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.

GEORGE E. PATAKI
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
DANIEL E. WALL
COMMISSIONER
JOHN F. BARR
EXECUTIVE DEPUTY COMMISSIONER
PA05-15
TO: Participating Agency Chief Executive Officers
FROM: Robert W. DuBois, Director of the Employee Benefits Division
SUBJECT: Second Notice - NYSHIP Policy Memo 127 and Verification Form
DATE: September 12, 2005
This letter serves as notification that we have not yet received your NYSHIP Policy Memo 127 verification form, as requested in my letter of May 20, 2005.
Another copy of the letter, along with the Policy Memo and Verification Form, is enclosed. It is important that we receive this information from you as soon as possible since the deadline for any necessary corrective action is December 31, 2005. Please return this form and any requested information no later than September 21, 2005.
If you have any questions about this policy, please contact Mary Frye, Director of Employee Insurance Programs at (518) 485-1771.
We appreciate your prompt attention concerning this matter.
Enclosures:
Letter to the Chief Executive Officers
Policy Memo 127 Verification Form
Employee Benefits Division Policy Memorandum
cc: Participating Agency Health Benefits Administrators