Department of Civil Service

PA09-05

TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: January 2009 Empire Plan Reports and NYSHIP General Information Book/Empire Plan Certificate Amendments
DATE: March 30, 2009

We will soon mail the January 2009 Empire Plan Reports and NYSHIP General Information Book/Empire Plan Certificate Amendments for Participating Agencies.

The Empire Plan Report includes:
Empire Plan Benefits
Mental Health and Substance Abuse Program: New Insurer and Administrator, Transition Benefits, What’s New, Non-Network Inpatient Care (2009 At A Glance Correction) and Questions and Answers; Prescription Drug Program: Flexible Formulary, Instant Rebate for generic Prilosec, Half- Tablet Program, Questions and Answers and Non-Preferred Copayment Increases; Medical/Surgical Benefits Program: $30 Copayment for Non-Hospital Outpatient Surgical Locations, Herpes Zoster Vaccine for Shingles, Prosthetic Wig Benefit, Participating Diabetes Education Centers and Diabetic Shoes, Centers of Excellence for Transplants and Cancer, Kidney Resource Services Program, Basic Medical and Non-Network Mental Health Practitioner Services – Annual Deductible and Coinsurance Maximums; Benefit Management Program: Prospective Procedure Review; NYSHIP Change: Leaving School Before Graduation; Reminders: Empire Plan At a Glance and Copay Cards, IRMAA and Participating Provider Directories; Other Articles: Annual Notice of Mastectomy and Reconstructive Surgery Benefits, NYSHIP Dependent Eligibility Verification Project; CAM Program Discontinued and Waiver of Out-of-Pocket Costs

NYSHIP General Information Book Changes
Leaving School Before Graduation and Medicare Reimbursement

Empire Plan Certificate Amendments
Benefits Management Program: Benefits Management, Prospective Procedure Review and Benefits Management Program; Hospital Benefits Program: Copayment, Outpatient MRI, MRA, CT, PET and Nuclear Medicine tests, Annual Coinsurance Maximum, Skilled Nursing Facility Care and Transplant Programs; Medical/Surgical Benefits Program: Copayment, Plan Overview, Outpatient MRI, MRA, CT, PET and Nuclear Medicine Tests, Meaning of Terms Used, Outpatient Surgical Locations, Chronic Care, Adult Immunizations, Diabetes Education Centers, Basic Medical Program, Annual Deductible, Non-Network Hospital, Skilled Nursing Facility and Hospice Facility Out-of-Pocket Expenses, Prosthetic Wigs, Diabetes Education Centers, Prospective Procedure Review, Diabetic Shoes, Cancer Program, Exclusions, Coordination of Benefits, Medicare and Medicare Coverage; Mental Health and Substance Abuse Benefit Program: Copayment, Overview, Meaning of Terms Used, Coinsurance Maximum, Medicare Coverage: How, Where and Appeals; Prescription Drug Benefits Program: Copayments

Distribution of Reports
These publications will be mailed to enrollee homes in early April 2009. We will send you a supply of each publication equal to 2 percent of your enrollment.

Publications available on our web site: www.cs.state.ny.us
Please check this web site for new publications. We generally post publications when we sign off for printing. That means you can see the publications before enrollees start receiving them.

Ordering Publications
You may order additional copies of the Reports, including Amendments, by using the Publications Supply Order Forms enclosed with your shipment. Or, instead of faxing the form, you may order on HBA Online. From the Department of Civil Service homepage, www.cs.state.ny.us, select the Benefit Programs button from the left hand navigation. Then click on HBA Online. Open Publications & Forms, then open NYSHIP Publication Order Forms. If you need help accessing HBA Online, please call the Help Desk or your processor.

If you are unsure of how to order publications or have questions about this distribution, please call the Communications Unit at 518-457-7577.