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
NY10-14
TO: New York State Health Benefits Administrators;
FROM: Employee Benefits Division
SUBJECT: April 2010 Empire Plan Reports and NYSHIP General Information Book/Empire Plan Certificate Amendments
DATE: April 30, 2010
We will soon mail the April 2010 Empire Plan Reports and NYSHIP General Information Book/Empire Plan Certificate Amendments to the following groups: NYSCOPBA (Contract Affected) and Council 82 (except employees in the Agency Law Enforcement Services Unit (ALESU)). The mailing also includes the NYSHIP Special Report on Health Insurance Fraud.
The Empire Plan Report includes:
Empire Plan Benefits
Empire Plan Adopts Flexible Formulary for 2010; Young Adult Option Coverage; NYS: Supplemental Continuation of Coverage; Flexible Formulary Questions and Answers; Instant Rebate for Omeprazole (generic Prilosec); Immunization Coverage; Mental Health/Substance Abuse Insurer and Administrator; Basic Medical and Non-Network Mental Health Practitioner Services – Annual Deductible and Coinsurance Maximums; Enhanced Hearing Aid Benefits through EPIC Hearing Service Plan; The Empire Plan Medical/Surgical Benefits Program Changes: Centers of Excellence Programs Travel Benefits; Kidney Resource Services Program; The Empire Plan Future Moms Program; Specialty Pharmacy Program; The Empire Plan Half- Tablet Program; Benefits Management Program Changes; 2010 Copayment Changes; Empire Plan Rate Change; Important Information about the Pre-Tax Contribution Program (PTCP) for Enrollees with Domestic Partners; Leaving School Before Graduation and NYSHIP Eligibility; Extended Workers’ Compensation Coverage; Reminders: Dependent Verification; Empire Plan At a Glance and Copay Cards; Medicare Part B Premium Reimbursement; Reimbursement of the Medicare Part B Income-Related Monthly Adjustment Amount (IRMAA) for Medicare-Primary Enrollees; Preretirement Seminars; Annual Notice of Mastectomy and Reconstructive Surgery Benefits.
NYSHIP General Information Book Changes
Your Spouse; Domestic Partner; Leaving School before graduation; Medical leave for students; Disabled Dependents; Young Adult Option; When your Family coverage begins; Exception: CHIP and Medicaid; PTCP Changes; Health Care Spending Account; Workers’ Compensation; Retiree Eligibility; NYS: Extended continuation of coverage; Medicare Reimbursement.
Empire Plan Certificate Amendments
Benefits Management Program: Benefits Management, Prospective Procedure Review, Benefits Management Program; Hospital and Related Expenses Program: Copayments, Outpatient MRI, MRA, CT, PET and Nuclear Medicine Tests, Skilled Nursing Facility Care, Transplants Program, Coordination of Benefits, Benefits after termination, Recovery of overpayments; Medical/Surgical Program: Copayment, Plan Overview, Outpatient MRI, MRA, CT, PET and Nuclear Medicine Tests, Meaning of Key Terms, Adult Immunizations, Outpatient Surgical Locations, Chronic Care, Diabetes Education Centers, Basic Medical Program, Annual Deductible, Non-Network Hospital Program Expenses, Prosthetic Wigs, Diabetes Education Centers, Prospective Procedure Review, Durable Medical Equipment, Diabetic Shoes, Cancer Program, Infertility Benefits, Exclusions, Coordination of Benefits, Medicare, Medicare Coverage, How, When, Recovery of overpayments, External Appeals; Mental Health and Substance Abuse Benefit Program: Certificate of Insurance; Prescription Drug Program: Certificate of Insurance.
Distribution of Reports
These publications will be mailed to enrollee homes in early May 2010. We will send you a supply of each publication equal to one percent of your affected enrollment.
Publications available on our web site: www.cs.state.ny.us
Please check this web site for new publications. We generally post publications when we sign off for printing. That means you can see the publications before enrollees start receiving them.
Ordering Publications
You may order additional copies of the Reports, including Amendments, or the Special Report by using the Publications Supply Order Forms on HBA Online. From the Department of Civil Service homepage, https://www.cs.state.ny.us, select the Benefit Programs button from the left hand navigation. Then click on HBA Online. Open Publications & Forms, then open NYSHIP Publication Order Forms. If you need help accessing HBA Online, please call the Help Desk or your processor.
If you are unsure of how to order publications or have questions about this distribution, please call the Communications Unit at 518-457-7577.