Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage The Department of Civil Service
administers health insurance programs for State and local government employees and their
dependents. The primary such program is the Empire Plan, which provides services costing
more than $1.4 billion a year. Medicare is a Federal health insurance program for disabled
people and people aged 65 or older. When Empire Plan enrollees become eligible for
Medicare, their medical expenses should generally be paid by Medicare. We reviewed the
hospitalization and major medical claims paid over a one-year period by the Empire Plan to
people aged 65 or older and estimated that about $3.4 million of these claims should have
been paid by Medicare. We recommend that these payments be recovered from Medicare.
We also recommend that improvements be made in the Empire Plan's procedures for
identifying enrollees who are eligible for Medicare.
For a complete copy of 95-S-92 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.