Page 17 - Work Force July-August 2022

Important reminders about Empire Plan network benefits
The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families. The Plan has four main parts: Hospital, Medical/Surgical, Mental Health/ Substance Use and the Prescription Drug Program.
The Empire Plan’s network is comprised of hospitals, medical/surgical providers, mental health/substance
use providers
— both inpatient
and outpatient as well as participating pharmacies.
Under the medical/surgical program, Empire Plan enrollees and dependents have access to United Healthcare’s national network of medical providers. The participating provider program network includes more than 1.2 million physicians, laboratories, and other providers
such as physical therapists, occupational therapists and chiropractors located throughout the United States. You have the freedom to choose any participating provider without a referral.
When using a participating provider, your out-of-pocket
expenses are lower — you
pay only your copayment(s)
if applicable, at the time of your visit. There is no
cost for many services through a participating
provider, including preventive services as required under the U.S.
Patient Protection and Affordable Care Act (PPACA).
The Empire Plan has guaranteed access to many different services (contact the Empire Plan when searching for a provider). You have guaranteed access to paid-in-full benefits through the Home Care Advocacy Program (HCAP) that covers home care/skilled nursing
services, durable medical equipment and certain medical supplies including diabetic and ostomy supplies.
As soon as your provider prescribes services covered
under HCAP, call the Empire Plan (press or say 1 for the Medical/ Surgical Program, then press or
say 3 for HCAP). The medical/ surgical program will preauthorize your services and/or equipment and supplies with an HCAP- approved provider. For diabetic supplies, except insulin pumps and Medijectors, call the Empire Plan Diabetic Supplies Pharmacy toll free at 1-800-321-0591 (insulin pumps and Medijectors must call HCAP). For ostomy supplies, call Byram Healthcare at 1-800-354-4054.
Always check if the provider participates in the Empire Plan before you receive services. Contact the Empire Plan directly at 1-877- 769-7447 with any benefit questions, to check a provider’s participation
status or to request a listing of participating providers.
Out-of-network referral mandate
Empire Plan complies with various state and federal mandates regarding mandated access to plan providers.
The Empire Plan must provide access to primary care and specialty providers if these services are
not available within a 30-mile
radius or 30-minute travel time
from your home address. This requirement applies to Empire
Plan primary enrollees residing within the United States. If you require access to a certain provider, contact the appropriate Empire Plan administrator at 1-877-769-7447.
Please refer to the Empire Plan Out-of-Network Reimbursement Disclosures for additional information regarding state and federal protections, such as surprise bills and information regarding out-of-network reimbursement and enrollee cost sharing requirements.
Dependent going to college? Make sure vaccinations 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 they leave, you may want
to add just one more item — make sure their vaccinations are up-to- date.
Your child received all of their vaccinations as a young child, so they are set for life, right? Not so. Not only do many vaccines given to children wear off over time, many vaccines that adults need may not have been given as a young child. HPV and meningitis vaccines are examples of vaccinations that may be recommended.
College students are at higher risk for certain infections. For example, students living in close proximity to others, such as in
a dorm or a shared apartment, are at higher risk of contracting meningitis.
The American College Health Association (ACHA) published specific guidance on immunization recommendations for college students.
“Immunizations offer safe
and effective protection from vaccine-preventable diseases and outbreaks. The United States is experiencing re-emergence of these diseases, in part due to factors such as un-immunized and under- immunized persons and global travel. The American College
Health Association (ACHA) strongly supports the use of vaccines
to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages
use of nonmedical exemptions to required vaccines.”
through your health plan (number on the back of your insurance card). Empire Plan enrollees can contact United Healthcare at 1-877-7NYSHIP (1-877-769-7447), option #1.
Additional information on ACHA guidelines can be found online at: https://tinyurl.com/ACHA-College- Immunization.
Questions regarding vaccination coverage should be addressed
July-August 2022 The Work Force 17