Page 16 - Work_Force_March_2018

State allows pharmacies to give kids flu shots
Due to widespread cases of
the flu across the state, Gov. Andrew Cuomo signed an executive order allowing certified licensed pharmacists to begin administering the influenza vaccine to
children ages 2 to 18, to
increase access and
convenience to those
seeking the vaccine.
The Empire Plan
has extended its
coverage of preventive
vaccines to include
the influenza vaccine
administered at network
retail pharmacies for
children. Parents and guardians
with children between the ages
of 6 months to 24 months are still encouraged to see their primary care provider for the vaccine.
The Empire Plan provides
select preventive vaccines without co-payment when administered at a pharmacy that participates in the CVS Caremark national vaccine network.
Vaccines available at a pharmacy include Influenza
(flu), Pneumococcal (pneumonia),
Meningococcal (meningitis), and Herpes zoster (shingles)* (*herpes zoster vaccine
requires a prescription and is only covered
with no co-payment for individuals age 60 and older.
The immunization is covered for enrollees age 55 through 59, subject to a $5 co-payment at a national vaccine network).
To find out if a pharmacy participates in the CVS Caremark
national vaccine network, call
the Prescription Drug Program (1-877-769-7447) or visit empireplanrxprogram.com and select ‘CVS Caremark,’ then ‘Find a Local Pharmacy.’ Be sure to select Vaccine Network under Advanced Search. Only certain pharmacies are
part of the CVS Caremark national vaccine network. Call the pharmacy in advance to verify availability of the vaccine.
If you are enrolled in a NYSHIP HMO, contact your plan directly to confirm vaccination access and coverage.
Reproductive Specialists of New York rejoins Enetwork
ffective Nov. 11, 2017,
Reproductive Specialists of New York, located in Mineola, rejoined the Empire Plan network of Center of Excellence facilities for infertility.
Paid-in-full benefits are available for Empire Plan enrollees and their enrolled dependents, subject to the lifetime maximum of $50,000 per covered person, when they choose a Center of Excellence for Infertility for qualified procedures. Prior authorization is required.
For more information, including an updated list of COE locations, please see NYSHIP’s publication, Reporting on Center of Excellence Programs at http:// tiny.cc/COE-2017.
Empire Plan claims deadlines for calendar year 2017
Empire Plan enrollees have until April 30, 2018, 120 days after
the end of the calendar year, to submit medical expenses which were incurred during the 2017 plan year to:
UnitedHealthcare Service Corp. P.O. Box 1600
Kingston, NY 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 BlueCross/BlueShield NYS Service Center
P.O. Box 1407 — Church Street Station
New York, NY 10008-1407
For Empire Plan and non-network Inpatient or Outpatient hospital services.
Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, NY 11802
For non-network mental health and substance abuse services.
CVS Caremark
P.O. Box 6590
Lee’s Summit, MO 64064-6590
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 obtain claim forms. As a reminder, when using the Empire Plan’s toll-free telephone 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, make sure you complete the requested subscriber information on the claim form, include the original billing
or receipt (if requested), and don’t forget to sign the claim form.
16 The Work Force
March 2018