Department of Civil Service

Information about Subrogation, Claims and Record Requests for NYSHIP Enrollees

Liens and Recovery:

While the Department of Civil Service's (DCS) standard practice does not include asserting a lien or pursuing New York State Health Insurance Program (NYSHIP) enrollees directly for the purposes of claims recovery, subject to applicable state law, the third-party administrators of the Empire Plan, whose contact information appears later on this page, may have the right to reimbursement related to any settlement, verdict, or insurance proceeds and pursue recovery.

NYSHIP is a self-funded government plan and not subject to the Federal Employee Retirement Income Security Act (ERISA).

How to Obtain a Copy of the Empire Plan Certificate:

The Empire Plan Certificate and other benefit documents can be found at nyship.ny.gov. Select Current Publications from the NYSHIP homepage or menu bar.

For Subrogation Information, Insurance Claims and Record Requests:

The DCS Employee Benefits Division (EBD) does not collect or maintain the following information: medical reports, insurance claims*, payroll or attendance records. Although EBD oversees NYSHIP, records of health insurance claims are maintained by the third-party administrators and most medical records are maintained by medical providers. Depending on the nature of the records, any request for records must be directed to the appropriate Empire Plan third-party administrator or Health Maintenance Organization (HMO).

* A valid, signed HIPAA-compliant release form and/or a valid subpoena or other order to release Protected Health Information (PHI) or other personal information (PI) is required before PHI or PI will be released.

Contact information for Empire Plan Administrators:

Note: The NYS Department of Financial Services only requires the retention of a claim file for six calendar years after all elements of the claim are resolved and the file is closed. https://www.dfs.ny.gov/insurance/ogco2002/rg207301.htm

Empire Plan Medical/Surgical Program:
To obtain medical claims information, outpatient physical therapy information or subrogation information, contact:

UnitedHealthcare
P.O. Box 1600
Kingston, NY 12402-1600

Empire Plan Hospital Program:
To obtain hospital claims or subrogation information, contact:

Anthem Blue Cross
New York State Service Center
P.O. Box 1407
Church Street Station
New York, NY 10008-1407

Empire Plan Mental Health and Substance Use Program:
To obtain mental health and substance use claims or subrogation information for services performed, contact:

• Between January 1, 2000, and December 31, 2008, or on or after January 1, 2014, to present:
  
  Carelon Behavioral Health, Inc. (formerly Beacon Health Options)
  P.O. Box 1850
  Hicksville, NY 11802


• On or after January 1, 2009, and before January 1, 2014:
  
  OptumHealth Behavioral Solutions
  P.O. Box 5190
  Kingston, NY 12402-5190

Empire Plan Prescription Drug Program:

To obtain prescription drug claims or subrogation information during the following dates, contact:

• From January 1, 2022, to present date for Medicare primary enrollees:
  
  SilverScript Insurance Company
  P.O. Box 6590
  Lee's Summit, MO 64064-6590


• From January 1, 2014, to present date for non-Medicare primary enrollees:
  
  CVS Caremark Customer Care Correspondence
  P.O. Box 6590
  Lee's Summit, MO 64064-6590


• On or after January 1, 2014, and before January 1, 2022 for Medicare primary enrollees:
  
  SilverScript Insurance Company
  P.O. Box 52067
  Phoenix, AZ 85072-2067


• On or after January 1, 2008, and before January 1, 2014 (all enrollees):
  
  UnitedHealthcare
  P.O. Box 1600
  Kingston, NY 12402-1600


• On or after January 1, 2006, and before January 1, 2008 (all enrollees):
  
  Anthem BlueCross
  P.O. Box 11826
  Albany, NY 12211


• Before January 1, 2006 (all enrollees):
  
  Express Scripts, Inc.
  Bloomington Patient Care Contact Center
  6301 Cecilia Circle
  Bloomington, MN 55439

HMO Enrollees under NYSHIP

Record requests and subrogation information for enrollees with coverage through a NYSHIP health maintenance organization (HMO) should be directed to the appropriate HMO.
Select Resources from the NYSHIP homepage, then select Claims and Subrogation. Click on HMO to see claims and subrogation contact information.