Page 17 - Work Force April 2024

Choose Empire Plan network providers
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, surgeons, anesthesiologists,
mental health
specialists,
physical therapists, acupuncturists and more types of providers.
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 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 “accept” your insurance doesn’t
mean they participate in the network. To get
the most out of your plan - and pay less, make sure to
participating network providers online by visiting NYSHIP Online at www.cs.ny.gov/employee-benefits and select Find a Provider or you can contact The Empire Plan at 1-877-7-NYSHIP and speak with the specific plan administrator.
Below is a listing of the administrators for The Empire Plan and the program they are responsible for overseeing.
United Healthcare oversees the medical/surgical services (such as office visits and surgery) as well as:
• The Home Care Advocacy Program (HCAP) for covered services and durable medical equipment/supplies, including 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.
Anthem Blue Cross oversees The Empire Plan’s Hospital Program and provides coverage at hospitals worldwide. Anthem Blue Cross also oversees the Empire Plan Center of Excellence Program for Transplants.
Carelon Behavioral Health
oversees The Empire Plan’s Mental Health and Substance Use Programs and provides a nationwide network for mental health and substance use treatment, including alcoholism, and the Center of Excellence Program for Substance Use Disorders.
CVS Caremark oversees The Empire Plan’s Prescription Drug Program and includes a nationwide network of participating pharmacies and 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)
confirm with providers ahead of time by asking, “Are you participating
and in-network with the specific carrier...United Healthcare, Anthem BlueCross or Carelon Behavioral Health...for The Empire Plan?”
You can search for Empire Plan
Keep your NYSHIP health insurance file up-to-date
If you meet the qualifications and carry NYSHIP health insurance, whether under The Empire Plan
or a NYSHIP HMO, the “General Information Book for NY Active Employees” includes important information regarding NYSHIP eligibility, enrollment options, how changes to employment impact health insurance and enrollee’s associated cost contributions.
A copy of the General Information Book is mailed to all enrollees and can also be found on the state Department of Civil Service’s NYSHIP Online website. It is recommended that you keep the General Information Book with important health insurance materials for
reference.
The agency health benefits
administrator (HBA) or the New York State Business Services Center performs various tasks to assist NYSHIP enrollees. The HBA serves as the employee’s contact for health insurance information and updates. The HBA communicates enrollee health insurance enrollments and updates to the state Department of Civil Service so enrollment files are updated timely.
Please note that it is the enrollee’s responsibility to notify the Agency HBA/Business Services Center of any changes that may affect your NYSHIP coverage. The state Department of Civil Service sends reminders to
NYSHIP enrollees reinforcing the importance of enrollees to keep their NYSHIP enrollment record up-to-date, to provide timely notification of address changes and advise if a dependent no longer meets NYSHIP eligibility requirements.
Here are examples of when enrollees should contact their agency HBA or NYS Business Services
Center to update health insurance information:
• Change in your name, mailing address, home address or phone number.
• Changes that result in your health insurance coverage type (individual/family).
• Seeking to add or 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 or leave state service.
To avoid delays, please ensure changes are notified in a timely manner. Questions about specific health insurance plan benefits should be addressed directly with your plan.
April 2024
The Work Force 17