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.
Empire Plan Providers, Pharmacies and Services
The Empire Plan Hospital Benefits Program has two levels of benefits - network and non-network. Network benefits apply when you use hospitals, hospices and skilled nursing facilities that participate in the BlueCross and BlueShield Association's network. This is currently the largest hospital network available in the United States. Ninety-seven percent of hospitals nationwide are network hospitals. Network coverage at select New York hospital based ambulatory surgical centers and hospital-owned urgent care centers is also available.
The Empire Plan is designed to provide enrollees with comprehensive medical care coverage. Using participating providers helps keep the cost to you and The Empire Plan at a reasonable level. UnitedHealthcare is the program administrator for this coverage.
The following Directory includes Medical/Surgical Providers, Laboratories, Outpatient Surgical locations, Cardiac Rehabilitation Centers, Urgent Care Centers and Orthotic/Prosthetic Devices Networks. The directory is updated weekly.
The Empire Plan Medical/Surgical Provider Directory
UnitedHealthcare has a customized website, MYUHC, for enrollees to access information about the Medical/Surgical Program. Enrollees can track their Plan's medical/surgical claims and history, print explanations of benefits (EOBs), create personalized provider directories and much more.
EPIC Hearing Healthcare Hearing Service Plan (HSP). Call toll-free 1-866-956-5400 to locate the nearest hearing aid service center and to access your Empire Plan benefit through the EPIC Hearing Service Plan.
If The Empire Plan is your primary insurance coverage and use a nonparticipating provider who is part of the MultiPlan group, your out-of-pocket expenses will, in most cases, be reduced.
Mental Health and Substance Use Program
The Empire Plan Mental Health and Substance Use Program, administered by Carelon, provides coverage for medically necessary inpatient and outpatient care through a network of participating providers; medically necessary non-network services are also covered. To ensure you receive the highest level of benefits, you should call Carelon before you seek mental health or substance use care, including treatment for alcoholism, even when a doctor refers you to the facility.
You have guaranteed access to network level of benefits if you call Carelon's Clinical Referral Line for assistance with finding a provider and arranging care. You can reach the Clinical Referral Line by calling The Empire Plan toll free at 1-877-7-NYSHIP and choosing option 3 for the MHSU Program, then selecting option 3 from the MHSU Program menu. The Clinical Referral Line is available 24 hours a day, every day of the year.
The Empire Plan customized AchieveSolutions website provides confidential online access to educational and screening materials, disease management programs, and claims and coverage information. For direct access to the provider/facility directory, visit ReferralConnect.
Prescription Drug Program
You can order mail service prescriptions online, reducing the prescription cost for you and The Empire Plan. Also, information about The Empire Plan pharmacy locations, including pharmacies participating in the vaccine network and 24-hour service pharmacies, is available here. CVS Caremark administers The Empire Plan Prescription Drug Program for retail pharmacy network and mail pharmacy services.