Page 18 - Work Force May 2024

On the Road with The Empire Plan
ON THE
ROAD
WITH THE EMPIRE PLAN | 2023
For NYS Employees | Retirees, Vestees, Dependent Survivors and Enrollees covered under Preferred List Provisions of New York State Government and their enrolled Dependents, COBRA Enrollees with their Empire Plan benefits and Young Adult Option Enrollees
Being familiar with the covered benefits and plan participant requirements of your health insurance plan is of great importance whether you are close to home or traveling.
The publication “On the Road with the Empire Plan” includes important plan information such as addresses, phone numbers and descriptions
of covered services, including services that may require contacting the appropriate Empire Plan administrator for precertification prior to receipt of services.
You can request a copy of “On the Road” through the Business Services Center or the health benefits administrator (HBA) at your agency or work location. You can also access an electronic version on NYSHIP’s website at https://tinyurl.com/EP- OnTheRoad.
Empire Plan coverage is
available worldwide and not just
for emergencies. Most parts of The Empire Plan have two levels of benefits. If you use an Empire Plan participating provider, medically necessary covered services and supplies can be accessed with
little or no cost. If you use a non- participating provider, medically necessary covered services and supplies can be accessed, but deductibles, coinsurance and benefit limits may apply.
The Empire Plan has nationwide participating provider networks.
For assistance locating a network provider, call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. The telephone prompts for each of the Empire Plan programs are:
• Medical/Surgical Program – press on your phone or say 1 for United Healthcare
• Hospital Program – press or say 2 for Anthem Blue Cross
• Mental Health/Substance Abuse Program – press or
say 3 for Carelon Behavioral
Health
• Prescription Drug Program –
press or say 4 for CVS
Caremark
• Empire Plan Nurseline – press
or say 5 (Registered nurses are available 24 hours per day/ seven days a week.)
The Empire Plan Hospital Program requires pre-certification by the enrollee/dependent before a scheduled (non-emergency) hospital admission, or within 48 hours or as soon as reasonably possible after
an emergency or urgent hospital admission, and before admission or transfer to a skilled nursing facility.
The Empire Plan Medical/Surgical Program requires pre-notification before having a scheduled (non- emergency) magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), computerized tomography (CT) scan, positron emission tomography (PET) scan or nuclear medicine test.
The Empire Plan’s Home Care Advocacy Program should be called for pre-certification before receiving medically necessary home care services, equipment or supplies anywhere in the United States.
Call the Empire Plan Diabetic Supplies Pharmacy at 1-800-321- 0591 for blood glucose self-testing equipment and supplies, including blood glucose monitors, test strips, lancets and lancet devices. Insulin pump requests must call HCAP for authorization. Call Byram Healthcare at 1-800-354-4054 for ostomy supplies.
Remote health care visits using Live Health Online (LHO) are cost- effective and can be a convenient alternative to urgent care centers, emergency rooms and in-person office visits near home or when traveling.
Through LHO, enrollees and dependents can access a board- certified doctor, psychiatrist,
psychologist or licensed therapist for a telephone or video visit.
To register, visit https://www. anthembluecross.com/nys or contact Live Health Online at 1-888- 548-3432, 24 hours a day, seven days a week.
The Empire Plan Nurseline provides access to health information and support 24 hours a day, seven days a week. Call The
Empire Plan at 1-877-769-7447
and press or say 5 to speak with a registered nurse about your health- related questions.
Bring a copy of the Empire Plan on the Road, your Empire Plan health insurance identification card, and your doctor’s contact information with you when you travel in case medical services are necessary while away from home.
Retiring soon? Join the
Retirees!
• Money-saving member benefits
• Representation to protect your pension and retirement benefits
• Access to insurance plans at CSEA’s low group rates
• Discounted dental and vision care programs
• Personal legal services referral network
• CSEA Retiree News
Spouses, domestic partners and retired CSEA staff are eligible to join a CSEA Retiree Local, too!
To learn more and join, visit cseany.org/retirees or call 800-342-4146
18 The Work Force
May 2024