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Empire Plan Summary of Benefits available online
Acupuncturists join Empire Plan network
The U.S. Patient Protection/ Affordable Care Act (PPACA) requires all insurance plans to make available a Summary
of Benefits and Coverage
(SBC) for benefits-
eligible employees, retirees and dependents.
Current Empire Plan
enrollees were mailed
a postcard discussing
the availability of the
2019 Summary of Benefits
and Coverage and Uniform Glossary online at www.cs.ny.gov/ employee-benefits/sbc.
Enrollees who do not have internet access may call 1-877-7-NYSHIP (1-877-769-7447) and
select the Medical/Surgical Program to request a copy.
The SBC is a simple and standardized multi-page comparison tool that
is intended to help consumers better
understand and
compare available
health insurance G options.
While this information may be
helpful, enrollees should also refer to other plan material, such as the Choices
booklet, the 2019 At a Glance and the rates and deadlines flyer for the most comprehensive coverage and benefit information.
ood news for Empire Plan
participants! In 2019, the Empire Plan participating provider network is being expanded to include licensed acupuncturists.
This is a new endeavor, so it will take time for the medical carrier to develop this network. The network will continue to expand throughout 2019. Visits to network providers are
subject to the applicable office visit co-payment.
To locate a network acupuncturist, enrollees can visit the online provider directory at www.empireplanproviders.com or call 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical/ Surgical Program.
Empire Plan claims deadlines for calendar year 2018
Empire
Plan
enrollees
have until
April 30,
2019 (120
days after
the end of
the calendar
year) in
which to
submit medical expenses which
were incurred during the 2018 plan year to:
United HealthCare Service Corp. P.O. Box 1600
Kingston, N.Y. 12402-1600 www.empireplanproviders.com/ claimform.htm
For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non- network physical therapy or chiropractic services.
Empire Blue Cross and Blue Shield NYS Service Center
P.O. Box 1407 – Church Street Station New York, N.Y. 10008-1407
For Empire Plan and non-network Inpatient or outpatient hospital services.
Beacon Health Options
P.O. Box 1850
Hicksville, N.Y. 11802
For non-network mental health and substance abuse services.
CVS Caremark
P.O. Box 6590
Lee’s Summit, M.O. 64064-6590 For prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.
Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769- 7447) with questions or to obtain
claim forms. As a reminder, when using the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system.
Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information. If you have a non-network claim submission, make sure you complete the requested subscriber information on the claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form.
February 2019
The Work Force 17