Page 16 - Work Force February 2020

Empire Plan 2020 Guide published
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 guide from New York State.
The At A Glance guide 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 guide. Although not an all-inclusive list, the Advanced Flexible Formulary
can be used as a resource to assist enrollees and health care providers to determine covered drugs within select therapeutic categories. Additionally, the formulary lists therapeutic alternatives for any medication that may be excluded.
What’s 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 fewer than 12 months to live (this benefit is retroactive to July 1, 2019).
• Enrollees ages 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.
This guide briefly describes Empire Plan benefits. It is not a complete description and is subject to change. For a complete description of your benefits and responsibilities, refer to your Empire Plan Certificate and Certificate Amendments.
For information regarding your New York State Health Insurance Program (NYSHIP) eligibility or enrollment, contact your Health Benefits Administrator. If you have questions regarding specific benefits or claims, contact the appropriate Empire Plan administrator (see page 19).
AT A GLANCE | JANUARY 2020
CSEA | Civil Service Employees Association
For Employees of the State of New York represented by Civil Service Employees Association (CSEA) and for their enrolled Dependents; and for COBRA Enrollees and Young Adult Option Enrollees with their Empire Plan benefits.
New York State Department of Civil Service, Employee Benefits Division, Albany, NY 12239 www.cs.ny.gov/employee-benefits
16 The Work Force
February 2020
Please see the January 2020 Empire Plan At A Glance for more detailed information regarding these benefits or call the Empire Plan at 1-877-769-7447.
Empire Plan claims deadline approaches for calendar year 2019
Empire Plan enrollees have until April 30, 2020 (120 days after the end of the calendar year) to submit medical expenses incurred during the 2019 plan year.
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 appropriate claim form, include the original billing or receipt (if requested), sign and return the claim form.
Claim submission for Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services:
United HealthCare
P.O. Box 1600
Kingston, N.Y. 12402-1600
Claims submission fax: 845-336-7716 Online: https://nyrmo. optummessenger.com/public/ opensubmit
Claim submission for Empire Plan non-network inpatient or outpatient hospital services:
Empire Blue Cross
NYS Service Center
P.O. Box 1407, Church Street Station New York, NY 10008-1407
Claims submission fax: 888-367-9788 Online: www.empireblue.com/forms
Claim submission for Empire
Plan non-network mental health and substance abuse services:
Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, NY 11802
Claims submission fax: 855-378-8309 Online: www.achievesolutions.net/ empireplan
Claim submission for Empire Plan prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card use:
CVS Caremark
P.O. Box 52136 Phoenix, AZ 85072-2136
Please contact the Empire Plan
at 1-877-7NYSHIP (1-877-769-7447) with additional questions about claim submissions or to obtain claim forms.