about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). Enroll in Medicare Parts A and B (be sure not to decline Part B). treatment before your NYSHIP card arrives, your provider can confirm your enrollment 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. NYSHIP HMOs are available in various geographic areas of New York State. Since 1995, the Department of Civil Service has won 209 awards recognizing excellence in health communications effectiveness. HIP Many of these changes cannot be reversed by diet and exercise. Medicare is a health insurance program administered by the federal government to individuals over age 65 or who are eligible due to disability. 2023 At A Glance - Easy to access benefits summary that can answer most of your general questions. benefits was sent to you. Not already be enrolled in NYSHIP as an employee. NYSHIP will again offer the Opt-Out Program in 2023, which will allow eligible employees who have employer sponsored group health insurance, to opt out of their NYSHIP coverage in exchange for an incentive payment. COVID-19 Information for Empire Plan Network Providers New York State Service Center, P.O. Aside from emergencies, coverage for services received outside the service area is limited and at the discretion of the individual HMO. What is The Empire Plan? PDF HEALTH INSURANCE CHOICES FOR 2022 - Business Services Center 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. Using participating providers helps keep the cost to you and The Empire Plan at a reasonable level. benefits, Demographic Data Self-Identification Form. Representatives are available 24 hours a day, seven days a week. The directory is updated weekly. *Some people confuse Medicare with Medicaid. This Empire Plan pays for covered hospital services, physicians' bills, prescription drugs, and various other medical treatments including massage therapy. United empire plan form: Fill out & sign online | DocHub The 2013 Participating Agency Per Enrollee Fee is $25.32 annually, or $2.11 monthly. Enrollees have access to over 1.2 million network providers and facilities throughout the United States and are not required to choose a Primary Care Physician (PCP) or obtain referrals to see specialists. A. A.The Empire Plan is NYSHIPs unique health insurance plan designed exclusively for New York States public employees and employers. The Coverage Examples are: Versions for each NYSHIP HMO 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. If you are a New York State Active Employee and unsure of your group, our Enrollee Group Wizard will ask you a series of questions in order to determine which group you should select. These definitions are intended to help improve consumer understanding and do not necessarily reflect your plans definition of the same term. TTY users call 711. PDF PA Participating Agencies Prior authorization is required. This is currently the largest hospital network available in the United States. you wish to, but you do not need to notify the plan administrator.) The section below includes a video, FAQs, publications, contact information and links to important resources about Medicare. If you examine your NYSHIP Empire Plan for plastic surgery coverage, you'll probably spend a long time looking. A. The Employee Benefits Division is required to send a Medicare Part D Prescription Drug Program notice annually to all active and retired NYSHIP enrollees and dependents who are 65 or older, or eligible for Medicare due to disability. This will help protect your identity. Rates and Health Plan Choices - Information on your health insurance options under NYSHIP. For more information on the new cards, please visit http://go.medicare.gov/newcard. Q. Beginning January 1, 2002, NYSHIP will replace Univera as administrator of What are the administrative costs for The Empire Plan? A. NYSHIP is one of the largest employer sponsored group health insurance programs in the United States. All rights reserved. What are the employee eligibility rules for The Empire Plan? 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. What local government employers currently participate in NYSHIP's Empire Plan? The Empire Plan Medical/Surgical Provider Directory Q. P.O. Table of Contents Enrollees usually pay a copayment as a per-visit fee. The Empire Plan is the primary health benefits plan for NYSHIP, providing coverage to about 1.1 million members. Medicare Rx prescription drug program (when address listed on record shows U.S. residence). The Empire Plan Hospital Benefits Program has two levels of benefits - network and non-network. The Empire Plan offers over 190,000 participating providers nationwide. Is this what I will pay if I experience one of these events? Your hospital benefits will differ depending on whether you choose a network or non-network hospital. And, while Medicare does not pay for medical services outside the U.S., Empire Plan benefits are available worldwide. Work a regular schedule of 20 hours or more a week, or be paid an annual salary at a rate of $2,000 or more per year, or be in one of the following categories: A paid member of a public legislative body, An unpaid board member of a public authority with at least six months service as a board member, Receive your major source of family income from your public employment. What is covered by Empire Plan Nyship? - Wellbeing Port Some HMOs may provide coverage for urgent or routine care outside the service area or for college students away from home. If you use a nonparticipating provider, deductibles, coinsurance and benefit limits may apply. SUNY campuses), in addition to your NYSHIP SEHP coverage. Does The Empire Plan offer a rate structure that includes a reduced premium for Medicare-eligible individuals? 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. PDF Empire Plan Contact Information - Government of New York The person who is listed as the Executor/Executrix for the deceased enrollee may apply for reimbursement on their behalf. provider directory online. To view a copy of an SBC for The Empire Plan or a NYSHIP HMO, visit www.cs.ny.gov/sbc. Please note: If your employment with SUNY in a benefits-eligible position NYSHIP SEHP, are not covered under Network coverage. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. Empire Plan Prescription Drug Program website, The Empire Plan Medical/Surgical Provider Directory, Demographic Data Self-Identification Form. The Empire Plan The Empire Plan is available to all employees of the State of New York and Participating Employers, regardless of location. 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. Yes. You will receive information about the plans available to you, and their cost, at the end of each calendar year. benefits on our contact the agency Health Benefits Administrator on your campus to update your Benefits are available, vary depending on the HMO and may require a greater percentage of cost sharing. Why do retirees still need The Empire Plan after they have primary coverage under Medicare? Q. Medical/Surgical Lets make healthy happen. As a reminder, it is no longer necessary to reenroll in the Opt-Out Program each year. A. You must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and Press or P.O. Available for iOS and Android devices. The Empire Plan covers the Medicare Part A hospital deductible ($1,132 per hospital stay of one to 60 days in 2011; amount may change yearly) as well as some other medical expenses Medicare does not cover. Contact Us Empire Login Empire Registration . The campus Student Health Center continues to be available to you (on most Yes, you can apply for IRMAA on behalf of a deceased enrollee. Please refer to the IRMAA Reimbursement Application instructions for more information. You can order mail service prescriptions online, reducing the prescription cost for you and The Empire Plan. Forms - The Empire Plan's Provider Directory The Empire Plan will never ask for your full Social Security number, credit card number or personal bank account information. directory and Certificate of Insurance will come separately. 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. What are The Empire Plan confidentiality practices? . Please read the summary carefully. The Empire Plan is designed to provide enrollees with comprehensive medical care coverage. These Coverage Examples are intended to help you compare your overall coverage and are not intended as a cost estimator. BlueCross BlueShield of Western New York Basic Medical Provider Discount Program Directory. The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). The Summary of Benefits and Coverage is a simple, federally mandated table intended to aid consumer understanding. 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 . The site will remember your group for future visits. 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 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. Choose your group and plan to get to the NYSHIP Online homepage. If you receive a pension, any reimbursement for Medicare Part B will be added to your pension check. TTY: 711 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. Welcome to the New York State Health Insurance Program (NYSHIP). The Empire Plan is available to New York States public employees and employers. 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. medical coverage: the NYSHIP SEHP does not require you or your covered dependents You should expect to choose a participating physician and a participating hospital. Enrollees can track their Plan's medical/surgical claims and history, print explanations of benefits (EOBs), create personalized provider directories and much more. It is important to know the difference between a phone/email/text scam and a legitimate call. The reports provide projected Empire Plan experience based on claims paid through the previous quarter and projected premium rates. Terms defined in the Uniform Glossary 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. For direct access to the provider/facility directory, visit ReferralConnect. 12.) How will I know if I am required to pay IRMAA? is ending, please discard the health insurance and dental plan ID cards and 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. 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. In order to provide you with targeted information about your benefits, you will need to select your group (negotiating unit . For Please Note: This page highlights only general differences between The Empire Plan and NYSHIP HMOs. You are always covered for emergency care. It is the combination of Medicare coverage plus The Empire Plan that protects enrollees. Do not sign up for any non-NYSHIP Medicare Advantage Plan or Part D prescription plan. Midtown and Queens Pharmacies OPEN 9:00am-5:00pm on Saturday You may contact your local SSA office to verify whether you pay IRMAA by visiting https://www.ssa.gov/onlineservices or call 800-772-1213. Use this checklist to focus your research and ensure that you select the plan that best meets your needs. PDF Department of Civil Service - Office of the New York State Comptroller A managed-care system in a specific geographic area that provides comprehensive coverage through a network of providers. Under this arrangement, the premium cost for the agencys Medicare-primary enrollees is lower than the cost for active employees. Box 1850, Hicksville, NY 11802, Claims submission fax: 855-378-8309 and Non-Participating Provider Claim Forms and Administrative Forms. In addition to the publication mailings, is other customer service provided? . 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. Be sure you understand how your benefits will be affected if you change options. Forms - Empire Plan Claims Forms If the doctor you choose participates in The Empire Plan, network benefits will apply for covered services. NYSHIP - Massage For Life Online: https://nyrmo.optummessenger.com/public/opensubmit. December 1, 2022 . 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. Why do retirees still need The Empire Plan after they have primary coverage under Medicare? The reports explain the basis for the projection. 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. 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. Approximately 800 local government employers currently offer NYSHIP's Empire Plan to their employees. In the aggregate, all Participating Agencies pay the same premium under the Medprime premium structure as they would pay under a traditional two-tier rate structure (individual and family). This site uses cookies. Your copayment(s) should be your only expense if you receive medically necessary and covered services from a participating provider. A. 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. Enrollees usually pay a copayment as a per-visit fee or coinsurance. A. I pay an IRMAA premium for Medicare Part D, can I be reimbursed? The Empire Plan has over 15,000 network hospitals, skilled nursing facilities and hospice care facilities nationwide. A copy of DD-214 and proof of full time student status is required. through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of Health Benefits. If you are currently enrolled in treatment for mental health/substance abuse This page has information about how your Medicare benefits will work with your NYSHIP coverage.*. The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Does The Empire Plan offer a rate structure that includes a reduced premium for Medicare-eligible individuals? If you need assistance, contact the agency Health Benefits Administrator on Demographic Data Self-Identification Form. 2021 Empire. Your HBA, usually located in your agencys personnel office, can also print you a copy. The Empire Plan customized AchieveSolutions website provides confidential online access to educational and screening materials, disease management programs, and claims and coverage information. NYSHIP Online Login - Government of New York A. NYSHIP protects over 1.2 million State and local government employees, retirees and their families in the United States. Call Member Services at 1-877-7-NYSHIP (1-877-769-7447), The Empire Plan Prescription Drug Program, The Empire Plan Mental Health and Substance Use Program. Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. Notice of Creditable Coverage Letter (COBRA). Open enrollment is the ideal time to make changes to your health insurance plan. Empire Plan Health Insurance Certificate - Detailed description of the benefits and plan . Box 6590, Lee's Summit, MO 64064-6590, Claims submission: P.O. Contact information, and Links to each Empire Plan program administrator web site, which each include a current list of providers.To find the most up-to-date information about your health insurance coverage, visit NYSHIP Online at https://www.cs.ny.gov/employee-benefits. UnitedHealthcare has a customized website, MYUHC, for enrollees to access information about the Medical/Surgical Program. A. The Empire Plan is a self-funded, non-ERISA health insurance option available to those eligible to participate in the New York State Health Insurance Program (NYSHIP) - primarily New York State government employees, retirees, and their dependents. The Summary of Benefits and Coverage (SBC) is a standardized comparison document required by the Patient Protection and Affordable Care Act. A self-insured Preferred Provider Organization (PPO) plan with features of a managed care system. Out-of-network benefits not available. EmpireBlue NYS Home Access health care services remotely using The Empire Plan's telehealth benefit through, Demographic Data Self-Identification Form. Independent Health PDF 2022 NYSHIP OPTIONS BY COUNTY - Government of New York enrollees except for references to the ID card and listings of cardiac rehabilitation The administrative agency fee was eliminated in 2004. TTY: 1-888-697-9054 Are there Empire Plan participating providers in our area? The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the audit Health Benefits - Retiree - Empire Plan - Government of New York (including alcoholism), please contact ValueOptions at 1-800-446-3995 for help HMOs have no annual deductible. guidance posted by the Federal Trade Commission (FTC). ), 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). MVP. in the enclosed summary. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. For medical, mental health and other providers, see the Participating Provider Directory. Copyright 2023 CVS Caremark. New York State Health Insurance Program (NYSHIP) Notice of Privacy Practices, Demographic Data Self-Identification Form, Be expected to work at least three months; and. Customer Care Correspondence, P.O. Empire Plan - Summary of Benefits and Coverage - Government of New York For questions about NYSHIP HMOs, contact the HMOs directly (see pages 6 and 7). Q. I see that the Coverage Examples page shows a "you pay" amount. Q. Also, information about The Empire Plan pharmacy locations, including pharmacies participating in the vaccine network and 24-hour service pharmacies, is available here. The directory you will receive for Empire Plan enrollees also applies to SEHP When an employer joins The Empire Plan, what publications are mailed to their employees? If you need medical This coverage continues in 2002. PDF 2022 Summary of Benefits - SilverScript
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