Changes for The Empire Plan starting Jan. 1, 2024

Beginning Jan. 1, 2024, Nassau County is adding 5,000 Civil Service Employee Association (CSEA) members to The Excelsior Plan, which is included in The Empire Plan. There are also benefit changes for these Empire Plan groups:

• Public Employees Federation (PEF), including COBRA and Young Adult Option enrollees
• United University Professions (UUP), including COBRA and Young Adult Option enrollees

You’ll see the following benefit changes when treating PEF and UUP members.

Elimination of multiple participating provider copayments per visit

The $25 participating provider copayment amount will remain the same, but just one $25 copayment will be required for all covered office visit, office surgery, radiology and/or laboratory services received by the same enrollee from the same provider on the same date of service. Please note that up to 2 copayments of $30 (for a total of $60) may apply for services at an urgent care center.

Change in maximum allowed amount for nonparticipating providers

Claims from nonparticipating providers will use Medicare rates as the fee basis. This means enrollees may have greater out-of-pocket costs when using a nonparticipating provider. In accordance with your contract, please refer enrollees to providers in The Empire Plan network when appropriate. Using network providers helps your patients avoid added costs and pay only a copayment for covered services.

New site of care program for infusions when The Empire Plan is primary coverage

Empire BlueCross will review the setting for infusion services under The Empire Plan Hospital Program and, if clinically appropriate, work with you, your patient and UnitedHealthcare to transition those services from an outpatient hospital setting to a new location. Alternate settings include freestanding infusion suites, a doctor’s office or the patient’s home. And there are no Medical/Surgical Program or Prescription Drug Program copayments when patients use an alternate setting.

Enrollees may choose to continue infusion services in an outpatient hospital setting when clinically appropriate or when there is no alternate setting available within 30 minutes or 30 miles of their home. Benefits for covered infusion services in an outpatient hospital setting are unchanged.

Visit limit added for out-of-network acupuncture services

Coverage is available for a maximum of 20 visits per calendar year for acupuncture services by nonparticipating providers, regardless of how many nonparticipating providers are visited.

Visit limit added for massage therapy services

Coverage is available for a maximum of 20 visits per calendar year for massage therapy services, regardless of how many providers are visited.

A new Center of Excellence for Substance Use Disorder Program

The Empire Plan Mental Health and Substance Use Program, administered by Carelon Behavioral Health, will include a new Center of Excellence for Substance Use Disorder Program in partnership with the Hazelden Betty Ford Foundation. The program provides authorized treatment at no cost to Empire Plan enrollees. When authorized, covered services include detoxification, residential rehabilitation, partial hospitalization, intensive outpatient care, care coordination for transition back to community, family treatment and support, and virtual support services. Detoxification facilities are available in California, Minnesota and Oregon, and outpatient services are available in California, Florida, Illinois, Minnesota, New York, Oregon and Washington. Travel, lodging and meal allowances are available for members and up to 2 travel companions.

Questions?

For questions, call The Empire Plan help desk at 877-769-7447 (877-7-NYSHIP), 8 a.m.–4:30 p.m. ET, Monday–Friday. You’ll press or say “1” to reach UnitedHealthcare.

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