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NYSHIP Certificate of Insurance

This online publication has been updated to include the Amendments through January 1, 2014. For details such as the effective dates of amendments, see your group-specific amendments in the Publications & Forms section of this site.

Contact Information

www.cs.ny.gov/employee-benefits

The Empire Plan

Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program.

Press or Say 1 Medical/Surgical Program:
Administered by UnitedHealthcare

Choose this option for medical/surgical benefits, claims and most appeals; outpatient radiology; certification of home care; medical equipment and supplies; Infertility and Cancer Centers of Excellence or chiropractic or physical therapy benefits; and policy conversions.

Representatives are available Monday through Friday, 8 a.m. to 4:30 p.m. Eastern Time
TTY: 1-888-697-9054

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

External Appeals
To request an application from the New York State Department of Financial Services:
1-800-400-8882

Home Care Advocacy Program (HCAP) Appeals
Home Care Advocacy Program
P.O. Box 5400
Kingston, NY 12402-5400

Diabetic Supplies (except insulin pumps and Medijectors)
Empire Plan Diabetic Supplies Pharmacy
1-888-306-7337

Ostomy Supplies
Byram Healthcare Centers
1-800-354-4054

Press or Say 2Hospital Program:
Administered by Empire BlueCross BlueShield

(Administrative services are provided by Empire HealthChoice Assurance, Inc., a licensee of the BlueCross and BlueShield Association, an association of independent BlueCross and BlueShield plans.)

Choose this option for hospital benefits and most claims and appeals, preadmission certification of inpatient hospital, skilled nursing facility admissions and Centers of Excellence for Transplant surgeries.

Representatives are available Monday through Friday, 8 a.m. to 5 p.m. Eastern Time
TTY: 1-800-241-6894

Empire BlueCross BlueShield
New York State Service Center
P.O. Box 1407, Church Street Station
New York, NY 10008-1407

Other Claims
If the hospital does not deal directly with its local Blue Cross Plan:
When filing the claim directly with the local Blue Cross Plan, refer the bill to:
Code YLS, Empire BlueCross BlueShield
New York State Service Center
P.O. Box 1407, Church Street Station
New York, NY 10008-1407

Hospitals Outside of the United States:
BlueCard Worldwide Service Center
P.O. Box 261630
Miami, FL 33126

Written Appeals
New York State Service Center
Medical Management Appeals Department
Mail Drop R 60
P.O. Box 11825
Albany, NY 12211

External Appeals
New York State Department of Financial Services
1-800-400-8882

Press or Say 3Mental Health and Substance Abuse Program:
Administered by Beacon Health Options

Choose this option for mental health and substance abuse benefits and claims, authorization of services and referrals to network providers.

Representatives are available 24 hours a day, seven days a week.
TTY: 1-855-643-1476

Beacon Health Options
P.O. Box 1800
Latham, NY 12110

Written Appeals
Beacon Health Options Appeals Department
P.O. Box 1800
Latham, NY 12110

External Appeals
New York State Department of Financial Services
1-800-400-8882

Press or Say 4Prescription Drug Program:
Administered by CVS/caremark

Choose this option for prescription drug benefits and claims, Empire Plan Formulary and the Mail Service Pharmacy.

Representatives are available 24 hours a day, seven days a week.
TTY: 711

General Correspondence, Prior Authorization, Grievances
CVS/caremark
Customer Care Correspondence
P.O. Box 6590
Lee's Summit, MO 64064-6590

Mail Service Pharmacy
CVS/caremark
P.O. Box 2110
Pittsburgh, PA 15230-2110

Claims
Mail completed claim forms to:
The Empire Plan Prescription Drug Program
CVS/caremark
P.O. Box 52136
Phoenix, AZ 85072-2136

Medical Exception Requests for Drugs Excluded from the Flexible Formulary
Tell your physician to fax these requests to: 1-888-487-9257

Written Appeals
Prescription Claim Appeals
MC 109
P.O. Box 52084
Phoenix, AZ 85072-2084

External Appeals
New York State Department of Financial Services
1-800-400-8882

If you are unable to resolve a problem with an Empire Plan program administrator

Contact The Consumer Assistance Unit of the New York State Department of Financial Services at:
New York State Department of Financial Services
One Commerce Plaza, Albany, NY 12257
1-800-342-3736 Monday through Friday 9 a.m. to 5 p.m. Eastern Time

NYSHIP HMOs

NYSHIP HMO contact information, including phone numbers, TTY numbers, addresses and web sites are available in the Choices booklet and on the New York State Department of Civil Service web site at
https://www.cs.ny.gov/employee-benefits

Social Security Administration

Call to enroll in Medicare. Under NYSHIP rules, you and your dependents must be enrolled in Medicare Parts A and B as soon as you or your dependents become eligible for coverage under Medicare that is primary to your Empire Plan coverage. You must be enrolled in Medicare even if you are working for another employer. Retirees, vestees, dependent survivors: Call to enroll three months before your 65th birthday or at any age if you become eligible because of disability or end stage renal disease. Call for Medicare cards.

1-800-772-1213
TTY: 1-800-325-0778
www.ssa.gov

Medicare Benefits and Claims

Including the Medicare Competitive Bidding Program for durable medical equipment and prosthetic and orthotics supplies.

1-800-MEDICARE (1-800-633-4227)
TTY: 1-877-486-2048
http://www.medicare.gov

Retirement Systems

Call about retirement checks and retirement system benefits

New York State and Local Employees’ Retirement System

1-866-805-0990 (outside Albany) toll free
518-474-7736 (Interactive Voice Response line)
www.osc.state.ny.us

New York State Teachers’ Retirement System

1-800-782-0289 (recorded information)
518-447-2666 or 1-800-356-3128
www.nystrs.org

New York State and Local Police and Fire Retirement System

518-474-7736 (Interactive Voice Response line)
www.osc.state.ny.us

Employee Benefits Division

518-457-5754 or 1-800-833-4344
Representatives are available Monday through Friday, 9 a.m. to 4 p.m. Eastern Time

New York State Department of Civil Service
Employee Benefits Division
Albany, New York 12239

U.S. Preventive Service Task Force (USPSTF)

For USPSTF recommendations
www.uspreventiveservicestaskforce.org