Page 17 - Work Force September 2024

Understanding Empire Plan benefits: preventive, diagnostic and routine care
Preventive, diagnostic, and routine care benefits are common types of health care you may receive under The Empire Plan.
Understanding the difference between them is not always easy,
but it is important. Coverage and out-of-pocket expenses can vary, depending on which type of service you receive. Be sure to discuss
with your provider why a test or service is being ordered. The same test or service can be considered preventive, diagnostic, or routine, depending on the description of why it is being performed. As a result, out- of-pocket costs paid by the enrollee may change based on the reason the service is requested.
Preventive care benefits
and services covered by The Empire Plan follow numerous guidelines and standards, including recommendations by the U.S. Preventive Services Task Force
(USPSTF), the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as well as requirements
of the U.S. Patient Protection and Affordable Care Act (PPACA).
The goal of preventive care is to detect potentially serious health conditions before symptoms develop, so patients can get early treatment.
Preventive care can include annual exams, screenings, and immunizations. Common examples of adult preventive care include annual wellness visits, cholesterol, high blood pressure and diabetes screenings as well as cancer
screenings, such as colonoscopies and mammograms.
Common examples of yearly pediatric preventive care (well- child) can include growth and body mass measurements, developmental screenings, behavioral assessments,
and immunizations. Many preventive services are
covered in full when using an Empire Plan
participating provider. Diagnostic care helps
diagnose risk factors or treat symptoms that
are already present. Diagnostic care would
involve following up with your provider to treat or monitor issues.
When a preventive visit becomes diagnostic, a copayment may apply when using a at a participating provider.
Routine care describes care that occurs on a regular basis, but it
is not preventive. Routine care is used to prevent a condition from becoming worse and to help manage symptoms. Common illnesses
that often require routine care include asthma, hypertension, and diabetes. Because routine care is not preventive, a copayment may apply when using a participating provider.
Please review the 2024 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care. As a reminder, you should review your Explanation of Benefits Statement (EOB) regularly. The EOB can provide a better understanding of how the services are billed, what the plan pays and your out-of-pocket costs.
If you have specific coverage questions or need assistance finding a participating provider, call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447).
Live Health Online:
Telemedicine option for Empire Plan enrollees and dependents
It is important to address the ever- .changing medical and behavioral health care needs of CSEA members.
As a reminder, CSEA Empire
Plan enrollees and dependents
have access to convenient virtual visits for no out-of-pocket cost
using Live Health Online. These services continue to be cost-effective alternatives for many services that can be treated virtually instead of higher-cost urgent care centers, emergency rooms or in-person office visits.
Since medical and behavioral health can significantly impact day- to-day life, it is important to maintain both physical and mental health. The Live Health Online telemedicine program offers Empire Plan enrollees and dependents access to covered-
September 2024
in-full telemedicine services from board-certified doctors as well as licensed mental health specialists.
Urgent care virtual visits for medical needs can be used for conditions such as colds/flu, minor rashes, pink eye or headache. For behavioral health, individuals
can speak with a therapist or psychologist from the privacy of their home or see a psychiatrist
and discuss possible medication management needs. Spanish speaking providers are also available.
To get started, visitanthembluecross.com/nys and select the link to Live Health Online to begin the registration process. When registering, or logging in if already registered, be sure to enter your Empire Plan identification
number and name exactly as they appear on your identification card. This will help ensure treatment
is received without charge to the enrollee.
If you need assistance with
the registration process or have questions, call Live Health Online at 1-888-548-3432. Live Health Online has representatives available 24 hours per day, seven days per week to assist you.
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