Page 17 - Work Force June 2023

Empire Plan negotiated health insurance changes effffective July 1, 2023
As a result of the ratified contract between CSEA and New York state, the negotiated health benefit changes become effective for CSEA-represented active state employees (and Unified Court System employees) effective
July 1, 2023.
CSEA active state members will have the opportunity to change their NYSHIP option for the remainder of 2023 during the upcoming Special Option Transfer Period (June 1 through June 30, 2023). During this time, you may choose to change your plan option between The Empire Plan and a NYSHIP-approved health maintenance organization (HMO) serving the area where you live or work.
If you decide to change your health insurance option during this Special Option Transfer Period, please see the NYSHIP July 1, 2023 rate change information.
The May 2023 “Empire Plan Special Report” explains the new benefits and the Special Option Transfer Period. Additional information about the Special Option Transfer Period is also contained
in the NYSHIP July 1, 2023, “Rate Changes Flyer.” Both publications were mailed to NYSHIP enrollee homes in May.
Empire Plan Live Health Online Telemedicine Program Continues as a Benefit:
• The Empire Plan voluntary telemedicine program, through LiveHealth Online,
which provides medical and mental health/substance use services, became a PERMANENT offering to enrollees and dependents
Empire Plan Site of Care
• Infusions requested in a hospital outpatient (OP) setting will be reviewed to determine appropriate site of care (Hospital OP, Provider OP office, HCAP home)
• •
Current In-Network Maximum out-of-pocket limit determined by the U.S. Patient Protection and Affordable Care Act. Effective July 1, 2023, the maximum out-of-pocket
limit for covered in-network services will reduce
• to $4,000 for individual coverage (from $9,100)
• to $8,000 for family coverage (from $18,200)
Mastectomy Bras will be covered in full, not subject to deductible and/or coinsurance.
Empire Plan Acupuncture Services
• Network acupuncture services continue to be unlimited and based on medical necessity.
• Effective July 1, 2023, out- of-network acupuncture will be limited to 20 visits per calendar year.
• Empire Plan carriers can be contacted directly for assistance in finding a participating provider.
Questions regarding these changes can be directed to the Empire Plan at 1-877-769-7447 (press or say 1 for Medical/Surgical Program) or call the CSEA Health Benefits Department at 1-800-286- 5242.
• $0 copayment (No
employee out-of-pocket
cost) •
When the program becomes effective, copayments for medical and prescription drugs will be waived for enrollees receiving infusions subject to site of care
in alternate sites other
than hospital outpatient department.
Hemophilia and oncology drugs are not included in the program (excluded from Site of Care review)
July 1, 2023 – Site of Care Redirection Program enters Phase One – for Remicade (and equivalent)
Empire Plan Massage Therapy
• Effective July 1, 2023, out- of-network massage therapy will be limited to 20 visits per calendar year.
Empire Plan Out-of-Network (Non-Participating Provider) Reimbursement
• Access LiveHealth Online: www.
empireblue.com/nys
Empire Plan Network Copayment Stacking Ends effective July 1, 2023:
• When an Empire Plan participating provider (primary care/specialist)
is used, the CSEA enrollee/ dependent will be responsible for a SINGLE $25 copayment for all services performed/ billed for the same enrollee, by the same provider/location on the same date of service.
Empire Plan Reduced In-Network Maximum Out-of-Pocket Limits
• •
•
Effective July 1, 2023, The Empire Plan carriers will reimburse out-of-network claims using a percentage of the Medicare Physician Fee Schedule (based on CPT codes and adjusted for geographic area) versus using FAIR Health rates (data determined using provider billed charges). Empire Plan participants continue to have access
to more than 1.2 million anesthesiologists, mental health specialists, physical therapists and more.
Empire Plan Mastectomy Brassieres • • Effective July 1, 2023,
June 2023
The Work Force 17