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Updated January 16, 2014 - Health Benefits Homepage

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What’s New in the Empire Plan for 2014?

 

UPDATE 12/30/13: Effective January 1, 2014, the Empire Plan Mental Health and Substance Abuse (MHSA) Program will be administered by ValueOptions.

If you need services or have any questions about the transition, call the Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447), press 3 for the MHSA Program and select the option for 2014 benefits.

Please note that you may have received publications, including the 2014 Empire Plan At A Glance and NYSHIP Rates & Deadlines for 2014 with incorrect contact information for the MHSA Program. Revised versions of these publications are posted on the Department of Civil Service website at https://www.cs.ny.gov. To access these publications:

  • Click on Benefit Programs,

  • Then NYSHIP Online and follow the prompts to the NYSHIP Online homepage and

  • Select using Your Benefits and then Publications.

If you received the Notice of Correction for the 2014 Health Insurance Choices booklet, please disregard it. The information in the 2014 Health Insurance Choices is correct and the online version reflects this as well.    

Autism coverage is required under New York state insurance law for screening, diagnosis and treatment of autism spectrum disorders including Applied Behavioral Analysis (ABA) services.  Effective January 1, 2014, the Empire Plan’s annual cap for ABA services is changing from $45,000 to a maximum annual of 680 hours of service, network and non-network combined.

The United States Preventive Services Task Force recommends a onetime screening for Hepatitis C infection to adults born between 1945 and 1965. According to the United States Centers for Disease Control and Prevention (CDC), approximately 75% of Hepatitis C infection and about 73% of Hepatitis C-associated mortality occurs in individuals born between 1945 and 1965 – the baby boomer generation. New York State Department of Health statistics show that as many as 150,000 New Yorkers are unaware of their Hepatitis C status. A new law (A.1286-A/S.2750-A) will ensure that all individuals born between 1945 and 1965 are offered a hepatitis C screening test or diagnostic test whenever they are a patient at a hospital, clinic or a physician’s office. United Health Care started covering the screening for this category of patients effective October 1, 2013. 

 

2014 Empire Plan Flexible Formulary

The 2014 Empire Plan Flexible Formulary is available here. Starting 1/1/14, the Empire Plan Prescription Drug Program will be administered by CVS Caremark. Enrollees will be able to securely log onto the Empire Plan Prescription Drug Program website administered by CVS Caremark.  With your secure logon, you will be able to use all of the web site features, including mail order prescription refill ordering and drug pricing tools.

To access the CVS Caremark website, go to the Department of Civil Service website at https://www.cs.ny.gov. Click on “Benefit Programs” and follow the prompts to the NYSHIP Online homepage, then select "Using Your Benefits". Select "Empire Plan Providers, Pharmacies and Services," and scroll down to "Prescription Drug Program." There is a link for the Empire Plan Prescription Drug Program website.

You can download a copy of the CVS Caremark Mail Service Order Form. The list of drugs (including generic equivalents) that require Prior Authorization is posted on the website. In addition, you may view a complete list of specialty medications included in the Prescription Drug Program. Each of these drugs can be ordered through the Specialty Pharmacy Program using the CVS Caremark Mail Service Order Form.

 


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Tips for Using Your Empire Plan Prescription Drug Coverage

Information you should take on your first visit to a pharmacy after January 1, 2014

CVS Caremark has made every effort to ensure that participating pharmacies know that the Empire Plan Prescription Drug Program is now administered by CVS Caremark and how they should submit claims for reimbursement to CVS Caremark.

However, we encourage you to take the following information with you the first time you fill a prescription on or after January 1, 2014:

1.    CVS Caremark administers The Empire Plan Prescription Drug Program

2.    Rx Group: RX6027

3.    Bank Identification Number (BIN):  004336

An introductory letter including a temporary ID card with this information was mailed to enrollees in December.  It was also included in the January 2014 Empire Plan Report.

You do not need a new identification card to fill your prescriptions. Continue to use the Empire Plan Benefit Card that you have been using.

Getting started with the CVS Caremark Mail Service pharmacy

It’s easy for an enrollee to use the CVS Caremark Mail Service pharmacy. Just follow these steps: 

1.     Get a prescription from your doctor for up to a 90-day supply of your medication.

2.     Complete and submit the CVS Caremark Mail Service Order Form.  To download a copy of the form, visit the Department of Civil Service web site at www.cs.ny.gov.  Click on Benefit Programs, then NYSHIP Online and follow the prompts to the NYSHIP Online homepage.  Select Find a Provider, then scroll down to the Prescription Drug Program and click on CVS Caremark Mail Service Order Form.  To request the form from CVS Caremark, call the Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447), press 4 for the Prescription Drug Program and select the 2014 benefits option. The form is also available from your agency’s Health Benefits Administrator in the Personnel Office. 

3.     Complete the CVS Caremark Mail Service Order Form.

4.     Insert the prescription, your copayment and the completed CVS Caremark Mail Service Order Form in the pre-addressed, postage-paid envelope and mail it (if you print the CVS Caremark Mail Service Order Form from the Civil Service web site, mail it to the address on the form). If you are unsure of your copayment, call the Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447), press 4 for the Prescription Drug Program and select the 2014 benefits option.

What your health care provider needs to know

Your health care provider may also submit your prescription(s) to the CVS Caremark Mail Service pharmacy.  You may want to bring the following information with you when seeing a health care provider. 

1.     CVS Caremark administers The Empire Plan Prescription Drug Program

2.     Providers may fax prescription orders to the CVS Caremark Mail Service pharmacy at 1-800-378-0323

3.     Providers may call prescription orders into the CVS Caremark Mail Service pharmacy at 1-800-378-5697

4.     Providers may submit prescription orders electronically (“e-scribes”) to the CVS Caremark Mail Service pharmacy using the address posted here.