Obtaining Access to the Empire Plan Participating Provider Directory

The Empire Plan Participating Provider Program offers a network of over 275,000 physicians, laboratories and other providers located throughout New York and in many other states.

Each year the Empire Plan sends postcards to all Empire Plan enrollees across the United States and Puerto Rico so that the enrollee may elect to have a printed directory for The Empire Plan Medical/Surgical Program mailed to them.

You can obtain a printed directory by returning the participating provider request postcard you receive in the mail.  If you would like to receive a directory from a different state or region other than your home zip code, simply write the name of the version you would like on the line provided on the postcard.  You can also get a copy of the directory by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and using option 1 for the Medical Program.  A directory will be mailed within 4-6 weeks of your request.  In addition, customer service representatives can provide a personalized directory.

To find an Empire Plan participating provider online, go to www.cs.ny.gov/employee-benefits. If prompted, choose your group and plan, and select Find a Provider.  You can choose from one of the following programs:  Hospital, Medical/Surgical, Mental Health and Substance Abuse or Prescription Drug.

Both Enrollees and the Plan save when participating providers are used.  You pay only the applicable copayment for most covered services.

    Enrolled in the Empire Plan? Make Sure Student’s Shots Are Up To Date

    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 he or she goes, you may want to add just one more item – make sure their shots are up to date.

    Growing research has found that some groups of college students may be at a higher risk of contracting bacterial meningitis, and that risk can be minimized by means of a quick injection.

    As Empire Plan enrollees and their eligible dependents gear up for another fall semester, the CSEA Health Benefits Department would like to remind those in charge of “PLANNING” that the Empire Plans’ vaccination and immunization benefit was enhanced to include the meningitis vaccine for dependent children.

    Enrollees who have questions about whether their child has received the meningitis vaccination should contact their doctor’s office.

    If you would like to learn more about the Empire Plans’ vaccination and immunization benefit, including the meningitis vaccine, please contact United HealthCare, the Empire Plan’s medical/surgical provider, at 1-877-7NYSHIP (1-877-769-7447).

     

      South Nassau Communities Hospital and Empire BlueCross BlueShield Reach Agreement

      South Nassau Communities Hospital and Empire BlueCross BlueShield (hospital administrator for the Empire Plan) announced that they have reached a contract agreement in which South Nassau Communities Hospital will continue as a participating hospital under the Empire Plan.

      This is great news considering the difficult negotiations leading up to the new agreement that will run until 2020. There will be no disruption of in-network service for members.

       

        The Empire Plan Covers Shingrix Vaccine for Prevention of Shingles

        The Centers for Disease Control (CDC) recently approved Shingrix as a recommended vaccine for (Shingles) herpes zoster.  The Shingrix vaccine has also been recommended by the Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster and related complications for those age 50 and older and is therefore required to be covered as a preventive service for this age group.

         

        Effective April 1, 2018, the Shingrix vaccine will be covered by both the Empire Plan Medical/Surgical Program and by the Prescription Drug Program through the CVS Caremark Vaccine Network. There will be no enrollee cost share for the Shingrix vaccine for enrollees age 50 and older when administered by an in-network provider.  Any Shingrix vaccine that was administered prior to April 1, 2018 will be a covered service but will have enrollee cost share applied.

         

        Please be aware that the Shingrix vaccine requires two shots to be administered and both Shingrix shots will be covered as described above.

          Assignment of Benefits for Non-Network MHSA Services

          Beacon Health Options (Beacon) is the administrator for The Empire Plan’s Mental Health and Substance Abuse Program (MHSA).  Until recently, the Empire Plan prohibited claim payments for non-network MHSA from being sent directly to a provider.  All non-network claim payments were paid directly to the member and the member was required to send payment to the provider of service.  This resulted in numerous problems for enrollees and providers of service.  The NYS Department of Civil Service recently reviewed and revised this policy and will allow assignment of benefits to non-network MHSA claims processed on or after March 1, 2018.  Beacon Health sent a letter explaining this change to enrollees who obtained services under the non-network portion of the MHSA Program.

           

          If you have already paid a non-network provider for a date of service and have not submitted a claim form to Beacon yet, do not indicate an assignment of benefits on the claim form. This will result in the provider being paid twice for the same date of service. If this does occur it will be your responsibility to recoup money owed to you from the non-network provider.

           

          By receiving MHSA Program services from a non-network provider your out-of-pocket costs are much higher.  If you have any questions or would like to discuss transitioning to a network provider, please contact Beacon’s Customer Service at 1-877-7-NYSHIP (877-769-7447), Option 3 between 8 AM and 8 PM (EST).

           

           

            New Medicare Cards Coming Soon

            To help protect your identity, Medicare will begin mailing new cards to everyone who receives Medicare benefits.  Medicare and Medicaid Services (CMS) has been directed to remove Social Security Numbers (SSN) from all Medicare cards by April 2019.  A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on new Medicare cards.  Beginning in April 2018, CMS will start mailing the replacement Medicare cards with the MBI to existing Medicare enrollees.

             

            Each MBI is a unique, randomly-generated, 11-character number made up only of numbers and uppercase letters.  The characters are “non-intelligent,” which means they don’t have any hidden or special meaning.  The new MBI will help protect private health care and financial information and will be coordinated with the Social Security administration and health care providers.  The Department of Civil Service, administrator of the New York State Health Insurance Program, is looking at any impact the new MBI numbers will have for NYSHIP enrollees and will communicate any new information in future periodicals.

             

            Medicare enrollees may start using their new Medicare cards and MBIs as soon as they get them.

             

            For additional information call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.  You can also visit the CMS website for additional information on the distribution of new cards; https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html

             

             

              Update to Free Identity Protection Services for Empire Plan Enrollees

              As noted in previous articles in the Workforce, Anthem BlueCross BlueShield, the parent company of The Empire Plan Hospital Program administrator, offers free identity protection services to all current Empire Plan enrollees through AllClear ID.    For more information, call 1-855-227-9830 or go to https://anthemcares.allclearid.com.

              The National Association of Insurance Commissioners (NAIC) has also asked Anthem to provide additional credit protection to minors under the age of 18 as of January 27, 2015 in the form of credit freezes.

              Credit Freeze for Minors

              Anthem has partnered with the three major credit bureaus (Equifax, Experian, and Transunion) and will cover the cost of a one-time freeze and one-time removal at each of these credit bureaus.

              Highlights:  The Program offers a one-time credit freeze and one-time credit freeze removal at each of the three major credit reporting bureaus for children affected by the cyber-attack to:

              • Parents or legal guardians of children under the age of 18 as of January 27, 2015 who are not yet 18 as of February 24, 2017
              • Minors who are now adults – children under 18 on January 27, 2015 who are 18 or older as of February 24, 2017

              Anthem will begin mailing letters to parents or legal guardians and adult children on February 24, 2017 and expects all letters to be mailed by the end of May.