Network coverage at select New York hospital based ambulatory surgical centers and hospital-owned urgent care centers is also available. A. 2023 At A Glance - Easy to access benefits summary that can answer most of your general questions. Empire Plan Health Insurance Certificate - Detailed description of the benefits and plan requirements. New York State Health Insurance Program - Empire Plan Members With Dual The Empire Plan is designed to provide enrollees with comprehensive medical care coverage. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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. The Department of Civil Service (Civil Service) is responsible for administering NYSHIP and determines NYSHIP's administrative policies and procedures. What local government employers currently participate in NYSHIPs Empire Plan? There are two Medprime family enrollments: family with one Medicare enrollee and family with two or more Medicare enrollees. If you have family coverage under NYSHIP, NYSHIP will also reimburse you for the standard Part B premium (and any Part B IRMAA) paid to SSA for any Medicare-primary dependent, provided the dependent is not reimbursed by another source or the premium is not paid by another entity. A. NYSHIP requires your governing body to pass a formal resolution to join The Empire Plan. Box 5190Kingston, NY 12402-5190 What are the employee eligibility rules for The Empire Plan? The Summary of Benefits and Coverage is a simple, federally mandated table intended to aid consumer understanding. If you are a retiree, please visit NYSHIP Online for Retirees. site, click on Employee Benefits, then Dental and GSEU. The Coverage Examples that are included in the SBC are based on a standard set of services that a patient might receive in either scenario. UnitedHealthcare has a customized website, MYUHC, for enrollees to access information about the Medical/Surgical Program. My dependent is over 65, how will they be reimbursed for Part B? Can IRMAA be reimbursed for a deceased enrollee? 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? A. NYSHIP Empire Plan Plastic Surgery: What Is Covered? There are two types of health insurance plans available to you under NYSHIP: The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs). NYSHIP General Information Book - General eligibility and enrollment rules and information. Network benefits apply when you use hospitals, hospices and skilled nursing facilities that participate in the BlueCross and BlueShield Association's network. Yes. Participating Agencies are required by law to reimburse Medicare-primary enrollees and dependents for the Part B premiums. Q. share of the biweekly premium for medical and dental and vision coverage in In addition to the publication mailings, is other customer service provided? provider directory online. If the doctor you choose participates in The Empire Plan, network benefits will apply for covered services. There are four major sections Important Questions, Common Medical Events, Excluded Services & Other Covered Services and Coverage Examples. (For the Empire Plan Prescription Drug Program, CVS Caremark will ask for payment information when ordering from the specialty or mail service pharmacies. New Medicare cards began mailing to all Medicare enrollees in April 2018. The Empire Plan Mental Health and Substance Use Program, administered by Carelon, provides coverage for medically necessary inpatient and outpatient care through a network of participating providers; medically necessary non-network services are also covered. Forms - Empire Plan Claim Forms, Non-Participating . Q. Q. 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. Empire Plan Prescription Drug Program - Caremark Medical/Surgical 2021 Empire. Table of Contents Any visits you make A. Claim Submission Instructions. Is this what I will pay if I experience one of these events? This coverage continues in 2002. PDF Insurance Transaction Form (HBA) 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. TTY users call 711. 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. Network Benefits for the NYSHIP SEHP are available to you when you receive medically Refer to Choices for 2019 and other plan material for more detailed information. extension of coverage. However, cards mailed at NYSHIP HMOs NYSHIP HMOs are available in various geographic areas of New York State. . Electronic Data Interchange (EDI) | NY Provider - Empire Blue The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Under this arrangement, the premium cost for the agencys Medicare-primary enrollees is lower than the cost for active employees. The Empire Plan Mental Health and Substance Use Program, administered by Carelon, provides coverage for medically necessary inpatient and outpatient care through a network of participating providers; medically necessary non-network services are also covered. You have guaranteed access to unlimited, medically necessary care. 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). Contact Us - The Empire Plan's Provider Directory A. Yes. Enrollees usually choose a PCP from the HMO's network for routine medical care. Empire BlueCross BlueShield 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. SUNY campuses), in addition to your NYSHIP SEHP coverage. Can I get a paper copy of the Summary of Benefits and Coverage if I need one? No. Social Security Administration: 1-800-772-1213, http://www.ssa.gov, Medicare: 1-800-633-4227, http://www.medicare.gov, Empire Plan Medicare Rx: 1-877-769-7447, Option 4, New York State Employee Retirement System: 1-866-805-0990, https://www.osc.state.ny.us/retire, Access health care services remotely using The Empire Plan's telehealth benefit through. The Empire Plan Hospital Benefits Program has two levels of benefits - network and non-network. A. If you receive a pension, any reimbursement for Medicare Part B will be added to your pension check. Open enrollment is the ideal time to make changes to your health insurance plan. We strongly encourage you to review other plan material before making a decision about the coverage you and your family will have for the next year. In order to provide you with targeted information about your benefits, you will need to select your group (negotiating unit) and health insurance plan when prompted. 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. PDF NYSHIP General Information Book For questions about NYSHIP HMOs, contact the HMOs directly (see pages 6 and 7). Representatives are available Monday through Friday, 8 a.m. to 4:30 p.m., Eastern time. 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. The New York State Health Insurance Program (NYSHIP) offers you the choice of The Empire Plan or a NYSHIP-approved Health Maintenance Organization (HMO) serving the area where you live or work. For questions about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). Please note that the Notice of Creditable Coverage Letter (COBRA). 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. Contact The Empire Plan - Government of New York EMPIRE PLAN (NYSHIP) | Nassau County, NY - Official Website A breast reduction, also known as a reduction mammoplasty, is a popular option for individuals with excess skin and soft tissue of their breasts. Beginning January 1, 2002, NYSHIP will replace Univera as administrator of When an employer joins The Empire Plan, what publications are mailed to their employees? Similarities and Differences 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. You will need to submit a copy of the Executor/Executrix paperwork in order to process the application. If you need assistance, contact the agency Health Benefits Administrator on Please note: If your employment with SUNY in a benefits-eligible position Aside from emergencies, coverage for services received outside the service area is limited and at the discretion of the individual HMO. The campus Student Health Center continues to be available to you (on most and Non-Participating Provider Claim Forms and Administrative Forms. PDF NYSHIP RATES & INFORMATION FOR 2023 - SUNY Upstate Medical University In addition to the publication mailings, is other customer service provided? NYSHIP - Massage For Life 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 check from the Office of the State Comptroller. The Empire Plan vs. NYSHIP HMOs - Government of New York administered by Davis Vision. What are the administrative costs for The Empire Plan? The New York State Department of Civil Service Employee Benefits Division provides quarterly reports to employers and mails Empire Plan information directly to enrollees. The New York State Department of Civil Service contracts with qualified companies to administer it. *Some people confuse Medicare with Medicaid. These terms are defined in the Uniform Glossary, a non-customized companion document to the SBC. The site will remember your group for future visits. Rates and Health Plan Choices - Information on your health insurance options under NYSHIP.. 2023 At A Glance - Easy to access benefits summary that can answer most of your general questions.. NYSHIP General Information Book - General eligibility and enrollment rules and information.. Medicare-primary Empire Plan enrollees and dependents will automatically be enrolled in the Empire Plan Medicare Rx, a Medicare Part D prescription drug program with expanded coverage designed especially for Empire Plan members. Mail or Fax Proofs with Completed PS-404 to: New York State Office of General Services NYSHIP is one of the largest employer sponsored group health insurance programs in the United States. The Social Security Administration does not notify the Employee Benefits Division when enrollees are required to pay IRMAA. On 1/1/24, the Empire name will become Anthem. Help Anytime! Empire 24/7 NurseLine | Employee Benefit Funds You can update or verify your Coordination of benefits here. Using participating providers helps keep the cost to you and The Empire Plan at a reasonable level. Please read the summary carefully. 2023 At A Glance - Easy to access benefits summary that can answer most of your general questions. To be eligible for coverage under a NYSHIP HMO, you must live or work in the HMOs service area. to your campus Student Health Center, which is not a network provider in the Medicare becomes your primary insurer when you are eligible for Medicare and enrolled in NYSHIP as a retiree, vestee, dependent survivor, or are covered under Preferred List provisions. Q. Enrollees usually pay a copayment as a per-visit fee. Your hospital benefits will differ depending on whether you choose a network or non-network hospital. NYSHIP SEHP, are not covered under Network coverage. 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. COVID-19 Information for Empire Plan Network Providers When Medicare is primary to NYSHIP coverage, NYSHIP reimburses you for the standard Medicare Part B premium you pay to SSA, excluding any penalty you may pay for late enrollment. You have to have cookies enabled so that you will only need to access this page and select your group once. This Empire Plan Network Administrative Guide applies to all network participation agreements which reference a "Network Administrative Guide" applicable to The Empire Plan. It is the combination of Medicare coverage plus The Empire Plan that protects enrollees. Call the Employee Benefits Division of the NYS Department of Civil Service, at 518-485-1771 for details. What are the administrative costs for The Empire Plan? medical coverage: the NYSHIP SEHP does not require you or your covered dependents 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. Demographic Data Self-Identification Form. Registered nurses are available 24 hours a day, seven days a week to answer health-related questions. For complete details about eligibility for employees, retirees, spouses and dependents, see the Who Is Eligible? and the Continuing Coverage When You Retire sections of the NYSHIP General Information Book for Participating Agencies. Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. time have an incorrect Internet address for our website. The Department of Civil Service is aware that third-party companies, unaffiliated with NYSHIP, are targeting enrollees through phone calls, emails and text messages with fraudulent offers to obtain COVID-19 at-home test kits for no cost and with expedited delivery. Payroll directory and Certificate of Insurance will come separately. When life changes, your health insurance should keep pace. P.O. Empire Plan Prescription Drug Program website, The Empire Plan Medical/Surgical Provider Directory, Demographic Data Self-Identification Form. Q. I see that the Coverage Examples page shows a "you pay" amount. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other covered medical expenses. Yes, you can apply for IRMAA on behalf of a deceased enrollee. As long as you receive medically necessary and covered services and obtain any required referrals, your copayment(s) or coinsurance should be your only expense. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program Medical/Surgical administered by UnitedHealthcare Representatives are available Monday through Friday, 8 a.m. to 4:30 p.m., Eastern time. Occasionally, a benefit change is introduced gradually over the course of time. A. NYSHIP is the New York State Health Insurance Program a comprehensive health insurance program for New York State public employees comprising The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs). 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. How are claims coordinated between Medicare and The Empire Plan? 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. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other covered medical expenses. Online: www.achievesolutions.net/empireplan, TTY: 711 Welcome to the New York State Health Insurance Program (NYSHIP) This document does not provide the full scope of coverage under any plan and should not be construed as a complete description of a plan's benefits. Your When an employer joins The Empire Plan, what publications are mailed to employees? The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), covers over 1.2 million active and retired State and participating organizations' employees and their dependents. The Department of Civil Service (Civil Service) is responsible for administering NYSHIP and determines NYSHIP's administrative policies and procedures. Blue Choice Representatives are available Monday through Friday, 8 a.m. to 5 p.m., Eastern time. How are claims coordinated between Medicare and The Empire Plan? Regional meetings are held to provide Participating Agency health benefit administrators with the opportunity to ask questions, get updates on Empire Plan activities and meet other Participating Agency representatives. The directory you will receive for Empire Plan enrollees also applies to SEHP If you need a paper copy of the Summary of Benefits and Coverage or the Uniform Glossary for a NYSHIP HMO, please contact the HMO. NYSHIP began providing SEHP dental care coverage, 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. You will have the option of changing your group at any time after the initial log on. Depending on where you live or work, one or several HMO plans will be available to you. 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. The Empire Plan offers over 190,000 participating providers nationwide. New Empire Plan benefit cards issued for all enrollees and covered All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plans unique terms. Empire Plan Providers and Pharmacies - Government of New York For printed copies of NYSHIP publications, contact your HBA. You are always covered for emergency care. Also includes information regarding COBRA continuation coverage and the Young Adult Option. Generally, to be eligible, the employee must: Q. You must notify the Employee Benefits Division in writing and provide a photocopy of your (or your dependent's) Medicare card to begin the reimbursement in these cases. Please see the NYSHIP General Information Book for more details, or contact the Benefits Unit at (518) 457-4272 or BSCBenefitsAdmin@ogs.ny.gov. The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the audit Empire Plan Health Insurance Certificate - Detailed description of the benefits and plan requirements. If The Empire Plan is primary for you or your covered dependents, you must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Hospital Program (administered by Empire BlueCross): Before a scheduled (nonemergency) hospital admission, skilled nursing facility admission/transfer or transplant surgery. The Summary of Benefits and Coverage is a standardized template and the cells cannot be altered, moved, or deleted by any plan. All rights reserved. Approximately 800 local government employers offer NYSHIP's Empire Plan to their employees. PDF Contact Information - SUNY Delhi A. through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of Approximately 800 local government employers currently offer NYSHIP's Empire Plan to their employees. Forms - The Empire Plan's Provider Directory Health Benefits - Retiree - Empire Plan - Government of New York Beginning January 1, 2002, SEHP enrollees will also have vision care benefits A. We are available 24/7 to help you with your prescription drug needs. For network participation agreements that reference a "Manual," please see the Empire Plan Physician & Provider Manual. Changes to The Empire Plan on July 1, 2023 | UHCprovider.com Health Benefits. ), 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). Both are administered by the Centers for Medicare and Medicaid Services (CMS). 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. Choose your group and plan to get to the NYSHIP Online homepage. Online: www.empireblue.com/nys/resources-forms. Please refer to the IRMAA Reimbursement Application instructions for more information. 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. It's unlikely that you would pay the same amount listed in the "you pay" cell of the Summary of Benefits and Coverage. https://nyrmo.optummessenger.com/public/opensubmit, Demographic Data Self-Identification Form. Call our Customer Service number, (TTY: 711). Benefits for covered services obtained from a nonparticipating provider are subject to a deductible and/or coinsurance. * Click here for a table of the counties each HMO serves in 2018. These definitions are intended to help improve consumer understanding and do not necessarily reflect your plans definition of the same term. No, the IRMAA amount assessed by SSA for Part D is not reimbursed by NYSHIP. Box 1600, Kingston, NY 12402-1600, Claims submission fax: 845-336-7716 Working with your benefits plan sponsor, CVS Caremark provides convenient and flexible options for the prescription drugs you and your family may need. Notice of Creditable Coverage Letter contact the Employee Benefits Division at 518457- -5754 or 1-800-833-4344. Health Benefits - PEF - Empire Plan - Government of New York
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