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.
ANDREW M. CUOMO
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
JERRY BOONE
COMMISSIONER
SEHP13-08
TO: Student Employee Health Plan Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Summary of Benefits and Coverage (SBC)
DATE: December 3, 2013
The Patient Protection and Affordable Care Act (PPACA) requires all insurance plans to make available a Summary of Benefits and Coverage (SBC) for employees eligible for benefits and potential enrollees. Current enrollees will be notified of the availability of the Summary of Benefits and Coverage and Uniform Glossary online at https://www.cs.ny.gov/sbc/index.cfm via annual mailings, including the rate notification for 2014. Employees who do not have internet access may call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical Program to request a copy of the SBC for The Empire Plan. Employees who need a copy for a NYSHIP HMO should contact the HMO. Empire Plan enrollees will receive the 2014 At A Glance publication in December, which provides a comprehensive summary of benefits for the coming year.
For an explanation of what the Summary of Benefits and Coverage is, please refer to memo SEHP12-09.
Important: Employees who are newly eligible for enrollment in NYSHIP must receive a copy of the attached notice at the time you provide NYSHIP enrollment information and no later than the first day the employee is in a benefits eligible position. In addition, the notice must be made available when a previously eligible employee is enrolling in NYSHIP or when an enrollee is seeking an option change outside of the option transfer period, e.g. because of a qualifying event.