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NYSHIP Certificate of Insurance

Empire Plan Programs and Administrators

To reach any of The Empire Plan program administrators, call toll free 1-877-7-NYSHIP (1-877-769-7447). This one number is your first step to Empire Plan information. Check the list below for the correct program administrator. When you call 1-877-7-NYSHIP, listen carefully to your choices and press or say your selection at any time during the message. Follow the instructions and you���ll automatically be connected to the appropriate program.

The Empire Plan Hospital Program Empire BlueCross BlueShield, New York State Service Center, P.O. Box 1407, Church Street Station, New York, NY 10008-1407. Website: www.empireblue.com. Call for information regarding hospital and related services.

You Must CallBenefits Management Program for Pre-Admission Certification You must call Empire BlueCross BlueShield before a maternity or scheduled hospital admission, within 48 hours after an emergency or urgent hospital admission and before admission or transfer to a skilled nursing facility (includes rehabilitation facilities).

You Must CallCenters of Excellence for Transplants Program You must call Empire BlueCross BlueShield before a hospital admission for the following transplant surgeries: bone marrow, peripheral stem cell, cord blood stem cell, heart, heart-lung, kidney, liver, lung, pancreas/pancreas after kidney, peripheral stem cell and simultaneous kidney-pancreas. Call for information about Centers of Excellence.

The Empire Plan Medical/Surgical Benefits Program UnitedHealthcare Insurance Company of New York, P.O. Box 1600, Kingston, NY 12402-1600. Website: www.myuhc.com. Call for information on benefits under Participating Provider, Basic Medical Provider Discount and Basic Medical Programs, predetermination of benefits, claims and participating providers.

Managed Physical Medicine Program/MPN Call UnitedHealthcare for information on benefits and to find MPN network providers for chiropractic treatment and physical therapy. If you do not use MPN network providers, you will receive a significantly lower level of benefits.

You Must CallBenefits Management Program for Prospective Procedure Review of MRI, MRA, CT, PET scans and Nuclear Medicine tests You must call UnitedHealthcare before having an elective (scheduled) procedure or nuclear medicine test.

You Must CallHome Care Advocacy Program (HCAP) You must call UnitedHealthcare to arrange for paid-in-full home care services, enteral formulas, diabetic shoes and/or durable medical equipment/supplies. If you do not follow HCAP requirements, you will receive a significantly lower level of benefits. You must also call UnitedHealthcare for HCAP approval of an external mastectomy prosthesis costing $1,000 or more.

You Must CallInfertility Benefits You must call UnitedHealthcare for prior authorization for the following Qualified Procedures, regardless of provider: Assisted Reproductive Technology (ART) procedures including in vitro fertilization and embryo placement, Gamete Intra-Fallopian Transfer (GIFT), Zygote Intra-Fallopian Transfer (ZIFT), Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility, assisted hatching and microsurgical sperm aspiration and extraction procedures; sperm, egg and/or inseminated egg procurement and processing and banking of sperm and inseminated eggs. Call UnitedHealthcare for information about infertility benefits and Centers of Excellence.

You Must CallCenters of Excellence for Cancer Program You must call UnitedHealthcare to participate in The Empire Plan Centers of Excellence for Cancer Program.

You Must CallThe Empire Plan Mental Health and Substance Abuse Program Beacon Health Options, PO Box 1800, Latham, NY 12110; Website: www.achievesolutions.net/empireplan. Call the Mental Health and Substance Abuse Program before seeking certain services from a mental health or substance abuse provider, including treatment for alcoholism. You will receive the highest level of benefits when you follow the Program requirements for network coverage. In a life-threatening situation, go to the nearest hospital emergency department. You must call the Program within 48 hours, or as soon as reasonably possible, after an emergency admission. The Mental Health and Substance Abuse Program���s Clinical Referral Line is available 24 hours a day, 7 days a week.

The Empire Plan Prescription Drug Program CVS/caremark appeals, grievances, prior authorization documentation, general correspondence: Empire Plan Prescription Drug Program, CVS/caremark, Customer Care Correspondence, P.O. Box 6590, Lee���s Summit, MO 64064-6590. Website: www.cs.ny.gov/empireplanrxprogram Claim forms from retail pharmacies: Empire Plan Prescription Drug Program, P.O. Box 52136, Phoenix, AZ 85072-2136. Mail Order Pharmacy: CVS/caremark, P.O. Box 2110, Pittsburgh, PA 15230-2110. For the most current list of prior authorization drugs, call The Empire Plan or go to www.cs.ny.gov/employee-benefits.

The Empire Plan NurseLineSM Call for health information and support, 24 hours a day, seven days a week.


Teletypewriter (TTY) numbers for callers when using a TTY device because of a hearing or speech disability:

  • Empire BlueCross BlueShield TTY only: 1-800-241-6894
  • UnitedHealthcare TTY only: 1-888-697-9054
  • Beacon Health Options TTY only: 1-855-643-1476
  • The Empire Plan Prescription Drug Program TTY only: 711