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
PA23-04
TO: Health Benefits Administrators of Participating Agencies (PAs) with The Empire Plan
FROM: Employee Benefits Division
SUBJECT: Publications for July 1, 2023 Empire Plan Benefit Changes
DATE: April 27, 2023
Effective July 1, 2023, there will be Empire Plan benefit changes due to changes negotiated by State employee unions that were administratively extended to active employees and retirees of NYSHIP Participating Agencies (PAs) with The Empire Plan.
Special Empire Plan Report
A May 2023 Empire Plan Special Report (PA0236) is now available online and will soon be mailed to enrollee homes and agencies. The May Report includes 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, copayment cards are still accurate and enrollees may contact HBAs for replacement copies.
Distribution: The May 2023 publication will begin to mail to enrollee homes in 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 the Report 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 Report 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 revised At A Glance and other publications
As a result of the benefit changes, the At A Glance publication will be updated. The revised publication will be mailed to enrollee homes in July with an updated Out of Network Reimbursement Disclosure. 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.