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
PA99-08
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 1999 Data Match Project: Paper Questionnaire or Electronic Media Questionnaire (EMQ)
DATE: July 7, 1999
This year's Data Match from HCFA will cover the years 1996,1997 and 1998. It asks for more detailed plan information than has been requested in previous years; the data for the Empire Plan medical and hospitalization components is attached. For the Data Match Project, the Empire Plan is not considered one plan because of its multiple insurers and their specific functions. You will report the Empire Plan medical and hospital components as separate plans.
Your agency is considered the sponsor for all plans since you pay the premium for the coverage of your employees; do not list the NYS Department of Civil Service as plan sponsor. If you have listed the Department as sponsor, contact the Data Match Contractor for instructions on how to correct your response.
The attached information for the Empire Plan medical and hospitalization components will allow you to submit your responses. Questions concerning the Empire Plan data should be referred to the Employee Benefits Division; general questions concerning the Data Match Project should be referred to the Data Match Contractor whose address appears in the Data Match instructions.
1999 Group Health Plan List for Data Match-PA
Report #: 2001
GHP Name: Empire Plan Hospitalization (EBC/BS) NYS Service center)
GHP address 1: EBC/BS New York State Service center
GHP address 2: 11 Corporate Woods Blvd.
GHP City: Albany
GHP State: New York
GHP ZIP: 12211
GHP TIN: Your Agency TIN
GHP Type: J
Claims Processor Name: Empire Plan Hospitalization (EBC/BS NYS Service Center)
Claims Processor address 1: New York State Service Center
Claims Processor address 2: 11 Corporate Woods Blvd.
Claims Processor city: Albany
Claims Processor state: New York
Claims Processor ZIP: 12211
Claims Processor TIN: 237391136
Insurer Name: Empire Blue Cross Blue Shield
Insurer address 1: 1 World Trade Center
Insurer address 2:
Insurer city: New York
Insurer state: New York
Insurer ZIP: 10048
Insurer TIN: 237391136
1999 Group Health Plan List for Data Match-PA
Report #: 2001
GHP Name: Empire Plan Medical
GHP address 1: UnitedHealthcare Service Corp.
GHP address 2: P0 Box 1600
GHP City: Kingston
GHP State: New York
GHP ZIP: 12402
GHP TIN: Your Agency TIN
GHP Type: K
Claims Processor Name: UnitedHealthcare Service Corp.
Claims Processor address 1: P0 Box 1600
Claims Processor address 2: 11 Corporate Woods Blvd.
Claims Processor city: Kingston
Claims Processor state: New York
Claims Processor ZIP: 12402
Claims Processor TIN: 061413734
Insurer Name: MetLife
Insurer address 1: 501 US HWY 22
Insurer address 2: PO Box 6891
Insurer city: Bridgewater
Insurer state: New Jersey
Insurer ZIP: 08807
Insurer TIN: 135581829