Questions About NYSHIP: The Empire Plan ONLY
Q: I have a question about my Empire Plan coverage. Is there a toll-free phone number I can call?
A: For information about NYSHIP: The Empire Plan benefits, you should call 1-877-7-NYSHIP (1-877-769-7447). In addition, you can also refer to the NYSHIP General Information Book which is sent to each NYSHIP enrollee, and is also available online. The fastest way to communicate with the County Comptroller’s Office about your NYSHIP enrollment is by e-mail or by phone at 516-571-2679.
Q: Is there a hotline I can call if I am in need of medical information or answers to health questions?
A: The Empire Plan NurseLine is available 24 hours a day, seven days a week for health information and support. Call 1-877-7-NYSHIP (1-877-769-7447) toll free and press or say “5” to speak with a registered nurse or to reach The Empire Plan NurseLine’s Health Information Library.
Also, for information on more than 1,000 topics, enter PIN number 335 and a four-digit topic code from The Empire Plan NurseLine brochure. If you do not have your brochure, ask the NurseLine nurse to send you one.
Q: If I am enrolled in The Empire Plan, can I go to any doctor for medical services?
A: Yes, however, the cost will usually be less if you use a participating provider. A participating provider is a medical provider who has agreed with the health insurer to provide services to you for a pre-approved amount that will be paid directly by the insurer. Generally, you are only responsible for a “co-pay” to the provider.
Q: How do I find out if my doctor is an Empire Plan participating provider? How do I locate an Empire Plan participating provider?
A: Calling your doctor directly may be the quickest and easiest way to ascertain whether the doctor is a participating provider. You can also call NYSHIP at 1-877-769-7447 or search online at The New York State Department of Civil Service's Web site, www.cs.state.ny.us. You may access employee health benefit information here. You may also request that a book of participating providers be sent to your home by NYSHIP.
Q: If I am having surgery or am about to be admitted to the hospital to give birth, must I call The Empire Plan first for approval?
A: Yes, you or your physician must call The Empire Plan before a scheduled inpatient hospital admission, and choose Empire Blue Cross Blue Shield for pre-admission certification.
You must call them at 1-877-769-7447:
- before any elective (scheduled) hospital admission;
- before the birth of a child;
- within 48 hours after an emergency or urgent admission.
In addition, you must call before admission to a skilled nursing facility.
Q: What plans can I join if there are no Empire Plan doctors in my area?
A: Under The Empire Plan, you may visit a non-participating doctor and submit a claim for partial reimbursement to United Health Care. As an alternative to Empire Plan coverage, the county also offers coverage by various HMOs in New York State that offer another group of doctors to choose from. You may only change your carrier once per year, during the Open Enrollment Period (during the month of December).
Q: What is MultiPlan?
A: MultiPlan is a nationwide provider organization network that contracts with The Empire Plan’s medical/surgical care insurer, United Health Care, to reduce the out-of-pocket costs of using a non-participating provider. If you are a NYSHIP enrollee and you need to see a doctor who is a non-participating provider, choosing a doctor from the MultiPlan network will cost you less money. You can find MultiPlan providers on the web at: www.multiplan.com.
Q: I’ve chosen to see a non-participating doctor and/or pharmacist for a prescription. How do I get my reimbursement?
A: You must obtain a claim form from the Comptroller’s Office, Health Benefit Unit, or from your department’s Human Resource Officer and then submit the completed form(s) to The Empire Plan. You may also print the necessary forms by clicking here.
Q: How will I know if my prescription is for a generic or a brand-name drug covered under The Empire Plan?
A: A list of the most commonly prescribed generic and brand-name drugs included on The Empire Plan Preferred Drug List can be found on the Web site of the New York State Department of Civil Service.
Choose Health Benefits and then choose 2006 Empire Plan Preferred Drug List.
This is not a complete list of all prescription drugs covered under The Empire Plan. For specific questions about your prescription coverage, please call The Empire Plan at 1-877-769-7447 (select “The Empire Plan Prescription Drug Program”).
For your reference, you can also find a price list of the most commonly prescribed drugs can be found on the Web site of the New York State Attorney General’s Office.
Q: After visiting a non-participating doctor or other non-participating provider, how long do I have to submit my claim for reimbursement?
A: You must submit your claims within 90 days after the end of the calendar year in which your visit took place. For instance, if your visit took place in 2005, you would have until March 31, 2006 to submit your claim(s). Claims should be submitted to:
- United HealthCare for The Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP), and for non-network physical medicine services;
- ValueOptions for non-network mental health and substance abuse services; and
- Caremark for prescriptions filled in 2005 at non-participating pharmacies or without using your New York Government Employee Benefit Card.
If The Empire Plan is your secondary insurer, you must submit claims within 90 days after your primary health insurance plan processes your claim.
Claims may be submitted later if you can supply documentation demonstrating a valid reason it was impossible for you to meet the deadlines (due to illness, for example).
Q: Will my doctor know which generic and brand-name drugs are on The Empire Plan’s preferred list?
A: The Empire Plan provides participating doctors with a list of most commonly prescribed generic and name-brand drugs included on The Empire Plan Preferred Drug List. However, it is your responsibility to know if your prescription drug is covered by The Empire Plan. Please refer to The Empire Plan Preferred Drug List, which can be found on the Web site of the New York State Department of Civil Service, or call The Empire Plan at 1-877-769-7447 for additional information..
Q: I recognize that Caremark has recently replaced ExpressScripts as the prescription drug carrier. I have refills remaining with the ExpressScripts Mail Service Pharmacy; will I lose these?
A: No, your refills will remain available because your prescription will be automatically transferred to the Caremark Mail Service Pharmacy as of January 1, 2006.