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.
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2017 Summary of Benefits and Coverage (SBC)
DATE: June 7, 2017
The Patient Protection and Affordable Care Act (PPACA) requires all insurance plans to make available a Summary of Benefits and Coverage (SBC) for employees/retirees who are enrolled in benefits or who are eligible for benefits and their eligible dependents. Current Empire Plan and Excelsior Plan enrollees were mailed a postcard in late November to announce the availability of the SBC and Uniform Glossary online at www.cs.ny.gov/employee-benefits/sbc.
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. Enrollees looking for a more comprehensive summary of benefits should be directed to review their 2017 At A Glance. This publication was mailed to enrollee homes in December 2016 and is also available online.
Important: Employees who are newly eligible to enroll 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 begins work 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 open enrollment, e.g. because of a qualifying event.