Page 18 - Work Force March 2025

Empire Plan benefits detailed in “Reporting On” publications
NOVEMBER 2023
The Empire Plan REPORTING ON ASTHMA
JULY 2023
REPORTING ON
CENTER OF EXCELLENCE
JANUARY 2024
REPORTING ON
MENTAL HEALTH & SUBSTANCE USE PROGRAM
The Empire Plan
The Empire Plan
PROGRAMS
The Empire Plan Mental Health and Substance Use (MHSU) Program can help you receive the treatment and care you need if you experience mental health or substance use issues. Receiving the appropriate treatment from a network provider or facility can help you get on the right path toward your recovery.
For Empire Plan Enrollees and for their enrolled Dependents, COBRA Enrollees with their Empire Plan benefits and Young Adult Option Enrollees
Excellence is defined as the quality of being outstanding. If you or a loved one experiences a medical crisis and you choose The Empire Plan Center of Excellence Programs, you will receive outstanding care. This can provide you and your family with peace of mind during a difficult time.
For Empire Plan Enrollees and for their enrolled Dependents, COBRA Enrollees with their Empire Plan benefits and Young Adult Option Enrollees
This report will help you better understand asthma, its symptoms and treatments and how The Empire Plan can help you control your asthma with a personalized program.
For Empire Plan Enrollees and for their enrolled Dependents, COBRA Enrollees with their Empire Plan benefits and Young Adult Option Enrollees
The Empire Plan’s “Reporting On” publications are issued periodically by the New York State Department of Civil Service to Empire Plan enrollees and their enrolled dependents.
The publications help describe the benefits available
under The Empire Plan.
Current publications
are on Civil Service’s NYSHIP Online website and
include topics
such as:
• Mental Health and
Substance
Use
Program: The
Empire Plan’s
Mental Health and
Substance Use Program (MHSU) for network treatment toward the path to recovery.
• Asthma: This report will help provide a better understanding of asthma, its symptoms, treatments and
•
The Empire Plan Asthma Support Program.
Centers of Excellence: Describes how the Empire Plan’s Centers of Excellence Programs for Cancer, Transplants, Mental Health
and Substance Use and Infertility can be used
to help your family find peace of mind
during a difficult time.
• Diabetes:
This report helps provide a better
understanding of the disease,
risk factors, and describes the
important role of the Empire Plan’s HCAP for
medically necessary diabetic supplies and diabetic shoes. (HCAP) Home Care Advocacy Program: Explains the Empire Plan’s HCAP coverage for covered skilled nursing care, home infusion therapy and
Empire Plan enrollees have until April 30, 2025 (120 days after the end of the calendar year) to submit medical expenses incurred during the 2024 plan year.
Network hospitals, providers
and 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:
United Healthcare
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax (845) 336-7716 Claim form: https://www.cs.ny.gov/ forms/UHC_3875.pdf
Claim submission for Empire Plan non-network inpatient or outpatient hospital services:
Anthem Blue Cross - NYS Service Center
P.O. Box 1407 - Church Street Station New York, NY 10008-1407
Claims submission fax: 866-829-2395 Plan info and online claim form: https://www.empireblue.com/nys/ resources-forms
Claim submission for Empire Plan non-network mental health and substance use services:
Carelon Behavioral Health
P.O. Box 1850
Hicksville, NY 11802
Claims submission fax: 855-378- 8309 Claim form: https://www.cs.ny.gov/ forms/cms1500-MHSA.pdf
Claim submission for Empire Plan prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card:
CVS/Caremark P.O. Box 52136
Phoenix, AZ 85072-2136
Claim form: https://www.cs.ny. gov/forms/CVSCM_Claim-Form_ commercial.pdf
Call the Empire Plan directly at 1-877-7-NYSHIP (1-877-769-7447) with any questions about claims submission.
18 The Work Force
March 2025
•
durable medical equipment. • Network Benefits: Discusses
the benefits available to Empire Plan enrollees who use network providers. Choosing an Empire Plan network Provider maximizes your benefits and minimizes your out-of-pocket expenses.
• Healthy Babies: Discusses important steps to take before the baby is born. Includes prenatal care, nutrition,
postpartum depression and the Empire Plan’s Building Healthy Families Program.
In addition to the above publications, NYSHIP Online includes other topics of interest. Visit NYSHIP Online at www.cs.ny.gov/employee- benefits. Choose your group
(active state, then CSEA and Empire Plan). From the main menu, select ‘Using Your Benefits’ and under publications, choose ‘Reporting On’ for more information.
Claims deadline approaches for 2024 Empire Plan claims