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The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.

State Seal
ANDREW M. CUOMO
GOVERNOR
STATE OF NEW YORK
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov

PA11-23

TO: Health Benefits Administrators of Participating Agencies with The Empire Plan
FROM: Employee Benefits Division
SUBJECT: 2012 Empire Plan At A Glance with 2012 Flexible Formulary
DATE: December 23, 2011

We are pleased to announce the 2012 Empire Plan At A Glance for Participating Agencies with the Empire Plan is at the printer and will soon be mailed to enrollees. The At A Glance is a useful guide to the Plan benefits for new employees, new retirees, conferences and health fairs. Encourage employees to use this guide together with their Empire Plan Certificate and Amendments.

The 2012 Empire Plan At A Glance publication will be mailed with the 2012 Empire Plan Flexible Formulary and a new 2012 copayment card.

Distribution
This publication will be mailed first class to enrollee homes in late December. We will send you, in separate shipments, a supply of each publication equal to two percent of your Empire Plan enrollment for new hires or retirees. A shipment of the At A Glance and copayment cards will be delivered to agencies in early January. A shipment of the 2012 Flexible Formulary Drug List was already mailed to you. These publications will also be included in PA Quick Order packages, which are only available to order on HBA Online.

Ordering Publications
You may order additional standalone copies of the 2012 Empire Plan At A Glance and the 2012 Empire Plan Flexible Formulary on HBA Online at https://www.cs.ny.gov/ebdonline. Open Publications & Forms, select PA and open NYSHIP Publication Order Forms, then PA with The Empire Plan. Or, you may use the Publications Supply Order Form enclosed with your shipments. Please wait until you receive your initial shipments before ordering more.

If you need assistance with your HBA Online registration or have forgotten your User ID and/or password, please contact the Department of Civil Service Help Desk at 1-800-HBA-EMS1 (800-422-3671). Please be prepared to leave your name, agency information and phone number so our Help Desk personnel may call you back.

If you have questions about NYSHIP benefits, please call your processor at the EBD HBA Help Line at 518-474-2780.

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