Page 16 - Work Force July-August 2023

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 consists of four main parts: Hospital, Medical/Surgical, Mental Health/Substance Use and the Prescription Drug Program.
The Empire Plan’s network is composed 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 is
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.
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, call the
Empire Plan Diabetic Supplies
Pharmacy toll free at 1-800-321-0591 (insulin
pumps 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.
Empire Plan complies with various state and federal mandates regarding mandated access to plan providers.
Out-of-network referral mandate
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 go, you may want to add just one more item — make sure their vaccinations are up-to-date.
Your child received all of their vaccinations when they were young, 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 to them when they were children. HPV and meningitis are examples of vaccines that may be recommended.
College students are at higher risk for certain infections. 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 (also known as herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.”
Additional information on ACHA
guidelines can be found online at: https://tinyurl.com/ACHA- guidelines.
Questions regarding vaccination coverage should be addressed
through your health plan (number on the back of your insurance card). Empire Plan enrollees can contact United Healthcare at 1-877-NYSHIP (1-877-769-7447), option 1.
16 The Work Force
July-August 2023