Recent Health Benefits News

The Flex Spending Account (FSA) is a negotiated state employee benefit that helps you save money by allowing you to pay certain expenses with pre-tax dollars. The Health Care Spending Account, the Dependent Care Advantage Account and the Adoption Advantage Account are benefit programs available under New York State’s FSA.

The state’s FSA Open Enrollment Campaign for the 2024 plan year will begin November 1 and end on Dec. 11, 2023. Total Administrative Services Corporation (TASC) is the administrator of the state’s FSA programs. TASC handles enrollments for the 2024 plan year and processes the run-out claims for the 2023 plan year.

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. Put simply, if you contribute pre-tax dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you may lose the balance remaining in your account when the plan year ends.

Important information about the Flex Spending Accounts:

Health Care Spending Account (HCSA) – Contributions to the HCSA are made through pre-tax payroll deductions and may be used for eligible healthcare expenses that are not covered by a health plan.

• The maximum annual contribution to the HCSA is $3,050 – this maximum is subject to update by the federal government.

• Employees will continue to access a debit card for use for eligible purchases and charges.

• The 2024 HCSA will include the maximum carryover of 2023 remaining balances. After the run-out period ends on March 31, 2024, up to $600 of funds remaining in the account will be transferred to the 2024 account for use anytime during the 2024 year. Monies carried over are not included in the maximum contribution limit.

Dependent Care Advantage Account (DCAA) – Up to $5,000 per year, per household can be contributed in the DCAA through pretax payroll deductions for elder care, disabled dependent care, or child care expenses.

• After eligible services have been received, the employee submits for reimbursement.

• The DCAA employer contribution will continue to be available in 2024

• The 2024 DCAA will include a grace period. The grace period allows an additional 2.5 months to incur dependent care expenses. Any remaining 2023 funds can be used to pay for expenses incurred between Jan. 1, 2024, and March 15, 2024.

Adoption Advantage Account (AAA) – Eligible employees may contribute up to $15,950 in the AAA for 2024 plan year. Contributions are made through pre-tax payroll deductions and may be used for expenses related to the adoption of an eligible child. Get more information about the state’s FSA programs by calling the FSA hotline at (800) 358-7202 or visiting https://oer.ny.gov/fsa.

New York State Active Employees: It’s that time of year to start thinking about your 2024 health insurance options.

New York State typically mails the Planning for Option Transfer flyers to enrollees in late September. The flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Pre-Tax Contribution Program (PTCP) and the Opt-Out Program, if applicable. This document is an important reminder and contains benefits and program deadlines.

If you are thinking of changing health insurance plans during the Open Enrollment Period, the NYSHIP Plan Comparison tool, available on NYSHIP online, generates an actual side-by-side comparison of Empire Plan and HMO benefits. This tool can help you easily compare services, copayments, coinsurance amounts and special programs for The Empire Plan and NYSHIP HMOs.

The comparison tool will be updated with 2024 benefits later this fall, around the same time the Option Transfer Period begins. To access this tool, visit the NYSHIP Online homepage at www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, and then choose Health Benefits & Option Transfer; click on Rates and Health Plan Choices, then NYSHIP Plan Comparison. Select your group (CSEA) and the counties in which you live and work, to show available NYSHIP health plans. Check the box next to the plans you wish to compare and generate a comparison table.

Please watch for additional information in The Work Force as the option transfer period draws near.

Now is the time to consider your NYSHIP health option for 2024. The 2024 “Planning for Option Transfer” publication was recently mailed to NYSHIP enrollees’ homes and includes information about the upcoming Option Transfer Period.

The annual Option Transfer Period is when NYSHIP enrollees can make changes to their 2024 NYSHIP option. The “Health Insurance Choices” guide for 2024 contains a more detailed comparison of NYSHIP benefits. The Choices guide is available from your agency health benefits administrator (HBA).

In addition to considering your health plan option, this is the time to review health care expenses for next year.

Do you currently participate in the Flex Spending Account (FSA) or the Productivity Enhancement Program (PEP)? If not, now is the ideal time to get more information about these costsaving benefits as enrollment begins in November. Enrollment is time sensitive and end dates vary.

Flex Spending Account Open Enrollment Period: Nov. 1 to Dec. 11, 2023

The Flex Spending Account 2024 plan year will begin on Jan. 1, 2024. The Flex Spending Account (FSA) is a negotiated employee benefit for state employees. A flex spending account offers a way to pay for your dependent care, health care expenses or adoption expenses with pre-tax dollars. If you are currently enrolled in the FSA program, you must re-enroll to continue your participation in 2024. The Flex Spending Account website at https://oer.ny.gov/fsa or hotline at (800) 358-7202 contains more information about eligibility and program rules.

Productivity Enhancement Program Enrollment Period: Nov. 1 to Dec. 11, 2023

The Productivity Enhancement Program (PEP) allows eligible full and part-time state employees to exchange previously accrued annual and/ or personal leave for a credit to be applied toward their NYSHIP premium. If you are eligible and elect this program, the credit will be included in your biweekly paychecks and divided evenly during the plan year.

For calendar year 2024, CSEA active state members can receive up to a $800 credit or $1,600 credit determined by salary grade and number of days forfeited. To elect PEP for 2024, you must apply between Nov. 1 and Dec. 11, 2023. Ask your agency health benefits administrator for details and an application. If you are currently enrolled in PEP and remain eligible, you must reenroll to continue receiving in 2024.

PTCP Election Period: The PTCP Election Period will run concurrently with the official NYSHIP Option Transfer Period, date to be announced.

The Pre-Tax Contribution Program is a voluntary program that allows your share of the health insurance premium to be deducted from wages before taxes are withheld. In exchange for this reduction in tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you experience a qualifying event and provide timely notification. Participation in the PTCP can be chosen when first eligible for health insurance benefits and may also be selected to participate or decline participation in PTCP each year during the PTCP election period.

Requests made during the PTCP election period become effective at the beginning of the 2024 plan year. If you want to change your PTCP election for 2024, complete a NYS Health Insurance Transaction Form PS-404 and submit it to your agency health benefits administrator before the PTCP election period deadline. Per IRS rules, this election period is the only opportunity to change your PTCP status for 2024; arbitrary, mid-year status changes are not allowed. Should a qualifying PTCP event occur mid-year, any request to change your NYSHIP coverage must be consistent with a PTCP qualifying event and submitted within 30 days of the event (or within the waiting period, if newly eligible). No action is required to keep your current PTCP status.

The Empire Plan is designed to provide enrollees with comprehensive medical care coverage. Using participating providers helps keep the cost to enrollees and the plan down.

The plan’s participating provider program includes medical/ surgical providers, laboratories, outpatient surgical locations, cardiac rehabilitation centers, urgent care centers, orthotic/prosthetic devices network, to name a few. The online directory is updated weekly.

Each year, the Empire Plan sends postcards to Empire Plan enrollees across the United States and Puerto Rico so that the enrollee may elect to have a printed directory mailed to them.

Although the online directories available are encouraged for use, since they contain the most updated information, enrollees have three options for obtaining Empire Plan participating provider information:

• Visit empireplanproviders.com.

• Call the Empire Plan at 1-877-7-NYSHIP and select the appropriate program administrator.

• Return the postcard sent by The Empire Plan (with a stamp) to request a directory for their mailing zip code or another state/region.

In compliance with federal law, a website or email address is included for providers who have reported one. In compliance with state law, languages spoken by providers and/or their staff as well as provider hospital affiliations are listed for the New York directories only

As a result of the ratified contract between CSEA and New York state, the negotiated health benefit changes become effective for CSEA-represented active state employees (and Unified Court System employees) effective July 1, 2023.

CSEA active state members will have the opportunity to change their NYSHIP option for the remainder of 2023 during the upcoming Special Option Transfer Period (June 1 through June 30, 2023). During this time, you may choose to change your plan option between The Empire Plan and a NYSHIP-approved health maintenance organization (HMO) serving the area where you live or work.

If you decide to change your health insurance option during this Special Option Transfer Period, please see the NYSHIP July 1, 2023 rate change information.

The May 2023 “Empire Plan Special Report” explains the new benefits and the Special Option Transfer Period. Additional information about the Special Option Transfer Period is also contained in the NYSHIP July 1, 2023, “Rate Changes Flyer.” Both publications were mailed to NYSHIP enrollee homes in May.

Empire Plan Live Health Online Telemedicine Program Continues as a Benefit:

• The Empire Plan voluntary telemedicine program, through LiveHealth Online, which provides medical and mental health/substance use services, became a PERMANENT offering to enrollees and dependents

• $0 copayment (No employee out-of-pocket cost)

• Access LiveHealth Online: www. empireblue.com/nys

Empire Plan Network Copayment Stacking Ends effective July 1, 2023:

• When an Empire Plan participating provider (primary care/specialist) is used, the CSEA enrollee/ dependent will be responsible for a SINGLE $25 copayment for all services performed/ billed for the same enrollee, by the same provider/location on the same date of service.

Empire Plan Reduced In-Network Maximum Out-of-Pocket Limits

• Current In-Network Maximum out-of-pocket limit determined by the U.S. Patient Protection and Affordable Care Act.

• Effective July 1, 2023, the maximum out-of-pocket limit for covered in-network services will reduce to $4,000 for individual coverage (from $9,100)
and to $8,000 for family coverage (from $18,200)

Empire Plan Site of Care

• Infusions requested in a hospital outpatient (OP) setting will be reviewed to determine appropriate site of care (Hospital OP, Provider OP office, HCAP home)

• When the program becomes effective, copayments for medical and prescription drugs will be waived for enrollees receiving infusions subject to site of care in alternate sites other than hospital outpatient department.

• Hemophilia and oncology drugs are not included in the program (excluded from Site of Care review)

• July 1, 2023 – Site of Care Redirection Program enters Phase One – for Remicade (and equivalent)

Empire Plan Mastectomy Brassieres

• Effective July 1, 2023, Mastectomy Bras will be covered in full, not subject to deductible and/or coinsurance.

Empire Plan Acupuncture Services

• Network acupuncture services continue to be unlimited and based on medical necessity.

• Effective July 1, 2023, out-of-network acupuncture will be limited to 20 visits per calendar year.

Empire Plan Massage Therapy

• Effective July 1, 2023, out-of-network massage therapy will be limited to 20 visits per calendar year.

Empire Plan Out-of-Network (Non-Participating Provider) Reimbursement

• Effective July 1, 2023, The Empire Plan carriers will reimburse out-of-network claims using a percentage of the Medicare Physician Fee Schedule (based on CPT codes and adjusted for geographic area) versus using FAIR Health rates (data determined using provider billed charges).

• Empire Plan participants continue to have access to more than 1.2 million anesthesiologists, mental health specialists, physical therapists and more.

• Empire Plan carriers can be contacted directly for assistance in finding a participating provider.

Questions regarding these changes can be directed to the Empire Plan at 1-877-769-7447 (press or say 1 for Medical/Surgical Program) or call the CSEA Health Benefits Department at 1-800-286- 5242.

Preventive, diagnostic, and routine care benefits are common types of health care you may receive under The Empire Plan.

Understanding the difference between them is not always easy, but it is important. Coverage and out-of-pocket expenses can vary, depending on which type of service you receive.

Be sure to discuss with your provider why a test or service is being ordered. The same test or service can be considered preventive, diagnostic or routine, depending on the description of why it is being performed. As a result, an enrollee’s out-of-pocket costs may change based on why the service is requested.

Preventive care benefits and services covered by The Empire Plan follow numerous guidelines and standards, including recommendations by the U.S. Preventive Services Task Force (USPSTF), the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as well as requirements of the U.S. Patient Protection and Affordable Care Act (PPACA).

The goal of preventive care is to detect potentially serious health conditions before symptoms develop and get early treatment.

Preventive care can include annual exams, screenings and immunizations.

Common examples of adult preventive care include annual wellness visits, screenings for cholesterol, high blood pressure and diabetes and cancer screenings such as colonoscopies and mammograms.

Common examples of yearly pediatric preventive care (well-child) can include growth and body mass measurements, developmental screenings, behavioral assessments and immunizations. Many preventive services are covered in full when using an Empire Plan participating provider.

Diagnostic care helps diagnose risk factors or treat symptoms that are already present. Diagnostic care would involve following up with your provider to treat or monitor issues. When a preventive visit becomes diagnostic, a copayment would apply when using a participating provider.

Routine care describes care that occurs on a regular basis, but it is not preventive. Routine care is used to prevent a condition from becoming worse and to help manage symptoms.

Common illnesses that often require routine care include asthma, hypertension, and diabetes. Because routine care is not preventive, a copayment would apply when using a participating provider.

Please review the 2023 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care.

You should review your Explanation of Benefits Statement (EOB) regularly. The EOB can provide a better understanding of how the services are billed, what the Plan pays and your out-of-pocket costs. If you have specific coverage questions or need assistance finding a participating provider, call the Empire Plan 1-877-7-NYSHIP (1-877-769-7447).

The cost of prescription drugs is one of the fastest growing components of health care costs in the United States.

The Empire Plan’s prescription drug benefit is designed to help manage drug costs and establish copayment levels that are more in line with the relative cost of various drugs to the Plan.

Each January, Empire Plan enrollees are sent the “Empire Plan at a Glance,” which is a summary of benefits available under the Empire Plan, and also includes applicable copayment(s). Copayments are not the only component that impacts overall health insurance costs.

To keep out-of-pocket prescription drug costs as low as possible, speak with your doctor about alternative drugs that may be available for your treatment and become aware of programs that can help you save money.

The Empire Plan Prescription Drug Program uses the Advanced Flexible Formulary to provide CSEA enrollees and dependents with the best value in prescription drug spending. All drugs included on the formularies have been approved by the FDA. The list is developed by a committee of pharmacists and physicians and are subject to change each January.

The Empire Plan Advanced Flexible Formulary uses a three-level copayment schedule – level 1 has the lowest copayment and most generic prescription drugs fall within this level.

Empire Plan Mail Service Pharmacy

One of the most cost-effective ways to receive your prescription drugs is through the CVS Caremark Mail Service Pharmacy. Empire Plan enrollees/dependents can order up to a 90-day supply of medication shipped directly to your home. Once a prescription is on file at the Mail Service Pharmacy, ordering refills is easy: by mail, phone or online. You download the mail service pharmacy order form at https://www.cs.ny.gov/ forms/CVSCM_MailServiceOrderForm. pdf. Questions about the Empire Plan Mail Service Pharmacy program can be directed to the Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447). Press or say 4 for the Prescription Drug Program.

Specialty Pharmacy Program

The Empire Plan Specialty Pharmacy Program offers enhanced services to individuals using specialty drugs. Most specialty drugs will only be covered when dispensed by The Empire Plan’s designated specialty pharmacy, CVS Caremark Specialty Pharmacy. Prior authorization is required for some specialty drugs.

Specialty drugs are used to treat complex conditions and usually require special handling, special administration or intensive patient monitoring.

The program provides enrollees with enhanced services that include disease and drug education, compliance management and sideeffect management, safety management, expedited and scheduled delivery of prescription drugs at no additional charge, refill reminder calls and all necessary supplies, such as needles and syringes applicable to the prescription drug.

Questions regarding specialty drugs can be directed to CVS Caremark at 1-877-7-NYSHIP (1-877-769-7447). Press or say 4 for the Prescription Drug Program and ask to speak with a representative from the Specialty Pharmacy Program.

Cost saving ideas

• Talk with your doctor about using over-the-counter drugs. Prescription drugs occasionally move to the over-the-counter market and become available without a prescription. An over-the-counter drug may be an alternative to save you money over prescription options.

• When your doctor starts you on a maintenance prescription drug, you may want to have it filled for a 30-day supply to ensure the drug is right for your condition before you pay a higher copayment for a 31-to-90-day supply.

• Ask your agency’s health benefits administration or business services center if you are eligible to participate in New York State’s Health Care Spending Account, which allows you to set aside part of your salary before taxes to pay for eligible health-related expenses. To learn more, visit https://oer.ny.gov/fsa.

• If you have a workers’ compensation injury, do not use the Empire Plan Prescription Drug Program for drugs to treat it. These claims should be covered in full through workers’ compensation.

For more information

Additional online resources are available on the Empire Plan’s CVS Caremark website. Visit empireplanrxprogram.com and select the CVS Caremark link or call The Empire Plan toll free at 1-877-7-NYHIP (1-877-769-7447) and press 4 for the Prescription Drug Program

 The Empire Plan’s “Reporting On” publications are issued periodically by New York State Department of Civil Service to Empire Plan enrollees and their enrolled Empire Plan dependents. 

Various series of the publication feature information crucial to understanding your Empire Plan benefits on topics such as: 

Asthma (March 2021) discusses the causes and symptoms of asthma, how to avoid triggers, the plan’s Asthma Management Program and Home Care Advocacy Program (HCAP). 

Centers of Excellence (February 2022-online) describes how the Empire Plan’s Centers of Excellence programs for cancer, transplants and infertility can help Empire Plan enrollees facing medical crisis. 

Diabetes (April 2021) discusses symptoms, treatment and complications associated with Type 1 and Type 2 diabetes, as well as benefits available through HCAP and Empire Plan’s Diabetes Management Program. 

Home Care Advocacy Program (January 2021) explains how HCAP under the Empire Plan provides in-home services and supplies when prescribed by your doctor. 

Mental Health & Substance Use (July 2021) details how The Empire Plan’s Mental Health and Substance Use (MHSU) Program can help you receive treatment and care for mental health or substance use issues. Receiving the appropriate treatment from a network provider or facility can help you get on the right path toward your recovery. 

Network Benefits (October 2020) discusses the benefits available to Empire Plan enrollees who use participating and network providers for medical/surgical, hospital, mental health and substance use services. 

Prenatal Care (April 2021) explains the components of good prenatal care, including pregnancy planning, nutrition, postpartum depression and the Empire Plan’s Future Moms Program. 

Prescription Drugs (February 2021) discusses specific information on copayment levels, mandatory generic substitution, the Flexible Formulary Drug List, Specialty Pharmacy Program and Drug Utilization Review under the plan. 

Smoking Cessation (May 2021) discusses the addictive power of nicotine, conditions and diseases caused by smoking, quitting strategies and information on the smoking cessation treatments covered by the Empire Plan. 

These publications are available on NYSHIP Online: www.cs.ny.gov/ employee-benefits. 

Choose your group (active state, then CSEA and Empire Plan), choose “using your benefits” and then current publications. Once there, scroll down to find “Reporting On.” 

Please note that the site uses cookies. You must enable cookies so that you will only need to access this page and select your group once. The site will remember your group for future visits. You will have the option of changing your group at any time after the initial logon. 

 The Empire Plan annually evaluates the network of Infertility Centers of Excellence. Strong Fertility Center will no longer be designated as an Empire Plan Center of Excellence, effective Jan.1, 2023. Affected members have received notification. 

Strong Fertility Center will remain an Empire Plan participating provider. Empire Plan enrollees and dependents will not lose access to the center, but the out-of-pocket cost sharing requirements may change because of the center not being considered an Infertility Center of Excellence. Members currently in a cycle will be able to finish that current cycle without any copayments applied. 

Questions regarding this change should be directed to United HealthCare at 1-877-769-7447 and choose option 1 for the Medical/ Surgical Program. 

Mental health is an important part of overall health and quality of life that affects how we think, feel, act, make choices and relate to others.

An individual’s mental health includes the emotional, psychological, and social well-being that is important at every stage of life, from childhood and adolescence through adulthood.

Today’s behavioral health issues are far from simple and when someone’s mental health is compromised. The cause is not always apparent to the individual or those around them.

Finding a trustworthy and knowledgeable mental health professional is an important step when receiving treatment. People have different reasons to consult a mental health professional. You may need a licensed provider who can prescribe medication, or perhaps you are primarily looking for a therapist to talk through an issue. It helps to know the provider type you are looking for.

Start by calling your insurer’s telephone number for mental health.

• HMO enrollees contact the telephone number on the back of your insurance card.

• Empire Plan enrollees have access to a 24/7 telemedicine program through Live Health Online to meet the medical and mental health needs of enrollees and dependents Important information for mental health care with no out-of-pocket costs. Empire Plan enrollees and dependents can register for Live Health Online at www.empireblue.com/nys.

• Carelon Behavioral Health (previously Beacon Health Options) is the Empire Plan’s mental health and substance use administrator. Empire Plan enrollees can receive information regarding network providers by outreaching to Carelon’s Clinical Referral Line (1-877-769-7447). In addition to information about network providers, Carelon now offers a new online therapy option through Talkspace, a network of mental health providers offering convenient online therapy, counseling and medication services to Empire Plan enrollees and their dependents. Engaging with a Talkspace therapist is subject to the same copayment that applies to a network in-person visit. For more information, visit www.talkspace. com/empireplan.

The Empire Plan’s Clinical Referral Line provides enrollees and dependents with up to three network providers. As a reminder, clarify your insurance benefits and the patient’s out-of-pocket responsibilities when scheduling appointments.

• When making an appointment, provide a summary of the situation to the provider so enough time can be blocked for the conversation.

• If there is a lengthy wait time until an open appointment, you could book the appointment and ask to be placed on a waiting list in the event someone cancels. In the meantime, continue calling other providers for possible earlier openings. Discuss cancellation policies, but typically, if not last minute, you can cancel your first appointment if you find something sooner.

• Reach out to your primary care doctor for recommendations, treatment, and support.

• If you experience an emergency, seek treatment from a hospital emergency room. State employees have an Employee Assistance Program (EAP) available to them as an additional resource. NYS EAP can be reached at < b>1-800-822-0244 or oer.ny.gov/eap.

 NYSHIP releases 2023 plan rates for CSEA active state employees, including Unified Court System

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. 30, 2022.

The State Division of Budget has approved the Empire Plan’s premium rates for calendar year 2023. Rates are listed on this page.

The Option Transfer Period, the time to choose your health insurance option for 2023, is now. 

Any state member wishing to change their NYSHIP health insurance option or enroll in the Opt-Out Program should submit the required signed documentation to their agency’s health benefits administrator no later than Dec. 30, 2022. You may also change your option online using MyNYSHIP at www.cs.ny.gov/mynyship again, no later than Dec. 30, 2022. 

The Pre-Tax (PTCP) Election Period runs concurrently with the NYSHIP annual Option Transfer Period. 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, which in turn 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. 30, 2022.

Please refer to the 2023 rates and the “Important Dates for your Benefit Choices” 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 could result in retroactive charges.

As we enter 2023, 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. 

See biweekly rates

Beacon Health Options, the administrator for the Empire Plan Mental Health and Substance Use (MHSU) Program, changed its name to Carelon Behavioral Health, Inc. effective March 1, 2023.

This is not a change in MHSU administrators; this is a name change resulting from carrier consolidations and rebranding. Elevance Health (previously known as Anthem) purchased Beacon and formed Carelon.

Empire Plan enrollees will not experience changes to coverage or the level of support because of the name change. To continue receiving the highest level of benefits, Empire Plan enrollees should call Carelon before seeking mental health or substance use care.

Guaranteed access to network level of benefits continues to be available if you call Carelon’s Clinical Referral Line for assistance in finding a provider and arranging care. You can reach the Clinical Referral line by calling the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and choosing option 3 for the MHSU program, then selecting option 3 from the MHSU Program menu.

The Clinical Referral Line is available 24 hours a day, every day of the year.

Is your child off to college this fall? If you’ve made a checklist of items to pack and things to take care of before they go, you may want to add just one more item — make sure their vaccinations are up-to-date.

Your child received all of their vaccinations when they were young, so they are set for life, right? Not so. Not only do many vaccines given to children wear off over time, many vaccines that adults need may not have been given to them when they were children. HPV and meningitis are examples of vaccines that may be recommended.

College students are at higher risk for certain infections. Students living in close proximity to others, such as in a dorm or a shared apartment, are at higher risk of contracting meningitis.

The American College Health Association (ACHA) published specific guidance on immunization recommendations for college students:

“Immunizations offer safe and effective protection from vaccine preventable diseases and outbreaks. The United States is experiencing re-emergence of these diseases, in part due to factors such as unimmunized and under-immunized persons and global travel. The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (also known as herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.”

Additional information on ACHA guidelines can be found online at https://tinyurl.com/ACHAguidelines.

Questions regarding vaccination coverage should be addressed through your health plan (number on the back of your insurance card). Empire Plan enrollees can contact United Healthcare at 1-877-NYSHIP (1-877-769-7447), option 1.

As a state employee, you may meet the qualifications and carry NYSHIP health insurance.

If you or your dependents have questions regarding a specific medical benefit/claim, or if you are trying to locate a participating provider, you should contact the health plan directly.

The Empire Plan can be reached toll free at 1-877-7-NYSHIP (1-877- 769-7447). Choose the appropriate program from the prompts. Health maintenance organization (HMO) enrollees should contact their HMO directly (telephone number on the back of insurance card).

The “General Information Book for NY Active Employees” includes information regarding NYSHIP eligibility rules, enrollment options, requirements and costs. A copy is mailed to all enrollees and can also be found on the Department of Civil Service’s NYSHIP online website. It is recommended that you keep the General Information Book with your health insurance materials for reference.

The agency health benefits administrator (HBA) or the New York State Business Services Center performs various tasks. For health insurance, the HBA serves as the employee’s contact for health insurance information, determining you or a dependent’s eligibility and providing necessary paperwork for health insurance enrollment.

Please note that the enrollee is responsible for notifying the HBA/Business Services Center of any changes that may affect your NYSHIP coverage. Civil Service sends reminders to NYSHIP enrollees, with covered dependents, reinforcing the enrollee’s responsibility to keep their NYSHIP enrollment record up to date and to provide timely notification to their HBA/Business Services Center when dependent(s) no longer meet eligibility requirements.

Below are examples of health insurance updates an enrollee should provide to their HBA or the New York State Business Services Center:

• Change in your name, mailing address, home address or phone number

• Seeking to change your coverage type (individual/ family)

• Seeking to add/delete an eligible dependent

• A covered dependent loses eligibility

• You get divorced (a copy of the divorce decree must be submitted)

• Employment status changes and/or removal from the payroll

• You are planning to retire

As noted above, questions about plan benefits should be addressed directly with your plan. The CSEA Joint Committee on Health Benefits can be contacted at 1-800-286-5242.

The Empire Plan is a unique health insurance plan that continues to be the comprehensive health plan that gives enrollees the freedom to choose whether to receive care from Empire Plan network providers or from non-network providers.

Although not all health care providers participate in the Empire Plan network, Empire Plan enrollees have access to 1.2 million physicians, laboratories, surgeons, anesthesiologists, mental health specialists, physical therapists, acupuncturists and more.

When accessing health care for yourself or your enrolled dependents, it is important to ensure that you are visiting an Empire Plan network provider. Participating network providers save you and the plan money.

• Your out-of-pocket responsibility is usually limited to only a copayment for covered services by network providers.

• Network providers will handle many administrative tasks for you, such as submitting claims to United Healthcare. Very IMPORTANT: Confirm network status before scheduling any visit. Just because a provider says they’ll “accept” your insurance doesn’t mean they are in the network. To get the most out of your plan — and pay less — make sure to confirm with providers ahead of time by asking, “Are you in network with (United Healthcare, Empire BlueCross, Carelon Behavioral Health, etc.) for The Empire Plan?”

You can search for Empire Plan participating network providers online by visiting NYSHIP Online at www.cs.ny.gov/employee-benefits Choose Empire Plan network providers and select Find a Provider. Enrollees can work with the Empire Plan carriers to find a network provider or to receive guaranteed access to network benefits. Enrollees can nominate out of network providers to join the Empire network as well.

Below is a listing of the administrators for The Empire Plan and the program they are responsible for overseeing.

United Healthcare oversees the Empire Plan Participating Provider Program for medical/surgical services (such as office visits and surgery) as well as:

• The Home Care Advocacy Program (HCAP) for covered home care services and durable medical equipment/ supplies, including diabetic supplies, diabetic shoes and enteral formulas.

• The Managed Physical Network (MPN) for chiropractic treatment and physical therapy.

• Centers of Excellence Program for Cancer and Infertility

• Access to acupuncturists under the Empire Plan Empire BlueCross oversees the Empire Plan’s Hospital Program and provides coverage at hospitals worldwide.

Empire Blue Cross also oversees the Empire Plan Center of Excellence Program for Transplants.

Carelon Behavioral Health (formerly Beacon Health Options) oversees the Empire Plan’s Mental Health and Substance Use Program and provides a nationwide network for mental health and substance use treatment, including alcoholism.

CVS Caremark oversees the Empire Plan’s Prescription Drug Program and includes a nationwide network of participating pharmacies and a Mail Order Pharmacy. Any questions about the Empire Plan network benefits should be addressed to the appropriate administrator at the Empire Plan’s toll-free number: 1-877-7-NYSHIP (1-877-769-7447).

The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families. The plan consists of four main parts: Hospital, Medical/Surgical, Mental Health/Substance Use and the Prescription Drug Program.

The Empire Plan’s network is composed of hospitals, medical/ surgical providers, mental health/ substance use providers – both inpatient and outpatient, as well as participating pharmacies.

Under the medical/surgical program, Empire Plan enrollees and dependents have access to United Healthcare’s national network of medical providers. The participating provider program network is more than 1.2 million physicians, laboratories, and other providers such as physical therapists, occupational therapists and chiropractors located throughout the United States. You have the freedom to choose any participating provider without a referral.

When using a participating provider, your out-of-pocket expenses are lower – you pay only your copayment(s) if applicable, at the time of your visit. There is no cost for many services through a participating provider, including preventive services as required under the U.S. Patient Protection and Affordable Care Act.

The Empire Plan has guaranteed access to many different services (contact the Empire Plan when searching for a provider). You have guaranteed access to paid-in-full benefits through the Home Care Advocacy Program (HCAP) that covers home care/skilled nursing services, durable medical equipment and certain medical supplies including diabetic and ostomy supplies.

As soon as your provider prescribes services covered under HCAP, call the Empire Plan (press or say 1 for the Medical/Surgical Program, then press or say 3 for HCAP). The medical/surgical program will preauthorize your services and/ or equipment and supplies with an HCAP-approved provider. For diabetic supplies, except insulin pumps, call the Empire Plan Diabetic Supplies Pharmacy toll free at 1-800-321-0591 (insulin pumps must call HCAP). For ostomy supplies, call Byram Healthcare at 1-800-354-4054.

Always check if the provider participates in the Empire Plan before you receive services. Contact the Empire Plan directly at 1-877- 769-7447 with any benefit questions, to check a provider’s participation status or to request a listing of participating providers.

Empire Plan complies with various state and federal mandates regarding mandated access to plan providers.

Out-of-network referral mandate

The Empire Plan must provide access to primary care and specialty providers if these services are not available within a 30-mile radius or 30-minute travel time from your home address. This requirement applies to Empire Plan primary enrollees residing within the United States. If you require access to a certain provider, contact the appropriate Empire Plan administrator at 1-877-769-7447.

Please refer to the Empire Plan Out-of-Network Reimbursement Disclosures for additional information regarding State and Federal protections, such as surprise bills and information regarding out-of-network reimbursement and enrollee cost sharing requirements.

 Select preventive vaccines are covered without copayment when administered at a pharmacy that participates in the CVS Caremark national vaccine network. Vaccines available at a pharmacy include: 

• COVID-19 
• Haemophilius influenzae Type B 
• Hepatitis A 
• Hepatitis B 
• Herpes zoster (shingles) 
• Human papillomavirus (HPV) 
• Inactivated poliovirus (polio) 
• Influenza (flu) 
• Measles, mumps, rubella 
• Meningococcal (meningitis) 
• Pneumococcal (pneumonia) 
• Rotavirus 
• Tetanus, diphtheria, pertussis 
• Varicella (chickenpox) 

To find out if a pharmacy participates in the CVS Caremark National Vaccine Network, call the Prescription Drug Program or visit www.empireplanrxprogram.com and select CVS Caremark, then select “Find a Local Pharmacy.” 

Be sure to select vaccine network under advanced search. Only certain pharmacies are part of the CVS Caremark national vaccine network and certain vaccines have age limitations. Call the pharmacy in advance to verify availability of the vaccine. 

If you have questions about this coverage or need help locating a vaccine pharmacy, call the Empire Plan at 1-877-769-7447, and press or say 4 to reach the Prescription Drug Program. 

Maintaining our mental and physical health is of great importance. The additional stress that many people have experienced in recent years has amplified the need for increased access to mental health services. 

LiveHealth Online’s Telemedicine Program for the Empire Plan enrollees and dependents is an enhanced telemedicine program as it covers medical and mental health visits. The telemedicine program is very convenient for common health concerns like colds, flu, fevers, rashes, infections and allergies. 

CSEA’s Executive Branch Negotiating Team worked with New York State to continue offering the LiveHealth Online Telemedicine Program in the current state contract. Our union’s team was successful, and the LiveHealth Online program will continue to be offered with covered-in-full visits for Empire Plan enrollees and dependents. 

Members and dependents covered by the Empire Plan continue to have access to covered-in-full telemedicine services from board-certified doctors and licensed mental health specialists. You can virtually visit a LiveHealth Online provider for medical and mental health by using a smartphone, tablet or personal computer. Spanish-speaking providers are also available.

Telemedicine allows individuals to see and talk to the LiveHealth Online doctor through your electronic device, while you remain in the comfort of your home or college dorm, for dependents away at college. You will have no need to travel to the doctor’s office or sit in the waiting room.

To get started, visit www.empireblue.com/nys and select the link to LiveHealth Online to begin the registration process. When registering, or logging in if already registered, be sure to enter your Empire Plan identification number and name exactly as they appear on your identification card; this will help ensure treatment is received without charge to the enrollee. 

If you need assistance with the registration process or have questions, call LiveHealth Online at 1-888-548-3432. LiveHealth Online has representatives available 24 hours a day, seven days a week to assist you.

 Now is the time to consider your NYSHIP health option for 2023. The “2023 Planning for Option Transfer” flyer was recently mailed to NYSHIP enrollee homes and includes information about the upcoming Option Transfer Period. 

The annual Option Transfer Period is when NYSHIP enrollees can make changes to their 2023 NYSHIP option. The “Health Insurance Choices” guide for 2023 contains a more detailed comparison of NYSHIP benefits. The guide will be available from your agency health benefits administrator (HBA). 

In addition to considering your health plan option, this is the time to review health care expenses for next year. 

Do you currently participate in the Flex Spending Account or the Productivity Enhancement Program (PEP)? If you don’t, now is the ideal time to get more information about these cost-saving benefits as enrollment begins in November. Enrollment is time sensitive and end dates vary.

Flex Spending Account Open Enrollment Period: Nov. 1 to Dec. 12, 2022

The Flex Spending Account 2023 plan year will begin on Jan. 1, 2023. The Flex Spending Account is a negotiated employee benefit for state employees. A flex spending account offers a way to pay for your dependent care, health care expenses, or adoption expenses with pre-tax dollars. If you are currently enrolled in the FSA program, you must re-enroll to continue your participation in 2023.

The Flex Spending Account website contains more information about eligibility and program rules. You can visit https://oer.ny.gov/FSA or call 1-800-358-7202 to enroll. 

Productivity Enhancement Program Enrollment Period: Nov. 1 to Dec. 12, 2022 

The Productivity Enhancement Program (PEP) allows eligible full and part-time state employees to exchange previously accrued annual and/or personal leave for a credit to be applied toward the NYSHIP premium. If you are eligible and elect this program, the credit will be included in your biweekly paychecks and divided evenly during the plan year. During negotiations, CSEA was successful in negotiating an increase to the PEP amounts/days allowed to use. 

For calendar year 2023, CSEA active state members can receive up to a $800 credit or $1,600 credit determined by salary grade and number of days forfeited. To elect PEP for 2023, you must apply between Nov. 1 and Dec. 12, 2022. Ask your agency health benefits administrator for details and an application. If you are currently enrolled in PEP and remain eligible, you must re-enroll to continue receiving in 2023.

PTCP Election Period: The Pre-Tax Contribution Program (PTCP) Election Period will run concurrently with the official NYSHIP Option Transfer Period for Health Insurance 

The PTCP is a voluntary program that allows your share of the health insurance premium to be deducted from wages before taxes are withheld. In exchange for this reduction in tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you experience a qualifying event and provide timely notification. 

Participation in the PTCP can be chosen when first eligible for health insurance benefits and may also be selected to participate or decline participation in PTCP each year during the PTCP election period. 

Requests made during the PTCP election period become effective at the beginning of the 2023 plan year. 

If you want to change your PTCP election for 2023, complete a NYS Health Insurance Transaction Form PS-404 and submit to your agency Health Benefits Administrator before the PTCP election period deadline. Per Internal Revenue Service rules, this election period is the only opportunity to change your PTCP status for 2023; arbitrary, mid-year status changes are not allowed. Should a qualifying PTCP event occur mid-year, any request to change your NYSHIP coverage must be consistent with a PTCP qualifying event and submitted within 30 days of the even (or within the waiting period, if newly eligible). No action is required to keep your current PTCP status.

The Flex Spending Account (FSA) is a negotiated state employee benefit that helps you save money by allowing you to pay certain expenses with pre-tax dollars. The Health Care Spending Account, the Dependent Care Advantage Account and the Adoption Advantage Account are benefit programs available under New York State’s FSA.

The state’s FSA Open Enrollment Campaign for the 2023 plan year will begin Nov. 1, 2022, and end on Dec. 12, 2022. New for 2023, Total Administrative Services Corporation (TASC) will be the administrator of the FSA programs and will be handling enrollments for the 2023 plan year. The current vendor will process the remainder of 2022 plan year claims, including up to the end of the run-out period on March 31, 2023.

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. Put simply, if you contribute pre-tax dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you may lose the balance remaining in your account when the plan year ends.

Here is more information about the types of Flex Spending Accounts:

Health Care Spending Account (HCSA) – Contributions to the HCSA are made through pre-tax payroll deductions and may be used for eligible health care expenses that are not covered by a health plan. 

The current maximum annual contribution to the HCSA is $2,850 for the 2023 plan year – this maximum is subject to update by the federal government.

Employees will continue to access a debit card for use for eligible purchases and charges. Current FSA debit cards from HealthEquity/WageWorks will be deactivated, and 2023 program participants will receive a new debit card.

The 2023 HCSA will include the maximum carryover of 2022 remaining balances. After the run-out period ends on March 31, 2023, up to $570 of funds remaining in the account will be transferred to the 2023 account for use any time during the 2023 year. Monies carried over are not included in the maximum contribution limits.

Dependent Care Advantage Account (DCAA) – Up to $5,000 per year, per household can be contributed in the DCAA through pre-tax payroll deductions for elder care, disabled dependent care or child care expenses. 

After eligible services have been received, the employee submits for reimbursement.

The DCAA employer contribution will continue to be available in 2023

The 2023 DCAA will include a grace period. Any remaining funds from the 2022 plan year can be used to pay for expenses incurred between Jan. 1, 2023, and March 15, 2023.

Adoption Advantage Account (AAA) – Eligible employees may contribute up to $14,890 in the AAA for 2023 plan year. Contributions are made through pre-tax payroll deductions and may be used for expenses related to the adoption of an eligible child.

Get more information about the state’s FSA programs by calling the FSA hotline at 1-800-358-7202 or visiting https://oer.ny.gov/fsa. 

 The Empire Plan is a unique health insurance plan that provides coverage whether you receive care from Empire Plan network providers or from non-network providers. 

When you or a loved one needs health care, make sure you are visiting a participating Empire Plan network provider. Staying in the Empire Plan network can save you (and the Plan) time and money: 

Your out-of-pocket responsibility is usually limited to only a copayment for covered services by network providers 

Network providers will handle many administrative tasks for you, such as submitting claims to United Healthcare. 

VERY IMPORTANT: Confirm network status before scheduling any visit. 

Just because a provider says they’ll “accept” your insurance, doesn’t mean they are in the network. To get the most out of your plan — and pay less — make sure to confirm with providers ahead of time by asking, “Are you in network with (United Healthcare, Empire BlueCross, Beacon, etc.) for The Empire Plan?” 

You can search for Empire Plan participating network providers online by visiting NYSHIP Online at www.cs.ny.gov/employee-benefits and select Find a Provider. 

On this page is a listing of the administrators for The Empire Plan and the program they are responsible for overseeing.

United Healthcare oversees the Empire Plan Participating Provider Program for medical/surgical services (such as office visits and surgery), as well as:

The Home Care Advocacy Program (HCAP) for covered home care services and durable medical equipment/supplies, including diabetic supplies, diabetic shoes and enteral formulas.

The Managed Physical Network (MPN) for chiropractic treatment and physical therapy.

Centers of Excellence Program for Cancer and Infertility.

Access to Acupuncturists under the Empire Plan has increased. 

Empire BlueCross oversees the Empire Plan’s Hospital Program and provides coverage at hospitals worldwide. BlueCross also oversees the Empire Plan Center of Excellence Program for Transplants.

Beacon Health Options oversees the Empire Plan’s Mental Health and Substance Abuse Program and provides a nationwide network for mental health and substance abuse treatment, including alcoholism.

CVS Caremark oversees the Empire Plan’s Prescription Drug Program and includes a nationwide network of participating pharmacies and a mail order pharmacy.

Any questions about the Empire Plan network benefits should be addressed to the appropriate administrator at the Empire Plan’s toll-free number, 1-877-7-NYSHIP (1-877-769-7447). 

 The Flex Spending Account (FSA) is a negotiated state employee benefit that helps save you money by allowing you to pay certain expenses with pre-tax dollars. 

The Health Care Spending Account, the Dependent Care Advantage Account (DCAA) and the Adoption Advantage Account are benefit programs available under New York State’s FSA.

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. Put simply, if you contribute pre-tax dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you will lose the balance remaining in your account when the plan year ends. 

You can only be reimbursed for expenses that are incurred during your period of coverage, which means:

If you enroll during the open enrollment period and remain on the state payroll for the entire year, your period of coverage is from January 1 to December 31.

If you enroll during the plan year as a new employee, your period of coverage will begin after you complete 60 consecutive calendar days of state service. Your coverage will end on December 31.

If you enroll during the plan year due to a change in status, your period of coverage will begin when your change in status application is received. However, it can’t take effect before the date of your qualifying event. Your coverage will end on December 31.

Participants have until March 31, 2023, to submit any eligible unreimbursed expenses from the 2022 plan year. Remember, if you plan properly, you are unlikely to forfeit any of your funds.

Reminders:

Health Care Spending Account participants were able to use up to $550 of their 2021 remaining balance for eligible expenses incurred during the 2022 calendar year if you had an account as of Dec. 31, 2021. 

DCAA participants were able to use the remaining balance in a 2021 DCAA account towards eligible expenses incurred during the 2022 calendar year.

You can check your 2022 HCSA and DCAA balances at https://participant.wageworks.com

If you have any questions, please call WageWorks/Health Equity at 1-800-358-7202

 New York State Active Employees: It’s that time of year to start thinking about your 2023 health insurance options.

New York State typically mails the Planning for Option Transfer flyers to enrollees in late September. The flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Pre-Tax Contribution Program (PTCP) and the Opt-Out Program, if applicable. This document is an important reminder and contains benefit and program deadlines.

If you are thinking of changing health insurance plans during the Open Enrollment Period, the NYSHIP Plan Comparison tool, available on NYSHIP online, generates an actual side-by-side comparison of Empire Plan and HMO benefits. This tool can help you easily compare and contrast services, copayments, coinsurance amounts and special programs for The Empire Plan and NYSHIP HMOs.

The comparison tool will be updated with 2023 benefits this fall at the same time the Option Transfer Period begins. To access this tool, visit the NYSHIP Online homepage at www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, and then choose Health Benefits & Option Transfer; click on Rates and Health Plan Choices and the NYSHIP Plan Comparison. Select your group (CSEA) and the counties in which you live and work. Check the box next to the plans you want to compare, and click on Compare Plans to generate the comparison table.

Please watch for additional information in The Work Force as the option transfer period draws near.

 Preventive, diagnostic and routine care benefits are common types of health care you may receive under The Empire Plan. 

Understanding the difference between them is not always easy, but it is important. Coverage and out-of-pocket expenses can vary depending on which type of service you receive. Be sure to discuss with your provider why a test or service is being ordered. The same test or service can be considered preventive, diagnostic, or routine (depending on the description of why it is being performed). As a result, out-of-pocket costs paid by the enrollee may change based on why the service is requested.

Preventive care benefits and services covered by The Empire Plan follow numerous guidelines and standards, including recommendations by the U.S. Preventive Services Task Force (USPSTF), the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as well as requirements of the Patient Protection and Affordable Care Act (PPACA).

The goal of preventive care is to detect potentially serious health conditions before symptoms develop and obtain early treatment. Preventive care can include annual exams, screenings, and immunizations. 

Common examples of adult preventive care include annual wellness visits, cholesterol, high blood pressure and diabetes screenings as well as cancer screenings, such as colonoscopies and mammograms. Common examples of yearly pediatric preventive care (well-child) can include growth and body mass measurements, developmental screenings, behavioral assessments, and immunizations. Many preventive services are covered in full when using an Empire Plan participating provider.

Diagnostic care helps diagnose risk factors or treat symptoms that are already present. Diagnostic care would involve following up with your provider to treat or monitor issues. When a preventive visit becomes diagnostic, a copayment would apply when using a participating provider.

Routine care describes care that occurs on a regular basis, but it is not preventive. Routine care is used to prevent a condition from becoming worse and to help manage symptoms. Common illnesses that often require routine care include asthma, hypertension, and diabetes. Because routine care is not preventive, a copayment would apply when using a participating provider.

Please review the 2022 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care. You should review your Explanation of Benefits Statement (EOB) regularly. The EOB can provide a better understanding of how the services are billed, what the Plan pays and your out-of-pocket costs. 

If you have specific coverage questions or need assistance finding a participating provider, call the Empire Plan 1-877-7-NYSHIP (1-877-769-7447).

 The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families. The Plan has four main parts: Hospital, Medical/Surgical, Mental Health/Substance Use and the Prescription Drug Program. 

The Empire Plan’s network is comprised of hospitals, medical/surgical providers, mental health/substance use providers — both inpatient and outpatient as well as participating pharmacies. 

Under the medical/surgical program, Empire Plan enrollees and dependents have access to United Healthcare’s national network of medical providers. The participating provider program network includes more than 1.2 million physicians, laboratories, and other providers such as physical therapists, occupational therapists and chiropractors located throughout the United States. You have the freedom to choose any participating provider without a referral.

When using a participating provider, your out-of-pocket expenses are lower — you pay only your copayment(s) if applicable, at the time of your visit. There is no cost for many services through a participating provider, including preventive services as required under the U.S. Patient Protection and Affordable Care Act (PPACA). 

The Empire Plan has guaranteed access to many different services (contact the Empire Plan when searching for a provider). You have guaranteed access to paid-in-full benefits through the Home Care Advocacy Program (HCAP) that covers home care/skilled nursing services, durable medical equipment and certain medical supplies including diabetic and ostomy supplies. 

As soon as your provider prescribes services covered under HCAP, call the Empire Plan (press or say 1 for the Medical/Surgical Program, then press or say 3 for HCAP). The medical/surgical program will preauthorize your services and/or equipment and supplies with an HCAP-approved provider. For diabetic supplies, except insulin pumps and Medijectors, call the Empire Plan Diabetic Supplies Pharmacy toll free at 1-800-321-0591 (insulin pumps and Medijectors must call HCAP). For ostomy supplies, call Byram Healthcare at 1-800-354-4054.

Always check if the provider participates in the Empire Plan before you receive services. Contact the Empire Plan directly at 1-877-769-7447 with any benefit questions, to check a provider’s participation status or to request a listing of participating providers.

Out-of-network referral mandate

Empire Plan complies with various state and federal mandates regarding mandated access to plan providers. 

The Empire Plan must provide access to primary care and specialty providers if these services are not available within a 30-mile radius or 30-minute travel time from your home address. This requirement applies to Empire Plan primary enrollees residing within the United States. If you require access to a certain provider, contact the appropriate Empire Plan administrator at 1-877-769-7447.

Please refer to the Empire Plan Out-of-Network Reimbursement Disclosures for additional information regarding state and federal protections, such as surprise bills and information regarding out-of-network reimbursement and enrollee cost sharing requirements

 On this page are important updates for Empire Plan enrollees about pandemic-related benefits including COVID-19 vaccines, telemedicine, mental health and substance abuse program and COVID-19 testing. 

COVID-19 vaccines

COVID-19 vaccines, including newly-approved vaccines that have recently received Emergency Use Authorization, are available at no cost. Please visit vaccines.gov for up-to-date information on COVID vaccine availability, who is eligible for vaccines and boosters and how to find a vaccine location near you. 

Empire Plan enrollees receiving a COVID-19 vaccine at a retail pharmacy may be asked for insurance information: 

• United Healthcare is the medical provider and Group Number is 030500. 

• CVS Caremark is the prescription drug administrator.

• The BIN is: 004336 

• The Group: RX6027 

• The PCN is ADV 

There is no out-of-pocket cost for the vaccine or the single booster dose for enrollees. If you were charged a copayment for your COVID-19 vaccine at a retail pharmacy, contact CVS Caremark to request reimbursement at caremark.com. 

Telemedicine visits 

Empire Plan enrollees continue to have access to virtual telemedicine visits for medical and mental health visits 24 hours a day, 365 days a year through LiveHealth Online (empireblue.com/nys). Telemedicine visits through LiveHealth Online are available with no copayment. 

Telehealth 

It is important to note that any virtual telehealth visit provided by an Empire Plan participating provider may be subject to a copayment if the visit is not related to a COVID diagnosis. 

Mental Health and Substance Use Program 

If Empire Plan enrollees or family members need assistance finding a mental health or substance use provider, please be reminded that the Empire Plan offers guaranteed access to network level benefits if you call the Plan administrator, Beacon Health Options clinical referral line for assistance arranging care. 

You can reach Beacon Health Options by calling 1-877-769-7447 and press or say 3 to reach the Mental Health and Substance Use Program. You can reach the Clinical Referral Line by selecting option 3 from the MHSU program menu. The Clinical Referral Line is available 24 hours a day, 365 days a year. 

COVID-19 testing 

In accordance with current regulations, Empire Plan member copayments, coinsurance and deductibles are waived when: 

• COVID-19 testing performed at approved locations and following U.S. Centers for Disease Control and Prevention (CDC) guidelines (tests specifically for surveillance may be excluded). 

• Visits are in conjunction with the above COVID-19 testing to diagnose COVID-19 at the following locations, including telehealth:

• An in-network provider’s office 

• An in-network urgent care center 

• A hospital emergency department 

• Any other in-network outpatient provider setting able to diagnose COVID-19. 

COVID-19 at-home testing 

Effective Jan. 15, 2022, the federal government directed health insurance providers to cover FDA-authorized at-home COVID-19 diagnostic tests. 

• The Empire Plan will cover up to eight FDA-authorized at-home COVID-19 diagnostic tests. 

• Over-the-counter diagnostic COVID-19 tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan ID card. 

 If a test is paid for out-of-pocket at a non-participating network pharmacy, Empire Plan members can submit for the maximum reimbursement through United HealthCare online at www.myuhc.com. 

• For more information, call the Empire Plan at 1-877- 769-7447 and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program. 

Questions and more resources 

• The Empire Plan NurseLine is available 24 hours a day, seven days a week to answer your health-related questions. 

• If you have any questions or concerns regarding your Empire Plan benefits, call the Empire Plan toll-free at 1-877-769-7447 and select the option for the appropriate program. 

 The New York State Department of Financial Services has developed FAQs about health insurance access during the pandemic. Visit: https://tinyurl.com/DFS-FAQs. 

Is your child off to college this fall? If you’ve made a checklist of items to pack and things to take care of before they leave, you may want to add just one more item — make sure their vaccinations are up-to-date.

Your child received all of their vaccinations as a young child, so they are set for life, right? Not so. Not only do many vaccines given to children wear off over time, many vaccines that adults need may not have been given as a young child. HPV and meningitis vaccines are examples of vaccinations that may be recommended.

College students are at higher risk for certain infections. For example, students living in close proximity to others, such as in a dorm or a shared apartment, are at higher risk of contracting meningitis.

The American College Health Association (ACHA) published specific guidance on immunization recommendations for college students. 

“Immunizations offer safe and effective protection from vaccine-preventable diseases and outbreaks. The United States is experiencing re-emergence of these diseases, in part due to factors such as un-immunized and under-immunized persons and global travel. The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.” 

Additional information on ACHA guidelines can be found online at: https://tinyurl.com/ACHA-College-Immunization.

Questions regarding vaccination coverage should be addressed through your health plan (number on the back of your insurance card). Empire Plan enrollees can contact United Healthcare at 1-877-7NYSHIP (1-877-769-7447), option #1.

Planning a trip? It’s good to know that no matter where you or your family go, you have the protection of The Empire Plan.

Remember, plan ahead and take the 2021 On the Road with The Empire Plan with you. The updated version of On the Road with The Empire Plan is available through the health benefits administrator at your agency or work location or can be accessed on NYSHIP’s website: https://tinyurl.com/EPontheroad. 

This publication includes contact and benefits information for Empire Plan programs that enrollees can reference while they are traveling or when their dependents are away from home. 

Empire Plan coverage is available worldwide and not just for emergencies. 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 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 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. The telephone prompts for Empire Plan programs are:

Prompt 1: Medical/Surgical Program

Prompt 2: Hospital Program

Prompt 3: Mental Health/Substance Abuse Program

Prompt 4: Prescription Drug Program

Prompt 5: Empire Plan Nurseline (Registered Nurses available 24 hours a day/7 days a week)

The Empire Plan’s Telemedicine Program, through LiveHealth Online, makes receiving health care convenient when at home or traveling. LiveHealth Online allows Empire Plan enrollees and covered dependents to seek medical or mental health appointments virtually with no out-of-pocket cost. Virtual visits with board-certified doctors (medical) or licensed therapists (mental health) can be held using a smartphone, tablet, or personal computer. Contact LiveHealth Online at 1-888-548-3432, 24 hours a day, seven days a week.

If you plan to travel this summer, we encourage you to review the newest version of On the Road with The Empire Plan. Be sure to bring this document along with your doctor’s contact information and health insurance identification card(s) with you in case you or your family need medical care while away from home. Safe travels!

Public health experts, including the U.S. Centers for Disease Control and Prevention (CDC), recommend the use of at-home diagnostic tests as a tool to help mitigate the spread of COVID-19.

The Biden-Harris administration has taken steps to make at-home tests more accessible. Under direction from the federal government, the Empire Plan will cover FDA-authorized at-home COVID-19 over-the-counter diagnostic tests.

All Empire Plan enrollees and dependents are eligible for this benefit. COVID-19 over-the-counter diagnostic tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan ID card (no doctor’s order or prescription is necessary). Empire Plan participants should go to the pharmacy counter with the COVID-19 test(s) so the pharmacy can process and bill your insurance directly.

Since this program was implemented as we were preparing to go to press, following are some Frequently Asked Questions the Empire Plan has assembled to assist participants:

Q1: Where can I get an over-the-counter (OTC) at-home COVID-19 test?

A1: COVID-19 at-home tests can be acquired at any pharmacy, store or online retailer that sells FDA-authorized COVID tests. If you present your health insurance card at the pharmacy counter, you can get an OTC test through a participating network pharmacy at no out-of-pocket cost.

Note: If you are charged for a test at a participating network pharmacy, submit for reimbursement on Caremark’s website at
www.caremark.com. If you need assistance, call The Empire Plan at 1-877-769-7447 and select option 4 for the Empire Plan Prescription Drug Program, 24 hours a day, seven days a week.

Q2: How am I reimbursed for the COVID-19 at-home test?

A2: If you purchase an FDA-authorized at-home test at a non-participating network pharmacy (e.g., Amazon or other online retailer), keep your receipt and submit a claim to United Healthcare. The maximum reimbursement per test is $12. United Healthcare, the Medical/Surgical Program administrator, will accept claim submissions.

Visit www.myuhc.com to access the reimbursement form, which can also be found at https://tinyurl.com/AtHomeTestForm

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Note: In the “Subscriber/policyholder information” section of the form, Member ID is the 9-digit number starting with 890 or 891 and Plan/Group # is: 030500.

Q3: How many COVID-19 OTC at-home tests will be covered?

A3: There is a maximum of eight tests per plan member, per month. COVID-19 at-home tests have expiration dates indicated on the package. Using an expired test risks getting an inaccurate result.

Q4: Which tests are FDA-authorized?

A4: As of Jan. 18, 2022, the list of COVID-19 OTC FDA-authorized tests* are:

• BinaxNOW COVID-19 Antigen Self Test
• COVID-19 At-Home Test (SD Biosensor, Inc.)
• CLINITEST Rapid COVID-19 Antigen Self-Test
• iHealth COVID-19 Antigen Rapid Test
• CareStart COVID-19 Antigen Home Test
• BD Veritor At-Home COVID-19 Test
• SCoV-2 Ag Detect Rapid Self-Test
• InteliSwab COVID-19 Rapid Test
• Celltrion DiaTrust COVID-19 Ag Home Test
• QuickVue At-Home OTC COVID-19 Test
• Flowflex COVID-19 Antigen Home Test
• Ellume COVID-19 Home Test

*The list of FDA-authorized tests is subject to change.

Q5: What if my test costs more than $12?

A5: Tests purchased at a participating network pharmacy will be covered in full. For claims that are submitted via www.myuhc.com, the plan will reimburse up to $12 per test ($24 for a box that contains two tests) for a maximum of eight tests per plan member, per month.

Q6: My primary coverage is Medicare. Am I eligible for an OTC test?

A6: Yes, this plan benefit applies for plan members who have Medicare as their primary coverage, and Empire Plan as their secondary health plan coverage.

Q7: I already bought and paid for a COVID-19 OTC test. Can I submit a claim for reimbursement for this test?

A7: Only tests purchased on or after Jan. 15, 2022, are eligible for reimbursement.

Q8: What other options do I have for ordering at-home tests?

A8 Beginning Jan.19, 2022, every home in the U.S. is eligible to order four free at-home COVID-19 tests via www.covidtests.gov. The tests are completely free. Orders will usually ship in 7-12 days.

Q9: I have additional questions. Who can assist me?

A9 : Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program.

Mental health is an important part of overall health and quality of life that affects how we think, feel, act, make choices and relate to others.

An individual’s mental health includes the emotional, psychological, and social well-being that is important at every stage of life, from childhood and adolescence through adulthood. 

Today’s behavioral health issues are far from simple. When someone’s mental health is compromised, the cause is not always apparent to the individual or those around them. Finding a trustworthy and knowledgeable mental health professional is an important step when receiving treatment. 

Below are some tips on finding the right mental health professional.

People have different reasons to consult a mental health professional. You may need a licensed provider who can prescribe medication or perhaps you are primarily looking for a therapist to talk through an issue. It helps to know the provider type you are looking for. 

Start by calling your insurer’s telephone number for mental health. 

NYS Empire Plan: 1-877-769-7447 (Beacon Health is Option #3). 

HMO enrollees enrollees: Consult the telephone number on the back of your insurance card.

Request phone numbers of participating professionals in your area. Gather referrals — try to get at least three names and numbers. When you call, clarify your insurance benefits and the patient’s out-of-pocket responsibilities.

If you are reluctant to call, ask a friend or family member to call for you. 

When making an appointment, provide a summary of the situation to the provider so enough time can be blocked for the conversation.

If there is a lengthy wait time until an open appointment, you could book the appointment and ask to be placed on a waiting list, in the event someone cancels. In the meantime, continue calling other providers for possible earlier openings. Discuss cancellation policies, and if you find an appointment sooner, cancel the initial appointment. 

Reach out to your primary care doctor for recommendations, treatment and support.

If you experience an emergency, seek treatment from a hospital emergency room.

Initial visits consist of gathering background information and concerns about the situation at hand. Note that therapeutic techniques may vary among providers with the same licensure. 

It is reasonable for patients to pose questions of the provider to help determine if a working connection can be built. After a few sessions, if it does not feel like the right “fit,” or if a provider lacks a particular expertise or experience that you are seeking, continue your search by calling and looking for a provider that best meets your needs.

Empire Plan enrollees can call the Clinical Referral Line through Beacon Health for names of mental health providers. Please see the image on this page for additional information.

Your health plan may also offer a telemedicine program, which allows you to seek virtual treatment without the need to leave your home. Empire Plan enrollees have a 24/7 Telemedicine program offered through LiveHealth Online that can meet the medical and mental health needs of enrollees and dependents with no out-of-pocket costs. Empire Plan enrollees/dependents can contact LiveHealth Online at 1-888-548-3432. 

State employees have an Employee Assistance Program (EAP) available to them as a resource. NYS EAP can be reached at 1-800-822-0244 or https://goer.ny.gov/employee-assistance-program.

 The cost of prescription drugs is one of the fastest growing components of health care costs in the United States. 

The Empire Plan’s prescription drug benefit is designed to help manage drug costs and establish copayment levels that are more in line with the relative cost of various drugs to the Plan. 

Each January, Empire Plan enrollees are sent the Empire Plan at a Glance, which is a summary of benefits available under the Empire Plan, and also includes applicable copayment(s). 

Copayments are not the only component that impacts overall health insurance costs. To keep out-of-pocket costs for prescription drugs as low as possible, speak with your doctor about alternative drugs that may be available for your treatment and become aware of programs that can help you save money.

The Empire Plan Prescription Drug Program uses the Advanced Flexible Formulary to provide CSEA enrollees and dependents with the best value in prescription drug spending. All drugs included on the formularies have been approved by the FDA. The list is developed by a committee of pharmacists and physicians and are subject to change each January. 

The Empire Plan Advanced Flexible Formulary uses a three-level copayment schedule – Level 1 has the lowest copayment and most generic prescription drugs fall within this level.

Empire Plan Mail Service Pharmacy

The most cost-effective way to receive your prescription drugs is through the Mail Service Pharmacy. When you fill your covered prescription drugs through the CVS Caremark Mail Service Pharmacy, you can order up to a 90-day supply shipped to your home. 

An order form can be printed at www.cs.ny.gov/employee-benefits. From the NYSHIP homepage, select Forms and scroll down to choose CVS Caremark Mail Service Order Form. You can call the Empire Plan toll free at 1-877-7NYSHIP (1-877-769-7447). Press or say 4 for the Prescription Drug Program.

Specialty Pharmacy Program

The Empire Plan Specialty Pharmacy Program offers enhanced services to individuals using specialty drugs. Most specialty drugs will only be covered when dispensed by The Empire Plan’s designated specialty pharmacy, CVS Caremark Specialty Pharmacy. Prior authorization is required for some specialty drugs.

A complete list of specialty drugs included in the Specialty Pharmacy Program is available on the New York State Department of Civil Service website at https://www.cs.ny.gov. Select Benefit Programs, then NYSHIP Online and follow the prompts to the NYSHIP Online homepage. Click on Using Your Benefits and then select Specialty Pharmacy Drug List. Each of these drugs can be ordered through the Specialty Pharmacy Program using the CVS Caremark Mail Service Order Form.

Additional cost-saving ideas

Talk with your doctor about using over-the-counter drugs. Prescription drugs occasionally move to the over-the-counter market and are then available without prescriptions. An over-the-counter drug may be a cost-effective alternative to your prescription medication.

When your doctor starts you on a new maintenance prescription drug, you may want to have the prescription filled for a 30-day supply to ensure the prescription is right for your condition before paying a higher copayment for a 31 to 90-day supply.

Ask your agency health benefits administrator or business services center if you are eligible to participate in New York State’s Health Care Spending Account, which allows you to set aside part of your salary before taxes to pay for health-related expenses or visit www.flexspend.ny.gov for more information.

Don’t use the Empire Plan Prescription Drug Program for drugs related to a workers’ compensation injury. These claims should be covered in full by workers’ compensation.

For more information 

Additional online resources are available on the Empire Plan’s CVS Caremark website. Visit www.empireplanrxprogram.com and select the CVS Caremark link or call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and press 4 for the Prescription Drug Program.

It is important to address the ever-changing health care needs of CSEA members during these continued unprecedented times.

CSEA’s Joint Committee on Health Benefits has worked with New York State to extend the covered-in-full Empire Plan Telemedicine Program through Empire Blue Cross’ partnership with LiveHealth Online through Dec. 31, 2022.

Empire Plan enrollees will continue to have access to covered-in-full telemedicine services from board-certified doctors and licensed mental health specialists. Services are accessed by using a smartphone, tablet or personal computer. Spanish speaking providers are also available.

The LiveHealth Online Telemedicine Program is very convenient for common health concerns like colds, flu, fevers, rashes, infections and allergies. Telemedicine allows you to see and talk to the LiveHealth Online doctor through your electronic device, while you remain in the comfort of your home or college dorm for dependents away at college (no need to travel to the doctor’s office or sit in the waiting room).

Maintaining our mental health as well as physical health is of great importance. The additional stress experienced by many people over the past two years has amplified the need for increased access to mental health services. LiveHealth Online’s Telemedicine Program for the Empire Plan enrollees and dependents is an enhanced telemedicine program as it also covers mental health visits (covered-in-full) with certified mental health providers.

To get started, visit www.empireblue.com/nys and select the link to LiveHealth Online to begin the registration process. When registering, or logging in if already registered, be sure to enter your Empire Plan identification number and name exactly as they appear on your identification card (this will help ensure treatment is received free of charge).

If you need assistance with the registration process or have questions, call LiveHealth Online at 1-888-548-3432. LiveHealth Online has representatives available 24 hours a day, seven days a week to assist you.

The Empire Plan annually evaluates the network of Infertility Centers of Excellence. The following Infertility Centers will no longer be designated as an Empire Plan Center of Excellence, effective Feb. 1, 2022:

• Boston IVF (Albany and Syracuse locations)
• Infertility & IVF Associates of Western New York (Snyder)
• Neway Fertility (New York City)

Although these providers of service will no longer be considered a Center of Excellence, they will remain as participating providers under the Empire Plan. Enrollees will be advised of the program change directly from the Infertility Center. Enrollees currently in a cycle will be able to finish that current cycle under COE benefits.

Questions regarding these changes should be directed to United HealthCare at 1-877-769-7447 and choose option 1 for Medical/Surgical Program.

“Summary of Benefits and Coverage” (SBC) is a simple, standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). All insurance plans are obligated to produce a summary of benefits based on a uniform template which is customized to reflect your plan’s unique terms.

Some words on the “Summary of Benefits and Coverage” appear in bold and underlined. These terms are defined in the Uniform Glossary, which is a non-customized companion document to the SBC. The definitions are intended to help improve consumer understanding and do not necessarily reflect your plan’s definition of the same term.

The SBC is simply intended to help consumers understand coverage under any plan and will not provide a full scope under your NYSHIP coverage. It should not be construed as a complete description of your NYSHIP plan. It is important to refer to your specific plan material for the customized definition used by your plan.

There are four major sections to the “Summary of Benefits and Coverage.” These examples are a standard set of services that a patient may seek. It is unlikely that you will pay the costs of these illustrated scenarios. They are strictly a set of standard services intended to help you compare your overall coverage.

• Important Questions
• Common Medical Events
• Excluded Services and Other Covered Services
• Coverage Examples, which could include having a baby, managing Type 2 diabetes or a simple fracture.

Should you need a copy of the Summary of Benefits and Coverage, Empire Plan enrollees can call 1-877-7-NYSHIP (1877-769-7447) and select the Medical/Surgical Program. NYSHIP HMO enrollees should contact your HMO directly.

 If you’re a state employee, you may meet the qualifications and carry NYSHIP health insurance. 

If you or your dependents have questions regarding a specific medical benefit/claim, or if you are trying to locate a participating provider, you should contact the health plan directly. 

The Empire Plan can be reached toll free at 1-877-7-NYSHIP (1-877-769-7447). Choose the appropriate program from the prompts. Health Maintenance Organization (HMO) enrollees should contact their HMO directly. The HMO’s telephone number will be on the back of the insurance card.

The General Information Book for NY Active Employees includes information regarding NYSHIP eligibility rules, enrollment options, requirements, and costs. A copy is mailed to all enrollees and can also be found on Civil Service’s NYSHIP online website at https://tinyurl.com/NYSHIP-Info.

It is recommended that you keep the General Information Book with your health insurance materials for reference.

The agency health benefits administrator (HBA) or the New York State Business Services Center performs various tasks. For health insurance, the HBA serves as the employee’s contact for health insurance information, determining you or a dependent’s eligibility and providing necessary paperwork for health insurance enrollment. 

Please note that the enrollee is responsible for notifying the HBA/Business Services Center of any changes that may affect your NYSHIP coverage. Civil Service sends reminders to NYSHIP enrollees, with covered dependents, reinforcing the enrollee’s responsibility to keep their NYSHIP enrollment record up to date and to provide timely notification to their HBA/Business Services Center when dependent(s) no longer meet eligibility requirements.

Below are examples of health insurance updates an enrollee should provide to their HBA or the New York State Business Services Center:

Change in your name, mailing address, home address or phone number

Seeking to change your coverage type (individual/family)

Seeking to add/delete an eligible dependent.

A covered dependent loses eligibility.

You get divorced (a copy of the divorce decree must be submitted).

Employment status changes and/or removal from the payroll.

You are planning to retire.

As noted above, questions about plan benefits should be addressed directly with your plan. The CSEA Joint Committee on Health Benefits can be contacted at 1-800-286-5242.

Select preventive vaccines are covered without co-payment when administered at a pharmacy that participates in the CVS Caremark national vaccine network. Vaccines available at a pharmacy are:

• COVID-19
• Influenza (flu)
• Pneumococcal (pneumonia)
• Meningococcal (meningitis)
• Herpes zoster (shingles) (no cost to those 50 years and older)

The Empire Plan has recently expanded coverage for non-seasonal vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Added vaccines now covered through pharmacy include:

Effective Dec. 10, 2021:

• Tetanus, Diptheria, Pertussis and DTap

Effective Jan 30, 2022:

• Hepatitis A and Hepatitis B
• Measles, Mumps, Rubella
• Varicella
• Human Papillomavirus (HPV)

To find out if a pharmacy participates in the CVS Caremark national vaccine network, visit empireplanrxprogram.com and select CVS Caremark, then select ‘Find a Local Pharmacy.’ Be sure to select ‘Vaccine network’ under Advanced Search. Call the pharmacy in advance to verify availability of the vaccine.

If you have questions about this expanded coverage or need help locating a pharmacy, call the Empire Plan at 1-877-769-7447 and press or say 4 to reach the Prescription Drug Program.

The Empire Plan’s “Reporting On” publication is issued periodically by New York State Civil Service to Empire Plan enrollees and their enrolled Empire Plan dependents, COBRA enrollees with Empire Plan benefits and young adult option enrollees.

Various series of the publication feature information crucial to understanding your Empire Plan benefits on topics such as: 

Centers of Excellence (February 2022-online) describes how the Empire Plan’s Centers of Excellence Programs for Cancer, Transplants and Infertility can help Empire Plan enrollees facing medical crises. 

Prescription Drugs (February 2021) discusses specific information on co-payment levels, mandatory generic substitution, the Flexible Formulary Drug List, Specialty Pharmacy Program and Drug Utilization Review under the plan.

Network Benefits (October 2020) discusses the benefits available to Empire Plan enrollees who use participating and network providers for medical/surgical, hospital, mental health and substance use services.

Home Care Advocacy Program (January 2021) explains how HCAP under the Empire Plan provides in-home services and supplies when prescribed by your doctor.

Diabetes (April 2021) discusses symptoms, treatment and complications associated with type 1 and type 2 diabetes, as well as benefits available through HCAP and Empire Plan’s Diabetes Management Program.

Asthma (March 2021) discusses the causes and symptoms of asthma, how to avoid triggers, the plan’s Asthma Management Program and HCAP.

Prenatal Care (April 2021) explains the components of good prenatal care, including pregnancy planning, nutrition, postpartum depression and the Empire Plan’s Future Moms Program.

Smoking Cessation (May 2021) discusses the addictive power of nicotine, conditions and diseases caused by smoking, quitting strategies and information on the smoking cessation treatments covered by the Empire Plan.

Mental Health & Substance Use (July 2021) If you are experiencing mental health or substance use issues, The Empire Plan Mental Health and Substance Use (MHSU) Program can help you receive the treatment and care you need. Receiving the appropriate treatment from a network provider or facility can help you get on the right path toward your recovery.

These Publications are available on NYSHIP Online Choose your group (Active State, then CSEA and Empire Plan. Choose “Using Your Benefits,” and then publications (Reporting On). 

Please note that the site uses cookies. You must enable cookies so that you will only need to access this page and select your group once. The site will remember your group for future visits. You will have the option of changing your group at any time after the initial log on.