PDF Department of Civil Service - New York State Comptroller For further information, visit www.hhs . 0000004766 00000 n Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and behavioral health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients. COVID-19 vaccines are covered by Medicare. Referrals; ID cards; Prior authorization and notification requirements; . You are only responsible for your in-network copayment, coinsurance, or deductible. Frequently Asked Questions About Your Health Insurance 0000006209 00000 n PDF Business Services Center Home Page | Business Services Center The office visit $20 co-pay will still apply to the following employee groups: - APSU -Council 82 -PEF 2. Out-of-Network Hospitals. Will I have to pay my deductible, copayment, or coinsurance for diagnosis or treatment of COVID-19 under my NY insurance policy? Need More Information? Empire Plan Medicare Rx Phone Numbers and Website Members or non-members, please call The Empire Plan toll free at 1-877-769-7447 and select option 4 for the prescription drug program. B_/BgSD2E&t9(rPA"e9(r0`lp6:glp6:gn?T|i4c9R~? outpatient physical therapy. Things to Know About Empire Plan Medicare Rx Hours of Operation You can call us 24 hours a day, 7 days a week. No. Your premium may not be more than 102% of the group premium. Balance billing refers to the additional bill that an out-of-network medical provider can send to a patient, in addition to the person's normal cost-sharing and the payments (if any) made by their health plan. 1-877-7-NYSHIP, press option 3 for the mental health/ substance use program, you will receive another set of . Starting January 15, 2022, health plans must cover at-home over-the-counter COVID-19 diagnostic tests authorized by the U.S. Food and Drug Administration (FDA). H]@IKf?0lR]~$4#*-FPjzp>9}z['0<> Q/*,/?w@ vn/`n&&G0e:cN_'~F5SoxSs"EO0^+J Will I be notified by my employer about continuing my health insurance if I lose my job? Formulary Appeal. Coronavirus (COVID-19) information: Health Insurance FAQs 0000004520 00000 n Medicare-primary NYSHIP HMO enrollees will be enrolled in the HMO's Medicare Advantage Plan. Contact Your Doctor. In addition, if you go to an out-of-network New York hospital, you will only be responsible for your in-network copayment, coinsurance, or deductible for inpatient hospital services which follow an emergency room visit. For more information, visit the Department of Healths website. %PDF-1.4 % With the new year (2020) around the corner The Empire Plan NYSHIP has released a list of more employee groups that will be affected by the office visit co-pay changes. The COVID-19 oral/nasal swab test can be done through public health laboratories, including New York States Wadsworth Center and the federal Centers for Disease Control and Prevention (CDC), and there is no charge to you. Providers can visit the HRSA website for more information about this program. If you are covered as a dependent on someone elses health insurance, and you lose your coverage because you no longer qualify as a dependent (for example, due to divorce, age limit for dependent children, or death of the insured), you have your own right to continue your coverage. Group Coverage Terminated for Loss of Employment. See Consumer Frequently Asked Questions: COBRA Coverage for more information. 0000001247 00000 n hmO8?.Z8 Lab Tests - Other Labs. Up to $600 per plan year for going to the gym, taking paid digital classes, or for youth sports fees. PDF Summary of Benefits and Coverage: What this Plan Covers & What You Pay Access to Out-of-Network Provider. If you think you are eligible for assistance but did not receive a notice or election form, you should contact your employer or former health plan administrator for more information. APSU The 2023 Administrative Guide for Commercial, Medicare Advantage and DSNP is applicable to all states except North Carolina. 0000003709 00000 n Self-Funded Coverage. If your insurer denies any other treatment as not medically necessary, or as experimental or investigational, you can appeal the denial with your insurer. 0000002098 00000 n Plan Name: NYSHIP Plan Effective Date: January 1, 2022 Benefits In-Network Additional Information Rehabilitation Services Chiropractic Services $20 copay / visit Physical - Occupational - Speech Therapies $20 copay / visit Up to 20 visits per contract year combined Cardiac Rehabilitation $20 copay / visit Up to 36 visits per event The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program The New York State Department of Civil Service, Employee Benefits Division at 518-457-5754 or 1-800-833-4344 The New York State Department of Financial Services at 518-474-6600 or 1-800-342-3736 What if my participating provider charges me for PPE? 2022 State NYSHIP Enrollee Biweekly Premium Contributions . $0 cost-share for primary care visits for children 18 and younger. PDF 2022 NYSHIP OPTIONS BY COUNTY - Government of New York You will not have to pay your copayment, coinsurance, or deductible when you get a laboratory test to diagnose COVID-19 at other labs either. These summaries are designed to highlight the benefits of the plan and do not detail all benefits, limitations, or exclusions. Visit COVIDtests.gov to order your free at-home over-the-counter COVID-19 tests. 0000001139 00000 n For more detailed information, a Membership Certificate is available for your review upon request. The member benefit contract will determine whether a procedure or service is covered. health insurance plans covering the same essential health benefits as on-exchange plans are available outside of the exchange or marketplace directly through Anthem. My job was terminated because my employer went out of business. 520 32 No. 0000048148 00000 n However, your insurer may require telehealth services to be provided by an in-network provider. Let your insurer know if you were charged a deductible, copayment, or coinsurance for diagnosis of COVID-19 and request a refund or credit for that payment. 4 Things to Know about COVID-19 Vaccines - Empire Blue A. Healthcare Provider Administrative Guides and Manuals The following links provide information including, but not limited to, prior authorization, processing claims, protocol, contact information and resources. Important Information - The Empire Plan's Provider Directory
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