Department of Civil Service

Frequently Asked Questions

1. What is NYSHIP?
2. What is The Empire Plan?
3. How many people does NYSHIP cover?
4. What are the administrative costs for The Empire Plan?
5. What are the employee eligibility rules for The Empire Plan?
6. Can retirees of public employers continue their Empire Plan coverage even after they become eligible for Medicare?
7. Does The Empire Plan offer a rate structure that includes a reduced premium for Medicare-primary individuals?
8. How are claims coordinated between Medicare and The Empire Plan?
9. Why do retirees still need The Empire Plan after they have primary coverage under Medicare?
10. How often do benefits change?
11. Are there Empire Plan participating providers in our area and other parts of the country?
12. As an employer, how do I become a Participating Agency in The Empire Plan?
13. What local government employers currently participate in The Empire Plan?
14. What are The Empire Plan's confidentiality practices?

Q. What is NYSHIP?

A. The New York State Health Insurance Program (NYSHIP) is a comprehensive health insurance program for New York State public employees administered by the New York State Department of Civil Service.

Q. What is The Empire Plan?

A. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other medical expenses. Enrollees have the freedom to choose from a national network of participating providers and pay only a copayment. Non-network benefits are also available at a higher out-of-pocket cost.

Q. How many people does NYSHIP cover?

A. NYSHIP is one of the largest employer-sponsored group health insurance programs in the United States, covering nearly 1.2 million people. Nearly 900 local government employers currently offer The Empire Plan to their employees.

Q. What are the administrative costs for The Empire Plan?

A. The most recently assessed administrative fee equates to $34.16 per enrollee. The fee is based upon annual budget projections and covers the administrative costs attributed to Participating Agencies.

Q. What are the employee eligibility rules for The Empire Plan?

A. Generally, to be eligible, an employee must meet all of the following conditions:

1. Be expected to work at least three months per year.
2. Work a regular schedule of 20 hours or more a week, be paid an annual salary of $2,000 or more per year, or be one of the following:
• A local elected official
• A paid member of a public legislative body
• An elected member of a school board
• An unpaid board member of a public authority with at least six months' service as a board member
• Someone receiving their major source of family income from their public employment
3. Not already be enrolled in NYSHIP as an employee.

Some groups (e.g., volunteer firefighters and emergency medical services) are eligible for The Empire Plan but must pay the full-share premium.

Local government employers may adopt modified rules within specific limits.

Q. Can retirees of public employers continue their Empire Plan coverage even after they become eligible for Medicare?

A. Most Participating Agencies that offer The Empire Plan permit employees who retire and have met certain requirements to continue their coverage after retirement and contribute to the cost. For complete details about eligibility for employees, retirees, spouses and dependents, see "Dependent Eligibility" and "Eligibility to Continue Coverage When You Retire" in the NYSHIP General Information Book.

For retirees and their dependents, The Empire Plan requires enrollment in Medicare Part A and/or B when first eligible. The Empire Plan also pays secondary to Medicare for these groups. Participating Agencies are required by law to reimburse Medicare-primary enrollees and dependents for the Part B premium.

Q. Does The Empire Plan offer a rate structure that includes a reduced premium for Medicare-primary individuals?

A. Yes, The Empire Plan's five-tier rate structure includes a reduced premium for those who are Medicare-primary.

Enrollees with individual coverage will be charged the MediPrime Individual rate effective the date Medicare is primary.

Households with at least one person enrolled in Medicare coverage that is primary to NYSHIP will pay the reduced MediPrime Family 1 or MediPrime Family 2+ rate.

Q. How are claims coordinated between Medicare and The Empire Plan?

A. The Empire Plan participates in the Medicare crossover process by which Medicare, as primary insurer, automatically forwards claims to Empire Plan insurance carriers for secondary payment.

For more detailed information, refer to our publication Medicare and NYSHIP and to the Medicare section of our General Information Book for Participating Agencies.

Q. Why do retirees still need The Empire Plan after they have primary coverage under Medicare?

A. It is the combination of Medicare and Empire Plan coverage that fully protects enrollees. When retirees and their dependents become Medicare-eligible, Medicare becomes primary for them. However, because Medicare only pays about 80% of costs, continued enrollment in The Empire Plan is necessary to maintain total coverage.

In addition, The Empire Plan covers the Medicare Part A hospital deductible ($1,676 per hospital stay of up to 60 days in 2025) as well as some other medical expenses Medicare does not cover. For example, prescription drugs and hearing aids are not covered under Medicare Part A or B, but The Empire Plan for Participating Agencies provides benefits for prescription drugs and a generous allowance for hearing aids. And, while Medicare does not pay for medical services outside the U.S., Empire Plan benefits are available worldwide.

For more detailed information, refer to Medicare and NYSHIP.

Q. How often do benefits change?

A. New York State negotiates NYSHIP health insurance benefits with employee unions every three to four years. The president of the Civil Service Commission usually extends negotiated benefit changes administratively to unrepresented groups such as Participating Agencies. Occasionally, a benefit change is introduced gradually.

Policies and benefits may also be affected by state and federal legislation and court decisions.

Q. Are there Empire Plan participating providers in our area and other parts of the country?

A. The Empire Plan has a worldwide network of over one million providers, including hospitals, skilled nursing facilities, hospice care facilities, specialists, pharmacies and more.

Find out what's available in your area by using our online provider directory.

Q. As an employer, how do I become a Participating Agency in The Empire Plan?

A. NYSHIP requires your governing body to pass a formal resolution to join The Empire Plan. Call the Employee Benefits Division of the Department of Civil Service at 518-485-1771 for details.

Q. What local government employers currently participate in The Empire Plan?

A. Almost 900 local government employers offer The Empire Plan to their employees.

Q. What are The Empire Plan's confidentiality practices?

A. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), health plans such as The Empire Plan are required to protect the confidentiality of protected health information (PHI).

PHI is individually identifiable health information related to your physical and mental health or condition, health care services provided to you or payments made for your care. This can be information created or received by a health plan, a health care clearinghouse or a health care provider that electronically transmits such information. Details are outlined in the NYSHIP Notice of Privacy Practices.