Page 14 - Work Force March 2022

TExpanded Plan Information for Empire Plan Enrollees
he Empire Plan’s “Reporting On” the Flexible Formulary Drug List, Management Program. publication is issued periodically Specialty Pharmacy Program and • Asthma (March 2021) discusses
substance use issues, The Empire Plan Mental Health and Substance Use (MHSU) Program can help you receive the treatment and care you need. Receiving the appropriate treatment from a network provider or facility can help you get on the right path toward your recovery
These Publications are available on NYSHIP Online https://www.cs.ny. gov/employee-benefits Choose your group (Active State, then CSEA and Empire Plan. Choose “Using Your Benefits,” and then publications (Reporting On).
Please note that the site uses cookies. You must enable cookies so that you will only need to access this page and select your group once. The site will remember your group for future visits. You will have the option of changing your group at any time after the initial log on. https:// www.cs.ny.gov/employee-benefits/nyship/ shared/publications/reporting-on/index.cfm
by New York State Civil Service to Drug Utilization Review under the Empire Plan enrollees and their plan.
enrolled Empire Plan dependents, • Network Benefits (October 2020) COBRA enrollees with Empire Plan discusses the benefits available benefits and young adult option to Empire Plan enrollees who • enrollees. use participating and network
Various series of the publication providers for medical/surgical, feature information crucial to hospital, mental health and understanding your Empire Plan substance use services. benefits on topics such as: • Home Care Advocacy Program
• Centers of Excellence (February (January 2021) explains how
2022-online) describes how HCAP under the Empire Plan • the Empire Plan’s Centers of provides in-home services and Excellence Programs for Cancer, supplies when prescribed by your Transplants and Infertility can doctor.
help Empire Plan enrollees facing • Diabetes (April 2021) discusses
medical crises. symptoms, treatment and
• Prescription Drugs (February complications associated with
2021) discusses specific type 1 and type 2 diabetes, as • information on co-payment levels, well as benefits available through mandatory generic substitution, HCAP and Empire Plan’s Diabetes
Summary of Benefits and Coverage
the causes and symptoms of asthma, how to avoid triggers, the plan’s Asthma Management Program and HCAP.
Prenatal Care (April 2021)
explains the components of good prenatal care, including pregnancy planning, nutrition, postpartum depression and the Empire Plan’s Future Moms Program.
Smoking Cessation (May 2021)
discusses the addictive power of nicotine, conditions and diseases caused by smoking, quitting strategies and information on the smoking cessation treatments covered by the Empire Plan. Mental Health & Substance
Use (July 2021) If you are experiencing mental health or
Empire Plan 2021 claims deadline approaching
mpire Plan enrollees have until April Empire Blue Cross NYS Service Center 30, 2022 (120 days after the end of P.O. Box 1407, Church Street Station
the calendar year) to submit medical expenses incurred during the 2021 plan year.
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 appropriate claim form, include the original billing or receipt (if requested), sign and return the claim form.
Claim submission for Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services:
New York State Government Employees Health Insurance Program UnitedHealthcare
P.O. Box 1600
Kingston, N.Y. 12402-1600
OR FAX TO (845) 336-7716
Online submissions: https://nyrmo. optummessenger.com/public/ opensubmit
Claim submission for Empire Plan non-network inpatient or outpatient hospital services:
New York, N.Y. 10008-1407
Claims submission fax: 888-367-9788 Online Submissions: www.empireblue. com/forms/
Claim submission for Empire Plan non-network mental health and substance use services:
Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, N.Y. 11802
Claims submission fax: 855-378- 8309 Online submissions: www.achievesolutions.net/empireplan
Claim submission for Empire Plan prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card use:
CVS Caremark P.O. Box 52136
Phoenix, A.Z. 85072-2136
Online submissions: www.caremark. com. Choose ‘submit a claim’ under ‘plan and benefits.’
For any questions, call the Empire Plan toll free: 1-877-7-NYSHIP (1-877-769-7447).
The “Summary of Benefits
and Coverage” (SBC) is a simple, standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). All insurance
plans are obligated to
produce a summary
of benefits based on a uniform template which
is customized to reflect your plan’s unique terms.
Some words on
the “Summary of
Benefits and Coverage”
appear in bold and underlined. These terms are defined in the Uniform Glossary, which is a non- customized companion document to the SBC. The definitions
are intended to help improve consumer understanding and do not necessarily reflect your plan’s definition of the same term.
The SBC is simply intended
to help consumers understand coverage under any plan and will not provide a full scope under your NYSHIP coverage. It should not be construed as a complete description of your NYSHIP plan. It is important to refer to your
specific plan material for the customized definition used by your plan.
14 The Work Force
March 2022
to
There are four major sections the “Summary of Benefits and Coverage.” These examples are a standard set of
• • •
•
services that a patient may seek. It is unlikely
that you will pay
the costs of these illustrated scenarios. They are strictly a set
of standard services intended to help you
compare your overall coverage.
Important Questions Common Medical Events Excluded Services and Other Covered Services Coverage Examples, which could include having a baby, managing Type
2 diabetes or a simple
fracture.
Should you need a copy of
the Summary of Benefits and Coverage, Empire Plan enrollees can call 1-877-7-NYSHIP (1877- 769-7447) and select the Medical/ Surgical Program. NYSHIP HMO enrollees should contact your HMO directly.