. They must write to the Employee BenefitsDivision requesting reenrollment in NYSHIPwithin 90 days of your death. (See page 23 for theaddress.) Eligibility requirements for your dependentsto reenroll in NYSHIP are the same as if you hadcontinued your coverage into retirement. If youhad Individual coverage in effect at the time ofretirement, your dependents will not be eligibleunder NYSHIP as dependent survivors.Choosing Your HealthPlan in RetirementUnderstanding YourNYSHIP OptionsThe first step toward making a good choice isunderstanding the similarities and differencesbetween options. There are two types of healthplans available to you under the New York StateHealth Insurance Program (NYSHIP): The EmpirePlan and NYSHIP-approved Health MaintenanceOrganizations (HMOs).The Empire Plan is designed for New York Stateemployees and retirees. The Plan provides coveragewhether you receive care from Empire Plan networkproviders or non-network providers. Enrollees arenot required to choose a primary care physician anddo not need referrals to see specialists. However,services such as hospital and skilled nursing facilityadmissions, certain mental health and substanceuse treatment, home care and certain prescriptiondrugs require prior authorization.The Empire Plan is available to all NYSHIP enrolleesregardless of where they live in retirement. Coverageis worldwide and is not limited to a geographicarea. However, you should review the list of networkproviders in the area in which you plan to retire.You will need to submit claim forms and pay ahigher share of the cost of services if you usea non-network provider.An HMO is a managed care system that providescomprehensive health care coverage through anetwork of providers within a specific geographicarea. NYSHIP enrollees have a choice of one ormore NYSHIP HMOs located in New York State.HMO enrollees usually must select a participatingprimary care physician to provide routine medicalcare and to make referrals to network specialistsand network hospitals when necessary.PLANNING FOR RETIREMENT/April 20218

You may enroll (or continue enrollment) in anyNYSHIP HMO that serves the area where you livein retirement. If you are enrolled in a NYSHIP HMOand no longer live in its service area, you mustchange to another plan. If you are Medicare-primaryand enroll in a NYSHIP Medicare Advantage HMO,in most cases you must live in the HMO’s servicearea. Check with your HMO if you have questions.Can I change my health insurance plan(option) in retirement?As a retiree, you may change your NYSHIP healthinsurance plan (option) once during a 12-monthperiod for any reason. Active employees maychange only during the annual Option TransferPeriod, unless they experience a qualifying event.You may change your plan more than once in a12-month period if: You are enrolled in a NYSHIP HMO and movepermanently out of your HMO’s service area, You move to an area served by a NYSHIP HMOthat did not serve your previous home area, or You add a new dependent acquired throughmarriage, domestic partnership, adoption orplacement for adoption.What happens to my sick leave creditif I cancel my NYSHIP coverage?Sick leave credit only applies when you are payinga NYSHIP premium. Upon reenrolling, you willreceive the same monthly sick leave credit asbefore you canceled coverage.NYSHIP and MedicareNote: The following information applies to you and yourcovered dependents.The Empire Plan and all HMOs offered underNYSHIP provide broad coverage for Medicareeligible enrollees, but there are importantdifferences among plans.The Empire PlanThe Empire Plan coordinates hospital, medicaland mental health and substance use benefitswith Medicare. Although Medicare does notcover medical expenses for services outside theUnited States, Empire Plan benefits are availableworldwide. See your NYSHIP General InformationBook and Empire Plan Certificate for details.See your NYSHIP General Information Book, EmpirePlan Reports/HMO Reports and Health InsuranceChoices for Retirees for more information aboutchanging your health insurance plan.The Employee Benefits Division will mail youinformation about NYSHIP options each year.The information will include summaries andcosts of NYSHIP plans available to you.Canceling NYSHIP CoverageAfter I retire, may I cancel NYSHIP coverageand later reenroll?After you retire, you may cancel your NYSHIPcoverage and reenroll at a later date. Under mostcircumstances, you will be subject to a waitingperiod of up to three months before your coverageis reinstated.9PLANNING FOR RETIREMENT/April 2021If you die during theperiod of time thatyour NYSHIP coverageis canceled, yourdependents will not beeligible for dependentsurvivor coverage.

NYSHIP Health MaintenanceOrganizations (HMOs)If you are Medicare-primary (Medicare pays beforeNYSHIP) and enrolled in a NYSHIP HMO, you willhave no Medicare benefits outside the HMO servicearea. With a Medicare Advantage Plan, all Medicareand HMO benefits are provided through the plan.You must follow the HMO’s requirements and usetheir providers. You may not receive any benefitsfrom Medicare or that HMO if you choose to receivecare outside your HMO other than for thoseservices as specified in the plan contract. Checkplan documents for any limitations or exclusions.Also check with your HMO about benefits when youtravel outside of your HMO’s service area or outsideof the country.Non-NYSHIP HMOsYou may receive information from Medicare and fromnon-NYSHIP HMOs in your area describing Medicareoptions available to you that are not part of NYSHIP.You may wonder whether to join one of these plans.Please be aware that your NYSHIP benefits will besignificantly reduced or canceled if you do.If you cancel your NYSHIP coverage to join a nonNYSHIP Medicare Advantage Plan, be aware that: The State will no longer reimburse you or yourMedicare-eligible dependents for the MedicarePart B premium. Your sick leave credit will not offset your healthinsurance costs. If you wish to reenroll in NYSHIP, there may be athree-month waiting period. If you die while you are not enrolled in NYSHIP,your dependents will not be eligible fordependent survivor coverage unless deferralrules apply (see page 8).Before you choose a Medicare Advantage Planthat is not part of NYSHIP, check with the EmployeeBenefits Division to see how your NYSHIP benefitswill be affected. In most cases, your NYSHIPcoverage will be canceled; if you are the enrollee,NYSHIP coverage will also be canceled for yourdependent(s) on the plan.PLANNING FOR RETIREMENT/April 202110

What is Medicare?Medicare is the federal health insurance programfor people aged 65 and older, people who aredisabled and have received Social Security DisabilityInsurance (SSDI) payments for 24 months, peoplewho are receiving SSDI due to amyotrophic lateralsclerosis (ALS) and those who have end-stagerenal disease (ESRD). It is administered by theSocial Security Administration and the Centersfor Medicare and Medicaid Services (CMS).Medicare has four parts:Medicare Part A covers inpatient care in a hospitalor skilled nursing facility, hospice care and homehealth care.In most circumstances, there is no cost for MedicarePart A. There are some individuals who do not qualifyfor Medicare Part A at no cost. These individuals arenot required to take Part A and may keep NYSHIP astheir primary coverage for Medicare Part A benefits.If Social Security tells you that you must p

Whatever you have planned and wherever you go in your retirement, your health benefits will be a key interest. The New York State Health Insurance Program . There are three criteria that you must meet to continue NYSHIP coverage as a State retiree: First, you must complete the minimum benefits-