07/20/21: COVID-19 Related Changes to Health Benefits

United HealthCare has provided a summary of changes to their benefits plan as a result of the COVID-19 pandemic. Click here for a summary.  This information is current as of July 2021 and is subject to change.

Health Benefits News

COVID-19 Medical Benefit Mandates: July 20,2021

NYSHIP General Information Book: January 21,2021: This replaces the 2017 NYSHIP General Information Book. The online version is available at:

https://www.cs.ny.gov/employee-benefits/nyship/shared/publications/general-information-book/2021/ny-gib-2021.pdf

Recall of Philips CPAP Machines and Medical Devices

Philips has issued a recall for certain sleep apnea machines and ventilators due to potential health risks. For more detailed information about the recall, click here.

Click here for the online registration process that Philips has created to allow you to check if your device is affected by the recall. If your device is being recalled, you should reach out to your physician to determine the most appropriate options for continued treatment. You can also call Philips toll free at 1-877-907-7508 for more information.

For questions about your benefits for medical devices, including CPAP machines, you can also call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Medical/Surgical Program, then the Benefits Management Program to reach the Home Care Advocacy Program (HCAP). Representatives are available from 8:00 a.m. to 4:30 p.m., Monday – Friday, ET.

Thinking of Retiring Soon?

The newly revised publication, Planning for Retirement is now available online to help you navigate the retirement process. This publication was created for employees of New York State and it includes important information on health insurance coverage and related benefits in retirement. Its companion publication, the Planning for Retirement Benefits Checklist, is also now available. Click on the links above to access them online, or ask you Heath Benefits Administrator for a copy. You can also order a Planning for Retirement Package here.

College-age Students’ Coverage

Effective July 1, 2020, enrollees who have elected both NYSHIP Vision and Dental Plan coverage will no longer be required to submit a full-time student verification form to Davis Vision (Davis). All full-time student verification will be obtained through the NYSHIP Dental Plan vendor, Emblem Health (Emblem), and will be considered adequate proof of full-time student status for the NYSHIP Vision Plan.

Dependent children ages 19 through 25 are still required to be a full-time student in order to be eligible for vision benefits. The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26 for medical regardless of student status.

As a result of this change, the vision benefit summary booklets have been revised to remove the student verification form. Additionally, the vision full-time student verification form posted on NYSHIP Online — www.cs.ny.gov/employee-benefits — has been replaced with guidance that all student verification is handled through Emblem.

Emblem Health, who is administering the dental program for enrollees under the New York State Health Insurance Program (NYSHIP), will begin a monthly systematic process of adding and removing dependents ages 19 through 25 based on their full-time student status. All information received from Emblem Health will also be used to update the dependent’s vision coverage under Davis Vision.

Removing Dependents (after first Friday of each month)
Dependents who have not confirmed as full-time student status will be removed from NYBEAS accordingly:

No response to Emblem Health Student Verification form 2 months prior to the 19th birthday: Dependent is removed the first of the month following their 19th birthday

No response to Emblem Student Verification form for Current Semester: Dependent is removed the first of the month following a 3-month extension beyond the last semester full-time student status was confirmed

Re-adding verified dependents (after the first Friday of each month)
Dependents who have confirmed full-time student status with Emblem Health since the previous monthly update, will be re-added to NYBEAS accordingly:

Retroactively: Dependent is re-added retroactive to the date they were originally removed with confirmation of continuous full-time student status.

When classes began: Dependent is re-added as of the first day of the month in which classes began. There will be a break in coverage when there is a break in between semesters. (Example: dependent attends Fall semester, but does not return to school again until the following Fall semester)

Age 25 removals: EBD will continue the automated process of removing all children from NYSHIP dental and vision effective the first of the month following their 25th birthday.

COBRA Eligibility
Dependents being removed from the file will automatically receive a COBRA application. Deadlines as noted on the application must be adhered to. Please instruct enrollees and/or their dependents to contact EBD at 1-800-833-4344 and select menu options for COBRA.

NYS Benefits

NYS Health Care and Dependent Care Advantage Account phone number: 1-800-358-7202

Health Care Spending Account and Dependent Care Advantage Account Information:
http://www.flexspend.ny.gov/ 

The Dependent Care Advantage Account (DCAA) and The Health Care Spending Account (HCSA) are types of flexible spending accounts, administered in compliance with Sections 125 and 129 of the Internal Revenue Code, that give you a way to pay your dependent care, health 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.

There are no fees for employees who participate in the FSA program. The FSA is funded by the Governor’s Office of Employee Relations in cooperation with the state public employee unions. The Legislature and Unified Court System also contribute on behalf of their employees.

The NYS Dept. of Civil Service/Employee Benefits Division web site has links to the Empire Plan Participating Provider Directory, benefits and enrollment information.

Listing of agency Health Benefit Administrators who handle enrollment problems and provide benefit information, usually located in the Personnel Office. From NYSHIP Online, click on “Using Your Benefits” and then “Health Benefit Administrators”. It allows employees to access the phone number for their HBA. It is not a list of all HBAs. For Agency code enter NYS Agencies

The Governor’s Office of Employee Relations site has information about benefits and collective bargaining.

NYS Work-Life Services has information about work/family programs for State employees.

External links on this we site are provided for your convenience only. PEF does not necessarily endorse these web sites and is NOT responsible for their content.

Empire Plan

The Empire Plan’s toll-free number: 1-877-7NYSHIP or 1-877-769-7447 

Traveling with The Empire Plan
Are you planning travel or will your child be starting college soon?  Remember to pack a copy of the 2021 On the Road with the Empire Plan booklet. Empire Plan coverage is available worldwide and not just for emergencies. Most parts of The Empire Plan have two levels of benefits known as network and non-network. If you use an Empire Plan participating (or network) provider, you will receive medically necessary covered services and supplies at little or no cost and have no claim forms to fill out. If you use a non-participating (or non-network) provider, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply.

The Empire Plan Medical/Surgical Program has network providers in many states, and the Hospital Program, Prescription Drug Program and Medicare Rx have nationwide networks. The Empire Plan Mental Health and Substance Abuse Program, the Home Care Advocacy Program (HCAP) and the Managed Physical Medicine Program guarantee access to network benefits nationwide if you call to make the necessary arrangements before you receive services. The toll-free number is 1-877-7-NYSHIP or 1-877-769-7447.

January 1, 2021, Nationwide Network Expansion
Empire Plan enrollees and covered dependents have access to UnitedHealthcare’s nationwide network of participating providers. The expanded network includes over 1.2 million physicians, laboratories and other providers such as physical therapists, occupational therapists and chiropractors located throughout the United States.

Telehealth Coverage
Telehealth coverage covers telehealth visits with participating providers in the Medical/Surgical Program and the Mental Health and Substance Abuse (MHSA) Program. Enrollees and covered dependents can access care through a video visit with their own doctor or therapist on a smartphone, tablet or personal computer. Telehealth visits are subject to the same enrollee cost sharing as in-person visits.

LiveHealth Online
Virtual Health Care Access with LiveHealth Online (LHO) – With Empire BlueCross’ partnership with LiveHealth Online, enrollees can stay home and have a telephone or video visit with a board-certified doctor or licensed therapist via smartphone, tablet, or personal computer. To get started, go to https://www.empireblue.com/nys and select the link to LiveHealth Online. Or, call LHO at 1-888-LiveHealth (1-888-548-3432), 24 hours/day, seven days/week.

Prescription Drug Program: Changes to The Empire Plan Flexible Formulary and Safety Notices
The list below contains a summary of changes to The Empire Plan Flexible Formulary. This table will be updated when drugs are excluded from coverage or if there are any safety notices or other impactful changes. If you have any questions regarding your prescription drug coverage, please contact The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 4 for the Prescription Drug Program or visit empireplanrxprogram.com.

United HealthCare (UHC) 1-877-769-7447 myuhc.com provides access to claims processed by United HealthCare, the participating 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: 030500 and choose a User ID. UHC will create a password and mail it to your home.
Basic Medical Provider Discount Program (Multiplan) 1-877-769-7447
When you use non-participating 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. 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 https://www.cs.ny.gov/employee-benefits. You can also call 1-877-7-NYSHIP and speak to a UHC representative.
Empire Blue Cross and Blue Shield – hospital services 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 personal 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 logon ID to safeguard the confidentiality of your records. You can check the status of a hospital claim or complete a coordination of benefits form.
Benefits Management Program Call UHC: 1-877-769-7447 for Prospective Procedure Review. For pre-admission certification (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 1-877-769-7447. It is your responsibility to call.
Beacon Health Options (formerly Value Options) 1-877-769-7447
Mental health & substance abuse services. You can access an online list of providers from the directory in the Civil Service web site at https://www.cs.ny.gov/employee-benefits.
CVS Caremark prescription drug program 1-877-769-7447
You can order prescription refills, check order status, view prescription history, check a drug copay and print forms through the link to the CVS Caremark website from the Civil Service website. From the Civil Service home page, follow the prompts for Benefit Programs, then NYSHIP Online, then Find a Provider. Scroll down to CVS Caremark.

 

HMOs

Health Maintenance Organizations
The toll-free numbers are for each HMO’s member services department.

Blue Choice 
165 Court St. Rochester, NY 14647
800-462-0108
585-454-4810

Empire BCBS HMO
P.O. Box 11800, Albany, NY
12211-0800
800-453-0113

Capital District Physicians’ Health Plan (CDPHP)
500 Patroon Creek Blvd., Albany, NY 12206-1057
800-777-2273
518-641-3700

Community Blue
1901 Main St., P.O. Box 80 Buffalo, NY, 14240-0080
877-576-6440
716-887-8840

Emblem Health (formerly HIP Health Plan of New York)
55 Water St., New York, NY 10041
877-861-0175

HMO Blue/Utica
Utica Business Park, 12 Rhoads Dr., Utica, NY 13502
800-722-7884

HMO Blue/Central & Southern Tier
333 Butternut Dr., Syracuse, NY, 13214
800-447-6269

Independent Health
511 Farber Lakes Dr., Buffalo, NY 14221
800-501-3439

MVP Health Care
P.O. Box 2207 625 State St., Schenectady, NY 12301-2207
888-687-6277

MVP Rochester
220 Alexander St., Rochester, NY 14607
585-325-3113
800-950-3224

Dental

The GHI Preferred Dental Plan is now called the EmblemHealth Preferred Dental Plan. All benefits remain the same. EmblemHealth is a for-profit health maintenance organization (HMO) and health insurance company based in New York City. It was formed in 2006 by the merger of Group Health Incorporated (GHI) and HIP Health Plan of New York.

EmblemHealth Dental Toll Free Customer Service can be reached at 1-800-947-0101.

College-age Students’ Coverage
Effective July 1, 2020, enrollees who have elected both NYSHIP Vision and Dental Plan coverage will no longer be required to submit a full-time student verification form to Davis Vision (Davis). All full-time student verification will be obtained through the NYSHIP Dental Plan vendor, Emblem Health (Emblem), and will be considered adequate proof of full-time student status for the NYSHIP Vision Plan.

Dependent children ages 19 through 25 are still required to be a full-time student in order to be eligible for vision benefits. The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26 for medical regardless of student status.

As a result of this change, the vision benefit summary booklets have been revised to remove the student verification form. Additionally, the vision full-time student verification form posted on NYSHIP Online — www.cs.ny.gov/employee-benefits — has been replaced with guidance that all student verification is handled through Emblem.

Emblem Health, who is administering the dental program for enrollees under the New York State Health Insurance Program (NYSHIP), will begin a monthly systematic process of adding and removing dependents ages 19 through 25 based on their full-time student status. All information received from Emblem Health will also be used to update the dependent’s vision coverage under Davis Vision.

The EmblemHealth Preferred Covered Services/deductible for Participating Providers can be found here: https://www.cs.ny.gov/employee-benefits/nyship/group/1/10/3/dental/3.cfm

The EmblemHealth Preferred Reimbursement Schedule for Non-Participating Providers can be found here: https://www.cs.ny.gov/employee-benefits/nyship/group/1/10/3/dental/12.cfm

For information regarding the EmblemHealth Preferred Dental Plan and to obtain the names of participating dentists in your area, refer to the Directory of Participating Dentists, call GHI Customer Service at 1-800-947-0101, or visit the website.

For additional information about dental health and dentistry, please visit these websites:

American Association of Orthodontists
For information about braces:  https://mylifemysmile.org/
American Dental Association
Oral health topics: http://www.mouthhealthy.org/en/glossary/
American Academy of Periodontology (gum disease specialty)
Consumer information about gum disease:  https://www.perio.org/consumer/gum-disease.htm
American Academy of Pediatric Dentistry
Resources for parents: http://www.mychildrensteeth.org/

Vision

The Davis Vision Care Customer Service Toll free phone number: 1-888-588-4823

Davis Vision online portal: https://idoc.davisvision.com/DavisVision.Member/Home/Index?id=$PPL2932&grp=XE9&subgrp=999&plan=98X

You can access the Davis Vision web site from the Department of Civil Service website: https://www.cs.ny.gov/employee-benefits/nyship/group/1/10/vision/index.cfm

If prompted, choose your group and plan, then select Other Benefits and then Vision Benefits. Follow the links to the Davis Vision website.

Out-of-Network Claims Address
Davis Vision
Vision Care Processing Unit
P.O. Box 152
Latham, N.Y.  12110

For more information about vision and eye care use the links below:

American Optometric Association
Eye and vision problems

Glossary of eye terminology
Includes common terms and symptoms

MayoClinic.com
Information about contact lenses

College-age Students’ Coverage
Effective July 1, 2020, enrollees who have elected both NYSHIP Vision and Dental Plan coverage will no longer be required to submit a full-time student verification form to Davis Vision (Davis). All full-time student verification will be obtained through the NYSHIP Dental Plan vendor, Emblem Health (Emblem), and will be considered adequate proof of full-time student status for the NYSHIP Vision Plan.

Dependent children ages 19 through 25 are still required to be a full-time student in order to be eligible for vision benefits. The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26 for medical regardless of student status.

As a result of this change, the vision benefit summary booklets have been revised to remove the student verification form. Additionally, the vision full-time student verification form posted on NYSHIP Online (www.cs.ny.gov/employee-benefits) has been replaced with guidance that all student verification is handled through Emblem.

Emblem Health, who is administering the dental program for enrollees under the New York State Health Insurance Program (NYSHIP), will begin a monthly systematic process of adding and removing dependents ages 19 through 25 based on their full-time student status. All information received from Emblem Health will also be used to update the dependent’s vision coverage under Davis Vision.

FAQ

How do I obtain a new or replacement ID Card?
Answer: You must contact the carrier directly. They will be able to issue a new and/or replacement ID card, along with providing your personal ID information via phone if available. You may also contact your Agency’s Health Benefits Administrator (HBA) normally located within the HR/Personnel Office. Please keep in mind PEF as a union does not have access to this information and is unable to obtain your personal ID information or issue ID Cards.

Where can I locate Health Benefits informational packets including The NYSHIP General Handbook and claims forms?
Answer: All of these materials are located via NYSHIP Online or from your Agency’s Health Benefits Administrator (HBA) normally located within the HR/Personnel Office.

Why am I and/or my dependent being denied services or being told we are inactive?
Answer: Your Agency’s Health Benefits Administrator (HBA), normally located within the HR/Personnel Office, is responsible for ensuring your enrollment records are accurate and fully up-to-date in the State’s NYBEAS system. Your HBA is responsible for making any necessary corrections and/or changes. Please keep in mind PEF as a union does not have access to this information and is unable to make these changes to personal profiles. 

How do I find out whether a service or item is covered under my plan?
Answer: General benefit information is in the plan’s benefit booklet or member handbook. To obtain more specific benefit information, the plan’s member or customer service department should be contacted. Empire Plan enrollees who want to know beforehand how much United HealthCare (UHC) will pay for a medical service or item may submit a Pre-determination Request form.

How can I find out which doctors participate in the Empire Plan?
Answer: Members may call UHC at 1-800-942-4640. UHC’s representatives can provide the information over the telephone or a printed listing can be generated upon request. The participating provider directory is also available on the NYS Department of Civil Service web site . On the Civil Service home page select Benefit Programs, then select NYSHIP Online and, if prompted, choose your group and Empire Plan. Then select Find a Provider. Enrollees should always confirm a provider’s participation status at the time they schedule an appointment.

What benefits are available if I go to a non-participating provider?
Answer: Services received from a non-participating provider are eligible for consideration under the Basic Medical Expense Program. The member is responsible for paying the provider and filing a claim with UHC. S/he will then be reimbursed for eligible expenses less any deductible and coinsurance amounts applied on the claim.

Are there any limitations on the number of copayments I have to pay an Empire Plan participating provider for services received during any single office visit?
Answer: There are two instances where the number of copayments is limited. First, if a participating provider bills for both an office visit charge and an office surgery charge in any single visit, only one copayment will be charged for these services. Second, when outpatient radiology services and diagnostic laboratory services are performed by the same participating provider during a single visit, only one copayment will be charged. However, if the participating provider sends a sample/specimen to another participating provider because s/he can’t perform the necessary lab services, another copayment will be charged.

Appeal Process Q&A

What recourse do I have if I disagree with a determination made by my HMO or Empire Plan insurer?
Answer: Each health care plan offered to PEF members has an appeal procedure. When an HMO or Empire Plan insurer has determined a medical service or item isn’t covered, in whole or in part, a review of the determination may be requested using this procedure. Details on how to file an appeal are in the plan’s benefit booklet or member handbook.

What can I do if I’m not satisfied with the outcome achieved through the plan’s appeal procedure?
Answer: Members who wish to pursue their appeal further should contact the PEF Joint Committee on Health Benefits (JCHB). They will conduct an investigation of the complaint that includes contacting the HMO or Empire Plan insurer to obtain an explanation of the determination. They will then report findings to the PEF JCHB. If the PEF JCHB decides the response is inconsistent with their understanding of Article 9 of the PEF/NYS contract, or the health plan’s contract with the State, they will present the appeal to management for resolution. If management upholds the plan’s determination, the PEF JCHB, in consultation with PEF’s Contract Administration Department, will determine whether or not to file a contract grievance.

What can I do if I’m not satisfied with the outcome achieved through the JCHB’s appeal process?
Answer: The member can file an external appeal, which is described in the following Q&A. In addition, at any point a member may contact one of the three state agencies that oversee health insurers and HMOs. These agencies are the NYS Department of Financial Services (DFS), the NYS Department of Health (DOH), and the Office of the Attorney General.

For problems related to the payment of benefits, members may contact the Consumer Services Bureau of the NYS DFS at 1-800-342-3736. DFS assures that an insurer’s actions are in accordance with NYS Insurance Law; DFS rules and regulations; and contractual provisions.

HMO enrollees who are unable to get the care they need, or who are dissatisfied with the quality of care they are receiving, may contact the DOH Managed Care Hotline at 1-800-206-8125. DOH is responsible for the authorization and regulation of HMOs in the state, and assures the delivery, continuity, accessibility and quality of health care services are satisfactory.

For problems where you think a law has been broken or fraud might be involved, members may contact the Attorney General’s Health Care Bureau at 1-800-771-7755.

Finally, a member may wish to file a lawsuit against the HMO or insurer when all other attempts to resolve the matter have failed.

How does the external appeals process work?
Answer: The external appeals process is for all health-care services denied on the grounds that the service is not medically necessary. There is also an external review process for patients with life-threatening or disabling conditions who want to participate in clinical trials, use off-label drugs, or use experimental or investigational procedures or treatments when such services are denied on the basis that they are experimental or investigative.

To be eligible for an external appeal, you must first exhaust the health plan’s internal review process. The law permits plans to charge patients up to $50 for an external appeal, but they must give the money back to you if you win the appeal. Randomly assigned agents certified by the state will do the external reviews. These agents are required to make a determination on an appeal within 30 days or three days for emergency cases. Your health plan will send you more information on the external appeals process. You can find a summary of the law through the NYS Department of Financial Services website.

UHC’s Reasonable and Customary (R&C) Charge is lower than what my provider charged me. How do they determine their R&C Charges and how often are they updated?
Answer: Since July 1, 2011, UHC has been using the FAIR Health, Inc. database to determine R&C Charges. FAIR Health is an independent, nonprofit organization selected by the Attorney General of the State of New York. The FAIR Health database is made up of charge data from billions of healthcare claims submitted to health insurers across the nation. The information in the database is updated by FAIR Health at scheduled times each year. The R&C Charge for The Empire Plan is set at the 90th percentile. An R&C Charge set at the 90th percentile is the amount equal to or greater than 90 percent of the charges in the database for the procedure billed in the geographic area where the provider is located (based on zip codes).

To help members estimate their out-of-pocket expenses for out-of-network care, FAIR Health has developed an online consumer cost look-up tool, available for free at www.fairhealthconsumer.org. Members can also find user-friendly educational materials at this site.

What can I do if I disagree with UHC’s R&C Charge?
Answer: Members enrolled in the New York State Health Insurance Program (NYSHIP) have a right to an external appeal when their HMO or The Empire Plan denies health care services as not medically necessary (including appropriateness, health care setting, level of care, or effectiveness of a covered benefit), or experimental / investigational (including a clinical trial or rare disease treatment).

You must send an external appeal application to the Department of Financial Services (DFS) within 4 months from the date of the final adverse determination from the first level of appeal with the health plan OR the health plan agrees to waive the internal appeal process. Health plans may charge you a $25 fee, not to exceed $75 in a single plan year. The fee will be returned to you if the external appeal agent overturns the health plan’s denial.

Randomly assigned external appeal agents certified by DFS will do the external reviews. These agents are required to notify you of the outcome within 72 hours for expedited appeals or 30 days for standard appeals. Your health plan is required to notify you of your right to an external appeal. For more detailed information, see the DFS web site at http://www.dfs.ny.gov/insurance/extapp/extappqa.htm

Combined Health Plan Contracts

Consumer information, services and publications

Healthfinder
A gateway consumer health and human services website sponsored by the U.S. government

National Library of Medicine
Includes direct MEDLINE access for on-line searches of medical literature


Prescription drugs

Food and Drug Administration

Provides information about drugs recently approved by the FDA, complete text of drug package inserts and Medwatch, the reporting program for adverse reactions and product problems.

Institute for Safe Medication Practices

Includes warnings about similar names and packaging of different drugs, a practitioner reporting system for medication errors, and alerts for patients.

MEDLINEplus: Drug Information

Drug information on thousands of prescription and over-the-counter medications from the National Institutes of Health.

Medication.comSponsored by the American Society of Health System Pharmacists; contains drug information by brand or generic name, potential side effects and precautions.

https://www.consumeraffairs.com/health/online-pharmacies
Consumer Affairs, a unit of Consumer Reports, developed this guide to online pharmacies. In addition to the pharmacy reviews, the site contains useful information such as how such pharmacies are licensed and accredited, how they maintain security, and whether having prescription drugs delivered is a safe option.

Helpful Links & Resources

Listing of agency Health Benefit Administrators who handle enrollment problems and provide benefit information are usually located in the agency Personnel Office. From NYSHIP Online, click on “Using Your Benefits” and then “Health Benefit Administrators.” It allows employees to access the phone number for their HBA. It is not a list of all HBAs. For Agency code enter NYS Agencies.

Health Care Spending Acct: 1-800-358-7202
www.flexspend.ny.gov

EmblemHealth (previously GHI) Preferred Dental Plan: 1-800-947-0101
https://cs.ny.gov/employee-benefits*

Davis Vision: 1-877-226-1412
https://cs.ny.gov/employee-benefits

The Empire Plan  toll-free number: 1-877-7NYSHIP or 1-877-769-7447
www.empireblue.com  

United HealthCare (UHC) 1-877-769-7447 myuhc.com provides access to claims processed by United HealthCare, the participating provider directory and enrollment verification. Register by visiting the website and clicking on the Register button. Fill in the basic information, including your Group Number: 030500 and choose a User ID. UHC will create a password and mail it to your home.
Basic Medical Provider Discount Program (Multiplan) 1-877-769-7447
When you use non-participating 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. 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 https://www.cs.ny.gov/employee-benefits. You can also call 1-877-7-NYSHIP and speak to a UHC representative.
Centers of Excellence for Cancer (Cancer Resource Services) 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/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 https://www.myoptumhealthcomplexmedical.com/gateway/public/welcome.jsp
Empire Blue Cross and Blue Shield – hospital services 1-877-769-7447
To use the Empire Blue Cross and Blue Shield website, register in the Member Services window on the site. You will need your personal 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 logon ID to safeguard the confidentiality of your records. You can check the status of a hospital claim and complete a coordination of benefits form.
Benefits Management Program Call UHC: 1-877-769-7447 for Prospective Procedure Review. For pre-admission certification (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 1-877-769-7447. It is your responsibility to call.
Beacon Health Options (formerly Value Options) 1-877-769-7447
Mental health & substance abuse services. You can access an online list of providers from the directory in the Civil Service web site at https://www.cs.ny.gov/employee-benefits.
CVS Caremark prescription drug program 1-877-769-7447
You can order prescription refills, check order status, view prescription history, check a drug copay and print forms through the link to the CVS Caremark website from the Civil Service website. From the Civil Service home page, follow the prompts for Benefit Programs, then NYSHIP Online, then Find a Provider. Scroll down to CVS Caremark.
Managed Physical Network 1-877-769-7447
Chiropractic care & physical therapy
Home Care Advocacy Program 1-877-769-7447
Durable medical equipment, home nursing care, infusion therapy and diabetic shoes. Diabetic supplies 1-888-306-7337. Ostomy supplies 1-800-354-4054. EPIC Hearing Service, 1-866-956-5400, is a program that offers nationwide access to hearing services and treatments, including hearing diagnostics and hearing aids.
Centers of Excellence for Infertility 1-877-769-7447
Call for prior authorization of qualified procedures, regardless of provider. Call for information about all services for infertility.

American Medical Association (AMA): DoctorFinder

American Board of Medical Specialistshttps://www.abms.org

NYS Department of Health Office of Professional Medical Conduct https://www.health.ny.gov/professionals/doctors/conduct/

Includes complaint form to file a complaint against a doctor or physician assistant; also includes names of doctors disciplined by the NYS Department of Health.

NYS Education Department OFfice of The Professions
http://www.op.nysed.gov/#

Contains plain-language consumer information about professionals licensed by the Education Department including chiropractors, dentists, nurses, physical and occupational therapists, optometrists, psychologists and social workers. Also included are a professional discipline complaint form, information about professionals disciplined by the Board of Regents and online license verification.