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
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA02-10
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2002 Data Match Project: Paper Questionnaire or Electronic Media Questionnaire (EMQ)
DATE: June 24, 2002
Participating agencies have begun to receive DataMatch questionnaires. The data for the Empire Plan medical and hospitalization components is attached. For the Data Match Project, the Empire Plan is not considered one plan because of its multiple insurers and their specific functions. You will report the Empire Plan medical and hospital components as separate plans. The Mental Health and Substance Abuse component of the Empire Plan has not been listed since the DataMatch Project has informed us that it is a special purpose indemnity plan for purposes of the DataMatch and does not need to be listed.
Your agency is considered the sponsor for all plans since you pay the premium for the coverage of your employees; do not list the NYS Department of Civil Service as plan sponsor in any correspondence with the DataMatch Project.
The information below for the Empire Plan medical and hospitalization components will allow you to submit your responses. Questions concerning the Empire Plan data should be referred to the Employee Benefits Division; general questions concerning the Data Match Project should be referred to the Data Match Contractor whose address appears in the Data Match instructions.
2002 Group Health Plan List for Data Match-PA
GHP Name: Empire Plan Hospitalization (EBC/BS) NYS Service center)
GHP address 1: EBC/BS New York State Service center
GHP address 2: 11 Corporate Woods Blvd.
GHP City: Albany
GHP State: New York
GHP Zip: 12211
Insurer TIN: 237391136
GHP Type: J
GHP Name: Empire Plan Medical
GHP address 1: UnitedHealthcare Service Corp.
GHP address 2: PO Box 1600
GHP City: Kingston
GHP State: New York
GHP Zip: 12402
GHP TIN: 061413734
GHP Type: K