Empire Plan Medicare Rx Program (PDP)
Effective January 1, 2013, NYSHIP replaced the Empire Plan Prescription Drug Program coverage for Medicare-primary enrollees and dependents with Empire Plan Medicare Rx (PDP), a Medicare Part D prescription drug program with expanded coverage designed especially for NYSHIP. Like the current prescription drug coverage, Empire Plan Medicare Rx is insured by UnitedHealthcare and jointly administered by Express Scripts/Medco Health Solutions, Inc. (ESI/Medco).
WATCH YOUR MAIL
Eligible individuals will be enrolled automatically in Empire Plan Medicare Rx. The Department of Civil Service (NYSHIP's administrator) and/or UnitedHealthcare will send information to Empire Plan enrollees and dependents who become Medicare-primary prior to their Medicare effective date.
The package includes:
- An introductory letter(101KB), Permanent Residential Address Form(41KB), and Empire Plan Medicare RX (PDP) checklist(8KB);
- An Empire Plan Medicare Rx (PDP) publication titled Your Plan Explained(3.57MB);
- The Empire Plan Medicare Rx (PDP) 2013 Summary of Benefits(510KB);
- A Statement of Understanding(99KB); and
- A Mandated Cancellation Form(287KB)*.
*Medicare rules require that Medicare-primary enrollees and dependents be provided with the choice of not enrolling in Empire Plan Medicare Rx. Medicare-primary enrollees and dependents will be automatically enrolled in Empire Plan Medicare Rx unless they return a completed Cancellation Form by the specified deadline.
IMPORTANT! Enrollees or dependents who submit a Cancellation Form will be disenrolled from all Empire Plan health insurance coverage as of the date of their scheduled Empire Plan Medicare Rx enrollment. In addition, all covered dependents will also be disenrolled from all Empire Plan health insurance coverage if an enrollee (the primary contract holder) submits a Cancellation Form.
Enrollment Information Package
As enrollments are accepted by CMS (in batches), Medicare-primary enrollees and dependents will separately receive an acknowledgement letter, a confirmation letter and their own Empire Plan Medicare Rx ID card.UnitedHealthcare will mail an individual Enrollment Information Package to Medicare-primary enrollees and dependents enrolled in Empire Plan Medicare Rx.
The Enrollment Information Package includes:
- An overview publication titled, “Your Plan Getting Started 2013”(640KB);
- The Empire Plan Medicare Rx (PDP) 2013 Evidence of Coverage(1.33MB);
- The Empire Plan Medicare Rx (PDP) 2013 Abridged Formulary(1.23MB) and 2013 Bonus Drug List(148KB); and
- A mandated Empire Plan Medicare Rx (PDP) 2013 Pharmacy Directory* (not available online).
*Note: The complete Pharmacy Directory will be included in the enrollment package for enrollees living in New York State. Enrollees in other states will receive a directory based on their local region.
For questions or additional information, please first review our FAQs below to determine if your question is listed. If you still have questions after doing so please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447; TTY 1-800-759-1089) and press 4 on the main menu and then the selection for Empire Plan Medicare Rx. Please note that the Department's Employee Benefits Division (EBD) is unable to guide you in your decision regarding cancellation due to CMS rules.
An informational presentation, Welcome: Your 2013 Empire Plan Medicare Rx (PDP), is posted here. Click on this link to view it.
How to Use your Empire Plan Medicare Rx (PDP) ID Cards(1.02MB)
Empire Plan Medicare Rx (PDP) Tip Sheet(103KB)
Below, please find a selection of questions and answers regarding Empire Plan Medicare Rx, grouped by the following topics: General, Benefits, Cost, Enrollment and ID Cards.
All the questions for a particular subject are available on one page. Please use the link at the bottom of the page or your back button to return to the homepage, or move to the next topic.
- Empire Plan Medicare Rx Mail-Order Form(68KB);
- Empire Plan Medicare Rx Health, Allergy & Medication Questionnaire(78KB);
- Medicare Part D Coordination of Benefits/Direct Claim Form(56KB);
- Empire Plan Medicare Rx Vaccine and Administration (Injection) Claim Form(57KB)
Please continue to check this page for additional information.
Updated March 5, 2013