0000004228 00000 n 1-877-7-NYSHIP, press option 3 for the mental health/ substance use program, you will receive another set of . 0000006649 00000 n Because of a loss of income, New Yorkers may also be eligible for Medicaid, the Essential Plan, subsidized Qualified Health Plans or Child Health Plus. A: Most County employees choose to enroll in the "Empire Plan" offered thru NYSHIP. The first set reflects 2023 biweekly rates for CSEA-represented employees who are Grade 9 and below. Information on medication coverage. hb``c``d```YLWY0&I36p0p? If so, will I have to pay a deductible, copayment, or coinsurance? $50 ($40 for NYS CSEA and UCS) copayment/visit to a hospital-owned urgent care center 20% coinsurance in an office; 10% . 0000000016 00000 n ;1R K `I,%'% XBK* M9Ho,qxHySHA\jS7z oG You are only responsible for your in-network copayment, coinsurance, or deductible. NYSHIP Online Guidelines for Web Navigation. 2022 State NYSHIP Enrollee Biweekly Premium Contributions . What if I think I have coronavirus (COVID-19)? 0000012693 00000 n If you have individual coverage (including under a qualified health plan) or small group coverage that was purchased in NY, you are covered for medically necessary emergency services in hospitals worldwide. In general, depending on the program, members are responsible for either notifying Empire Plan program vendors of certain services or for using network care providers for these services. 0000021102 00000 n ps{YyPlW=VC7xa=x/x` 6-@ #?b2COS65gz6FJrmS:5R33i36Ci3:^Y The Empire Plan's Provider Directory NYSHIP Claims and Administrative Forms, Copyright 2020 | CSEA Local 1000, AFSCME, AFL-CIO, See the 2023 State NYSHIP Enrollee Biweekly Premium Contributions, See NYS Department of Civil Services NYSHIP Rates and Deadlines publication, Health Insurance Transaction Form PS-404, Health Insurance Affordability and Accountability Act EBD-543. Contact your insurer. The office visit $20 co-pay will still apply to the following employee groups: - APSU -Council 82 -PEF 2. &szg|n`>#ifOC,L.B5%&Rde.jMOQ}yz , The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. 0000000016 00000 n 0000003482 00000 n 0000015114 00000 n The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. 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. Check the NY Department of Healths website on Coronavirus information for the most up-to-date information on what you should do. . If your insurer denies your request, you have a right to appeal that denial with your insurer and then to request an independent external appeal. If you need documentation of your need to isolate for school or work, you can fill out an Affirmation of Isolation Form instead of getting an Order of Isolation from the state or county Department of Health. You may have to pay your copayment, coinsurance, or deductible for any in-person follow-up care or treatment. CDPHP provides the programs and services you need to get and stay healthy, including personalized activities and challenges, virtual and in-person mental health support, the ability to find a doctor or compare costs for services with just a few clicks, and so much more. Health plans are not required to provide coverage of testing (including an at-home over-the-counter COVID-19 test) that is for employment purposes. Ask for Approval. Your insurer will notify you of the right to buy a conversion policy. Its a surprise bill if, during your in-network doctors office visit, an out-of-network provider treats you, or your doctor takes a specimen from you (for example, blood) and sends it to an out-of-network laboratory, or when referrals are required under your plan and your doctor refers you to an out-of-network provider. For more information on the amounts of financial assistance available to you, please visit the NY State of Health: The Official Health Plan Marketplace. Totally disabled generally means that you cant engage in any work or other gainful activity due to injury or disease. Yes. Out-of-State Coverage. You will not have to pay your copayment, coinsurance, or deductible even if you have a HDHP, since vaccines are preventive services which are not subject to the deductible or other cost-sharing. Effective 01/01/2020- Excelsior Plan members will have the office visit co-pay of $35. If you are totally disabled on the date your individual health insurance policy terminates, your insurer will continue to pay for covered services for up to 12 months, or until you are no longer disabled, if sooner. ** Certain covered drugs do not require a copayment when using a Network Pharmacy: *** When available over-the-counter, USPSTF A and B rated medications require a prescription order to process without cost sharing. Your email address will not be published. Health insurance policies typically cover the following services that you may need: Lab Tests - Public Lab. Learn more about decision timeframes under Appealing Decisions by HMOs and Insurers. Empire Plan supplement - 2022 Administrative Guide expand_more. 0000035149 00000 n H\An@E"DB;$ C4~D$~Evw?]p N]-v47zT]p!*L//Su;}6?qV G=at{H5+~yIfhej^B^ecYU`bn'xC_/K-% 5ys5k|I.Blds_?L~,g[syS3 What do I do if I test positive for COVID-19 using an at-home over-the-counter COVID-19 test? Empire members have no out-of-pocket costs for the vaccination during this national public health emergency. Frequently Asked Questions About Your Health Insurance Up to $600 per plan year for going to the gym, taking paid digital classes, or for youth sports fees. 0000035031 00000 n Required fields are marked *. Check out the tiles and watch the videos below for details. Generally, if you are the employee or covered dependent, you must pay the cost of continued health insurance. Visit COVIDtests.gov to order your free at-home over-the-counter COVID-19 tests. Visit NYSHIP online You will not have to pay your copayment, coinsurance, or deductible when you go to your doctor, a provider at another outpatient setting, an urgent care center, or an emergency room to diagnose COVID-19, including when the services are provided through telehealth. NY Coverage. (Please note that grandfathered large group plans are not required to cover vaccines for persons aged 19 or older, though federal law prohibits providers from billing you for the COVID-19 vaccine or its administration. 0000001182 00000 n Learn how you can get the most out of your health insurance benefits. PDF Program The Empire Plan The Excelsior Plan - Government of New York
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