Page 17 - Work Force July-August 2024

Empire Plan network benefits and provider directory
The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families.
The Empire Plan’s network is composed of hospitals, medical/ surgical providers (including primary care, specialists, surgery, chiropractic and physical therapy), Home Care Advocacy Program (HCAP) for covered home care services, durable medical equipment/supplies (including diabetic and ostomy supplies), mental health/substance use providers and participating pharmacies.
Empire Plan enrollees and dependents have access to
the United Healthcare 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 throughout the United States. Enrollees have the
freedom to choose any participating provider without a referral. Always check if the provider participates in the United Healthcare network for The Empire Plan before receiving services.
Enrollees can check whether a provider participates in the Empire Plan by visiting
NYSHIP online at www.cs.ny.gov/ employee-benefits.
Once there, choose your group and plan, and then select “Find a Provider.”
Although it is
encouraged to use the
online provider search,
The Empire Plan has started
the annual mailing of postcards
to request a printed Empire Plan Participating Provider Directory. The postcards are broken into separate mailings, covering the geographic areas in which enrollees live. Postcards will soon be mailed to enrollees. Once enrollees return
the postcard requesting a printed directory, distribution will begin in July.
The Empire Plan has guaranteed access and/or paid-in-full benefits to certain pre-certified services arranged by the plan. To receive
paid-in-full benefits for network Home Care Advocacy
Program (HCAP) services, call The Empire Plan
to pre-certify and arrange for covered
services provided in the home (skilled
nursing services, home infusion, covered
durable medical equipment/supplies, diabetic supplies or 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/supplies
with an HCAP-approved provider. For diabetic supplies, except
insulin pumps, call The Empire Plan Diabetic Supplies Pharmacy directly at 1-800-321-0591. For ostomy supplies, call Byram Healthcare Centers directly at 1-800-354-4054.
If your physician feels there
are no network providers with the appropriate level of training and experience to treat a condition accessible to you, within a 30-mile radius or 30-minute travel time from your home, you may request an out- of-network referral from the Empire Plan. Out-of-network referrals are available nationwide; however, you must call The Empire Plan and get approval before seeking services.
Choosing to use Empire Plan network providers helps you maximize benefits and minimize your out-of-pocket health care costs. Using network providers also helps keep Empire Plan overall costs down, which also helps to keep all plan participant’s health insurance premiums lower.
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 he or she goes, you may want to add just one more item — make sure their vaccinations are up-to- date.
Your child received all their vaccinations when younger, so
they are set for life, right? Not so. Not only do many vaccines given
to children wear off over time, but many vaccines that adults need
may not have been given as a child. HPV and meningitis are examples of vaccines that may be recommended.
College students are at higher risk for certain infections. Students living near others, such as in a dorm or a shared apartment, are at higher risk of contracting meningitis.
The American College Health Association (ACHA) publishes 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.”
The ACHA Vaccine-Preventable Diseases Advisory Committee updates this document yearly
in accordance with changing public health recommendations. These guidelines follow Advisory Committee on Immunization Practices (ACIP) recommendations published by the U.S. Centers for Disease Control and Prevention (CDC).
Additional information on ACHA guidelines can be found online at:
https://www.acha.org/ documents/resources/ guidelines/ACHA_Immunization_ Recommendations_May2024.pdf
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 1-877-7NYSHIP (1-877-769-7447) option 1.
July-August 2024
The Work Force 17