Empire Plan at A Glance for 2020

Empire Plan enrollees of New York State represented by CSEA, as well as their enrolled dependents, have recently been sent the January 2020 At a Glance from New York State guide.
At A Glance is a guide that provides a brief description of Empire Plan benefits and references significant changes enrollees may see in 2020.
The 2020 Empire Plan Advanced Flexible Formulary is also included in the mailing with the Empire at a Glance. Although not an all-inclusive list, the Advanced Flexible Formulary can be used as a resource to assist enrollees and health care providers determine covered drugs within select therapeutic categories. Additionally, the formulary lists therapeutic alternatives for any medication that may be excluded.

What is New for the Empire Plan in 2020:
• Empire Plan enrollees are eligible for hospice care if the doctor and hospice medical director certify that the covered patient is terminally ill and likely has less than 12 months to live (this benefit is retroactive to July 1, 2019).
• Enrollees age 9 through 45 are covered for the human papillomavirus (HPV)-9 immunization at no cost when the vaccine is received from a participating provider. Other forms of HPV vaccines continue to be covered through age 26 (this benefit is retroactive to Oct. 1, 2019).
• Effective Jan. 1, 2020, Empire Plan infertility benefits will cover enrollees for a minimum of three IVF cycles per lifetime. Additionally, standard fertility preservation services are covered when a medical treatment, such as treatment for cancer (radiation therapy or chemotherapy), will directly or indirectly lead to infertility.
• Effective Jan. 1, 2020, HIV-prevention medication for Pre-Exposure Prophylaxis (PrEP) will be covered with no co-payment, deductible or any other out-of-pocket costs for enrollees who do not have HIV but are at high risk of acquiring it. Screening for HIV continues to be covered with no out-of-pocket costs when using a network provider.
• Effective Jan. 1, 2020, modified solid food products (MSFPs) are no longer subject to a $2,500 total maximum reimbursement per covered person, per year. Modified solid food products are covered when prescribed by a physician or provider. This benefit is not subject to deductible or coinsurance.

Please see the January 2020 Empire Plan At a Glance for more detailed information regarding these benefits or outreach to the Empire Plan at 1-877-769-7447.