Health Benefits Department News
Get all of the latest news about how to use your NYSHIP benefits!
2026
Being familiar with the covered benefits and plan-participant requirements of the health insurance coverage you and your family are enrolled in is of great importance when close to home, as well as when traveling.
Recently released publications, “The Empire Plan Across the United States” and “The Empire Plan Worldwide” include important plan information such as descriptions of covered services, including services that may require prior outreach or precertification prior to receipt of services, addresses and phone numbers.
These publications can be requested through the agency Health Benefits Administrator or Business Services Center at your work location, or electronic versions can be accessed on NYSHIP’s website for domestic travel, visit https://www.cs.ny.gov/employee-benefits/hba/shared/publications/ep-travel-guides/2025/ep-us-2025.pdf If you plan to travel outside the United States, visit https://www.cs.ny.gov/employee-benefits/hba/shared/publications/ep-travel-guides/2025/ep-ww-2025.pdf
Empire Plan coverage is available across the country as well as worldwide and not just foremergencies. Most parts of The Empire Plan have two levels of benefits. If you use an Empire Plan participating provider, medically necessary covered services and supplies can be accessed with little or no out-of-pocket cost. If you use a non-participating provider, medically necessary covered services and supplies can be accessed, but deductibles, coinsurance and benefit limits may apply.
The Empire Plan has nationwide participating provider networks. For questions regarding coverage or assistance locating a network Empire Plan provider, call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program by the telephone prompts below:
1: Medical/Surgical Program, Managed Physical Medical Program or the Home Care Advocacy Program (HCAP)
2: Hospital Program
3: Mental Health and Substance Use Program
4: Prescription Drug Program
5: Empire Plan Nurseline (Registered Nurses available 24hrs/7days a week)
The Empire Plan Medical/Surgical Program requires pre-notification before having a scheduled (non-emergency) magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), computerized tomography (CT) scan, positron emission tomography (PET) scan or nuclear medicine test.
To find a network provider, download the United Healthcare app or visit the online directory at https://www.empireplanproviders.com/. If covered services are not available from a network provider within a 30-mile radius or 30-minute travel time from your home address, The Empire Plan will provide network-level benefits to non-network primary care and specialty physicians within that area. You must call the Medical/Surgical Program before seeking such non-network services.
The Empire Plan’s Home Care Advocacy Program provides benefits nationwide for home skilled nursing services and/or durable medical equipment and certain supplies, including diabetic supplies. Program requirements need to be followed, and precertification should be obtained before you seek home-skilled nursing services, equipment, supplies (including insulin pumps must call the HCAP). The Empire Plan Diabetic Supplies Pharmacy should be contacted at 1-800-321-0591 for blood glucose self-testing equipment and supplies.
The Empire Plan Hospital Program requires precertification by enrollee/dependent before a scheduled (non-emergency) hospital admission (or within 48 hours or as soon as reasonably possible after an emergency or urgent hospital admission), and before admission or transfer to a skilled nursing facility (including a rehabilitation facility).
The Empire Plan Mental Health and Substance Use Program provides benefits for inpatient and certain outpatient mental health and substance use (MHSU) care. To receive the highest level of benefits, contact the MHSU program before you seek inpatient services for MHSU care to be referred to an appropriate provider, or within 48 hours or as soon as reasonably possible after an emergency MHSU hospitalization.
For a list of network MHSU practitioners and facilities, visit https://www.carelonbh.com/empireplan/en/home. If there are no network providers in your area, you have guaranteed access to network-level benefits if you call the Clinical Referral Line in advance 1-877-769-7447 (press or say 3) to arrange your care with an appropriate provider. The Clinical Referral Line is available 24 hours a day, seven days a week and is staffed by experienced clinicians.
The Empire Plan Prescription Drug Program offers access to more than 60,000 network pharmacies nationwide as well as a mail service pharmacy and a designated specialty pharmacy. Prepare for your trip by filling prescriptions prior to your departure, as restrictions may apply to controlled substances in certain states.
Remote (telemedicine) health care visits using Live Health Online (LHO) are cost-effective and can be a convenient alternative to urgent care centers, emergency rooms and in-person office visits. You can utilize LHO at no cost to you ($0 copayment) to access a board-certified doctor, psychiatrist, psychologist or licensed therapist for a phone or video visit.
To register, visit https://www.anthembluecross.com/nys or contact Live Health Online at 1-888-548-3432, 24 hours a day, seven days a week.
The Empire Plan Nurseline provides access to health information and support 24 hours a day, seven days a week. When you call the Empire Plan, press or say 5 to speak with a registered nurse about your health-related questions.
When traveling domestically, bring a copy of The Empire Plan Across the United States. For those traveling abroad, The Empire Plan Worldwide contains important information on accessing benefits around the globe.
2026 DIRECTIONS: Pre-Retirement Planning Webinars
If you are an Executive Branch state employee and have been thinking of retiring, New York State’s Pre-Retirement Planning Webinars provide important information, such as how to maintain your NYSHIP health insurance in retirement.
The DIRECTIONS: Pre-Retirement Planning was developed to assist New York State employees eligible to retire within five years to plan for one of the most challenging and exciting periods in life — retirement. New York State offers its Executive Branch employees pre-retirement planning information through both online resources and DIRECTIONS: Pre-Retirement Planning webinars.
The scheduled webinars for February and March 2026 will be held on Webex, as noted below.
The DIRECTIONS: Pre-Retirement Planning Tuesday webinars include two speakers that will cover an overview, NYS Deferred Compensation Plan and NYS State and Local Retirement (Pension).
February 17, 2026, 9 am – 12 noon
March 17, 2026, 9 am – 12 noon
The DIRECTIONS: Pre-Retirement Planning Wednesday webinars include two speakers that will cover an overview, Social Security and NYSHIP (health insurance & Medicare).
February 18, 2026, 9 am – 12 noon
March 18, 2026, 9 am – 12 noon
Employees have the option to select which days to attend, and do not need to attend consecutive days in the same month. They may opt to attend the Tuesday webinars in one month and the Wednesday webinars another month. Every agency has an assigned DIRECTIONS: Pre-Retirement Planning liaison who can provide additional information regarding the webinars. Visit the state’s website for more information or the webinar registration page.
DIRECTIONS: Pre-Retirement Planning is sponsored by the state Office of Employee Relations and the state Office of the State Comptroller, with funding for CSEA-represented state employees provided by the CSEA/NYS collective bargaining agreement.
NYSHIP Retiree Health Care:
Being aware of your rights and responsibilities as an enrollee in NYSHIP (New York State Health Insurance Program) is important, especially when considering retirement. You will want to verify eligibility to maintain NYSHIP coverage as a retiree.
It is also important to know the rules and requirements that impact your NYSHIP coverage, such as enrollment in Medicare and if you are eligible for sick leave credit to help offset your retiree health insurance premium.
NYSHIP is administered by the NYS Department of Civil Service Employee Benefits Division.
If you are thinking about retiring, visit the Civil Service’s website for important information and order a Planning for Retirement Package which includes a Planning for Retirement booklet, and a Benefits Checklist. These materials will help you navigate the retirement process, make important decisions and prepare questions for meeting with your agency health benefits administrator about retirement.
Visit the NYS Department of Civil Service’s webpage for more information.
Specific questions regarding your NYSHIP eligibility can be directed to your agency health benefits administrator or the Department of Civil Service at 1-800-833-4344 or 518-457-5754.
Empire Plan enrollees have until April 30, 2026 (120 days after the end of the calendar year) to submit medical expenses incurred during the 2025 plan year.
Network hospitals, providers and pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information.
If you have a non-network claim submission, make sure you complete the requested subscriber information on the appropriate claim form, include the original billing or receipt (if requested), sign and return the claim form.
Claim submission for Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services:
United Healthcare
P.O. Box 1600
Kingston, N.Y. 12402-1600
Claims submission fax (845) 336-7716
Claim submission for Empire Plan non-network inpatient or outpatient hospital services:
Anthem Blue Cross – NYS Service Center
P.O. Box 1407 – Church Street Station
New York, N.Y. 10008-1407
Claims submission fax: 866-829-2395
Plan info and online claim form
Claim submission for Empire Plan non-network mental health and substance use services:
Carelon Behavioral Health
P.O. Box 1850
Hicksville, N.Y. 11802
Claims submission fax: 855-378- 8309
Claim submission for Empire Plan prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card use:
CVS/Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136
Call the Empire Plan directly at 1-877-7-NYSHIP (1-877-769-7447) with any questions about claims submission.
Editor’s Note: Please note that as this edition arrives at your home, the deadlines referenced in this article may have passed. We are including the information for anyone who may receive it before Dec. 31, 2025.
The State Division of Budget has approved the Empire Plan’s premium rates for 2026. The rates are listed on this page.
The Option Transfer Period — the time to choose your health insurance option for 2026 — will end Dec. 31, 2025.
Any state member wishing to change their NYSHIP health insurance option or enroll in the Opt-Out Program must submit the required signed documentation to their agency’s health benefits administrator no later than Dec. 31, 2025. You may also change your option online using MyNYSHIP at www.cs.ny.gov/mynyship.
The Pre-Tax Contribution Program allows employees to have their share of health insurance premiums deducted from their wages before taxes are withheld, which may lower tax liability. Any state member wishing to change their Pre-Tax election must submit a signed Health Insurance Transaction Form (PS-404) to their agency’s health benefits administrator no later than Dec. 31, 2025.
Please see your agency Health Benefits Administrator for information on the effective date of new health insurance options and when to expect any health insurance deduction changes. Deduction changes related to an option change request may be made in a future paycheck and, therefore, could result in retroactive charges.
As we enter 2026, it is a good time to verify that your personal information on your health insurance record is up to date. To ensure timely notification of plan information, it is important that your name, address, and phone number are correct. Notify your agency’s health benefits administrator of any updates.
2025
Now is the time for New York state employees to compare NYSHIP health plans if you are considering changing your health insurance option for the 2026 plan year.
Consider your choices carefully. During the annual option transfer period, health insurance options may be changed for any reason. Changes may be made outside the designated option transfer period only under certain circumstances, described in the NYSHIP General Information Book. The NYSHIP official annual option transfer period will be held after rates are approved; dates have not yet been announced.
Selecting a health insurance plan for you and your family is an important and personal decision; only you know your family’s lifestyle, health, budget and benefit preferences. An important step toward making the best choice for you and your family is to understand the NYSHIP options and how they may differ.
The 2026 Health Insurance Choices guide has been sent to state agencies. The Choices guide includes a summary of The Empire Plan and each of the NYSHIP health maintenance organizations (HMO). Current NYSHIP HMO enrollees are encouraged to familiarize themselves with the side-by-side comparison of 2025-26 benefits sent by the HMO. If you are thinking of changing options, also familiarize yourself with other health plans available in your area. Please note that several of the NYSHIP HMOs have made changes to the required employee out-of-pocket costs (copayments) for 2026.
New York state also offers a plan comparison tool (updated annually to reflect new rates) to assist by creating a side-by-side comparison of the benefits provided by each of the
NYSHIP plans in your area. To make a comparison, go to nyship.ny.gov and enter your group and plan if prompted. From the NYSHIP online home page, select Health Benefits & Option Transfer. Click on Rates and Health Plan Choices, and then NYSHIP Plan Comparison. You can select the counties in which you live or work. A listing of available health plans will appear, and you can check the box next to the plans you want included in the comparison.
As this edition went to press, the 2026 NYSHIP premium rates had not yet approved. Once approved, the 2026 NYSHIP health plan rates will be mailed and posted on NYSHIP Online. Included in the rate flyer will also be important dates and deadlines, as well as information on when any changes to health insurance payroll deductions will occur.
PTCP election period
The Pre-Tax Contribution Program (PTCP) election period for Executive Branch state employees runs concurrent with the annual option transfer period. PTCP is a voluntary program that allows employees to have their share of health insurance
premium deducted from their wages before taxes are withheld, which may lower tax liability. Per Internal Revenue Service (IRS) rules, the PTCP election period is the only opportunity for employees to change their PTCP status without a qualifying event. If you wish to verify your PTCP status, please review your health insurance premium notice on your paycheck.
If you are enrolled in PTCP, your paycheck stub shows “Regular Before-Tax Health.” Your health insurance premium is deducted from your wages before taxes are withheld.
If you are not enrolled in PTCP, or part of your deduction is taken after tax (for example, if you have a non-federally qualified dependent), your paycheck stub shows “Regular After-Tax Health.” Your health insurance premium (or a portion of) is deducted after taxes are withheld.
No action is required if you wish to keep your current health insurance option or current PTCP election.
Once the official option transfer period is announced, if you wish to make changes to your NYSHIP health insurance, complete and sign all the necessary paperwork, keep a copy for your records, and return all required forms on time to your agency health Benefits administrator
Contract renewal negotiations between Anthem, the Empire Plan’s Hospital Program administrator, and Mount Sinai in downstate New York are underway. Negotiations between health plans and health systems are a routine part of the health care industry.
The current contract with Mount Sinai is due to expire effective Dec. 31, 2025. If Anthem does not reach an agreement, the following Mount Sinai hospitals will become out-of-network with the Empire Plan Hospital Program on March 1, 2026:
• Mount Sinai Brooklyn (Brooklyn)
• The Mount Sinai Hospital (Manhattan)
• Mount Sinai Morningside (Manhattan)
• Mount Sinai Queens (Queens)
• Mount Sinai South Nassau (Oceanside)
• Mount Sinai West (Manhattan)
• New York Eye and Ear Infirmary of Mount Sinai (Manhattan)
Anthem has advised they are optimistic a new agreement with Mount Sinai will be reached before the current contract expires.
This situation does not impact medically necessary emergency services and does not impact any services covered under The Empire Plan’s Medical/Surgical Program, administered by Unted Healthcare.
As noted, it is hopeful that an agreement between Anthem and Mount Sinai facilities will be reached prior to any potential impact on patients.
Any questions or request for updates can be addressed by calling 1-877-769-7447 (1-877-7-NYSHIP) and press or say 2 for the Hospital Program or visiting anthembluecross.com/nys for regular updates.
The Empire Plan maximum out-of-pocket limits for covered in-network services will be updated for 2026 in accordance with the terms of the collective bargaining agreements. Detailed information will be contained in the 2026 Empire Plan “At a Glance.”
NYSHIP HMO: As of Jan. 1, 2026, Emblem Health will expand its Downstate NYSHIP service area (Option #050) to include Rockland County.
NYSHIP Option Transfer: If you are contemplating a change to your NYSHIP health insurance option for 2026, ensure a completed NYSHIP Health Insurance Transaction Form (PS-404) is returned to your agency Health Benefits Administrator (HBA), or make the change online using MyNYSHIP, before the Option Transfer deadline (rate flyer released in November).
Planning to retire or vest in 2026: If you continue your NYSHIP enrollment as a retiree or vestee, health insurance options can be changed once any time during a 12-month period, for any reason. Take the time now to familiarize yourself with the eligibility requirements for continuing your health insurance coverage. Refer to your General Information Book and ask your HBA for copies of “Planning for Retirement” and “Choices for 2026 for Retirees.”
Notify HBA of changes: You must notify your HBA of any changes to your enrollment record (home address, phone number, marital status, dependent eligibility) in a timely manner. Changes in your family status, such as the addition or loss of a dependent, may mean that you need to change your health insurance coverage from individual to family or from family to individual. If you submit a request within 30 days of a change in family status, you may make these coverage changes without being subject to a late enrollment waiting period. Promptly inform your HBA about any change to ensure it is effective as of the actual date of change in family status.
Cost of NYSHIP Coverage: The 2026 NYSHIP health plan rates will be mailed to your home and posted on the NYSHIP website as soon as they have been approved. The rates flyer announces the option-change deadline and dates on which changes in health insurance payroll deductions will occur.
Pre-Tax Contribution Program: The PTCP is a voluntary program that allows employees to have their share of health insurance premiums deducted from their wages before taxes are withheld. Employees must initially decide whether to participate in PTCP when first eligible for NYSHIP coverage. Employees may change their PTCP status each year during the PTCP Election Period, which coincides with the annual Option Transfer Period. If you wish to change your PTCP election for 2026 plan year, complete and sign a NYSHIP Health Insurance Transaction Form (PS404) and submit it during the PTCP Election Period to your HBA.
State Executive Branch employees:
Reminder to check, use Flex Spending Account funds
The Flex Spending Account (FSA) is a negotiated state employee benefit that helps save money by allowing individuals to pay certain out-of-pocket expenses using pretax dollars.
The Health Care Spending Account (HCSA), the Dependent Care Advantage Account (DCAA) and the Adoption Advantage Account are benefit programs available under New York State’s FSA.
As we get closer to the end of the calendar year, it’s a good time to evaluate the remaining funds in your FSA and take steps to make sure all funds are spent before the plan year ends.
Because of the tax advantages of the FSA, the Internal Revenue Service (IRS) has strict guidelines for its use. One of these guidelines is commonly known as the “use it or lose it” rule.
HCSA carryover allowances
Unused contributions will carry over to the next plan year for you to use for previous year expenses during the plan year runout period (Jan. 1- March 31, 2026). Unsubmitted claims from 2025 can be submitted during the runout period.
After the runout, any remaining funds, up to the IRS limit from the previous year ($660 for 2025 into 2026), will then carry over into your 2026 plan year account balance. It’s important to plan accordingly to avoid forfeiting any of your FSA funds.
DCAA and adoption grace period
The grace period allows an additional 2 ½ months to incur dependent care or adoption-related expenses. You can use any funds remaining in your account after the plan year ends to pay for expenses incurred between Jan. 1, 2026 and March 15, 2026. Claims must be submitted by the March 31 deadline.
To check your 2025 balance, visit https://uba.tasconline.com/login or call the FSA administrator, Total Administrative Services Corporation (TASC) at 800-358-7202.
We are approaching that time of year when active New York state employees begin to consider their NYSHIP health options for 2026.
“Planning for Option Transfer for 2026” was recently mailed to enrollees’ homes. The publication includes important information about the Option Transfer Period to be held later this year, as well including important information on voluntary programs that have been negotiated to help save costs for CSEA state employees.
Option Transfer Period – dates TBD
The Option Transfer Period is the time of year when enrollees can change their NYSHIP option for the next plan year. The Pre-Tax Contribution Program (PTCP), which allows health insurance premiums to be deducted from wages before taxes are withheld, will run concurrently with the annual Option Transfer Period. During the Option Transfer Period, enrollees can elect or change their NYSHIP participation and/or PTCP participation. Please look for additional information.
Productivity Enhancement Program (PEP) – Enrollment Period is Nov. 1 – Dec. 8, 2025.
This negotiated program allows eligible full and part-time employees to exchange previously accrued leave in return for a credit to be applied toward their NYSHIP premium. Detailed information is included in the Planning for Option Transfer for 2026 guide. Please see your agency health benefits administrator with questions or to enroll.
Flex Spending Account (FSA) – Enrollment Period is Nov. 1 – Dec. 8, 2025
This negotiated program allows you to set aside pre-tax dollars to pay for 2026 health care, dependent care or adoption-related costs. Funds placed into a Health Care Spending Account (HCSA) may be used to cover a wide range of eligible expenses, including copayments, prescription medications and many over-the-counter products. Detailed information is included in the Planning for Option Transfer 2026 guide. Visit oer.ny.gov/FSA to enroll.
Employees who participated in the PEP or FSA for plan year 2025 must re-enroll to participate in 2026.
The 2026 NYSHIP rates, as well as various dates and deadlines for the annual open enrollment period, will be included in the Rates and Deadlines for 2026 flyer. This flyer will be mailed by the State and posted on Civil Service’s website online once the rates have been approved. Please see future Work Force editions for updates
The Flex Spending Account (FSA) is a negotiated state employee benefit that helps save money by allowing individuals to pay certain out-of-pocket expenses, using pre-tax dollars.
The Health Care Spending Account (HCSA), the Dependent Care Advantage Account (DCAA) and the Adoption Advantage Account are benefit programs available under New York State’s FSA.
As we get closer to the end of the calendar year, it is a good time to evaluate the remaining funds in your FSA and take steps to make sure all the remaining funds are spent before the plan year ends.
Because of the tax advantages of the FSA, the Internal Revenue Service (IRS) has strict guidelines for its use. One of these guidelines is commonly known as the “use it or lose it” rule.
State Employee HCSA Carryover Allowances
Unused contributions will carry over to the next plan year for you to use during the plan year runout period (January 1 – March 31, 2026). Unsubmitted claims from 2025 can be submitted during the runout. After the runout, any remaining funds, up to the IRS limit from the previous year (2025 into 2026 is $660), will then carryover into the 2026 plan year’s account balance. It is important to plan accordingly to avoid forfeiting any of your FSA funds.
State Employee DCAA and Adoption Grace Period
The grace period allows an additional 2.5 months to incur dependent care or adoption-related expenses. You can use any funds remaining in your account after the plan year ends to pay for expenses incurred between January 1 and March 15, 2026. Claims must be submitted by the March 31 deadline.
To check your 2025 balance, visit https://uba.tasconline.com/login or call the FSA Administrator, Total Administrative Services Corporation (TASC) at 800-358-7202.