Empire Plan Providers, Pharmacies and Services
NOTE: The Student Employee Health Plan (SEHP) uses The Empire Plan's network of providers for hospital, medical/surgical, mental health and substance use and pharmacy services. However, benefit plan design varies from The Empire Plan. Refer to your Plan materials for information.
Hospital Program
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. Ninety-seven percent of hospitals nationwide are network hospitals. Network coverage at select New York hospital based ambulatory surgical centers and hospital-owned urgent care centers is also available.
The Empire Plan Hospital Program Website and Directory
Medical/Surgical Program
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 includes Medical/Surgical Providers, Laboratories, Outpatient Surgical locations, Cardiac Rehabilitation Centers, Urgent Care Centers and Orthotic/Prosthetic Devices Networks. The directory is updated weekly.
The Empire Plan Medical/Surgical Provider Directory
UnitedHealthcare has a customized website, MYUHC, for enrollees to access information about the Medical/Surgical Program. Enrollees can track their Plan's medical/surgical claims and history, print explanations of benefits (EOBs), create personalized provider directories and much more.
Mental Health and Substance Use Program
The Empire Plan Mental Health and Substance Use Program, administered by Carelon, 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 Carelon before you seek mental health or substance use 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 Carelon.
You have guaranteed access to network level of benefits if you call Carelon's Clinical Referral Line for assistance with finding a provider and arranging care. You can reach the Clinical Referral Line by calling The Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for the MHSU Program, then selecting option 3 from the MHSU Program menu. The Clinical Referral Line is available 24 hours a day, every day of the year.
The Empire Plan customized Achieve Solutions website provides confidential online access to educational and screening materials, disease management programs, and claims and coverage information. For direct access to the provider/facility directory, visit ReferralConnect.
Prescription Drug Program
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, including pharmacies participating in the vaccine network and 24-hour service pharmacies, is available here. CVS Caremark administers The Empire Plan Prescription Drug Program for retail pharmacy network and mail pharmacy services.