Important Claim Deadlines

March 31, 2006 is the last day to submit your 2005 claims to:

• United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services
• ValueOptions for non-network mental health and substance abuse services
• Express Scripts for prescriptions filled in 2005 at non-participating pharmacies or without using your New York Government Employee Benefit Card

If the Empire Plan is your secondary insurer, you must submit claims by March 31, 2006 , or within 90 days after your primary health insurance plan processes your claim, whichever is later. Claims submitted after the deadline will be rejected. The carriers will only reconsider their denial of these claims if you provide documentation indicating it was not reasonably possible for you to meet the deadline (for example, due to illness).

Ask your agency Health Benefits Administrator for claim forms, or call the Empire Plan toll-free telephone number 1-877-7NYSHIP (1-877-769-7447).  You can also download the forms using the NYS Department of Civil Service website www.cs.ny.state.us.  Click on “Employee Benefits” and then “Publications & Forms”. Select “Health Insurance Forms” then “Empire Plan”.

Mail completed claim forms with supporting bills, receipts and, if applicable, a Medicare Summary Notice or statement from your other primary insurer to:

• United HealthCare
  P.O. Box 1600
  Kingston , New York 12402-1600

• ValueOptions
  P.O. Box 778
  Troy , New York 12181-0778

• The Empire Plan Prescription Drug Program
  Claims Review Unit

P.O. Box 1180

Troy , NY 12181-1180

(2005 claims only)

Note: If you are covered under the Empire Plan as an enrollee and as a dependent, you may submit claims for reimbursement of copayments to the Empire Plan as your secondary insurer.