Empire Plan benefit changes: What’s new in 2015? Here are some updates on recent changes to the Empire Plan as a result of negotiations or legislative changes. The information in this article is intended for New York state active employees. Please watch your mail for The Empire Plan Report At a Glance, which describes these programs in further detail. Vaccine benefit in network pharmacies Effective Oct. 1, 2014, Empire Plan-primary enrollees can receive certain preventive vaccines when administered at a pharmacy that participates in the CVS/Caremark national vaccine network. Vaccines available in a pharmacy are: Influenza (flu), Pneumococcal (pneumonia), Meningococcal (meningitis), and Herpes Zoster (shingles). The Herpes Zoster vaccine requires a prescription. To find out if a pharmacy participates in the CVS/ Caremark national vaccine network, call the Prescription Drug Program at 1-877-769- 7447. Only certain pharmacies are part of the CVS/Caremark national vaccine network. Patient Protection and Affordable Care Act (PPACA) provider non-discrimination As part of new Patient Protection and Affordable Care Act provisions, a health insurance plan may not discriminate against any health plan provider acting within the scope of that provider’s license or certification under applicable state law. If the Empire Plan covers a medical service, the plan Medical exception process for excluded drugs Effective September 2014, the Empire Plan implemented a medical exception process for non-formulary excluded from coverage. Your physician can submit a medical necessity exception request to CVS/Caremark if certain requirements are met. Autism coverage Effective Jan. 1, 2015, there is no annual maximum for applied behavior analysis (ABA) services for the treatment of autism spectrum disorders. The prior cap of 680 hours of service each plan year no longer applies. April 30 is deadline for 2014 Empire Plan claims Empire Plan enrollees have until April 30, 2015 (120 days after the end of the calendar year) to submit medical expenses that were incurred during the 2014 plan year to one of the following: United HealthCare Service Corp. P.O. Box 1600 Kingston, N.Y. 12402-1600 For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services. Empire Blue Cross and Blue Shield NYS Service Center (Code YLS) P.O. Box 1407 – Church Street Station New York, N.Y. 10008-1407 For Empire Plan and non-network inpatient or outpatient hospital services. Value Options P.O. Box 1800 Latham, N.Y. 12110 For non-network mental health and substance abuse services. drugs that are The Empire Plan Prescription Drug Program c/o CVS Caremark P.O. Box 52136 Phoenix, AZ 85072-2136 For prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card. Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to get claim forms. As a reminder, when using the Empire Plan’s toll-free telephone must cover it by any provider licensed to render the covered service (subject to network/ non-network out-of-pocket cost sharing). Please contact the appropriate program administrator for questions regarding coverage and out-of-pocket cost sharing requirements under this provision. Nutritionists and registered dieticians Nutritionists and registered dieticians are now covered as participating providers under the Empire Plan’s Medical/Surgical Program (United HealthCare). Refer to the Medical/ Surgical Program directory or call the Empire Plan’s Medical/Surgical Program at 1-877-769-7447. number, please pay extra attention to the choices offered by the automated system. Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information. If you have a non-network claim submission, complete the requested subscriber information on the claim form, include the original billing or receipt, if requested, and sign the claim form. 16 The Work Force March 2015
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