The Empire Plan

HealthBenefits Updated September 4, 2008 - Health Benefits Homepage
NYS Benefits	Empire Plan	HMOs	Dental
Vision	Health Plan Contacts	Joint Committee on Health Benefits	Help with Problems
Doctors	FAQS	Helpful Links	Forms

Empire Plan

The Empire Plan's toll-free number is 1-877-7NYSHIP or 1-877-769-7447

Copayment Guide

Prescription Drug Program	Copay
Up to a 30-day supply from retail pharmacy or mail service
Generic drug	$5
Preferred brand-name drug	$15
Non-preferred brand-name drug*	$40
31-90 day supply from a participating retail pharmacy
Generic drug	$10
Preferred brand-name drug	$30
Non-preferred brand-name drug*	$70
31-90 day supply from mail service
Generic drug	$5
Preferred brand-name drug	$20
Non-preferred brand-name drug*	$65

*Non-preferred brand name drugs that have an FDA-approved generic equivalent may have additional out-of-pocket costs because of the mandatory substitution requirement.

Participating Provider Services
Office visit	$18
Office surgery	$18
Radiology	$18
Diagnostic laboratory tests	$18
Free-standing cardiac rehab center visit	$18
Urgent care center	$18
Free-standing outpatient surgical centers	$30
Local professional/commercial ambulance transportation	$35
Chiropractic or Physical Therapy Services
Office visit	$18
Radiology	$18
Diagnostic laboratory tests	$18
Hospital Services in a Network Hospital
Outpatient physical therapy	$18
Outpatient surgery	$35
Diagnostic radiology	$35
Mammography screening	$35
Administration of Desferal for Cooley's Anemia	$35
Emergency room care+	$60
Precertification
Precertification required for all planned admissions including maternity, and certain surgical and medical procedures regardless of inpatient or outpatient setting. Enrollees must call 1-877-7NYSHIP or 1-877-769-7447.
Prospective Procedure Review
Enrollees required to call 1-877-7NYSHIP or 1-877-769-7447 prior to elective CAT Scans, PET Scans, Magnetic Resonance Angiography (MRAs) and Nuclear Medicine in an outpatient setting. Call is not required for emergency or inpatient procedures.*
Mental Health and Substance Abuse Program
Visit to outpatient substance abuse treatment program	$18
Visit to mental health professional	$18
Emergency room care+	$60
Collect only ONE COPAY
Office visit & office surgery on same date OR	$18
Radiology & Laboratory service on same date	$18
NO COPAY: Allergy Immunotherapy, Chemotherapy, Hemodialysis, Prenatal Care, Radiation Therapy, Well Child Care

+The Emergency Room copay is waived if the patient is admitted to the hospital.

*If you fail to call, you will be responsible for paying 50% of the amount allowed or $250, whichever is less. You will also be responsible for the applicable copay or, if you used a non-par provider, deductible and/or coinsurance amounts.

Check the 2008 Empire Plan Preferred Drug List. This list is a summary of frequently prescribed drugs. For information about other drugs not on the list call UHC/Medco at 1-877-7NYSHIP or 1-877-769-7447 and listen for the prompts for the 2008 Empire Plan Prescription Drug Program.

The following list contains information about the Empire Plan insurance carriers and vendors. Web sites are included, and it's often faster than calling to find a par provider or other basic information on the website. The Empire Plan participating provider directory on the Civil Service web site enables you to search for a conveniently located provider by specialty. From the Civil Service home page, follow the prompts for NYSHIP Online, then Find a Provider. Scroll down to find the type of provider you need.

Please read about Empire Plan Chemotherapy Benefits.

United HealthCare 1-877-7NYSHIP or 1-877-769-7447
The on-line par provider directory is the most current source of information about participating providers, but call to verify the provider's status. Download a non-participating provider claim form. This file can only be viewed with Adobe Acrobat Reader which can be downloaded for free at Adobe. myuhc.com provides access to claims processed by United HealthCare, the par provider directory and enrollment verification. Register by visiting the web site and clicking on the Register button. Fill in the basic information, including your Group Number which is 030500, and choose a User ID. United HealthCare will create a password and mail it to your home.

Basic Medical Provider Discount Program (Multiplan) 1-877-7NYSHIP or 1-877-769-7447 When you use non-par physicians who are affiliated with Multiplan, you will receive discounts on the provider’s usual fees. You still must satisfy the annual deductible and 20% coinsurance required by Basic Medical, but you cannot be balance billed for any additional amounts. Multiplan has more than 200,000 providers in their network. Be sure to confirm the provider’s participation before receiving services. You can access an online list of Multiplan providers from the directory in the Civil Service web site at www.cs.state.ny.us. You can also call 1-877-7-NYSHIP and speak to a United HealthCare representative.

Centers of Excellence for Cancer (Cancer Resource Services) 1-877-7NYSHIP or 1-877-769-7447 This program provides paid-in-full coverage for cancer-related expenses received through a nationwide network known as Cancer Resource Services (CRS). CRS is staffed by experienced cancer nurses who can explain treatment options and help you choose the best physician and cancer center for a specific type of cancer. The CRS network includes many of the nation’s leading cancer centers, such as Roswell Park Cancer Institute, Memorial Sloan Kettering Cancer Center and Dana-Farber Cancer Institute. Reimbursement for travel expenses is available. For more information call toll-free 1-866-936-6002 from 8 a.m. to 8 p.m., Monday – Friday, or visit the CRS web site at www.urncrs.com.

Empire Blue Cross and Blue Shield - hospital services
1-877-7NYSHIP or 1-877-769-7447
To use the Empire Blue Cross and Blue Shield web site, register in the Member Services window on the site. You will need your ID number, which is the first nine digits of your NY Government Employee Benefit Card. Create a personal password, which is combined with a one-time use activation key number and your log-on ID to safeguard the confidentiality of your records. You can check the status of a hospital claim, complete a coordination of benefits form, or fill out a dependent student questionnaire.

Benefits Management Program
Call United HealthCare at 1-877-7NYSHIP or 1-877-769-7447 for MRI precertification.
For all other precertifications (before a scheduled hospital admission; within 48 hours after an emergency or urgent admission; before admission or transfer to a skilled-nursing facility; before the birth of a child or as soon as a doctor confirms a pregnancy) call Empire Blue Cross Blue Shield at 1-877-7NYSHIP or 1-877-769-7447.

ValueOptions 1-877-7NYSHIP or 1-877-769-7447
Mental health & substance abuse services

UHC/Medco prescription drug program - 1-877-7NYSHIP or 1-877-769-7447
Effective January 1, 2008, you can order prescription refills, check order status, view prescription history, check a drug copay and print forms through the link to the UHC/Medco web site from the Civil Service web site. From the Civil Service home page, follow the prompts for Benefit Programs, then NYSHIP Online, then Find a Provider. Scroll down to UHC/Medco.

Managed Physical Network 1-877-7NYSHIP or 1-877-769-7447
Chiropractic & physical therapy

Home Care Advocacy Program 1-877-7NYSHIP or 1-877-769-7447
Durable medical equipment, home nursing care, infusion therapy, diabetic supplies

Complementary and Alternative Medicine (CAM) Program 1-888-447-2144

Enrollees can receive services from network massage therapists, acupuncturists, dietitians and nutritionists at a 25 percent discount from normal fees. The enrollee pays the provider directly. There are no claim forms and no reimbursement from the Empire Plan. The program is available only in New York state.

Call 1-888-447-2144 for names, addresses and phone numbers of CAM network providers. The toll-free line is staffed Monday through Friday, 8:00 a.m. to 4:30 p.m. Enrollees contact CAM providers directly to make an appointment. The CAM web site at www.empireplancam.com has more information about the program, including a provider locator to help enrollees find a network provider. Enrollees may also nominate a provider on the web site.

Infertility Treatment 1-877-7NYSHIP or 1-877-769-7447
Call for prior authorization of qualified procedures, regardless of provider.
Call for information about Centers of Excellence for Infertility.

Hit Counter