Page 17 - Work Force June 2021

Attention Empire Plan Members:
Boost Your Mental Health
Before the pandemic, access to mental health and substance use care was already a concern in the United States.
As the COVID-19 pandemic continues to drag on, anxiety or depressive disorders have increased and people have reported
negative impacts on their
mental health and well-
being, such as difficulty
sleeping or eating and/
or increased alcohol or
substance use.
To ensure Empire
Plan enrollees and their
dependents can receive the
mental health and substance
use care they need, the Clinical Referral Line, administered by Beacon Health Options, provides enrollees and covered dependents with connection to a licensed clinician who will assist in finding a participating provider to meet your needs.
The Empire Plan’s Clinical Referral Line is available 24 hours a day, every day of the year. You can reach the Clinical Referral Line by calling the Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for Beacon Health Options, the Mental Health and
Substance Use Program.
Empire Plan members and
their enrolled dependents have guaranteed access to in-network benefits
when you call and utilize the Clinical Referral
Line to obtain access to highly trained, specialized
clinicians in the mental health and substance use
treatment fields.
If you are enrolled in a NYSHIP HMO,
please contact your HMO (by dialing the number on back of your health insurance card) for information related to mental health and substance use services.
WE CAN HELP YOU GET THE MENTAL HEALTH OR SUBSTANCE USE CARE THAT YOU NEED
Empire Plan enrollees and covered dependents who are in need of Mental Health or Substance Use treatment can call Beacon Health Options’ Clinical Referral Line for assistance with finding a network provider and arranging care. You have guaranteed access to in- network benefits when you call the Clinical Referral Line.
The Clinical Referral Line is staffed with highly trained and specialized clinicians in the mental health and substance use treatment fields and
are there to help you find the best care. The clinicians may also help you make an appointment with a quality provider. In an emergency, they can help you decide where to start receiving care.
If you are enrolled in a NYSHIP HMO, please contact your HMO for information related to receiving Mental Health and Substance Use services.
You can reach the Clinical Referral Line by calling the Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for the Mental Health and Substance Use
Program, then selecting option 3 from the Mental Health and Substance Use Program menu.
Department of Civil Service • Employee Benefits Division • www.cs.ny.gov
PUnderstanding Empire Plan benefits: preventive, diagnostic and routine care
reventive, diagnostic, and routine recommendations by the U.S. screenings, such as colonoscopies worse and to help manage symptoms. care benefits are common types Preventive Services Task Force and mammograms. Common illnesses that often
of health care you may receive under The Empire Plan.
Understanding the difference between them is not always easy, but it is important. Coverage and out-of- pocket expenses can vary, depending on which type of service you receive.
Be sure to discuss with your provider why a test or service is being ordered. The same test or service can be considered preventive, diagnostic, or routine (depending
on the description of why it is being performed). As a result, out-of-pocket costs paid by the enrollee may change, based on why the service is requested.
Preventive care benefits
and services covered by The Empire Plan follow numerous guidelines and standards, including
(USPSTF), the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services, and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as
well as requirements of the Patient Protection and Affordable Care Act (PPACA).
The goal of preventive care
is to detect potentially serious health conditions before symptoms develop and obtain early treatment. Preventive care can include
annual exams, screenings, and immunizations. Common examples of adult preventive care include annual wellness visits, cholesterol, high blood pressure and diabetes screenings as well as cancer
Common examples of yearly pediatric preventive care (well- child) can include growth and body mass measurements, developmental screenings, behavioral assessments, and immunizations. Many preventive services are covered in full when using an Empire Plan participating provider.
Diagnostic care helps diagnose risk factors or treat symptoms that are already present. Diagnostic care would involve following up with your provider to treat or monitor issues. When a preventive visit becomes diagnostic, a co-payment would apply when using a participating provider.
Routine care describes care that occurs on a regular basis, but is not preventive. Routine care is used to prevent a condition from becoming
require routine care include asthma, hypertension, and diabetes. Because routine care is not preventive, a co-payment would apply when using a participating provider.
Please review the 2021 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care. You should review your Explanation of Benefits Statement (EOB) regularly. The EOB can provide a better understanding of how the services are billed, what the Plan pays and your out-of-pocket costs.
If you have specific coverage questions or need assistance finding a participating provider, call the Empire Plan 1-877-7-NYSHIP (1-877- 769-7447).
June 2021
The Work Force 17
The Clinical Referral Line is available 24 hours a day, every day
of the year.
1-877-7-NYSHIP OPTION 3