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.
KATHY HOCHUL
Governor
TIMOTHY R. HOGUES
Commissioner
NY23-08
TO: New York State Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Publications for July 1, 2023 Empire Plan Benefit Changes for NY Active (CSEA/UCS/M/C; Legislature) Employees and NY Retirees
DATE: April 27, 2023
Effective July 1, 2023, there will be Empire Plan benefit changes as a result of:
- The recently ratified contract between the State and the Civil Service Employees Association (CSEA);
- The recently ratified contracts between the Unified Court System (UCS) and its unions;
- An administrative extension of the collectively bargained changes to employees designed Management/Confidential (M/C) in the Executive branch; State Legislature and other unrepresented employees; and
- An administrative extension of the collectively bargained changes to New York State retirees.
Special Empire Plan Reports
A May 2023 Empire Plan Special Report for affected NY Active employees (NY1461) as well as a version for NY Retirees (AL1940) are now available online and will soon be mailed to enrollee homes and agencies. The May Reports include information about reduced in-network maximum out-of-pocket limits, single visit copayment, a change to the reimbursement methodology for non-network claims, a new Center of Excellence for Substance Use Disorder and the Site of Care Program for Infusions. Note: Since copayments are not changing, group-specific copayment cards are still accurate and enrollees may contact HBAs for replacement copies.
Distribution: The May 2023 publications will begin to mail to enrollee homes in late April-early May. The mail files were pulled from NYBEAS on April 22, 2023 so any enrollee who was not on the file on that date should be provided with a copy. We will also ship two copies of each publication to agencies.
July 1 Benefit Changes Online Presentation
An informational presentation about the benefit changes has been created and is available online. A QR code is included in the Reports to access it using a mobile device or tablet. The approximately 12-minute resource can also be accessed on NYSHIP Online under What’s New.
July 1, 2023 Rate Changes and Special Option Transfer Period
There will be July 1, 2023 rate changes as a result of the benefit changes and affected active enrollees and retirees will be permitted to change their option during a Special Option Transfer Period from June 1 through June 30, 2023.
The May 2023 July 1, 2023 Rate Changes flyers for CSEA/UCS/M/C; Legislature (NY1465) and NY Retirees (NY1466) are now available online and will soon be mailed to enrollee homes and agencies. Empire Plan rates will be reduced as a result of the benefit changes and due to capping on the non-prescription drug components of the premium, some HMO rates will be increased.
Distribution: The May 2023 Rate Change flyers will be mailed to enrollee homes in May. Note that the retiree version will only be mailed to those enrollees who live in New York State. The mail files were pulled from NYBEAS on April 22, 2023, so any enrollee not on the file as of that date should be provided with a copy. We will also ship two copies of each publication to agencies.
You will receive a memo from the Division that provides complete details for Health Benefits Administrators regarding the rate change and how the Special Option Transfer Period will be administered. Please hold any questions you may have about the rate change and Special Option Transfer until you have received and carefully reviewed the upcoming memo.
July 1, 2023 revised At A Glance and other publications
As a result of the benefit changes, the At A Glance publications for affected NY Active groups (CSEA, UCS and M/C; Legislature) and NY Retirees will be updated. The revised publications will be mailed to enrollee homes in July with an updated Out of Network Reimbursement Disclosure for settled and unrepresented groups. Some of the supplemental publications that are usually inserted with this publication are not changing for July 1 so they will not be included again. They include the January 1, 2023 Empire Plan Advanced Flexible Formulary and the 2023 Preventive Care Coverage Guide. We will provide details of their mailing in a follow-up HBA memo.
The Summary of Benefits and Coverage (SBC) publication required by the Patient Protection and Affordable Care Act has also been updated to reflect the July 1, 2023 benefit changes. Enrollees can access it online at www.cs.ny.gov/sbc or call The Empire Plan toll-free number and select the option for the Medical/Surgical Program to obtain a printed copy.
Publications Available on NYSHIP Online: www.cs.ny.gov/employee-benefits
You can access the publications online under Using Your Benefits from the
NYSHIP Online homepage.
Ordering Publications
You may order additional copies of the publications on HBA Online under Publications & Forms. Please do not order copies until you have received your shipments.
If you need help accessing HBA Online, contact the ITS Service Desk at 844-891-1786, fixit@its.ny.gov or via chat at https://chat.its.ny.gov. If you are unsure of how to order publications or have questions about this distribution, please call the EBD Communications Unit at 518-457-7577.