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
LOLA W. BRABHAM
Acting Commissioner
PA18-12
PAEX18-12
TO: Participating Agency 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 Empire Plan and Excelsior Plan enrollees will be mailed a postcard in late November to announce the availability of the 2019 Summary of Benefits and Coverage 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/Surgical Program to request a copy. 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 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, due to a qualifying event.