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Submit 2019 Empire Plan claims by April 29


If the Empire Plan is your primary insurer, April 29, 2020 (120 days after the end of the calendar year), is the last day to submit your 2019 claims if you have used a non-network provider or non-network pharmacy.

If The Empire Plan is your secondary insurer, you must submit claims by April 29, 2020, or within 120 days after your primary health insurance plan processes your claim, whichever is later.

For non-network provider claim forms, you can ask your agency health benefits administrator or find them online at http://www.cs.ny.gov/employee-benefits. Just follow the prompts there to access NYSHIP Online and select “Forms”.  Or call 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program.

Submit completed claim forms with supporting bills, receipts and, if applicable, a Medicare summary notice or statement from your other primary plan as follows:

The Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and non-network physical medicine services:

UnitedHealthcare Insurance Co. of New York
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax:  845-336-7716

Non-network inpatient and outpatient hospital services:

Empire BlueCross BlueShield
New York State Service Center
P.O. Box 1407, Church Street Station
New York, New York, 10008-1407
Claim submission fax:  888-367-9788

Non-network mental health and substance abuse services:

Beacon Health Options, Inc.
P.O. Box 1850
Hicksville, NY 11802

Claims submission fax:  855-378-8309

Prescriptions filled in 2019 at non-network pharmacies or without using your Empire Plan Benefit Card:

CVS Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136