“Smart Savings” Coverage when both spouses, or partners, work for the County
Q: What is the Smart Savings Program?
A: The Smart Savings program ends the practice of providing two family health benefits policies to employees who are married to or partnered with another county employee or retiree. In Smart Savings, one spouse or partner is the primary person for health benefits coverage and the other spouse or partner is a dependent. The dependent spouse or partner receives the County’s health insurance Buyback (currently $2,000) and the family is reimbursed should they have out of pocket expenses over the buyback amount that would have been covered if they had retained two family health benefits policies.
Q: Who is covered by Smart Savings?
A: Smart Savings covers all County and College employees. County non-union retirees are also covered. All other retirees are covered if they retired on or after:
September 1, 2007 for PBA members
June 1, 2008 for ShOA members
June 1, 2008 for DAI members
February 1, 2009 for CSEA members
February 1, 2009 for NCC non-union employees
September 1, 2009 for NCCFT members
In addition to the above, the Smart Savings program is offered to all retirees who retired prior to the dates listed. For these retirees, the program is entirely voluntary.
Q: May I opt-out of Smart Savings?
A: You cannot opt out unless you are one of the retirees who enrolled in the program voluntarily. Although under current County rules, you and your spouse or partner may choose to have two individual health insurance policies instead of one family policy under Smart Savings.
Q: Will Smart Savings result in a reduction in health benefits?
A: No. Smart Savings maintains the same level of benefits to the employees/retirees and their families.
Q: I am married to another Nassau County employee and we do not have any children. Can we get two individual health insurance policies instead of one family policy?
A: Yes. You may take two individual health insurance policies instead of one family policy. However, you will not receive the buy back or the reimbursement...
Q: Can my spouse and I switch who is the primary person and who is the dependent?
A: Yes. You may change which spouse or partner is primary and which is the dependent once a year during the open enrollment period. The change will be effective as of January 1 following the open enrollment period.
Q: What happens if I am the dependent for health benefits and my spouse dies or we get a divorce?
A: If you are an active employee you and your dependents will be covered under your own policy. If you are a retiree or a vestee, NYSHIP rules provide that as long as you maintained continuous covererage as a dependent, you can be provided health benefits as the primary person upon a change in status, such as a divorce or in the event the primary policyholder dies. Under NYSHIP rules, the previous coverage continues automatically for 90 days after the change of status. You must notify the Comptroller’s Health Benefits Unit of the change in status within the 90 day period so that we can switch you to become the primary person under NYSHIP rules. Please note that vestees will be required to pay the vestee premium rates applicable at that time.
Q: How will I receive my Smart Savings health insurance Buyback reimbursement?
A: The Buyback amount, currently $2,000, is paid to employees through a payroll check. Retirees enrolled in the Smart Savings program also receive the Buyback amount. For these retirees, checks will be issued in the beginning of the year for which the coverage is being declined. The Buyback amount is taxable, and will be reported to the IRS in the W-2 for employees and on a MISC-1099 for retirees.
PROCEDURES FOR FILING A CLAIM REIMBURSEMENT UNDER THE SMART SAVINGS PROGRAM
1. The Reimbursement Form should be used when a family covered by the Smart Savings Program has expended in excess of $2,000.00 for expenses that would have otherwise been reimbursed under a second family health insurance plan.
2. When you submit your first claim for reimbursement, you must include one or more Explanation of Benefits forms (“EOBs”) verifying out-of-pocket expenses that would otherwise have been reimbursed under a second family health insurance plan in excess of $2,000.00. If you do not submit EOBs totaling $2,000.00, your claim for reimbursement will be returned to you unprocessed.
3. You only need to submit proof of expenses totaling $2,000.00 once per plan year along with proof of payment of these expenses in order to be reimbursed for your additional expenses.
4. Be sure to print clearly and legibly using either black or blue ink when completing this form.
5. A claim for reimbursement cannot be processed without the claimant’s Insurance Card Number.
6. Completed Reimbursement Forms along with the Explanation of Benefits (EOBs) and proof of payment should be mailed directly to the Plan Administrator.
7. You may submit either original documents or copies. If the copies submitted are illegible, the Plan Administrator reserves the right to return the submission to the claimant unprocessed. If you are submitting multiple Reimbursement Forms in one envelope, please paper clip the appropriate Reimbursement Form, EOBs and any additional documentation together.
8. The Plan Administrator reserves the right to request additional documentation from claimants prior to processing a claim.
9. The deadline for submission of reimbursements for the year 2012 is May 1, 2013.
Please mail your completed form(s) to the Plan Administrator listed below:
NASSAU COUNTY SMART SAVINGS PROGRAM
c/o Pamela D’Apuzzo
RR Health Strategies, LLC
926 RXR Plaza
Uniondale, NY 11556
All inquiries regarding reimbursement under the Smart Savings Program should be directed to the Plan Administrator. Reimbursement Forms may be obtained by clicking here or by calling the Plan Administrator at (631)231-0505.