The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
Compute monthly premiums and annual cost for your agency. The Empire Plan's managed care features and copayments help keep costs down. View recent Empire Plan Quarterly Experience Reports.
Empire Plan Quarterly Experience Reports are mailed to Participating Agency employers. The reports provide comprehensive projections of Empire Plan experience for the remainder of the current year based on claims paid through the previous quarter and the projected premium rates for the following year. The reports explain the basis for the projections.
The Empire Plan has an extensive network of providers, as well as access to non-participating providers worldwide.
At home, at work, on vacation, in college or in retirement, The Empire Plan is with enrollees throughout life.
The Empire Plan offers employers and enrollees superior customer service.
Frequently Asked Questions about NYSHIP and The Empire Plan
Current rates for
The Empire Plan.
Learn when our Empire Plan representatives will be at public employer meetings near you.
Questions about NYSHIP for local governments?

Empire Plan Providers, Pharmacies and Services

 

Hospital Program

Empire BlueCross Blue Shield Logo
The Empire Plan Hospital Benefits Program has two levels of benefits - network and non-network. Network benefits apply when you use hospitals, hospices and skilled nursing facilities that participate in the BlueCross and BlueShield Association's network. This is currently the largest hospital network available in the United States. Over 90 percent of hospitals nationwide are network hospitals.

Hospitals
Hospital Based Ambulatory Surgical Centers
Hospice Care
Skilled Nursing Facilities
Hospital Owned Urgent Care Centers - May 2013

 

Medical/Surgical Program

United Healthcare Logo
The Empire Plan is designed to provide enrollees with comprehensive medical care coverage. Using participating providers helps keep the cost to you and The Empire Plan at a reasonable level. UnitedHealthcare is the program administrator for this coverage.

The following Directory also includes Medical/Surgical Providers, Laboratories, Outpatient Surgical locations, Cardiac Rehabilitation Centers, Urgent Care Centers and Orthotic/Prosthetic Devices Networks. The directory is updated weekly.

Find and Locate: The Empire Plan Medical/Surgical Provider Directory
The Empire Plan has a customized web site, MyUHC, for enrollees to access information about program which is administered by UnitedHealthcare. Enrollees can track their Plan’s medical/surgical claims and history, print explanations of benefits (EOBs), create personalized provider directories and much more. To find out more about this resource and how to access the MyUHC web site, view this overview summary.

EPIC Hearing Healthcare Hearing Service Plan (HSP). Call toll-free 1-866-956-5400 to locate the nearest hearing aid service center and to access your Empire Plan benefit through the EPIC Hearing Service Plan.

MultiPlan Logo
Basic Medical Provider Discount Program Providers

 

Mental Health and Substance Abuse Program

Optum Health logo
The Empire Plan Mental Health and Substance Abuse Program, administered by OptumHealth Behavioral Solutions, provides coverage for medically necessary inpatient and outpatient care through a network of participating providers; medically necessary non-network services are also covered. To ensure you receive the highest level of benefits, you should call OptumHealth before you seek mental health or substance abuse care, including treatment for alcoholism, even when a doctor refers you to the facility. Guaranteed access to network level of benefits is available if arranged through OptumHealth.

The Empire Plan customized liveandworkwell website provides confidential online access to educational and screening materials, disease management programs, provider/facility directories, and claims and coverage information.

Live and Work Well logo

For more information about this Program, you may link to the liveandworkwell website and enter the access code: Empire, or you may call 1-877-7-NYSHIP (1-877-769-7447) and press Option 3.

 

Prescription Drug Program

Medco logoUnited Healthcare Logo
You can order mail service prescriptions online, reducing the prescription cost for you and The Empire Plan. Also, information about The Empire Plan pharmacy locations and 24-hour service pharmacies is available here. UnitedHealthcare will insure and administer The Empire Plan Prescription Drug Program and partners with Medco Health Solutions for retail pharmacy network and mail pharmacy services.

Empire Plan Prescription Drug Program Web Site

Empire Plan Prescription Drug Mail Service Order Form

Download and photocopy Medco Pharmacy Mail-Order Form as needed
Health, Allergy and Medication Questionnaire (to be completed and mailed with each NEW prescription)
Mail prescriptions and questionnaire to:
Medco
P.O. Box 6500
Cincinnati, OH 45201-6500

Empire Plan Drugs that Require Prior Authorization

Empire Plan Prescription Drug Half Tablet Program

When taking a medication that is part of the Specialty Pharmacy Program, enrollees receive enhanced services that include disease and drug education, compliance management, side-effect management and safety management. Also included in this Program are expedited, scheduled delivery of your medications at no additional charge, refill reminder calls, and all necessary supplies such as needles and syringes applicable to the medication.

Specialty Pharmacy Program View a complete list of specialty medications included in the Program. Each of these drugs can be ordered through the Specialty Pharmacy Program using the Medco Pharmacy Order Form.

Spotlight on Generics