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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA97-13
TO: Agency Health Benefits Administrators of Participating Agencies
FROM: Employee Benefits Division
SUBJECT: Empire Plan Coordination of Benefits Questionnaire
DATE: September 26, 1997
We are sending you a copy of the 1997 Coordination of Benefits (COB) questionnaire that MetraHealth Service Corp. will be mailing to your Empire Plan enrollees with Family coverage by First class mail beginning October 1.
Enrollees have been asked to complete the COB questionnaire and return it in the enclosed postage paid envelope addressed to MetraHealth.
You may receive the COB questionnaire. If you do, please send it to: Administrator for MetLife Empire Plan, MetraHealth Service Corp., Coordinati on of Benefits Unit, P.O. Box 1600, Kingston, NY 12402-1600.
MetraHealth will send you the COB questionnaires returned to them as undeliverable by the post office. Please contact the enrollee, give them the COB form and correct their home address.
If you have any questions about the COB questionnaire, please call MetraHealth at 1-800-942-4640. Thank you for your assistance with this project.