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Updated January 17, 2014 - Health Benefits Homepage

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Empire Plan

The Empire Plan's toll-free number is 1-877-7NYSHIP or 1-877-769-7447 
The 2014 Empire Plan Flexible Formulary is posted here.  This list is limited to frequently prescribed drugs. For information about other drugs not on the list, call CVS Caremark at 1-877-7NYSHIP or 1-877-769-7447 and listen for the prompts for the Empire Plan Prescription Drug Program.

Note: Prescription Drug and Mental Health/Substance Abuse Administrator Changes Effective January 1, 2014. Use the same Empire Plan toll-free number listed above to contact CVS Caremark and Value Options.

“New to You” Prescriptions Program  

Effective January 1, 2013, a “New to You" Prescriptions program was implemented for PS&T employees enrolled in The Empire Plan. This program requires you to have two (2) 30-day supplies of a newly prescribed medication filled at a retail pharmacy, subject to the 30-day supply copay, prior to being able to obtain a 90-day fill at the 90-day supply copay. This will help to determine the effectiveness/ineffectiveness of the new medication while promoting cost savings. More information is available here.

Prescription Drug Program

Copay

30-day supply at network retail, mail service or specialty pharmacy  
Level 1 (Most Generics) $5
Level 2 (Preferred) $25
Level 3 (Non-preferred)* $45
31-90 day supply at mail service or specialty pharmacy  
Level 1 (Most Generics) $5
Level 2 (Preferred) $50
Level 3 (Non-preferred)* $90
31-90 day supply at network retail pharmacy  
Level 1 (Most Generics) $10
Level 2 (Preferred) $50
Level 3 (Non-preferred)* $90

*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.

No Changes in Medical or Hospital Copays During the 2011-2015 Contract

Participating Provider Services Copay
Office visit $20
Office surgery $20
Radiology $20
Diagnostic laboratory tests $20
Free-standing cardiac rehab center visit $20
Convenience care clinic $20
Urgent care center $20
Free-standing outpatient surgical centers $30
Local professional/commercial ambulance transportation $35
Chiropractic or Physical Therapy Services  
Office visit $20
Radiology $20
Diagnostic laboratory tests $20
Hospital Services in a Network Hospital  
Outpatient physical therapy $20
Outpatient surgery $60
Diagnostic radiology $40
Mammography screening $40
Administration of Desferal for Cooley's Anemia $40
Emergency room care+ $70
Pre-Admission Certification  
Enrollees must call 1-877-7NYSHIP or 1-877-769-7447 before any scheduled admission, before the birth of a child, and within 48 hours after an emergency or urgent admission.  
Prospective Procedure Review  
Enrollees must 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 $20
Visit to mental health professional $20
Emergency room care+ $70
Collect only ONE COPAY when billed by the same provider  
Office visit & office surgery on same date OR $20
Radiology & Laboratory service on same date $20
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.  

Preventive Care Services

 
Benefit Effective Date

Additional Information

Preventive care services covered under federal health care reform law not subject to copayment

10/1/11

See https://healthcare.gov/what-are-my-preventive-care-benefits
Additional preventive care services covered under federal health care reform law not subject to copayment for  women (including pregnant women)

1/1/13

See https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2
Additional preventive care services covered under federal health care reform law not subject to copayment for children

1/1/13

See https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3

Combined Annual Deductible & Coinsurance Maximum

 
Combined Annual Deductible & Coinsurance Maximum
Combined Annual Deductible $1,000/enrollee, $1,000/spouse/partner, & $1,000 all dependent children combined. Includes non-network expenses under the Basic Medical Program, Home Care Advocacy Program and the Mental Health and Substance Abuse Program.
Combined Coinsurance Maximum $3,000/enrollee, $3,000/spouse/partner, & $3,000 all dependent children combined. Includes non-network expenses under the Basic Medical Program, Home Care Advocacy Program and the Mental Health and Substance Abuse Program.

 

The 2014 Empire Plan Flexible Formulary is posted here.  This list is limited to frequently prescribed drugs. For information about other drugs not on the list, call CVS Caremark at 1-877-7NYSHIP or 1-877-769-7447 and listen for the prompts for the 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. 
 

 

United HealthCare  1-877-7NYSHIP or 1-877-769-7447
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, 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. 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.ny.gov. 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 https://www.myoptumhealthcomplexmedical.com/gateway/public/welcome.jsp
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.
Benefits Management Program
Call United HealthCare at 1-877-7NYSHIP or 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 1-877-7NYSHIP or 1-877-769-7447. It is your responsibility to call.
Value Options  1-877-7NYSHIP or 1-877-769-7447
Mental health & substance abuse services. You can access an online list of Value Options providers from the directory in the Civil Service web site at www.cs.ny.gov.
CVS Caremark prescription drug program  1-877-7NYSHIP or 1-877-769-7447
The 2014 Empire Plan Flexible Formulary is posted here. 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  1-877-7NYSHIP or 1-877-769-7447
Chiropractic care & physical therapy
Home Care Advocacy Program 1-877-7NYSHIP or 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  Program that offers nationwide access to hearing services and treatments, including hearing diagnostics and hearing aids.

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.