Page 17 - Work Force May 2023

Choose Empire Plan network providers
The Empire Plan is a unique health insurance plan that continues to be the comprehensive health plan that gives enrollees the freedom to choose whether to receive care from Empire Plan network providers or from non-network providers.
Although not all health care providers participate in the Empire Plan network,
Empire Plan enrollees
have access to 1.2 million physicians, laboratories, surgeons, anesthesiologists, mental health specialists, physical therapists, acupuncturists and more.
When accessing health
care for yourself or your enrolled dependents, it is important to ensure that you are visiting an Empire Plan network provider. Participating network providers save you and the plan money.
• Your out-of-pocket responsibility is usually
•
limited to only a copayment for covered services by network providers.
Network providers will handle many administrative tasks
for you, such as submitting claims to United Healthcare.
Very IMPORTANT: Confirm network status before
scheduling any visit.
Just because a provider says they’ll
“accept” your insurance doesn’t mean they are in the network. To
get the most out of your plan — and pay
less — make sure to confirm with providers
and select Find a Provider. Enrollees can work with the Empire Plan carriers to find a network provider or to receive guaranteed access
to network benefits. Enrollees can nominate out of network providers to join the Empire network as well.
Below is a listing of the administrators for The Empire Plan and the program they are responsible for overseeing.
United Healthcare oversees the Empire Plan Participating Provider Program for medical/surgical services (such as office visits and surgery) as well as:
• The Home Care Advocacy Program (HCAP) for covered home care services and durable medical equipment/ supplies, including diabetic supplies, diabetic shoes and enteral formulas.
• The Managed Physical Network (MPN) for chiropractic treatment and physical therapy.
• Centers of Excellence Program for Cancer and Infertility
• Access to acupuncturists under the Empire Plan
Empire BlueCross oversees the Empire Plan’s Hospital Program
and provides coverage at hospitals worldwide. BlueCross also oversees the Empire Plan Center of Excellence Program for Transplants.
Carelon Behavioral Health
(formerly Beacon Health Options) oversees the Empire Plan’s Mental Health and Substance Use Program and provides a nationwide network for mental health and substance use treatment, including alcoholism.
CVS Caremark oversees the Empire Plan’s Prescription Drug Program and includes a nationwide network of participating pharmacies and a Mail Order Pharmacy.
Any questions about the Empire Plan network benefits should be addressed to the appropriate administrator at the Empire Plan’s toll-free number: 1-877-7-NYSHIP (1-877-769-7447).
May 2023
The Work Force 17
ahead of time by asking, “Are you in network with (United Healthcare, Empire BlueCross, Carelon Behavioral Health, etc.) for The Empire Plan?”
You can search for Empire Plan participating network providers online by visiting NYSHIP Online at www.cs.ny.gov/employee-benefits
Important to keep NYSHIP health insurance file up-to-date
As a state employee, you may meet the qualifications and carry NYSHIP health insurance.
If you or your dependents have questions regarding a specific medical benefit/claim, or if you are trying to locate a participating provider, you should contact the health plan directly.
The Empire Plan can be reached toll free at 1-877-7-NYSHIP (1-877- 769-7447). Choose the appropriate program from the prompts. Health maintenance organization (HMO) enrollees should contact their HMO directly (telephone number on the back of insurance card).
The “General Information Book for NY Active Employees” includes information regarding NYSHIP
eligibility rules, enrollment options, requirements and costs. A copy is mailed to all enrollees and can also be found on the Department of Civil Service’s NYSHIP online website.
It is recommended that you keep the General Information Book with your health insurance materials for reference.
The agency health benefits administrator (HBA) or the New York State Business Services Center performs various tasks. For health insurance, the HBA serves as the employee’s contact for health insurance information, determining you or a dependent’s eligibility and providing necessary paperwork for health insurance enrollment.
Please note that the enrollee
is responsible for notifying the HBA/Business Services Center of any changes that may affect your NYSHIP coverage. Civil Service sends reminders to NYSHIP enrollees, with covered dependents, reinforcing the enrollee’s responsibility to keep their NYSHIP enrollment record up to date and
to provide timely notification to their HBA/Business Services Center when dependent(s) no longer meet eligibility requirements.
Below are examples of health insurance updates an enrollee should provide to their HBA or the New York State Business Services Center:
• Change in your name, mailing address, home address or
phone number
• Seeking to change your
coverage type (individual/
family)
• Seeking to add/delete an
eligible dependent
• A covered dependent loses
eligibility
• You get divorced (a copy of
the divorce decree must be
submitted)
• Employment status changes
and/or removal from the
payroll
• You are planning to retire
As noted above, questions about
plan benefits should be addressed directly with your plan. The CSEA Joint Committee on Health Benefits can be contacted at 1-800-286-5242.