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The NYPERL EBD 542 1 form serves as a crucial document for employees in New York State who are considering enrolling in the New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL). This form outlines important information regarding the enrollment process, including eligibility criteria and deadlines. Employees have a 60-day window from their date of hire or first eligibility to enroll without needing to provide evidence of insurability. This is particularly significant, as those who miss this window may face additional requirements, such as health statements or physical exams, to qualify for coverage. The form also includes sections for personal information, such as the employee's name, date of birth, and agency details, ensuring that the enrollment process is streamlined and organized. Additionally, it emphasizes the importance of understanding the nature of long-term care, which can arise from various circumstances, including aging or health issues. NYPERL aims to provide financial protection against the high costs of long-term care services, which are often not fully covered by traditional health insurance or Medicare. With premiums based on age and selected benefits, employees are encouraged to consider their individual needs carefully before enrolling. The form also provides instructions on how to obtain further information and submit applications, highlighting the role of MedAmerica Insurance Company in administering the plan.

Similar forms

  • Health Insurance Enrollment Form: Similar to the NYPERL EBD 542 1 form, this document provides essential information regarding health insurance options available to employees. It typically includes sections for personal details, coverage choices, and deadlines for enrollment.
  • Retirement Plan Enrollment Form: This document serves a similar purpose for employees looking to enroll in retirement plans. It outlines eligibility criteria, contribution options, and important deadlines, much like the NYPERL form does for long-term care insurance.
  • Flexible Spending Account (FSA) Enrollment Form: This form allows employees to participate in an FSA, detailing contribution limits and eligible expenses. Like the NYPERL form, it emphasizes deadlines and the importance of timely submission.
  • Life Insurance Application Form: Employees use this form to apply for life insurance coverage. It requires personal information and often includes health-related questions, paralleling the evidence of insurability aspect of the NYPERL form.
  • Dependent Care Benefits Enrollment Form: This document enables employees to enroll in dependent care benefits. It includes similar sections for personal information and deadlines, akin to the NYPERL enrollment instructions.
  • COBRA Continuation Coverage Election Notice: This notice informs employees of their rights to continue health insurance coverage after leaving employment. It shares the NYPERL form's focus on important deadlines and the consequences of inaction.
  • Short-Term Disability Insurance Enrollment Form: This form allows employees to enroll in short-term disability insurance, detailing coverage options and eligibility. It mirrors the NYPERL form in its emphasis on the enrollment process and necessary documentation.

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State of New York

Department of Civil Service

Alfred E. Smith State Office Bldg.

Albany, NY 12239

EMPLOYEE BENEFITS DIVISION

NYPERL NYS Employee Notice and Fact Sheet

EBD-542.1 (8/06L)

New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL)

EMPLOYEE NOTICE AND FACT SHEET

With Instructions on Enrolling

EMPLOYING AGENCY SECTION

Employee Name

 

 

 

 

Date of Birth

 

 

 

Agency

 

 

 

 

 

Date of Hire or

 

Name &

 

 

 

Salary

 

Date First Eligible

 

Agency Code

 

 

 

Grade

 

Agency Contact

 

 

 

Agency Contact

 

Name

 

 

 

Phone#

 

OPEN ENROLLMENT EXPIRATION DATE

(60 CALENDAR DAYS After Date Employee is Hired or First Eligible for Guarantee Issue)

EMPLOYEE SECTION

I have been offered an opportunity to enroll in the NYS Public Employee and Retiree Long Term Care Insurance Plan (NYPERL), and have received a NYPERL fact sheet and instructions on how to receive additional information to enroll in NYPERL.

I understand that I have 60 days from the date I became first eligible for guarantee issue to enroll in NYPERL without having to produce evidence of insurability such as a health statement, an interview, or a physical exam.

I understand that if I decide to apply to participate in NYPERL after the 60-day period has passed, then I will be required to produce evidence of insurability, to be determined by the Insurer at that time.

I understand that I am responsible for contacting the Insurer to obtain additional information and an application to enroll in NYPERL if I decide to enroll in the Plan, and that I am responsible for the completion and submission of the application to the Insurer.

Employee Signature

 

Date

Employee SSN

Personal Privacy Protection Law Notification The information you provide on this document is being requested in accordance with Article 11-A of the Civil Service Law for the principal purpose of notifying employees of their 60-day open enrollment opportunity for the New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL). The information will be used in accordance with Public Officers Law section 96 (1) also known as the Personal Privacy Protection Law. Failure to provide the information requested may interfere with your employer's ability to ensure the proper administration of NYPERL. This information will be maintained by your employer and by MedAmerica Insurance Company of New York, 165 Court Street, Rochester, New York 14647. For information concerning the Personal Privacy Protection Law, call (518) 457-9375. If you have any questions regarding this form, please call your employer’s Personnel Office.

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State of New York

Department of Civil Service

Alfred E. Smith State Office Bldg.

Albany, NY 12239

EMPLOYEE BENEFITS DIVISION

NYPERL NYS Employee Notice and Fact Sheet

EBD-542.1 (8/06L)

New York State Public Employee Long Term Care Insurance Plan (NYPERL)

EMPLOYEE NOTICE AND FACT SHEET

With Instructions on Enrolling

NYPERL is your employer's voluntary, employee-pay-all group long-term care insurance plan.

Long-term care is assistance you need if you are unable to carry out the basic activities of everyday living—bathing, continence, dressing, toileting, eating, or transferring, such as from a chair or bed. The need could arise from an accident or a debilitating illness. Or it could simply be the natural result of aging.

Only a small portion of the long-term care services you are likely to need are covered by health insurance or Medicare and long term care is expensive. According to a NYS Partnership study conducted in 2004, the average nursing facility cost in New York State is $95,937 per year.

NYPERL is designed to provide financial protection against the costs associated with long-term care covered services provided by a(n): nursing facility; home health care agency; adult day care center; or assisted living facility.

Premiums are based upon your age when you apply and the benefits you select. The younger you are when you apply, the lower the premium. As in any long term care insurance product, premiums may change, but only if the insurer changes the premium rates for all persons in the same premium payment class, regardless of where you reside at the time of the premium change.

NYPERL is administered and insured by MedAmerica Insurance Company of New York (Home Office: Rochester,

NY) and MedAmerica Insurance Company (Home Office: Pittsburgh, PA) headquartered in Rochester.

You should not buy long term care insurance if the only way you can afford to pay for it is by not paying other important bills. Look closely at your needs and resources, and discuss it with a family member to decide if long-term care insurance is right for you.

INSTRUCTIONS ON ENROLLING

An enrollment kit and more NYPERL information may be obtained by calling MedAmerica’s NYPERL Customer Service toll free number, 1-866-474-LTCI (5824), or by visiting the NYPERL website at www.NYPERL.net. Once you have reviewed the materials in the enrollment kit or the information on the website, Customer Service staff can walk you through the enrollment form and answer any questions you might have.

NYPERL applications are found in the Enrollment Booklet in the enrollment kit or are available on the NYPERL website. Submit your completed application to MedAmerica, not to your employer.

If an eligible employee is actively at work and applies for NYPERL during the 60 day open enrollment period, a health statement, health interview, physical exam or other evidence of insurability is not required. If you are an eligible employee applying under open enrollment, use Enrollment Form 1 found in the Enrollment Booklet of the enrollment kit.

If you are applying after the expiration of open enrollment or if an eligible family member is applying, use Enrollment Form 2 found in the Enrollment Booklet of the enrollment kit. This enrollment form contains a health statement that you must complete with the application.

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Common mistakes

Filling out the NYPERL EBD 542 1 form can seem straightforward, but many people make common mistakes that can lead to delays or complications. One frequent error is failing to provide accurate personal information. For instance, the employee's name, date of birth, and Social Security number must be correct. A small typo can result in significant issues later on, especially when it comes to processing the application or verifying eligibility.

Another common mistake involves overlooking the open enrollment expiration date. Employees have a limited window of 60 calendar days to enroll without needing to provide evidence of insurability. Many individuals miscalculate this period or forget to check the specific date, which can lead to missed opportunities for coverage. It is crucial to mark this date clearly and set reminders to ensure timely enrollment.

Some applicants also neglect to read the instructions thoroughly. The form includes specific guidelines on how to submit the application and what to include. Skipping these instructions can lead to incomplete submissions, requiring additional follow-up and potentially delaying coverage. Understanding the process can save time and reduce frustration.

In addition, many people forget to sign and date the form before submission. This step is essential; without a signature, the application may be considered invalid. Taking a moment to review the completed form can help catch this oversight and ensure that all necessary fields are filled out correctly.

Lastly, individuals often underestimate the importance of contacting the insurer for additional information. While the form provides essential details, reaching out to MedAmerica for clarification on any questions can be beneficial. This proactive approach can help avoid misunderstandings and ensure a smoother enrollment process.

More About Nyperl Ebd 542 1

  1. What is the NYPERL EBD 542 1 form?

    The NYPERL EBD 542 1 form is an employee notice and fact sheet regarding the New York State Public Employee and Retiree Long Term Care Insurance Plan (NYPERL). It provides essential information about the enrollment process, eligibility, and the benefits associated with the long-term care insurance plan.

  2. Who is eligible to enroll in NYPERL?

    All public employees and retirees in New York State are eligible to enroll in the NYPERL program. Employees must be actively at work and can enroll during a 60-day open enrollment period that begins when they first become eligible for guarantee issue. This period allows them to enroll without needing to provide evidence of insurability.

  3. What is the significance of the 60-day open enrollment period?

    The 60-day open enrollment period is crucial because it allows eligible employees to enroll in NYPERL without needing to submit a health statement or undergo a physical exam. If an employee does not enroll within this timeframe, they will need to provide evidence of insurability, which could include health statements or interviews, to be considered for coverage.

  4. How can an employee enroll in NYPERL?

    To enroll in NYPERL, employees should obtain an enrollment kit, which includes the necessary forms and additional information. This kit can be requested by calling MedAmerica’s NYPERL Customer Service at 1-866-474-LTCI (5824) or by visiting the NYPERL website at www.NYPERL.net. After reviewing the materials, employees can complete the enrollment form and submit it directly to MedAmerica, not to their employer.

  5. What types of services are covered under NYPERL?

    NYPERL provides financial protection against the costs associated with long-term care services. This includes care provided in nursing facilities, home health care agencies, adult day care centers, and assisted living facilities. The plan aims to assist individuals who may need help with daily activities due to aging, illness, or accidents.

  6. Are premiums for NYPERL fixed?

    Premiums for NYPERL are based on the age of the employee at the time of application and the selected benefits. While premiums may change, any increase would apply uniformly to all individuals within the same premium payment class. This means that if the insurer adjusts rates, it will affect all members equally, regardless of their location.

  7. What should employees consider before enrolling in NYPERL?

    Before enrolling, employees should carefully evaluate their financial situation and long-term care needs. It is essential to consider whether the premiums fit within their budget without compromising other important expenses. Consulting with family members or financial advisors can also provide valuable insights into whether long-term care insurance is appropriate for their circumstances.

Misconceptions

There are several misconceptions about the NYPERL EBD 542 1 form that can lead to confusion for employees considering enrollment in the New York State Public Employee and Retiree Long Term Care Insurance Plan. Below are six common misconceptions explained.

  • Misconception 1: The NYPERL enrollment is mandatory.

    • This is not true. Participation in the NYPERL plan is entirely voluntary. Employees can choose whether or not to enroll based on their individual needs and circumstances.

  • Misconception 2: You can enroll at any time.

    • Enrollment must occur within 60 days of becoming eligible for guarantee issue. After this period, employees will need to provide evidence of insurability, which can complicate the application process.

  • Misconception 3: All long-term care services are covered.

    • While NYPERL does provide coverage for a range of services, not all long-term care needs may be included. It is crucial to review the specific benefits offered to understand what is covered.

  • Misconception 4: Premiums will never change.

    • Premiums can change, but only if the insurer adjusts rates for all individuals in the same premium payment class. It is important to be aware that changes can occur over time.

  • Misconception 5: You must submit the application to your employer.

    • This is incorrect. Completed applications should be submitted directly to MedAmerica Insurance Company, not your employer. This ensures that your application is processed correctly.

  • Misconception 6: Long-term care insurance is only for the elderly.

    • Long-term care needs can arise from various situations, including accidents or debilitating illnesses, not just aging. Therefore, younger employees may also benefit from considering this insurance.

Understanding these misconceptions can help employees make informed decisions about their long-term care insurance options. Always consider discussing your situation with a family member or financial advisor to ensure you choose the best path for your needs.

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Key takeaways

When filling out and using the NYPERL EBD 542 1 form, consider the following key takeaways:

  • Understand the Importance of Timeliness: You have 60 calendar days from your first eligibility date to enroll without needing to provide health evidence.
  • Contact Information: Ensure that your agency contact information is accurate. This will help you receive timely assistance.
  • Employee Responsibility: It is your responsibility to reach out to the insurer for additional information and to submit your application.
  • Application Submission: Always submit your completed application directly to MedAmerica, not to your employer.
  • Health Statement Requirement: If you apply after the open enrollment period, a health statement will be necessary.
  • Financial Considerations: Assess your financial situation carefully before enrolling, as premiums are employee-paid.
  • Long-Term Care Definition: Understand what long-term care entails, including assistance with daily living activities.
  • Premium Variability: Be aware that premiums may change based on age at application and insurer decisions affecting all policyholders.
  • Enrollment Kit Resources: Utilize the enrollment kit and the NYPERL website for guidance during the application process.
  • Consultation Encouraged: Discuss your decision with family members to ensure that long-term care insurance aligns with your needs.

Nyperl Ebd 542 1: Usage Guide

Filling out the NYPERL EBD 542 1 form is a straightforward process, but it’s important to follow each step carefully to ensure that all necessary information is provided. Once the form is completed, it should be submitted to MedAmerica Insurance Company, not your employer. This is a crucial step in the enrollment process for the New York State Public Employee and Retiree Long Term Care Insurance Plan.

  1. Obtain the Form: Start by obtaining the NYPERL EBD 542 1 form. You can find it in the enrollment kit or download it from the NYPERL website.
  2. Complete the Employing Agency Section: Fill in your name, date of birth, agency name, date of hire, agency code, grade, and agency contact information.
  3. Check the Open Enrollment Expiration Date: Ensure you know the expiration date for your open enrollment period, which is 60 calendar days from your date of hire or first eligibility.
  4. Fill Out the Employee Section: Indicate that you have been offered the opportunity to enroll in NYPERL. Confirm your understanding of the 60-day enrollment window.
  5. Provide Your Signature and Date: Sign and date the form to confirm your application.
  6. Include Your Social Security Number: Write down your SSN in the designated area on the form.
  7. Review the Personal Privacy Protection Law Notification: Understand how your information will be used and the importance of providing accurate information.
  8. Submit the Form: Send the completed form to MedAmerica Insurance Company at the address provided, not to your employer.
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