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2023 articles

NYSHIP releases 2023 plan rates for CSEA active state employees, including Unified Court System

 NYSHIP releases 2023 plan rates for CSEA active state employees, including Unified Court System

Editor’s Note: Please note that as this edition arrives at your home, the deadlines referenced in this article may have passed. We are including the information for anyone who may receive it before Dec. 30, 2022.

The State Division of Budget has approved the Empire Plan’s premium rates for calendar year 2023. Rates are listed on this page.

The Option Transfer Period, the time to choose your health insurance option for 2023, is now. 

Any state member wishing to change their NYSHIP health insurance option or enroll in the Opt-Out Program should submit the required signed documentation to their agency’s health benefits administrator no later than Dec. 30, 2022. You may also change your option online using MyNYSHIP at www.cs.ny.gov/mynyship again, no later than Dec. 30, 2022. 

The Pre-Tax (PTCP) Election Period runs concurrently with the NYSHIP annual Option Transfer Period. The PTCP is a voluntary program that allows employees to have their share of health insurance premiums deducted from their wages before taxes are withheld, which in turn may lower tax liability. Any state member wishing to change their Pre-Tax election must submit a signed health insurance transaction form (PS-404) to their agency’s health benefits administrator no later than Dec. 30, 2022.

Please refer to the 2023 rates and the “Important Dates for your Benefit Choices” for information on the effective date of new health insurance options and when to expect any health insurance deduction changes. Deduction changes related to an option change request may be made in a future paycheck and could result in retroactive charges.

As we enter 2023, it is a good time to verify that your personal information on your health insurance record is up to date. To ensure timely notification of plan information, it is important that your name, address and phone number are correct. Notify your agency’s health benefits administrator of any updates. 

See biweekly rates

LiveHealth Online provides telemedicine to Empire Plan enrollees

Maintaining our mental and physical health is of great importance. The additional stress that many people have experienced in recent years has amplified the need for increased access to mental health services. 

LiveHealth Online’s Telemedicine Program for the Empire Plan enrollees and dependents is an enhanced telemedicine program as it covers medical and mental health visits. The telemedicine program is very convenient for common health concerns like colds, flu, fevers, rashes, infections and allergies. 

CSEA’s Executive Branch Negotiating Team worked with New York State to continue offering the LiveHealth Online Telemedicine Program in the current state contract. Our union’s team was successful, and the LiveHealth Online program will continue to be offered with covered-in-full visits for Empire Plan enrollees and dependents. 

Members and dependents covered by the Empire Plan continue to have access to covered-in-full telemedicine services from board-certified doctors and licensed mental health specialists. You can virtually visit a LiveHealth Online provider for medical and mental health by using a smartphone, tablet or personal computer. Spanish-speaking providers are also available.

Telemedicine allows individuals to see and talk to the LiveHealth Online doctor through your electronic device, while you remain in the comfort of your home or college dorm, for dependents away at college. You will have no need to travel to the doctor’s office or sit in the waiting room.

To get started, visit www.empireblue.com/nys and select the link to LiveHealth 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 LiveHealth Online at 1-888-548-3432. LiveHealth Online has representatives available 24 hours a day, seven days a week to assist you.

2022 articles

State employee NYSHIP HMO and Empire Plan updates for 2023

 State employee NYSHIP HMO and Empire Plan updates for 2023 

Here are important updates that impact NYSHIP enrollees and dependents in NYSHIP health maintenance organizations (HMOs), as well as the Empire Plan: 

NYSHIP option transfer for 2023 

New York State offers a new online resource that provides easy access to option transfer related information to enable enrollees to compare NYSHIP benefits and costs. To learn more, visit https:// tinyurl.com/NYSHIP-option-transfer. 

Option transfer information, deadlines and health insurance premium rates will be communicated when announced by New York State. 

Productivity Enhancement Program (PEP) deadline 

The Productivity Enhancement Program is a negotiated employee benefit that allows eligible full and part-time state employees to exchange previously accrued annual and/or personal leave for a credit to be applied toward their NYSHIP premium. The PEP enrollment period ends Dec. 12, 2022. Please see your agency health benefits administrator for additional information. 

Flexible Spending Account (FSA) deadline 

The Flexible Spending Account (FSA) is a negotiated employee benefit for state employees that offers a way to pay for your unreimbursed health care expenses through the Health Care Spending Account. Open enrollment for the FSA programs, which include the Health Care Spending Account, the Dependent Care Advantage Account and the Adoption Advantage Account, ends Dec. 12, 2022. Please see your agency health benefits administrator for additional information. 

New health insurance cards 

Each year, the U.S. Patient Protection and Affordable Care Act sets new amounts limiting total network out-of-pocket costs. The federal law requires the inclusion of annual out-of-pocket costs on employee health insurance benefit cards and impacts all NYSHIP plans. 

The Empire Plan will issue new 2023 benefit cards for all enrollees and covered dependents. The new benefit cards will include annual deductibles and out-of-pocket maximum information. To accommodate differences in these amounts, the Empire Plan will have two versions of the cards; individual and family. 

Please note: All NYSHIP health maintenance organizations (HMOs) will also be reissuing benefit cards for the upcoming plan year. HMO enrollees should contact their HMO with any additional questions. 

CDPHP (NYSHIP HMO) and St. Peters Health Partners 

CDPHP and Trinity/St. Peter’s Health Partners are in active negotiations to renew their contract, which is set to expire on Jan. 1, 2023. If new contract terms are not reached by then, members will be permitted to use St. Peter’s Health Partner Facilities as an in-network provider for an additional 60 days, ending on March 1, 2023. For members who are in an ongoing course of care, the 60 days is extended for an additional 30 days to April 1, 2023. 

Additional information can be obtained by contacting CDPHP at 1-866-834-5945 or visiting CDPHP’s link that contains more detailed information and frequently asked questions at https:// keephealthcarelocal.com. 

Empire Plan Building Healthy Families Program 

The Empire Plan’s current Future Moms Program will be enhanced and renamed the Building Healthy Families Program, effective Jan. 1, 

2023. This enhanced program will broaden the scope of the program to include access to pre-pregnancy, maternity and postpartum care, as well as parenting support. Additional information can be obtained by contacting Empire BlueCross directly at 1-877-769-7447 Option 2, or empireblue.com/nys or through the Sydney Health app, which is available to Empire Plan enrollees and dependents. Empire Plan Live Health Online Empire Plan members and dependents continue to have access to this voluntary telemedicine program with no out-of-pocket cost to participants. Live Health Online telemedicine program can be used for medical conditions (board-certified doctor), as well as mental health services (licensed therapist or psychiatrist). Empire Plan enrollees/dependents have access to live providers 24 hours a day, seven days a week without leaving their home. CSEA was successful in negotiating the continuation of the covered-in-full Live Health Online Program for Empire Plan enrollees and dependents. Visit https://livehealthonline.com for additional information or to register for the program. Use your Empire Plan identification information to sign in. 

Important dates to remember for 2023 health planning

 Now is the time to consider your NYSHIP health option for 2023. The “2023 Planning for Option Transfer” flyer was recently mailed to NYSHIP enrollee homes and includes information about the upcoming Option Transfer Period. 

The annual Option Transfer Period is when NYSHIP enrollees can make changes to their 2023 NYSHIP option. The “Health Insurance Choices” guide for 2023 contains a more detailed comparison of NYSHIP benefits. The guide will be available from your agency health benefits administrator (HBA). 

In addition to considering your health plan option, this is the time to review health care expenses for next year. 

Do you currently participate in the Flex Spending Account or the Productivity Enhancement Program (PEP)? If you don’t, now is the ideal time to get more information about these cost-saving benefits as enrollment begins in November. Enrollment is time sensitive and end dates vary.

Flex Spending Account Open Enrollment Period: Nov. 1 to Dec. 12, 2022

The Flex Spending Account 2023 plan year will begin on Jan. 1, 2023. The Flex Spending Account is a negotiated employee benefit for state employees. A flex spending account offers a way to pay for your dependent care, health care expenses, or adoption expenses with pre-tax dollars. If you are currently enrolled in the FSA program, you must re-enroll to continue your participation in 2023.

The Flex Spending Account website contains more information about eligibility and program rules. You can visit https://oer.ny.gov/FSA or call 1-800-358-7202 to enroll. 

Productivity Enhancement Program Enrollment Period: Nov. 1 to Dec. 12, 2022 

The Productivity Enhancement Program (PEP) allows eligible full and part-time state employees to exchange previously accrued annual and/or personal leave for a credit to be applied toward the NYSHIP premium. If you are eligible and elect this program, the credit will be included in your biweekly paychecks and divided evenly during the plan year. During negotiations, CSEA was successful in negotiating an increase to the PEP amounts/days allowed to use. 

For calendar year 2023, CSEA active state members can receive up to a $800 credit or $1,600 credit determined by salary grade and number of days forfeited. To elect PEP for 2023, you must apply between Nov. 1 and Dec. 12, 2022. Ask your agency health benefits administrator for details and an application. If you are currently enrolled in PEP and remain eligible, you must re-enroll to continue receiving in 2023.

PTCP Election Period: The Pre-Tax Contribution Program (PTCP) Election Period will run concurrently with the official NYSHIP Option Transfer Period for Health Insurance 

The PTCP is a voluntary program that allows your share of the health insurance premium to be deducted from wages before taxes are withheld. In exchange for this reduction in tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you experience a qualifying event and provide timely notification. 

Participation in the PTCP can be chosen when first eligible for health insurance benefits and may also be selected to participate or decline participation in PTCP each year during the PTCP election period. 

Requests made during the PTCP election period become effective at the beginning of the 2023 plan year. 

If you want to change your PTCP election for 2023, complete a NYS Health Insurance Transaction Form PS-404 and submit to your agency Health Benefits Administrator before the PTCP election period deadline. Per Internal Revenue Service rules, this election period is the only opportunity to change your PTCP status for 2023; arbitrary, mid-year status changes are not allowed. Should a qualifying PTCP event occur mid-year, any request to change your NYSHIP coverage must be consistent with a PTCP qualifying event and submitted within 30 days of the even (or within the waiting period, if newly eligible). No action is required to keep your current PTCP status.

Flex Spending Account Update

The Flex Spending Account (FSA) is a negotiated state employee benefit that helps you save money by allowing you to pay certain expenses with pre-tax dollars. The Health Care Spending Account, the Dependent Care Advantage Account and the Adoption Advantage Account are benefit programs available under New York State’s FSA.

The state’s FSA Open Enrollment Campaign for the 2023 plan year will begin Nov. 1, 2022, and end on Dec. 12, 2022. New for 2023, Total Administrative Services Corporation (TASC) will be the administrator of the FSA programs and will be handling enrollments for the 2023 plan year. The current vendor will process the remainder of 2022 plan year claims, including up to the end of the run-out period on March 31, 2023.

Because of the tax advantages of the FSA, the Internal Revenue Service (IRS) has strict guidelines for its use. One of these guidelines is commonly known as the “use it or lose it” rule. Put simply, if you contribute pre-tax dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you may lose the balance remaining in your account when the plan year ends.

Here is more information about the types of Flex Spending Accounts:

Health Care Spending Account (HCSA) – Contributions to the HCSA are made through pre-tax payroll deductions and may be used for eligible health care expenses that are not covered by a health plan. 

The current maximum annual contribution to the HCSA is $2,850 for the 2023 plan year – this maximum is subject to update by the federal government.

Employees will continue to access a debit card for use for eligible purchases and charges. Current FSA debit cards from HealthEquity/WageWorks will be deactivated, and 2023 program participants will receive a new debit card.

The 2023 HCSA will include the maximum carryover of 2022 remaining balances. After the run-out period ends on March 31, 2023, up to $570 of funds remaining in the account will be transferred to the 2023 account for use any time during the 2023 year. Monies carried over are not included in the maximum contribution limits.

Dependent Care Advantage Account (DCAA) – Up to $5,000 per year, per household can be contributed in the DCAA through pre-tax payroll deductions for elder care, disabled dependent care or child care expenses. 

After eligible services have been received, the employee submits for reimbursement.

The DCAA employer contribution will continue to be available in 2023

The 2023 DCAA will include a grace period. Any remaining funds from the 2022 plan year can be used to pay for expenses incurred between Jan. 1, 2023, and March 15, 2023.

Adoption Advantage Account (AAA) – Eligible employees may contribute up to $14,890 in the AAA for 2023 plan year. Contributions are made through pre-tax payroll deductions and may be used for expenses related to the adoption of an eligible child.

Get more information about the state’s FSA programs by calling the FSA hotline at 1-800-358-7202 or visiting https://oer.ny.gov/fsa. 

Use Empire Plan Network Providers

 The Empire Plan is a unique health insurance plan that provides coverage whether you receive care from Empire Plan network providers or from non-network providers. 

When you or a loved one needs health care, make sure you are visiting a participating Empire Plan network provider. Staying in the Empire Plan network can save you (and the Plan) time and 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 ahead of time by asking, “Are you in network with (United Healthcare, Empire BlueCross, Beacon, 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 and select Find a Provider. 

On this page 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 has increased. 

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.

Beacon Health Options oversees the Empire Plan’s Mental Health and Substance Abuse Program and provides a nationwide network for mental health and substance abuse 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). 

Reminder – Use Flex Spending Account funds by end of calendar year

 The Flex Spending Account (FSA) is a negotiated state employee benefit that helps save you money by allowing you to pay certain expenses with pre-tax dollars. 

The Health Care Spending Account, the Dependent Care Advantage Account (DCAA) and the Adoption Advantage Account are benefit programs available under New York State’s FSA.

Because of the tax advantages of the FSA, the Internal Revenue Service (IRS) has strict guidelines for its use. One of these guidelines is commonly known as the “use it or lose it” rule. Put simply, if you contribute pre-tax dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you will lose the balance remaining in your account when the plan year ends. 

You can only be reimbursed for expenses that are incurred during your period of coverage, which means:

If you enroll during the open enrollment period and remain on the state payroll for the entire year, your period of coverage is from January 1 to December 31.

If you enroll during the plan year as a new employee, your period of coverage will begin after you complete 60 consecutive calendar days of state service. Your coverage will end on December 31.

If you enroll during the plan year due to a change in status, your period of coverage will begin when your change in status application is received. However, it can’t take effect before the date of your qualifying event. Your coverage will end on December 31.

Participants have until March 31, 2023, to submit any eligible unreimbursed expenses from the 2022 plan year. Remember, if you plan properly, you are unlikely to forfeit any of your funds.

Reminders:

Health Care Spending Account participants were able to use up to $550 of their 2021 remaining balance for eligible expenses incurred during the 2022 calendar year if you had an account as of Dec. 31, 2021. 

DCAA participants were able to use the remaining balance in a 2021 DCAA account towards eligible expenses incurred during the 2022 calendar year.

You can check your 2022 HCSA and DCAA balances at https://participant.wageworks.com

If you have any questions, please call WageWorks/Health Equity at 1-800-358-7202

Choosing your health insurance option for 2023

 New York State Active Employees: It’s that time of year to start thinking about your 2023 health insurance options.

New York State typically mails the Planning for Option Transfer flyers to enrollees in late September. The flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Pre-Tax Contribution Program (PTCP) and the Opt-Out Program, if applicable. This document is an important reminder and contains benefit and program deadlines.

If you are thinking of changing health insurance plans during the Open Enrollment Period, the NYSHIP Plan Comparison tool, available on NYSHIP online, generates an actual side-by-side comparison of Empire Plan and HMO benefits. This tool can help you easily compare and contrast services, copayments, coinsurance amounts and special programs for The Empire Plan and NYSHIP HMOs.

The comparison tool will be updated with 2023 benefits this fall at the same time the Option Transfer Period begins. To access this tool, visit the NYSHIP Online homepage at www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, and then choose Health Benefits & Option Transfer; click on Rates and Health Plan Choices and the NYSHIP Plan Comparison. Select your group (CSEA) and the counties in which you live and work. Check the box next to the plans you want to compare, and click on Compare Plans to generate the comparison table.

Please watch for additional information in The Work Force as the option transfer period draws near.

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 why 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 Patient Protection and Affordable Care Act (PPACA).

The goal of preventive care is to detect potentially serious health conditions before symptoms develop and obtain 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 would apply when using 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 would apply when using a participating provider.

Please review the 2022 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care. 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 1-877-7-NYSHIP (1-877-769-7447).

Important reminders about Empire Plan network benefits

 The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families. The Plan has four main parts: Hospital, Medical/Surgical, Mental Health/Substance Use and the Prescription Drug Program. 

The Empire Plan’s network is comprised of hospitals, medical/surgical providers, mental health/substance use providers — both inpatient and outpatient as well as participating pharmacies. 

Under the medical/surgical program, Empire Plan enrollees and dependents have access to United Healthcare’s national network of medical providers. The participating provider program network includes more than 1.2 million physicians, laboratories, and other providers such as physical therapists, occupational therapists and chiropractors located throughout the United States. You have the freedom to choose any participating provider without a referral.

When using a participating provider, your out-of-pocket expenses are lower — you pay only your copayment(s) if applicable, at the time of your visit. There is no cost for many services through a participating provider, including preventive services as required under the U.S. Patient Protection and Affordable Care Act (PPACA). 

The Empire Plan has guaranteed access to many different services (contact the Empire Plan when searching for a provider). You have guaranteed access to paid-in-full benefits through the Home Care Advocacy Program (HCAP) that covers home care/skilled nursing services, durable medical equipment and certain medical supplies including diabetic and ostomy supplies. 

As soon as your provider prescribes services covered under HCAP, call the Empire Plan (press or say 1 for the Medical/Surgical Program, then press or say 3 for HCAP). The medical/surgical program will preauthorize your services and/or equipment and supplies with an HCAP-approved provider. For diabetic supplies, except insulin pumps and Medijectors, call the Empire Plan Diabetic Supplies Pharmacy toll free at 1-800-321-0591 (insulin pumps and Medijectors must call HCAP). For ostomy supplies, call Byram Healthcare at 1-800-354-4054.

Always check if the provider participates in the Empire Plan before you receive services. Contact the Empire Plan directly at 1-877-769-7447 with any benefit questions, to check a provider’s participation status or to request a listing of participating providers.

Out-of-network referral mandate

Empire Plan complies with various state and federal mandates regarding mandated access to plan providers. 

The Empire Plan must provide access to primary care and specialty providers if these services are not available within a 30-mile radius or 30-minute travel time from your home address. This requirement applies to Empire Plan primary enrollees residing within the United States. If you require access to a certain provider, contact the appropriate Empire Plan administrator at 1-877-769-7447.

Please refer to the Empire Plan Out-of-Network Reimbursement Disclosures for additional information regarding state and federal protections, such as surprise bills and information regarding out-of-network reimbursement and enrollee cost sharing requirements

Important updates for Empire Plan enrollees about COVID-related benefits

 On this page are important updates for Empire Plan enrollees about pandemic-related benefits including COVID-19 vaccines, telemedicine, mental health and substance abuse program and COVID-19 testing. 

COVID-19 vaccines

COVID-19 vaccines, including newly-approved vaccines that have recently received Emergency Use Authorization, are available at no cost. Please visit vaccines.gov for up-to-date information on COVID vaccine availability, who is eligible for vaccines and boosters and how to find a vaccine location near you. 

Empire Plan enrollees receiving a COVID-19 vaccine at a retail pharmacy may be asked for insurance information: 

• United Healthcare is the medical provider and Group Number is 030500. 

• CVS Caremark is the prescription drug administrator.

• The BIN is: 004336 

• The Group: RX6027 

• The PCN is ADV 

There is no out-of-pocket cost for the vaccine or the single booster dose for enrollees. If you were charged a copayment for your COVID-19 vaccine at a retail pharmacy, contact CVS Caremark to request reimbursement at caremark.com. 

Telemedicine visits 

Empire Plan enrollees continue to have access to virtual telemedicine visits for medical and mental health visits 24 hours a day, 365 days a year through LiveHealth Online (empireblue.com/nys). Telemedicine visits through LiveHealth Online are available with no copayment. 

Telehealth 

It is important to note that any virtual telehealth visit provided by an Empire Plan participating provider may be subject to a copayment if the visit is not related to a COVID diagnosis. 

Mental Health and Substance Use Program 

If Empire Plan enrollees or family members need assistance finding a mental health or substance use provider, please be reminded that the Empire Plan offers guaranteed access to network level benefits if you call the Plan administrator, Beacon Health Options clinical referral line for assistance arranging care. 

You can reach Beacon Health Options by calling 1-877-769-7447 and press or say 3 to reach the Mental Health and Substance Use Program. You can reach the Clinical Referral Line by selecting option 3 from the MHSU program menu. The Clinical Referral Line is available 24 hours a day, 365 days a year. 

COVID-19 testing 

In accordance with current regulations, Empire Plan member copayments, coinsurance and deductibles are waived when: 

• COVID-19 testing performed at approved locations and following U.S. Centers for Disease Control and Prevention (CDC) guidelines (tests specifically for surveillance may be excluded). 

• Visits are in conjunction with the above COVID-19 testing to diagnose COVID-19 at the following locations, including telehealth:

• An in-network provider’s office 

• An in-network urgent care center 

• A hospital emergency department 

• Any other in-network outpatient provider setting able to diagnose COVID-19. 

COVID-19 at-home testing 

Effective Jan. 15, 2022, the federal government directed health insurance providers to cover FDA-authorized at-home COVID-19 diagnostic tests. 

• The Empire Plan will cover up to eight FDA-authorized at-home COVID-19 diagnostic tests. 

• Over-the-counter diagnostic COVID-19 tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan ID card. 

 If a test is paid for out-of-pocket at a non-participating network pharmacy, Empire Plan members can submit for the maximum reimbursement through United HealthCare online at www.myuhc.com. 

• For more information, call the Empire Plan at 1-877- 769-7447 and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program. 

Questions and more resources 

• The Empire Plan NurseLine is available 24 hours a day, seven days a week to answer your health-related questions. 

• If you have any questions or concerns regarding your Empire Plan benefits, call the Empire Plan toll-free at 1-877-769-7447 and select the option for the appropriate program. 

 The New York State Department of Financial Services has developed FAQs about health insurance access during the pandemic. Visit: https://tinyurl.com/DFS-FAQs. 

Dependent going to college? Make sure vaccinations are up-to-date

Is your child off to college this fall? If you’ve made a checklist of items to pack and things to take care of before they leave, you may want to add just one more item — make sure their vaccinations are up-to-date.

Your child received all of their vaccinations as a young child, so they are set for life, right? Not so. Not only do many vaccines given to children wear off over time, many vaccines that adults need may not have been given as a young child. HPV and meningitis vaccines are examples of vaccinations that may be recommended.

College students are at higher risk for certain infections. For example, students living in close proximity to others, such as in a dorm or a shared apartment, are at higher risk of contracting meningitis.

The American College Health Association (ACHA) published specific guidance on immunization recommendations for college students. 

“Immunizations offer safe and effective protection from vaccine-preventable diseases and outbreaks. The United States is experiencing re-emergence of these diseases, in part due to factors such as un-immunized and under-immunized persons and global travel. The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.” 

Additional information on ACHA guidelines can be found online at: https://tinyurl.com/ACHA-College-Immunization.

Questions regarding vaccination coverage should be addressed through your health plan (number on the back of your insurance card). Empire Plan enrollees can contact United Healthcare at 1-877-7NYSHIP (1-877-769-7447), option #1.

On the Road with The Empire Plan

Planning a trip? It’s good to know that no matter where you or your family go, you have the protection of The Empire Plan.

Remember, plan ahead and take the 2021 On the Road with The Empire Plan with you. The updated version of On the Road with The Empire Plan is available through the health benefits administrator at your agency or work location or can be accessed on NYSHIP’s website: https://tinyurl.com/EPontheroad. 

This publication includes contact and benefits information for Empire Plan programs that enrollees can reference while they are traveling or when their dependents are away from home. 

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 Empire Plan provider, call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. The telephone prompts for Empire Plan programs are:

Prompt 1: Medical/Surgical Program

Prompt 2: Hospital Program

Prompt 3: Mental Health/Substance Abuse Program

Prompt 4: Prescription Drug Program

Prompt 5: Empire Plan Nurseline (Registered Nurses available 24 hours a day/7 days a week)

The Empire Plan’s Telemedicine Program, through LiveHealth Online, makes receiving health care convenient when at home or traveling. LiveHealth Online allows Empire Plan enrollees and covered dependents to seek medical or mental health appointments virtually with no out-of-pocket cost. Virtual visits with board-certified doctors (medical) or licensed therapists (mental health) can be held using a smartphone, tablet, or personal computer. Contact LiveHealth Online at 1-888-548-3432, 24 hours a day, seven days a week.

If you plan to travel this summer, we encourage you to review the newest version of On the Road with The Empire Plan. Be sure to bring this document along with your doctor’s contact information and health insurance identification card(s) with you in case you or your family need medical care while away from home. Safe travels!

Empire Plan coverage for COVID-19 At-Home Tests

Public health experts, including the U.S. Centers for Disease Control and Prevention (CDC), recommend the use of at-home diagnostic tests as a tool to help mitigate the spread of COVID-19.

The Biden-Harris administration has taken steps to make at-home tests more accessible. Under direction from the federal government, the Empire Plan will cover FDA-authorized at-home COVID-19 over-the-counter diagnostic tests.

All Empire Plan enrollees and dependents are eligible for this benefit. COVID-19 over-the-counter diagnostic tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan ID card (no doctor’s order or prescription is necessary). Empire Plan participants should go to the pharmacy counter with the COVID-19 test(s) so the pharmacy can process and bill your insurance directly.

Since this program was implemented as we were preparing to go to press, following are some Frequently Asked Questions the Empire Plan has assembled to assist participants:

Q1: Where can I get an over-the-counter (OTC) at-home COVID-19 test?

A1: COVID-19 at-home tests can be acquired at any pharmacy, store or online retailer that sells FDA-authorized COVID tests. If you present your health insurance card at the pharmacy counter, you can get an OTC test through a participating network pharmacy at no out-of-pocket cost.

Note: If you are charged for a test at a participating network pharmacy, submit for reimbursement on Caremark’s website at
www.caremark.com. If you need assistance, call The Empire Plan at 1-877-769-7447 and select option 4 for the Empire Plan Prescription Drug Program, 24 hours a day, seven days a week.

Q2: How am I reimbursed for the COVID-19 at-home test?

A2: If you purchase an FDA-authorized at-home test at a non-participating network pharmacy (e.g., Amazon or other online retailer), keep your receipt and submit a claim to United Healthcare. The maximum reimbursement per test is $12. United Healthcare, the Medical/Surgical Program administrator, will accept claim submissions.

Visit www.myuhc.com to access the reimbursement form, which can also be found at https://tinyurl.com/AtHomeTestForm

.

Note: In the “Subscriber/policyholder information” section of the form, Member ID is the 9-digit number starting with 890 or 891 and Plan/Group # is: 030500.

Q3: How many COVID-19 OTC at-home tests will be covered?

A3: There is a maximum of eight tests per plan member, per month. COVID-19 at-home tests have expiration dates indicated on the package. Using an expired test risks getting an inaccurate result.

Q4: Which tests are FDA-authorized?

A4: As of Jan. 18, 2022, the list of COVID-19 OTC FDA-authorized tests* are:

  • BinaxNOW COVID-19 Antigen Self Test
  • COVID-19 At-Home Test (SD Biosensor, Inc.)
  • CLINITEST Rapid COVID-19 Antigen Self-Test
  • iHealth COVID-19 Antigen Rapid Test
  • CareStart COVID-19 Antigen Home Test
  • BD Veritor At-Home COVID-19 Test
  • SCoV-2 Ag Detect Rapid Self-Test
  • InteliSwab COVID-19 Rapid Test
  • Celltrion DiaTrust COVID-19 Ag Home Test
  • QuickVue At-Home OTC COVID-19 Test
  • Flowflex COVID-19 Antigen Home Test
  • Ellume COVID-19 Home Test

*The list of FDA-authorized tests is subject to change.

Q5: What if my test costs more than $12?

A5: Tests purchased at a participating network pharmacy will be covered in full. For claims that are submitted via www.myuhc.com, the plan will reimburse up to $12 per test ($24 for a box that contains two tests) for a maximum of eight tests per plan member, per month.

Q6: My primary coverage is Medicare. Am I eligible for an OTC test?

A6: Yes, this plan benefit applies for plan members who have Medicare as their primary coverage, and Empire Plan as their secondary health plan coverage.

Q7: I already bought and paid for a COVID-19 OTC test. Can I submit a claim for reimbursement for this test?

A7: Only tests purchased on or after Jan. 15, 2022, are eligible for reimbursement.

Q8: What other options do I have for ordering at-home tests?

A8 Beginning Jan.19, 2022, every home in the U.S. is eligible to order four free at-home COVID-19 tests via www.covidtests.gov. The tests are completely free. Orders will usually ship in 7-12 days.

Q9: I have additional questions. Who can assist me?

A9 : Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program.

Importance of caring for your mental health

Mental health is an important part of overall health and quality of life that affects how we think, feel, act, make choices and relate to others.

An individual’s mental health includes the emotional, psychological, and social well-being that is important at every stage of life, from childhood and adolescence through adulthood. 

Today’s behavioral health issues are far from simple. When someone’s mental health is compromised, the cause is not always apparent to the individual or those around them. Finding a trustworthy and knowledgeable mental health professional is an important step when receiving treatment. 

Below are some tips on finding the right mental health professional.

People have different reasons to consult a mental health professional. You may need a licensed provider who can prescribe medication or perhaps you are primarily looking for a therapist to talk through an issue. It helps to know the provider type you are looking for. 

Start by calling your insurer’s telephone number for mental health. 

NYS Empire Plan: 1-877-769-7447 (Beacon Health is Option #3). 

HMO enrollees enrollees: Consult the telephone number on the back of your insurance card.

Request phone numbers of participating professionals in your area. Gather referrals — try to get at least three names and numbers. When you call, clarify your insurance benefits and the patient’s out-of-pocket responsibilities.

If you are reluctant to call, ask a friend or family member to call for you. 

When making an appointment, provide a summary of the situation to the provider so enough time can be blocked for the conversation.

If there is a lengthy wait time until an open appointment, you could book the appointment and ask to be placed on a waiting list, in the event someone cancels. In the meantime, continue calling other providers for possible earlier openings. Discuss cancellation policies, and if you find an appointment sooner, cancel the initial appointment. 

Reach out to your primary care doctor for recommendations, treatment and support.

If you experience an emergency, seek treatment from a hospital emergency room.

Initial visits consist of gathering background information and concerns about the situation at hand. Note that therapeutic techniques may vary among providers with the same licensure. 

It is reasonable for patients to pose questions of the provider to help determine if a working connection can be built. After a few sessions, if it does not feel like the right “fit,” or if a provider lacks a particular expertise or experience that you are seeking, continue your search by calling and looking for a provider that best meets your needs.

Empire Plan enrollees can call the Clinical Referral Line through Beacon Health for names of mental health providers. Please see the image on this page for additional information.

Your health plan may also offer a telemedicine program, which allows you to seek virtual treatment without the need to leave your home. Empire Plan enrollees have a 24/7 Telemedicine program offered through LiveHealth Online that can meet the medical and mental health needs of enrollees and dependents with no out-of-pocket costs. Empire Plan enrollees/dependents can contact LiveHealth Online at 1-888-548-3432. 

State employees have an Employee Assistance Program (EAP) available to them as a resource. NYS EAP can be reached at 1-800-822-0244 or https://goer.ny.gov/employee-assistance-program.

Empire Plan prescription drug savings options

 The cost of prescription drugs is one of the fastest growing components of health care costs in the United States. 

The Empire Plan’s prescription drug benefit is designed to help manage drug costs and establish copayment levels that are more in line with the relative cost of various drugs to the Plan. 

Each January, Empire Plan enrollees are sent the Empire Plan at a Glance, which is a summary of benefits available under the Empire Plan, and also includes applicable copayment(s). 

Copayments are not the only component that impacts overall health insurance costs. To keep out-of-pocket costs for prescription drugs as low as possible, speak with your doctor about alternative drugs that may be available for your treatment and become aware of programs that can help you save money.

The Empire Plan Prescription Drug Program uses the Advanced Flexible Formulary to provide CSEA enrollees and dependents with the best value in prescription drug spending. All drugs included on the formularies have been approved by the FDA. The list is developed by a committee of pharmacists and physicians and are subject to change each January. 

The Empire Plan Advanced Flexible Formulary uses a three-level copayment schedule – Level 1 has the lowest copayment and most generic prescription drugs fall within this level.

Empire Plan Mail Service Pharmacy

The most cost-effective way to receive your prescription drugs is through the Mail Service Pharmacy. When you fill your covered prescription drugs through the CVS Caremark Mail Service Pharmacy, you can order up to a 90-day supply shipped to your home. 

An order form can be printed at www.cs.ny.gov/employee-benefits. From the NYSHIP homepage, select Forms and scroll down to choose CVS Caremark Mail Service Order Form. You can call the Empire Plan toll free at 1-877-7NYSHIP (1-877-769-7447). Press or say 4 for the Prescription Drug Program.

Specialty Pharmacy Program

The Empire Plan Specialty Pharmacy Program offers enhanced services to individuals using specialty drugs. Most specialty drugs will only be covered when dispensed by The Empire Plan’s designated specialty pharmacy, CVS Caremark Specialty Pharmacy. Prior authorization is required for some specialty drugs.

A complete list of specialty drugs included in the Specialty Pharmacy Program is available on the New York State Department of Civil Service website at https://www.cs.ny.gov. Select Benefit Programs, then NYSHIP Online and follow the prompts to the NYSHIP Online homepage. Click on Using Your Benefits and then select Specialty Pharmacy Drug List. Each of these drugs can be ordered through the Specialty Pharmacy Program using the CVS Caremark Mail Service Order Form.

Additional cost-saving ideas

Talk with your doctor about using over-the-counter drugs. Prescription drugs occasionally move to the over-the-counter market and are then available without prescriptions. An over-the-counter drug may be a cost-effective alternative to your prescription medication.

When your doctor starts you on a new maintenance prescription drug, you may want to have the prescription filled for a 30-day supply to ensure the prescription is right for your condition before paying a higher copayment for a 31 to 90-day supply.

Ask your agency health benefits administrator or business services center if you are eligible to participate in New York State’s Health Care Spending Account, which allows you to set aside part of your salary before taxes to pay for health-related expenses or visit www.flexspend.ny.gov for more information.

Don’t use the Empire Plan Prescription Drug Program for drugs related to a workers’ compensation injury. These claims should be covered in full by workers’ compensation.

For more information 

Additional online resources are available on the Empire Plan’s CVS Caremark website. Visit www.empireplanrxprogram.com and select the CVS Caremark link or call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and press 4 for the Prescription Drug Program.

LiveHealth Online covered-in-full benefits extended through Dec. 31, 2022

It is important to address the ever-changing health care needs of CSEA members during these continued unprecedented times.

CSEA’s Joint Committee on Health Benefits has worked with New York State to extend the covered-in-full Empire Plan Telemedicine Program through Empire Blue Cross’ partnership with LiveHealth Online through Dec. 31, 2022.

Empire Plan enrollees will continue to have access to covered-in-full telemedicine services from board-certified doctors and licensed mental health specialists. Services are accessed by using a smartphone, tablet or personal computer. Spanish speaking providers are also available.

The LiveHealth Online Telemedicine Program is very convenient for common health concerns like colds, flu, fevers, rashes, infections and allergies. Telemedicine allows you to see and talk to the LiveHealth Online doctor through your electronic device, while you remain in the comfort of your home or college dorm for dependents away at college (no need to travel to the doctor’s office or sit in the waiting room).

Maintaining our mental health as well as physical health is of great importance. The additional stress experienced by many people over the past two years has amplified the need for increased access to mental health services. LiveHealth Online’s Telemedicine Program for the Empire Plan enrollees and dependents is an enhanced telemedicine program as it also covers mental health visits (covered-in-full) with certified mental health providers.

To get started, visit www.empireblue.com/nys and select the link to LiveHealth 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 free of charge).

If you need assistance with the registration process or have questions, call LiveHealth Online at 1-888-548-3432. LiveHealth Online has representatives available 24 hours a day, seven days a week to assist you.

Empire Plan removal of Infertility Centers of Excellence

The Empire Plan annually evaluates the network of Infertility Centers of Excellence. The following Infertility Centers will no longer be designated as an Empire Plan Center of Excellence, effective Feb. 1, 2022:

  • Boston IVF (Albany and Syracuse locations)
  • Infertility & IVF Associates of Western New York (Snyder)
  • Neway Fertility (New York City)
    • Although these providers of service will no longer be considered a Center of Excellence, they will remain as participating providers under the Empire Plan. Enrollees will be advised of the program change directly from the Infertility Center. Enrollees currently in a cycle will be able to finish that current cycle under COE benefits.

      Questions regarding these changes should be directed to United HealthCare at 1-877-769-7447 and choose option 1 for Medical/Surgical Program.

Summary of Benefits and Coverage

“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.

There are four major sections to 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.

Important to keep NYSHIP health insurance file up-to-date

 If you’re 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. The HMO’s telephone number will be on the back of the 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 Civil Service’s NYSHIP online website at https://tinyurl.com/NYSHIP-Info.

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.

Empire Plan vaccine coverage at network pharmacy

Select preventive vaccines are covered without co-payment when administered at a pharmacy that participates in the CVS Caremark national vaccine network. Vaccines available at a pharmacy are:

  • COVID-19
  • Influenza (flu)
  • Pneumococcal (pneumonia)
  • Meningococcal (meningitis)
  • Herpes zoster (shingles) (no cost to those 50 years and older)

The Empire Plan has recently expanded coverage for non-seasonal vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Added vaccines now covered through pharmacy include:

Effective Dec. 10, 2021:

  • Tetanus, Diptheria, Pertussis and DTap

Effective Jan 30, 2022:

  • Hepatitis A and Hepatitis B
  • Measles, Mumps, Rubella
  • Varicella
  • Human Papillomavirus (HPV)

To find out if a pharmacy participates in the CVS Caremark national vaccine network, visit empireplanrxprogram.com and select CVS Caremark, then select ‘Find a Local Pharmacy.’ Be sure to select ‘Vaccine network’ under Advanced Search. Call the pharmacy in advance to verify availability of the vaccine.

If you have questions about this expanded coverage or need help locating a pharmacy, call the Empire Plan at 1-877-769-7447 and press or say 4 to reach the Prescription Drug Program.

Expanded Plan Information for Empire Plan Enrollees

The Empire Plan’s “Reporting On” publication is issued periodically by New York State Civil Service to Empire Plan enrollees and their enrolled Empire Plan dependents, COBRA enrollees with Empire Plan benefits and young adult option enrollees.

Various series of the publication feature information crucial to understanding your Empire Plan benefits on topics such as: 

Centers of Excellence (February 2022-online) describes how the Empire Plan’s Centers of Excellence Programs for Cancer, Transplants and Infertility can help Empire Plan enrollees facing medical crises. 

Prescription Drugs (February 2021) discusses specific information on co-payment levels, mandatory generic substitution, the Flexible Formulary Drug List, Specialty Pharmacy Program and Drug Utilization Review under the plan.

Network Benefits (October 2020) discusses the benefits available to Empire Plan enrollees who use participating and network providers for medical/surgical, hospital, mental health and substance use services.

Home Care Advocacy Program (January 2021) explains how HCAP under the Empire Plan provides in-home services and supplies when prescribed by your doctor.

Diabetes (April 2021) discusses symptoms, treatment and complications associated with type 1 and type 2 diabetes, as well as benefits available through HCAP and Empire Plan’s Diabetes Management Program.

Asthma (March 2021) discusses 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 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 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.

Expanded Plan Information for Empire Plan Enrollees

The Empire Plan’s “Reporting On” publication is issued periodically by New York State Civil Service to Empire Plan enrollees and their enrolled Empire Plan dependents, COBRA enrollees with Empire Plan benefits and young adult option enrollees.

Various series of the publication feature information crucial to understanding your Empire Plan benefits on topics such as:

    • Centers of Excellence (February 2022-online) describes how the Empire Plan’s Centers of Excellence Programs for Cancer, Transplants and Infertility can help Empire Plan enrollees facing medical crises.
    • Prescription Drugs (February 2021) discusses specific information on co-payment levels, mandatory generic substitution, the Flexible Formulary Drug List, Specialty Pharmacy Program and Drug Utilization Review under the plan.
    • Network Benefits (October 2020) discusses the benefits available to Empire Plan enrollees who use participating and network providers for medical/surgical, hospital, mental health and substance use services.
    • Home Care Advocacy Program (January 2021) explains how HCAP under the Empire Plan provides in-home services and supplies when prescribed by your doctor.
    • Diabetes (April 2021) discusses symptoms, treatment and complications associated with type 1 and type 2 diabetes, as well as benefits available through HCAP and Empire Plan’s Diabetes Management Program.
    • Asthma (March 2021) discusses 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 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.Choose your group (Active State, then CSEA and Empire Plan. Choose “Using Your Benefits,” and then publications (Reporting On).

NOTE: 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.

2021 articles

Important Update to the Flex Spending Accounts for State Employees

The Flex Spending Account (FSA) is a negotiated benefit for state employees that helps them to save money by allowing certain expenses to be paid with pre-tax dollars.

Employees who are eligible for FSAs are typically subject to a use-it-or-lose-it rule which means that remaining balances at the end of each year are forfeited. Our lives continue to be impacted by COVID.  Participants may have experienced a reduction of qualified expenses to your Health Care Spending Account (HCSA) or Dependent Care Advantage Account (DCAA).

We are pleased New York State is allowing two IRS-approved provisions to help reduce potential forfeitures.

 

Health Care Spending Account Carryover for Plan Year 2021:

The HCSA, which helps state employees pay for health-related expenses with tax-free dollars, will now allow up to $550 of remaining balances from your 2021 HCSA to go toward eligible expenses incurred during the 2022 calendar year.  Employees must be enrolled as of Dec. 31, 2021, for those dollars to carry over. The last day to submit claims is March 31, 2023.

 

Dependent Care Advantage Account Grace Period Extended:

DCAA, the account that helps state employees pay for custodial child, elder or disabled dependent care while at work, has adopted a carryover for Plan Year 2021.  Participants will now be able to use the remaining balance in their 2021 DCAA towards eligible expenses incurred during the 2022 calendar year if they had an account as of Dec. 31, 2021.  Current participants will receive an email with this information.

 

Participants can check their 2021 balance at participant.wageworks.com/nysfsa or by calling 1-800-358-7202.

Important Update to the Flex Spending Accounts for State Employees

The Flex Spending Account (FSA) is a negotiated benefit for state employees that helps them to save money by allowing certain expenses to be paid with pre-tax dollars.

Employees who are eligible for FSAs are typically subject to a use-it-or-lose-it rule which means that remaining balances at the end of each year are forfeited. Our lives continue to be impacted by COVID.  Participants may have experienced a reduction of qualified expenses to your Health Care Spending Account (HCSA) or Dependent Care Advantage Account (DCAA).

We are pleased New York State is allowing two IRS-approved provisions to help reduce potential forfeitures.

 

Health Care Spending Account Carryover for Plan Year 2021:

The HCSA which helps state employees pay for health-related expenses with tax-free dollars, will now allow up to $550 of remaining balances from your 2021 HCSA to go toward eligible expenses incurred during the 2022 calendar year.  Employees must be enrolled as of Dec. 31, 2021, for those dollars to carry over. The last day to submit claims is March 31, 2023.

 

Dependent Care Advantage Account Grace Period Extended:

DCAA, the account that helps state employees pay for custodial child, elder or disabled dependent care while at work, has adopted a carryover for Plan Year 2021.  Participants will now be able to use the remaining balance in their 2021 DCAA towards eligible expenses incurred during the 2022 calendar year if they had an account as of Dec. 31, 2021.  Current participants will receive an email with this information.

 

Participants can check their 2021 balance at participant.wageworks.com/nysfsa or by calling 1-800-358-7202.

Important Update to the Flex Spending Accounts for State Employees

The Flex Spending Account (FSA) is a negotiated benefit for state employees that helps them to save money by allowing certain expenses to be paid with pre-tax dollars.

Employees who are eligible for FSAs are typically subject to a use-it-or-lose-it rule which means that remaining balances at the end of each year are forfeited. Our lives continue to be impacted by COVID.  Participants may have experienced a reduction of qualified expenses to your Health Care Spending Account (HCSA) or Dependent Care Advantage Account (DCAA).

We are pleased New York State is allowing two IRS-approved provisions to help reduce potential forfeitures.

 

Health Care Spending Account Carryover for Plan Year 2021:

The HCSA which helps state employees pay for health-related expenses with tax-free dollars, will now allow up to $550 of remaining balances from your 2021 HCSA to go toward eligible expenses incurred during the 2022 calendar year.  Employees must be enrolled as of Dec. 31, 2021, for those dollars to carry over. The last day to submit claims is March 31, 2023.

 

Dependent Care Advantage Account Grace Period Extended:

DCAA, the account that helps state employees pay for custodial child, elder or disabled dependent care while at work, has adopted a carryover for Plan Year 2021.  Participants will now be able to use the remaining balance in their 2021 DCAA towards eligible expenses incurred during the 2022 calendar year if they had an account as of Dec. 31, 2021.  Current participants will receive an email with this information.

 

Participants can check their 2021 balance at participant.wageworks.com/nysfsa or by calling 1-800-358-7202.

Important reminders for 2022 enrollment

Now is the time to think about health care expenses for next year. State employees who are considering participating in the negotiated cost-saving programs still have time to enroll, but the deadlines for the 2022 plan year are fast approaching.

Productivity Enhancement Program (PEP) allows eligible CSEA active state employees to exchange previously accrued annual leave (vacation) and/or personal leave up to $600 credit (about $23 biweekly) or$1,200 credit (approximately $46 biweekly) to be applied to the employee share of the
NYSHIP premium. The amount is determined by salary grade and the number of days forfeited. If you wish to enroll in the PEP program, act promptly as the enrollment period for 2022 ends on Nov. 29, 2021.

The Flex Spending Account (FSA) offers three negotiated benefits to state employees – the Health Care Spending Account (HCSA), the Dependent Care Advantage Account (DCAA), and the Adoption Advantage Account.

These are types of flexible spending accounts that give enrollees a way to pay health care, dependent care, or adoption expenses with pre-tax dollars.
Enrollment in the FSA is voluntary – you can decide to enroll in any or all of the benefits and choose how much to have taken out of your paycheck to pay for your eligible expenses.

The Health Care Spending Account is used for medical, hospital, laboratory, prescription, dental, vision, hearing and other expenses that are not reimbursed by your health insurance or benefit plan. Additional eligible expenses can include:

  • Over-the-counter drugs and supplies
  • Breast pumps
  • Contact lenses
  • Laser eye surgery
  • Orthodontia (verify reimbursement policy with administrator)
  • Menstrual care products
  • The Dependent Care Advantage Account (DCAA) can be used if you are paying for dependent care expenses to work. Benefits can be available for child care (up to age 12), elder care expenses, expenses for a spouse or other dependent of any age who is mentally or physically incapable of self-care. Eligible expenses can include:

    • Before or after school programs
    • Child care center
    • Family daycare provider
    • Summer/sports day camp
    • The Adoption Advantage Account can be used to make pre-tax payroll deductions to help pay for an adoption that meets the IRS’s definition of a qualified adoption. Participants in the Flex Spending Account (FSA) should note that the 2022 plan year will begin on Jan. 1, 2022. If you have questions about eligibility or program rules, visit the Flex Spending Account website at www.flexspendny.gov or call
      1-800-358-7202.

Important dates to remember for 2022

NYSHIP enrollees should start thinking about their health care expenses for next year.

Do you currently participate in the Flex Spending Account or the Productivity Enhancement Program (PEP)? If you don’t, now is the ideal time to get more information about these cost-saving benefits as enrollment begins in November (enrollment is time sensitive and end dates vary).

Flex Spending Account Open Enrollment Period: Nov. 2 – 29, 2021

The Flex Spending Account 2022 plan year will begin on Jan. 1, 2022. The Flex Spending Account is a negotiated employee benefit for state employees. A flex spending account offers a way to pay for your dependent care, health care expenses, or adoption expenses with pre-tax dollars.

The Flex Spending Account website at www.flexspend.ny.gov contains more information about eligibility and program rules. You can visit www.goer.ny.gov/FSA or call 1-800-358-7202 to enroll. If you are currently enrolled in the Flex Spending Account program, you must re-enroll to continue your participation in 2022.

Productivity Enhancement Program Enrollment Period: Nov. 2 – 29, 2021

The Productivity Enhancement Program (PEP) allows eligible full and part-time state employees to exchange previously accrued annual and/or personal leave in return for a credit to be applied toward their NYSHIP premium. If you are eligible and elect this program, the credit will be included in your biweekly paychecks and divided evenly during the plan year.

During the last round of negotiations, CSEA was successful negotiating an increase to the PEP amounts. For calendar year 2022, CSEA active state members can receive up to a $600 credit or $1,200 credit determined by salary grade and number of days forfeited.

To elect PEP for 2022, you must apply between Nov. 2 and 29, 2021. Ask your agency Health Benefits Administrator for details and an application. If you are currently enrolled in PEP and remain eligible, you must re-enroll to continue receiving in 2022.

PTCP Election Period: will run concurrently with the official NYSHIP Option Transfer Period for Health Insurance

The Pre-Tax Contribution Program is a voluntary program that allows your share of the health insurance premium to be deducted from wages before taxes are withheld. In exchange for this reduction in tax liability, you agree to maintain the same pre-tax health insurance deduction for the entire plan year, unless you experience a qualifying event and provide timely notification. Participation in the PTCP can be chosen when first eligible for health insurance benefits and may also be selected to participate or decline participation in PTCP each year during the PTCP election period.

Requests made during the PTCP election period become effective at the beginning of the 2022 plan year. If you want to change your PTCP election for 2022, complete a NYS Health Insurance Transaction Form PS-404 and submit to your agency Health Benefits Administrator before the PTCP election period deadline.

Per IRS rules, this election period is the only opportunity to change your PTCP status for 2022; arbitrary, mid-year status changes are not allowed. Should a qualifying PTCP event occur mid-year, you may be able to change your health option or coverage type (family to individual) or cancel coverage, if all
requirements are met. Any PTCP qualifying event request to change your benefits during the tax year must be submitted within 30 days of the event (or within the waiting period, if newly eligible); delays may be costly. No action is required to keep your current PTCP status.

NYSHIP health plan choices for 2022

Now is the time for New York State employees to compare NYSHIP health plans if you are considering changing your health insurance option for the 2022 plan year.

Consider your choices carefully, as you typically are unable to change your option after the annual Option Transfer Period.

Selecting a health insurance plan for you and your family is an important and personal decision. Only you know your family’s lifestyle, health, budget and benefit preferences. An important step toward making the best choice for you and your family is to understand the NYSHIP options and how they may differ.

You can request a copy of the Health Insurance Choices for 2022guide from your state agency. The Health Insurance Choices guide includes a summary of The Empire Plan and each of the NYSHIP health maintenance organizations (HMOs). NYSHIP enrollees are encouraged to familiarize themselves with the health plans available in their area.

New York State also offers a plan comparison tool to assist by creating a side-by-side comparison of the benefits provided by each of the NYSHIP plans in your area.

To perform a comparison, go to www.cs.ny.gov/employee-benefits and choose your group and plan, if prompted. From the NYSHIP online homepage, select Health Benefits & Option Transfer. Click on Rates and Health Plan Choices and then NYSHIP Plan Comparison. You can select the counties in which you live or work. A listing of health plans available will be listed and you can check the box next to the plans you want included in the comparison.

At the time this article was sent to press, the 2022 NYSHIP premium rates were not yet approved. Once approved, the 2022 NYSHIP health plan rates will be mailed to your home and posted on NYSHIP Online. The rate flyer will also include the option change deadline and dates that changes in health insurance payroll deductions will occur.

The Pre-Tax Contribution Program (PTCP) Election Period for Executive Branch State Employees runs concurrent with the annual Option Transfer Period. The (PTCP) is a voluntary program that allows employees to have their share of the health insurance premium deducted from their wages before taxes are withheld, which in turn may lower the tax liability. Pre-tax status is initially chosen when first enrolled in health insurance.

Per Internal Revenue Service (IRS) rules, the PTCP Election Period is the only opportunity for employees to change their PTCP status (without a qualifying event). If you wish to verify your PTCP status, please review your paycheck.

  • If you are enrolled in PTCP, your paycheck stub shows “Regular Before-Tax Health.” Your health insurance premium is deducted from your wages before taxes are withheld.
  • If you are not enrolled in PTCP, or part of your deduction is taken after tax (e.g. you have a non-federally qualified dependent), your paycheck stub shows “Regular After-Tax Health.” Your health insurance premium (or a portion of) is deducted from your wages after taxes are withheld.

Once the Option Transfer Period is announced, the following actions can be made by timely completing the necessary paperwork with your Agency Health Benefits administrator:

  • Change your Pre-Tax Contribution Program Election
  • Change your NYSHIP option for the next plan year to one of the following:
  • The Empire Plan
  • A NYSHIP Health Maintenance Organization (HMO) offered where you live or work
  • The Opt-Out Program (if eligible and meet criteria)

No action is required if you wish to keep your current option and you are still eligible for it.

Additional changes permitted during the Option Transfer Period:

  • Change from Family to Individual (regardless of whether a qualifying event has affected your dependents’ eligibility)
  • Change from Individual to Family (late enrollment provisions will apply)
  • Voluntarily cancel your coverage (regardless of a qualifying event affecting your eligibility)
  • Enroll in NYSHIP coverage (late enrollment provisions will apply)

Updates for Empire Plan enrollees:

The following enhancements will be made in 2022:

  • Effective Jan. 1, 2022, certain diabetic supplies dispensed at a network pharmacy are covered in full under The Empire Plan, for both Plan-
    primary and Medicare-primary enrollees and their covered dependents.
  • Diabetic supplies that are covered include insulin syringes, insulin needles, insulin pen needles, alcohol swabs and gauze. These supplies will still be available at no cost through the Home Care Advocacy Program (HCAP). Plan-primary enrollees and their dependents with diabetes should continue to obtain glucometers, insulin pumps, glucose monitors, lancets and test strips through the Plan’s Diabetic Supplies Pharmacy by calling 1-800-
    321-0591. Medicare-primary enrollees should contact Medicare to obtain these supplies. Note: You must contact HCAP for authorization of insulin pumps and Medi-Jectors. For more information about diabetic supplies purchased at a network pharmacy, call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and press or say 4 for the Prescription Drug Program. To contact HCAP, press or say 1 for the Medical/ Surgical Program and then press or say 3 for HCAP.
  • Enrollees and dependents under The Empire Plan will continue to have access to the telemedicine program through LiveHealth Online. Through Empire BlueCross’s partnership with LiveHealth Online, you can stay home and have a telephone or video visit with a board-certified doctor or licensed therapist on your smartphone, tablet, or personal computer. Virtual visits through LiveHealth Online continue to be covered- in-full through Dec. 31, 2022. To begin the registration process for remote care, go to www.empireblue.com/nys and select the link to LiveHealth Online or call 1-888-548-3432.

Updates for NYSHIP HMO enrollees for 2022:

  • HMOs are community rated and determine co-payments and other out-of-pocket expenses. HMOs send enrollees a side-by-side comparison showing any changes made from plan year 2021 to plan year 2022.
  • BlueCross BlueShield of Western NY is now called Highmark BlueShield of Western NY. BlueShield of Northeastern NY is now called Highmark BlueShield of Northeastern NY.
  • CDPHP Central HMO (option #300) will expand its NYSHIP service area to include Clinton and Franklin counties.
  • MVP Health Care Rochester HMO (option #058) will expand its NYSHIP service area to include Jefferson, Lewis, and St. Lawrence counties.

Additional information regarding these plans can be found in the Choices Guide or by performing a plan comparison on NYSHIP Online.

Choosing your health insurance option for 2022

New York State Active Employees: It’s that time of year to start thinking about your 2022 health insurance options.

New York State typically mails the Planning for Option Transfer flyers to enrollees in late September. The flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Pre-Tax Contribution Program (PTCP) and the Opt-Out Program, if applicable. This document is an important reminder and contains benefit and program deadlines.

If you are thinking of changing health insurance plans during the Open Enrollment Period, the NYSHIP Plan Comparison tool, available on NYSHIP online, generates an actual side-by-side comparison of Empire Plan and HMO benefits. This tool can help you easily compare and contrast services, co-payments, coinsurance amounts and special programs for The Empire Plan and NYSHIP HMOs.

The comparison tool will be updated with 2022 benefits this fall at the same time the Option Transfer Period begins. To access this tool, visit theNYSHIP Online home page. Select your group and plan, if prompted, and then choose Health Benefits & Option Transfer; click on Rates and Health Plan Choices and the NYSHIP Plan Comparison. Select your group (CSEA) and the counties in which you live and work. Check the box next to the plans you want to compare, and click on Compare Plans to generate the comparison table.

Please watch for more information in The Work Force as the option transfer period draws near.

On the road with the Empire Plan


Planning a trip? It’s good to know that no matter where you or your family go, you have the protection of The Empire Plan.

Remember, plan ahead and take the 2021 On the Road with The Empire Plan with you. The updated version of On the Road with The Empire Plan is available through the Health Benefit Administrator at your Agency or work location or can be accessed on NYSHIP’s website.

This publication includes contact and benefits information for Empire Plan programs that enrollees can reference while they are traveling or when their dependents are away from home.

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 nonparticipating 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 Empire Plan provider, call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. The telephone prompts for Empire Plan programs are;
1 Medical/Surgical Program
2 Hospital Program
3 Mental Health/Substance Abuse Program
4 Prescription Drug Program
5 Empire Plan Nurseline (Registered nurses available 24 hours a day/7 days a week)

The Empire Plan’s Telemedicine Program, through LiveHealth Online, makes receiving health care convenient when at home or traveling. LiveHealth Online allows Empire Plan enrollees and covered dependents to seek medical or mental health appointments virtually with no out-of-pocket cost.

Virtual visits with board-certified doctors (medical) or licensed therapists (mental health) can be held using a smartphone, tablet, or personal computer. Contact LiveHealth Online at 1-888-548-3432, 24 hours a day, seven days a week.

If you plan to travel this summer, we encourage you to review the newest version of the Empire Plan’s On the Road. Be sure to bring this document along with your doctor’s contact information and health insurance identification card(s) with you in case you or your family need medical care while away from home. Safe travels!

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 why 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 US 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 Patient Protection and Affordable Care Act (PPACA).

The goal of preventive care is to detect potentially serious health conditions before symptoms develop and obtain early treatment. Preventive care can include annual exams, screenings, and immunizations. Common examples adult preventive care includes annual wellness visits, cholesterol, high blood pressure and diabetes screenings as well as cancer screenings, such as colonoscopies and mammograms.

Common 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 co-payment would 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 co-payment would apply when using a participating provider.

Please review the 2021 Empire Plan Preventive Care Coverage Guide for more details regarding preventive, diagnostic and routine care. 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 1-877-7-NYSHIP (1-877-769-7447).

Flex Spending Account update

The Flex Spending Account (FSA) is a negotiated state employee benefit that helps save you money by allowing you to pay certain expenses with pre-tax dollars. The Health Care Spending Account and the Dependent Care Advantage Account are benefit programs under New York State’s FSA.

There have been several enhancements to tax savings accounts during the COVID pandemic. On March 26, 2021, the Internal Revenue Service (IRS) released an announcement that pertains to the Health Care Spending Account.

New York State (NYS) employees who currently participate in the Health Care Spending Account will receive notice from the plan administrator in the quarterly statement regarding this new enhancement:

• Personal Protective Equipment (PPE) that is purchased primarily to prevent the spread of COVID-19 is eligible for reimbursement through the health care spending account. Reimbursable COVID-19 PPE expenses include amounts paid for masks, hand sanitizers and sanitizing wipes.

Previously-announced enhancements to the Health Care Spending Account for NYS employees include:

• Health Care Spending Account participants are now able to use up to $500 of their 2020 remaining balance for eligible expenses incurred during 2021.

• Over-the-counter drugs and medicines are eligible for reimbursement without a written prescription through the HCSA.

• Menstrual care products are considered medical expenses that are eligible for reimbursement through the HCSA.

HealthEquity, New York State’s HCSA program administrator, is updating their system to reflect this most recent update. Additional information can be obtained by calling the FSA hotline at 1-800-358-7202.

Use Empire Plan network providers

The Empire Plan is a unique health insurance plan that provides coverage whether you receive care from Empire Plan network providers or from non-network providers.

When you or a loved one needs health care, make sure you are visiting a participating Empire Plan network provider. Staying in the Empire Plan network can save you (and the Plan) time and money:
• Your out-of-pocket responsibility is usually limited to only a co-payment for covered services by network providers
• Network providers will handle many administrative tasks for you, such as submitting claims to United HealthCare.

It is 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 ahead of time by asking, “Are you in network with (United HealthCare, Empire BlueCross, Beacon, etc.) for The Empire Plan?”

You can search for Empire Plan participating network providers online by visiting NYSHIP Online and select Find a Provider.

Here is a listing of the administrators for The Empire Plan and the program(s) 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 has increased.

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.

Beacon Health Options oversees the Empire Plan’s Mental Health and Substance Abuse Program and provides a nationwide network for mental health and substance abuse 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).

Dependent going to college? Make sure vaccinations are up-to-date

Is your child off to college this fall? If you’ve made a checklist of items to pack and things to take care of before he or she goes, you may want to add just one more item – make sure their vaccinations are up-to-date.

Your child received all of their vaccinations as a young child, so they are set for life, right? Not so. Not only do many vaccines given to children wear off over time, many vaccines that adults need may not have been given as a young child. HPV and meningitis are examples of vaccines that may be recommended.

College students are at higher risk for certain infections. Students living in close proximity to others, such as in a dorm or a shared apartment, are at higher risk of contracting meningitis.

According to the Centers for Disease Control and Prevention (CDC), keeping up-to-date with recommended vaccines is the best defense against meningitis.

During the 2020 COVID-19 pandemic, many colleges moved to online college classes. As colleges and universities have started welcoming students back on campus, the American College Health Association (ACHA) published specific guidance on COVID-19 vaccination, stating that where state law and available resources allow, ACHA recommends COVID-19 vaccination requirements for all on-campus college and university students for fall semester 2021, including exemptions for medical contraindications.

This recommendation applies to all students who live on campus and/or participate in on-campus classes, studies, research, or activities. Students should research their current school policies on required vaccinations. Learn more

Questions regarding vaccination coverage should be addressed through your health plan (number on the back of health insurance card). Empire Plan enrollees can contact United HealthCare at 1-877-7NYSHIP (1-877-769-7447) and press 1.

Attention Empire Plan Members: Boost Your Mental Health

Before the pandemic, access to mental health and substance use care was already a concern in the United States.

As the COVID-19 pandemic continues to drag on, anxiety or depressive disorders have increased and patients have reported negative impact on their mental health and well-being, such as difficulty sleeping or eating and/or increased alcohol or substance use.

To ensure Empire Plan enrollees and their dependents can receive the mental health and substance use care they need, the Clinical Referral Line, administered by Beacon Health Options, provides enrollees and covered dependents with connection to a licensed clinician who will assist in finding a participating provider to meet your needs.

The Empire Plan’s Clinical Referral Line is available 24 hours a day, every day of the year. You can reach the Clinical Referral Line by calling the Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for Beacon Health Options, the Mental Health and Substance Use Program.

Empire Plan members and their enrolled dependents have guaranteed access to in-network benefits when you call and utilize the Clinical Referral Line to obtain access to highly trained, specialized clinicians in the mental health and substance use treatment fields.

If you are enrolled in a NYSHIP HMO, please contact your HMO (by dialing the number on back of your health insurance card) for information related to mental health and substance use services.

Ensure your NYSHIP health insurance file is 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 2021 General Information Book for NY Active Employees, which you can access online, has recently been mailed to enrollees’ homes. This updated General Information Book includes information regarding NYSHIP eligibility rules, enrollment options, requirements and costs. 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 eligibility for you and/or a dependent and providing necessary paperwork for health insurance enrollment.

It is important to note that the enrollee is responsible for notifying the HBA/Business Services Center know of any changes that may affect your NYSHIP coverage. The Department of Civil Service is currently in the process of sending 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:
• Your name, mailing address, home address or phone number changes;
• You are seeking to change your coverage type (individual/family);
• You are seeking to add/delete an eligible dependent;
• A covered dependent loses eligibility;
• You get divorced (a copy of the divorce decree must be submitted);
• Your employment status changes and/or you are removed 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.

Important reminder for state HCSA and DCAA participants

As noted in previous articles, flexible spending accounts are subject to the use-it-or-lose-it rule; any account balances remaining at the end of the plan year are traditionally forfeited.

The 2020 Flexible Spending Accounts for state employees were enhanced to allow for IRS provisions to help reduce potential forfeitures. The state’s Health Care Spending Account (HCSA) allows participants to carry over up to $500 of remaining HCSA funds at the end of 2020 to use toward eligible expenses incurred during the 2021 calendar year.

Participants in the state’s Dependent Care Advantage Account (DCAA) are permitted a 2 ½ month grace period (Jan. 1-March 15, 2021) to use remaining 2020 funds to pay for 2021 dependent care expenses.

FSA participants with any questions should outreach to Wage Works/Health Equity. WageWorks/Health Equity is the Administrator of New York State’s Flexible Spending Accounts and can be contacted at 1-800-358-7202.

LiveHealth Online - Empire Plan’s telemedicine program - covered-in-full benefits extended through Dec. 31, 2021

It is important to address the ever-changing health care needs of CSEA members during these continued unprecedented times.

CSEA’s Joint Committee on Health Benefits has worked with New York State to extend the covered-in-full Empire Plan Telemedicine Program through Empire Blue Cross’ partnership with LiveHealth Online through Dec. 31, 2021.

Empire Plan enrollees will continue to have access to covered-in-full telemedicine services from board-certified doctors and licensed mental health specialists. Services are accessed by using a smartphone, tablet or personal computer. Spanish speaking providers are also available.

The LiveHealth Online Telemedicine Program is very convenient for common health concerns like colds, the flu, fevers, rashes, infections and allergies. Telemedicine allows you to see and talk to the LiveHealth Online doctor through your electronic device, while you remain in the comfort of your home (no need to travel to the doctor’s office or sit in the waiting room).

Maintaining our mental health as well as physical health is of great importance. The additional stress experienced by many over the past year has amplified the need for increased access to mental health services. LiveHealth Online’s Telemedicine Program for the Empire Plan enrollees and dependents is an enhanced telemedicine program as it also covers mental health visits (covered-in-full) with certified mental health providers.

To get started, visit www.empireblue.com/nys and select the link to LiveHealth 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 free of charge).

If you need assistance with the registration process or have questions, call LiveHealth Online at 1-888-LiveHealth (1-888-548-3432). LiveHealth Online has representatives available 24 hours a day, seven days a week to assist you.

Important flex spending updates

The Flex Spending Account (FSA) is a negotiated employee benefit that helps state employees save money by allowing certain expenses to be paid with pre-tax dollars.

Employees eligible for FSAs are typically subject to the use-it-or-lose-it rule, meaning that any account balances remaining at the end of the plan year are forfeited.

The Flexible Spending Accounts for state employees were previously enhanced to allow for IRS provisions to help reduce potential forfeitures for 2020.

The State FSA includes the Dependent Care Advantage Account (DCAA). The DCAA helps state employees pay for custodial child care, elder care, or disabled dependent care while they are at work.

Due to the unprecedented events in 2020, the state’s DCAA account was modified to allow a temporary grace period in 2021 for participants to incur dependent care expenses that could be reimbursed using 2020 account balances (if they had DCAA as of Dec. 31, 2020).

The DCAA temporary grace period has been extended. Funds remaining from the 2020 NYS DCAA plan year can now cover expenses incurred between Jan. 1, 2020 to Sept. 15, 2021. DCAA enrollees may seek reimbursement for children who turned 13 during the 2020 plan year as well.

Participants can check remaining balances on their DCAA accounts by contacting the NYS Flex Spending Account hotline at 1-800-358-7202 or online at participant.wageworks.com/nysfsa.

Please note the DCAA claims submission deadline: the last day to submit DCAA claims incurred through Sept. 15, 2021 is Sept. 30, 2021.

Additionally, we are pleased to report that due to the Consolidation Appropriations Act and the American Rescue Plan Act of 2021, the DCAA has been modified to include the following two important changes:

• The maximum contribution levels have been increased from $2,500 to $5,250 for single or married filing separately and from $5,000 to $10,500 for married filing jointly or head of household.

• Employees are now allowed to change their DCAA election amount without a qualifying change in status event reason. The change event reason will appear as: “No Reason (Consolidated Appropriations Act).” Use this to enroll, change, re-start or terminate your 2021 DCAA. Changes will not be retroactive but will be applied to the next available payroll date for processing.

Please email fsa@goer.ny.gov or call WageWorks/Health Equity (1-800-358-7202) if you have questions about any of these new changes.

Empire Plan claims deadlines for calendar year 2020

Empire Plan enrollees have until April 30, 2021 (120 days after the end of the calendar year) to submit medical expenses which were incurred during the 2020 plan year to:

United HealthCare Service Corp.
P.O. Box 1600
Kingston, N.Y. 12402-1600
Claims fax: 845-336-7716

Online submission: https://nyrmo.optummessenger.com/public/opensubmit
For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services.

Empire Blue Cross
NYS Service Center
P.O. Box 1407 – Church Street Station
New York, NY 10008-1407

Claims fax: 888-367-9788
Online claim forms: www.empireblue.com/forms
For Empire Plan and non-network inpatient or outpatient hospital services.

Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, NY 11802

Claims fax: 855-378-8309
Online form: www.achievesolutions.net/achievesolutions/en/empireplan/Home.do
For non-network mental health and substance abuse services.

CVS Caremark
Customer Care Correspondence
P.O. Box 6590
Lee’s Summit, MO 64064-6590

For prescriptions filled at non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.

Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to obtain claim forms. As a reminder, when using the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system.

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 claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form.

Telehealth and Telemedicine Program Coverage for Empire Plan Enrollees

It has become evident during the pandemic that telehealth coverage is a vital means to address the current health and wellness needs of those requiring medical services.

Telehealth is a tool that allows health care professionals to evaluate, diagnose and treat patients using telecommunications technology. Medical visits using smartphones, tablets or personal computers has proven to be a popular means to visit your doctor through a secure connection that meets HIPAA and confidentiality regulations. It appears that this form of treatment may be here to stay long after the public health emergency ends.

Telehealth visits with your provider can be used for many different services, including:

• Sick/illness visits, including suspected exposure to COVID-19
• Behavioral health treatments such as for treatment of anxiety and depression
• Medication management
• Follow-up visits or chronic disease management
• Preventive support for issues such as weight loss and smoking cessation

Telehealth visits with a network Empire Plan participating provider or therapist would be subject to the same co-payment(s)s as in-person office visit. During the state and federal COVID-19 emergency periods, co-payments for network telehealth are waived.

NOTE: Waiver of co-payments does not apply to telehealth visits with non-participating providers.

Although some health care professionals now offer telehealth visits as an alternative for patients, not all have this ability.

To expand access to medical services for members, CSEA worked with New York State to enable the offering of a 24/7 telemedicine program for all Empire Plan enrollees and dependents.

The Empire Plan’s telemedicine program utilizes LiveHealth Online to provide virtual visits 24 hours a day, seven days a week with a live doctor, without the need to leave home; Spanish speaking doctors are also available.

LiveHealth Online services for Empire Plan enrollees are not limited to medical visits. Virtual mental health visits are also available to Empire Plan enrollees and dependents.

LiveHealth Online telemedicine services for Empire Plan enrollees and dependents are provided with no out-of-pocket cost (through at least 12/31/21).

To register or obtain additional information regarding the telemedicine program, visit https://www.empireblue.com/nys Questions regarding the LiveHealth Online telemedicine program can be addressed through the Empire Plan’s hospital carrier at 1-877-769-7447 (1-877-769-7447) and select option 2 for the Hospital Program.

Enhancements to State Flexible Spending Accounts

The Flex Spending Account (FSA) is a negotiated employee benefit that helps State employees save money by allowing certain expenses to be paid with pre-tax dollars. Employees eligible for FSAs are subject to the use-it-or-lose-it rule, meaning that any account balances remaining at the end of the plan year are typically forfeited.

Unprecedented events, closures and restrictions during 2020 resulted in a reduction of qualified expenses for many participants of Flexible Spending Accounts (State’s HCSA or DCAA). The Flexible Spending Accounts for State employees have been enhanced to allow for IRS provisions to help reduce potential forfeitures.

The Health Care Spending Account (HCSA) helps state employees pay for health-related expenses with tax-free dollars. The State’s Health Care Spending Account (HCSA) is being enhanced to allow participants to carry over up to $500 of remaining HCSA funds at the end of 2020 to use toward eligible expenses incurred during the 2021 calendar year.

The Dependent Care Advantage Account (DCAA) helps State employees pay for custodial child care, elder care, or disabled dependent care while they are at work. New York State’s DCAA account is being enhanced to allow an additional 2 ½ month grace period (1/1/2021 to 3/15/2021). This additional grace period will enable participants to incur dependent care expenses that can be reimbursed using 2020 account balances.

Participants can check 2020 remaining balances on their HCSA or DCAA accounts by the NYS Flex Spending Account hotline at 1-800-358-7202 or online at participant.wageworks.com/nysfsa.