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
LOLA W. BRABHAM
TO: Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2019 Summary of Benefits and Coverage (SBC)
DATE: November 27, 2018
The Patient Protection and Affordable Care Act (PPACA) requires all insurance plans to make available a Summary of Benefits and Coverage (SBC) for benefits-eligible employees, retirees and dependents. Current enrollees are notified via annual mailings, including Option Transfer Information for 2019, that the SBC and Uniform Glossary are available online, at www.cs.ny.gov/employee-benefits/sbc/pe.
The SBCs for The Empire Plan and all NYSHIP HMOs are posted online. Employees who do not have internet access may call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical 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 looking for a more comprehensive summary of benefits should be directed to review their 2019 At A Glance. This publication will be mailed to enrollee homes in December 2018 and will also be 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 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 Annual Option Transfer Period, due to a qualifying event.