Are Empire Plan participating providers available in other parts of the country? Forms - The Empire Plan's Provider Directory Enroll in Medicare Parts A and B (be sure not to decline Part B). A. Network benefits apply when you use hospitals, hospices and skilled nursing facilities that participate in the BlueCross and BlueShield Association's network. Online: https://nyrmo.optummessenger.com/public/opensubmit. TTY users should call 711. www.empireplanrxprogram.com. A. Serving residents and businesses in the 28 eastern and southeastern counties of New York State. PDF New York State Health Insurance Program (NYSHIP) Required Proofs The New York State Department of Civil Service Employee Benefits Division provides quarterly reports to employers and mails Empire Plan information directly to enrollees. UnitedHealthcare is the program administrator for this coverage. As an employer, how do I become a Participating Agency in The Empire Plan? A. NYSHIP requires your governing body to pass a formal resolution to join The Empire Plan. Blue Choice A. Both are administered by the Centers for Medicare and Medicaid Services (CMS). The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. You have to have cookies enabled so that you will only need to access this page and select your group once. The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. is ending, please discard the health insurance and dental plan ID cards and NYSHIP, the New York State Health Insurance Program, is a unique Empire Plan designed specifically for New York State's Public Employees and Employers. The administrative agency fee was eliminated in 2004. On 1/1/24, the Empire name will become Anthem. Empire Plan Prescription Drug Program - Caremark Open enrollment is the ideal time to make changes to your health insurance plan. Empire Plan Medicare Rx Phone Numbers and Website Members or non-members, please call The Empire Plan toll free at 1-877-769-7447 and select option 4 for the prescription drug program. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. * PDF Contact Information - SUNY Delhi You have guaranteed access to network level of benefits if you call Carelon's Clinical Referral Line for assistance with finding a provider and arranging care. For more detailed information, refer to our publication, Medicare and NYSHIP - May 2022. 305 W. 44th Street New York, NY 10036 (212) 586-6400 All Health Centers are open 9:00 AM to 5:00 PM, Monday through Friday. Select the Medical/Surgical Program and then the appropriate prompt for option transfer benefit questions. EDI lets you: Box 1407, Church Street Station, New York, NY 10008-1407, Claims submission fax: 866-829-2395 Contact information, and Links to each Empire Plan program administrator web site, which each include a current list of providers.To find the most up-to-date information about your health insurance coverage, visit NYSHIP Online at https://www.cs.ny.gov/employee-benefits. Is this what I will pay if I experience one of these events? Similarities and Differences Are Empire Plan participating providers available in other parts of the country? Welcome to the New York State Health Insurance Program (NYSHIP). If you are a retiree, please visit NYSHIP Online for Retirees. Refer to your plan material for the definition used by your plan. Contact will be made by an insurance agent or insurance company. Medical/Surgical Health Benefits. In addition to detailed benefits information, materials range from benefits newsletters to provider directories. (including alcoholism), please contact ValueOptions at 1-800-446-3995 for help These terms are defined in the Uniform Glossary, a non-customized companion document to the SBC. PDF PA Participating Agencies BlueCross BlueShield of Western New York Online: www.achievesolutions.net/empireplan, TTY: 711 You can reach the Clinical Referral Line by calling The Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for the MHSU Program, then selecting option 3 from the MHSU Program menu. Work a regular schedule of 20 hours or more a week, or be paid an annual salary at a rate of $2,000 or more per year, or be in one of the following categories: A paid member of a public legislative body, An unpaid board member of a public authority with at least six months service as a board member, Receive your major source of family income from your public employment. The Empire Plan Medical/Surgical Provider Directory The Empire Plan covers the Medicare Part A hospital deductible ($1,132 per hospital stay of one to 60 days in 2011; amount may change yearly) as well as some other medical expenses Medicare does not cover. How will I know if I am required to pay IRMAA? The New York State Health Insurance Program (NYSHIP) offers eligible employees the option of choosing either The Empire Plan or a NYSHIP HMO for health insurance coverage. Enrollees may securely log into the Empire Plan Prescription Drug Program web site administered by CVS Caremark to access tools including drug pricing and prescription refills as well as the Formulary. centers. Empire Plan - Summary of Benefits and Coverage The Summary of Benefits and Coverage The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). Select the Medical/Surgical Program and then the appropriate prompt for option transfer benefit questions. The section below includes a video, FAQs, publications, contact information and links to important resources about Medicare. Does The Empire Plan offer a rate structure that includes a reduced premium for Medicare-eligible individuals? In the aggregate, all Participating Agencies pay the same premium under the Medprime premium structure as they would pay under a traditional two-tier rate structure (individual and family). The Empire Plan Hospital Program, administered by Empire BlueCross, provides coverage for inpatient and outpatient services provided by a hospital or skilled nursing facility and hospice care. A complete package of current publications can be ordered by the Agency Health Benefits Administrator for a direct mailing to the home of a new hire or new enrollee. Claim Submission Instructions. When an employer joins The Empire Plan, what publications are mailed to employees? Note an important change from your Univera MVP. Training on NYBEAS (the NYSHIP enrollment system) for health benefits administrators of new Participating Agencies is offered at the Department of Civil Service offices in small group settings or on a one-on-one basis. EPIC Hearing Healthcare Hearing Service Plan (HSP). If you pay your NYSHIP premium by direct payments to the Employee Benefits Division, Medicare Part B reimbursements will be credited toward your monthly NYSHIP premium payments, and if your Medicare reimbursement exceeds your health insurance premium, you will receive a quarterly reimbursement . NYSHIP Online Login - Government of New York The State has established minimum Empire Plan eligibility requirements, but local government employers may adopt modified rules within specific limits. You have guaranteed access to unlimited, medically necessary care. Please refer to the IRMAA Reimbursement Application instructions for more information. Eventually, you may come across something that says some plastic surgery is considered cosmetic and is excluded from coverage. Except in an emergency, you generally do not have coverage at non-network hospitals unless authorized by the HMO. Independent Health The 2013 Participating Agency Per Enrollee Fee is $25.32 annually, or $2.11 monthly. In addition to the publication mailings, is other customer service provided? Mail or Fax Proofs with Completed PS-404 to: New York State Office of General Services share of the biweekly premium for medical and dental and vision coverage in This Empire Plan Network Administrative Guide applies to all network participation agreements which reference a "Network Administrative Guide" applicable to The Empire Plan. PHI is individually identifiable health information related to your physical and mental health or condition, health care services provided to you, or payments made for your care, which is created or received by a health plan, a health care clearinghouse, or a health care provider that electronically transmits such information. to select a primary care physician. When life changes, your health insurance should keep pace. Reviewing responses to Frequently Asked Questions about the two NYSHIP plan types is another way to figure out which one will best meet your needs. HBAs can also access training videos on HBA Online. Do not sign up for any non-NYSHIP Medicare Advantage Plan or Part D prescription plan. Welcome to NYSHIP Online, where you will find information on the New York State Health Insurance Program for State and Local Government for active employees. Most public employers (Participating Agencies) that offer NYSHIPs Empire Plan permit employees who retire and have met certain requirements to continue their coverage after retirement and contribute to the cost. Your SBC may provide you with some information that will explain how you are covered for certain services, such as what your copayment is. You may search the participating The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Posted on November 17, 2021 New York State employees who are enrolled in the Empire Plan will be receiving new benefits cards for all enrollees and covered dependents. Learn more about our Sydney Health App by clicking here. NYSHIP HMOs are available in various geographic areas of New York State. . Also, information about The Empire Plan pharmacy locations, including pharmacies participating in the vaccine network and 24-hour service pharmacies, is available here. Demographic Data Self-Identification Form. Persons enrolled in The Empire Plan who are eligible for primary coverage under the federal Medicare program are enrolled with either Medprime individual (individual enrolled in Medicare) or Medprime family (family coverage with one or more members enrolled in Medicare) coverage. Q. 12.) (For the Empire Plan Prescription Drug Program, CVS Caremark will ask for payment information when ordering from the specialty or mail service pharmacies. NYSHIPs Empire Plan pays secondary to Medicare. The notice attests to the creditable coverage status of the NYSHIP prescription drug program. Access health care services remotely using The Empire Plan's telehealth benefit through, Demographic Data Self-Identification Form. EMPIRE PLAN (NYSHIP) | Nassau County, NY - Official Website extension of coverage. If The Empire Plan is primary* for you or your covered dependents, you must call the Benefits Management Program before certain services are received anywhere in the United States and follow the Program requirements to receive maximum benefits under the Plan. You may not be enrolled in an HMO outside your area. NYSHIP SEHP, are not covered under Network coverage. Participating Agencies are required by law to reimburse Medicare-primary enrollees and dependents for the Part B premiums. ), If you believe you were the victim of a scam involving at-home test kits or any scam related to your health benefits, please refer to guidance posted by the Federal Trade Commission (FTC). While all NYSHIP plans provide a wide range of hospital, medical/surgical, mental health/substance use and prescription drug coverage, there are some fundamental differences between the two plan types. Benefits for covered services, not just urgent and emergency care, are available worldwide. For retirees and their dependents, NYSHIP requires enrollment in Medicare Parts A and B when first eligible. Click here for a table of the counties each HMO serves in 2018, Demographic Data Self-Identification Form. Yes. Ninety-seven percent of hospitals nationwide are network hospitals. Q. * Forms - Empire Plan Claim Forms, Non-Participating . The Empire Plan (NYSHIP) Breast Reduction Guide administered by GHI, on July 1, 2001. Please call Member Services at 1-877-7-NYSHIP (1-877-769-7447), Option 2, Monday to Friday, 8:00 a.m . Table of Contents If you go to an Empire Plan participating provider, MPN Network provider, or a MultiPlan provider, all you have to do is ensure that the provider has accurate and up-to-date personal information (name, address, health insurance identification number, signature) needed to complete the claim form. necessary care from any provider who is under contract with UnitedHealthcare For example, prescription drugs and hearing aids are not covered under Medicare Part A or Part B, but The Empire Plan for Empire Plan Participating Agencies provides benefits for prescription drugs provides a generous allowance for hearing aids. The directory you will receive for Empire Plan enrollees also applies to SEHP Are there Empire Plan participating providers in our area? If you are a New York State Active Employee and unsure of your group, our Enrollee Group Wizard will ask you a series of questions in order to determine which group you should select. Approximately 800 local government employers currently offer NYSHIP's Empire Plan to their employees. (Of course, you may still select one if Yes. Under the federal privacy regulations relating to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), health plans such as The Empire Plan are required to protect the confidentiality of Protected Health Information (PHI). What are the employee eligibility rules for The Empire Plan? Always refer to other plan material, such as Choices for 2019 for more information about The Empire Plan and NYSHIP HMOs if you are making a decision about your family's coverage. A. change your PTCP election for the 2023 plan year, complete and sign a . What are The Empire Plan confidentiality practices? (1), An employee will be married on June 10 and applies for a change from Individual to Family coverage on or before June 10th. TTY: 1-888-697-9054 What local government employers currently participate in NYSHIP's Empire Plan? Enrollees can track their Plan's medical/surgical claims and history, print explanations of benefits (EOBs), create personalized provider directories and much more. Be sure you understand how your benefits will be affected if you change options. You have coverage worldwide, but your benefits are highest at network facilities. Medicaid is a health insurance program for low-income persons of any age, is jointly funded by federal and state governments, and usually administered at the county or local level. To get started, you MUST select one of the following: Click here for NYSHIP Online for RETIREES, Demographic Data Self-Identification Form. Empire Plan Health Insurance Certificate - Detailed description of the benefits and plan requirements. To ensure you receive the highest level of benefits, you should call Carelon before you seek mental health or substance use care, including treatment for alcoholism, even when a doctor refers you to the facility. Representatives are available Monday through Friday, 8 a.m. to 5 p.m., Eastern time. HMO Blue Working with your benefits plan sponsor, CVS Caremark provides convenient and flexible options for the prescription drugs you and your family may need. Can I get a paper copy of the Summary of Benefits and Coverage if I need one? guidance posted by the Federal Trade Commission (FTC). Q. The Employee Benefits Division is required to send a Medicare Part D Prescription Drug Program notice annually to all active and retired NYSHIP enrollees and dependents who are 65 or older, or eligible for Medicare due to disability. A managed-care system in a specific geographic area that provides comprehensive coverage through a network of providers. Please Note: This page highlights only general differences between The Empire Plan and NYSHIP HMOs. benefits was sent to you. Please see the NYSHIP General Information Book for more details, or contact the Benefits Unit at (518) 457-4272 or BSCBenefitsAdmin@ogs.ny.gov. To help you remember to enroll in Medicare, NYSHIP will send you a letter and Medicare information packet a few months before your 65th birthday. Enrollees usually choose a PCP from the HMO's network for routine medical care. Graduate Student Employees Union (GSEU). CDPHP Empire Plan Toll free 1-877-7NYSHIP (1-877-769-7447), choose UnitedHealthcare Cancer Resource Services 1-866-936-6002 Empire Plan Diabetic Supplies Pharmacy 1-888-306-7337 Ostomy Supplies - Byram Healthcare Centers 1-800-354-4054 Questions? Call Member Services at 1-877-7-NYSHIP (1-877-769-7447), The Empire Plan Prescription Drug Program, The Empire Plan Mental Health and Substance Use Program. A. HIP New Medicare cards began mailing to all Medicare enrollees in April 2018. A self-insured Preferred Provider Organization (PPO) plan with features of a managed care system. Should I use the Summary of Benefits and Coverage to decide which NYSHIP option is best for my family? Why do retirees still need The Empire Plan after they have primary coverage under Medicare? The directory is updated weekly. Cards will be sent to the mailing address on file for each enrollee. For network participation agreements that reference a "Manual," please see the Empire Plan Physician & Provider Manual. The Empire Plan Prescription Drug Program has more than 50,000 participating pharmacies nationwide as well as a mail service pharmacy. Online: www.empireblue.com/nys/resources-forms. You are always covered for emergency care. The State negotiates NYSHIP health insurance benefits with State employee unions every three or four years. Some HMOs may provide coverage for urgent or routine care outside the service area or for college students away from home. For Yes. COVID-19 Information for Empire Plan Network Providers EDI, including electronic remittance advices (ERAs) and electronic funds transfers (EFTs), allows for a faster, more efficient and cost-effective way for providers and employers to do business. treatment before your NYSHIP card arrives, your provider can confirm your enrollment A. You can order mail service prescriptions online, reducing the prescription cost for you and The Empire Plan. The Clinical Referral Line is available 24 hours a day, every day of the year. A.The Empire Plan is NYSHIPs unique health insurance plan designed exclusively for New York States public employees and employers. To be reimbursed for IRMAA, you must complete the IRMAA Reimbursement Request application and submit it to the Employee Benefits Division along with proofs of payment of your Medicare Part B premium. PDF Department of Civil Service - Office of the New York State Comptroller All rights reserved. contact the agency Health Benefits Administrator on your campus to update your What local government employers currently participate in NYSHIPs Empire Plan? Prior authorization is required. Copyright 2023 CVS Caremark. records. Q. You must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and Press or How are claims coordinated between Medicare and The Empire Plan? Notice of Creditable Coverage Letter Medicare is a health insurance program administered by the federal government to individuals over age 65 or who are eligible due to disability. No. New York State Health Insurance Program - Empire Plan Members With Dual The New York State Department of Civil Service contracts with qualified companies to administer it. site, click on Employee Benefits, then Dental and GSEU. If The Empire Plan is your primary insurance coverage and use a nonparticipating provider who is part of the MultiPlan group, your out-of-pocket expenses will, in most cases, be reduced. Generally, to be eligible, the employee must: Q. The Empire Plan is the primary health benefits plan for NYSHIP, providing coverage to about 1.1 million members. These Coverage Examples are intended to help you compare your overall coverage and are not intended as a cost estimator. benefits on our Reimbursement is not automatic for any enrollee or covered dependent who is under age 65 and is eligible for Medicare due to disability, ESRD, or ALS. The administrative enrollee fee is based upon annual budget projections and covers the administrative costs that are attributed to Participating Agencies. Yes, coverage is available worldwide. Your Print insert_link Link Effective July 1, 2023, enrollee benefits for the following groups in The Empire Plan are changing: Civil Service Employees Association (CSEA) Management/Confidential; Legislature Unified Court System (UCS) Participating Agencies Participating Employers A. PDF Empire Plan Contact Information - Government of New York Many of these changes cannot be reversed by diet and exercise. Yes, if you need a paper copy of the Summary of Benefits and Coverage for The Empire Plan or the Uniform Glossary, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical Program. New Empire Plan benefit cards issued for all enrollees and covered benefits, Demographic Data Self-Identification Form. Do I have to enroll in Medicare if I am enrolled in NYSHIP? PDF NYSHIP - Government of New York PDF NYSHIP General Information Book General Information Book for Active Employees, Retirees, Vestees and Dependent Survivors of NYSHIP Participating Agencies with The Empire Plan or the Excelsior Plan and their Eligible Dependents. Q. If you receive a pension, any reimbursement for Medicare Part B will be added to your pension check. Will my Summary of Benefits and Coverage explain how services are covered? However, cards mailed at If you need a paper copy, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical Program. You will need to submit a copy of the Executor/Executrix paperwork in order to process the application. The Empire Plan has many managed-care features, Enrollees have the freedom to choose participating providers and pay only a copayment or choose non-participating providers and pay a higher share of the cost. And, while Medicare does not pay for medical services outside the U.S., Empire Plan benefits are available worldwide. Also includes information regarding COBRA continuation coverage and the Young Adult Option. 2023 Empire Plan and NYSHIP Rates for State Employees Empire BlueCross BlueShield The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you may be required to pay for your monthly Medicare premiums if you have higher annual earnings. Box 1850Hicksville, NY 11802 On or after January 1, 2009 and before January 1, 2014: OptumHealth Behavioral Solutions P.O. The reports provide projected Empire Plan experience based on claims paid through the previous quarter and projected premium rates. A. If you are a retiree, please visit NYSHIP Online for Retirees. TTY: 1-888-697-9054 P.O. The Empire Plan pays for covered hospital services, physicians bills, prescription drugs and other covered medical expenses. 2002 is $4.82 for Individual coverage or $22.98 for Family coverage. P.O. I am (or my dependent is) Medicare-eligible prior to age 65, how will I/they be reimbursed for Part B? Details are outlined in the New York State Health Insurance Program (NYSHIP) Notice of Privacy Practices, effective beginning April 14, 2003. PDF 2019 Road - SUNY Geneseo A copy of DD-214 and proof of full time student status is required. Through the Home Care Advocacy Program (HCAP), benefits for home care, durable medical equipment and certain medical supplies (including diabetic and ostomy supplies) and enteral formulas are paid in full. Policies and benefits may also be affected by State and federal legislation and court decisions. about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). There are four major sections Important Questions, Common Medical Events, Excluded Services & Other Covered Services and Coverage Examples. Basic Medical Provider Discount Program Directory. Yes, you can apply for IRMAA on behalf of a deceased enrollee. Your hospital benefits will differ depending on whether you choose a network or non-network hospital. TTY: 711 The President of the Civil Service Commission can and usually does extend negotiated benefit changes administratively to unrepresented groups such as Participating Agencies. Available for iOS and Android devices. Empire Plan Providers and Pharmacies - Government of New York
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