We require advance notification of the procedures and services listed in the chart below. %PDF-1.4 % When your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) certifies you need it, Medicare Part B (Medical Insurance) helps pay for. If you have individual or group health insurance coverage that you or your employer bought in New York, including through the NY State of Health Marketplace or the New York State Health Insurance Program (NYSHIP) for public employees, COVID-19 vaccines are covered. hmO8?.Z8 If you lost your employer coverage, you have a separate special enrollment period to buy health insurance coverage though the Marketplace for 60 days after your loss. 10 Certain drugs require prior authorization and/or have quantity limit specifications. 0000004634 00000 n What if I am uninsured? This encourages New Yorkers to seek medical attention from their homes rather than visit a hospital or doctor's office ultimately reducing strain on the healthcare system and preventing further spread of the virus. For more information, visit the Department of Healths website. Pharmacy app allows you to view medication costs, search for potential savings, and more. In-Network Cost-Sharing. The Department of Financial Services supervises many different types of institutions. Can I still continue my group health insurance? Yes, a federal law called the CARES Act provides that tests for COVID-19 antibodies are covered without a copayment, coinsurance, or deductible when your attending healthcare provider determines that the testing is medically appropriate for you. 0000021102 00000 n NF1101 2022 NYSHIP Plan Comparison You are not responsible for paying premiums during an extension of benefits. Your premium may not be more than 102% of the group premium. You should check your health insurance policy, or contact your insurer or employer, to understand the benefits covered under your policy. Can my insurer cancel or refuse to renew my insurance policy if I get COVID-19? Please see the FAQs on the American Rescue Plan below for more information. The Empire Plan 001 $50.89 $4.59 $219.75 $20.14 Blue Choice 066 $42.58 $0.21 $182.57 . Contact Your Provider. The member benefit contract will determine whether a procedure or service is covered. You should check with your provider to see if your provider offers telehealth services. Up to $600 per plan year for going to the gym, taking paid digital classes, or for youth sports fees. _OF$ You are covered for medically necessary emergency services in hospitals. My name is Kate Patskovska, CPB. Surprise Bill If You Are Referred By Your Doctor. APSU New for 2023! 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. The NYSHIP Plan is the standard coverage for all employees. 1. The office visit $20 co-pay will still apply to the following employee groups: - APSU -Council 82 -PEF 2. Be enrolled in NYSHIP and eligible for retiree coverage Prove enrollment in other coverage Elect to defer before you leave the payroll Questions 20 Dental and Vision Benefits 2022 COBRA Dental and VisionMonthly Rates These rates do not apply to dental and vision coverage under Union Benefit Funds. Follow KR2 Medical Billing on WordPress.com, MVP Health Plans: reimbursement of sick E&M codes billed w/preventative codes -05/01/23. The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Who pays the premium if I lose my job and I continue my health insurance through my former employer? | Albany, New York 12206, 2023 New York HMO Benefit Summary Rx Plans, 2022 - 2023 Benefit Changes for HMO plans, 2022 - 2023 Benefit Changes for HMO Rx Plans, 2023 Summary of Benefits and Coverage Rx Plans, 2022 New York HMO Benefit Summary Rx Plans, 2021 - 2022 Benefit Changes for HMO plans, 2021 - 2022 Benefit Changes for HMO Rx Plans, 2022 Summary of Benefits and Coverage Rx Plans. Providers can get reimbursed for COVID-19 vaccine administration through the U.S. Human Resources & Services Administration COVID-19 Relief Fund Program. This does not apply to Medicare-primary Empire Plan enrollees and their covered dependents. See the 2023 State NYSHIP Enrollee Biweekly Premium Contributions Empire members receive the COVID-19 vaccine at no cost. Yes. Generally, if you are the employee or covered dependent, you must pay the cost of continued health insurance. No. 0000037637 00000 n No action is necessary for those State employees who are currently enrolled and continue to qualify for the Opt-Out Program. -Unified Court System-COBANC. 0000000936 00000 n The following represents the 2023 biweekly premium contributions for CSEA active state employees (and Unified Court System). 0000003596 00000 n Does my health insurance cover COVID-19 vaccines? If your employer goes out of business or no longer provides group health insurance to employees, you cannot get COBRA or continuation benefits. Please refer to the following list: 1. 0000001247 00000 n 2021 NYSHIP Benefit Plan Comparison . 0000005145 00000 n You are only responsible for your in-network deductible, copayment, or coinsurance. Employees Enrolled in 2022 FSA Plan include: HEALTH CARE SPENDING ACCOUNT: 14,910. Will my NY health insurance policy cover a COVID-19 diagnostic test ordered by a health care provider even if I am not showing symptoms of COVID-19 and have not had any exposure to a person with the virus? I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. 0000003307 00000 n All Rights Reserved | Capital District Physicians' Health Plan, Inc. | 500 Patroon Creek Blvd. NYSHIP will again offer the Opt-Out Program in 2023, which will allow eligible employees who have employer sponsored group health insurance, to opt out of their NYSHIP coverage in exchange for an incentive payment. As a reminder, it is no longer necessary to reenroll in the Opt-Out Program each year. Y0001_GRP_3926_2022_M_NYSHIP_9482_2632_811 2022 Summary of Benefits . Will my health insurance cover telehealth services? hb```b``ea`e`f`@ +zR&I\O7. With Anthem, you have access to both on-exchange and off-exchange health insurance plans. 0000007848 00000 n Ask for Approval. Welcome to The Empire Plan's Online Participating Provider Directory. $0 Copay for Kids Your health plan must cover eight tests per month for each individual covered by your plan. How do I get an at-home over-the-counter COVID-19 test? It is not a surprise bill if you signed a written consent that you knew the services were out-of-network and would not be covered by your health plan. 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. p JxfID04!9x\0Rx(0|J OY If you are feeling sick, use telehealth services before going to the doctor's office, urgent care or the emergency room. Group Coverage Terminated for Loss of Employment. for 2023 by December 30, 2022 The annual Option Transfer Period is here. Need More Information? 0000037518 00000 n Effective 01/01/2020- Excelsior Plan members will have the office visit co-pay of $35. Providers in the CDC COVID-19 Vaccination Program must give you the vaccine even if you are uninsured. Large Group Coverage. If you have coverage for prescription drugs, and your insurers formulary does not include a prescription drug that your doctor thinks you need, you can use your insurers formulary exception process to request coverage of an off-formulary prescription drug. |m34# |nd)|`lF5U|{h#?82 #C?$cqYPlYoLeIP8u?tlzB2Sv>Rx#y>b Z=cT?Xaocz'y_~S;]Xn$Y#Tp'}[6!t For specific formulary updates check here, Side-by-side comparison and highlights of benefits of the plan, Side-by-side comparison and highlights of benefits of the plan with drug coverage, How you and the plan would share the cost for covered health care services, How you and the plan would share the cost for covered health care services with drug coverage. I dont have health insurance. No. Many insurance policies cover a 90-day supply of prescription drugs if you use their mail order pharmacy. You will need to submit claim forms and pay a higher share of the cost if you choose a non-participating provider or non-network provider. NY Insurance Coverage. NYSHIP's Empire Plan has been reimbursing providers at 90% of the usual and customary rate determined by the cost estimate nonprofit FAIR Health for services since 2015 to also prevent balance . Demographic Data Self-Identification Form, Office Visit, Office Surgery, Radiology, Diagnostic Laboratory Tests, Free-standing Cardiac Rehabilitation Center Visit, Convenience Care Clinic Visit, Non-hospital Outpatient Surgical Locations, Office Visit, Radiology, Diagnostic Laboratory Tests, Urgent Care Center Visit, Outpatient Services for Diagnostic Radiology and Diagnostic Laboratory Tests in a network Hospital or Hospital Extension Clinic, Visit to Outpatient Substance Use Treatment Program, Level 2 Drugs, Preferred Drugs or Compound Drugs, Oral chemotherapy drugs, when prescribed for the treatment of cancer, Generic oral contraceptive drugs and devices or brand-name contraceptive drugs/devices without a generic equivalent (single-source brand-name drugs/devices), with up to a 12-month supply of contraceptives at one time without an initial 3-month supply, Tamoxifen, raloxifene, anastrozole and exemestane when prescribed for women age 35 and over for the primary prevention of breast cancer, Pre-Exposure Prophylaxis (PrEP), when prescribed for enrollees who are at high risk of acquiring HIV, Certain preventive adult vaccines when administered by a licensed pharmacist at a pharmacy that participates in the CVS Caremark national vaccine network, Certain prescription and over-the-counter medications*** that are recommended for preventive services without cost sharing and have in effect a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force (USPSTF). If you have Medicare, check with the Centers for Medicare & Medicaid Services (CMS) at (800) MEDICARE, the Medicare Rights Center at (800) 333-4114, www.medicare.gov, or the CMS fact sheet because different protections will apply. If your employer went out of business, you will not be able to get COBRA or continuation coverage. You may have to pay your copayment, coinsurance, or deductible for any in-person follow-up care or treatment. If you have a question, call 1-877-7-NYSHIP (1-877-769-7447) toll free and select the appropriate program from the menu. If you have a question, call 1-877-7-NYSHIP (1-877-769-7447) toll free and select the appropriate program from the menu. The extended benefits are only available to treat the condition causing your disability. This applies to all members, regardless of their type of health plan or the doctor or healthcare professional they choose to visit for COVID-19 vaccination. For further information, visit www.hhs . You can quickly compare health plan options and apply for assistance that could lower the cost of health coverage. No. 0000005866 00000 n s;wt2@&6udHHof 2I2=0u$$Q2Z#vODcX8\(#dCOi. Out-of-Network Hospitals. If you are enrolled through the NY State of Health: The Official Health Plan Marketplace you will have lower premiums through 2022 due to the ARP regardless of your income. If your employer bought your policy in another state, contact your employer for details. See the 2022 Empire Plan Preventive Care Coverage Guide for a list of covered services. The Department of Financial Services issued guidance on the ways you may receive telehealth services. \\mu?qk<6IO{=%U,"+o[_")S\pI.B'{ld3[l%&x ^B/K%x 5BMY4QQQQ^qg_=:zv#R_W+J}R_W+**tz&?Z9sPA9s0s ";}6Mq,u3-]v8./+ ] endstream endobj 97 0 obj <> endobj 98 0 obj <>stream Effective 01/01/2020 the following employee groups will have a $25 office visit co-pay: Please note there are two sets of rates. If Covered at Your Providers Office. 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. Where do I go for more information about at-home COVID-19 tests? What happens if I lose my health insurance when I am sick? Physical Health Mental Health Mental Health and Substance Use What benefits will my NY health insurance policy cover? What if I get charged a deductible, copayment, coinsurance, or other charge for a COVID-19 vaccine? Does my health insurance cover at-home COVID-19 diagnostic tests? 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. Your insurer will notify you of the right to buy a conversion policy. 0000007319 00000 n 2022 State NYSHIP Enrollee Biweekly Premium Contributions . 520 0 obj <> endobj xref 0000002948 00000 n You can use the same login details here. Since the site uses cookies to bring you targeted information regarding your health benefits, you will need to select your group and health insurance plan when prompted. 3V7 |F B endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream Wx endstream endobj 99 0 obj <>stream Serving New Yorkers for more than 85 years, Empire BlueCross BlueShield (Empire) is on a mission to materially and measurably improve the health of New Yorkers. Ask your employer whether your large group plan is grandfathered.). May a participating provider charge me a fee for personal protective equipment (PPE) used during my visit? endstream endobj 1537 0 obj <>stream If you lose your insurance coverage and you are totally disabled (including as a result of COVID-19), you have the following protections if you meet the requirements below. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other covered medical expenses. 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. Table of Contents show Are mental illnesses covered by insurance? You should contact your health plan to find out where you can obtain over-the-counter COVID-19 tests at no cost or whether you will need to submit a claim for reimbursement after you purchase a test. However, if you get services unrelated to your COVID-19 vaccine at the same time, you may get charged cost-sharing for those other unrelated services. COBRA and Continuation of Coverage. Can I get these tests reimbursed by insurance? 0000045658 00000 n Providers can visit the HRSA website for more information about this program. The testing is covered regardless of whether it is performed in-network or out-of-network. The 2022 open enrollment period is extended during the Public Health Emergency for COVID-19. The No Surprises Act provides broad consumer protections against "surprise" balance billing as of 2022. U|nL(.deiLGL:<391#V@(&h&5&4,SJcJ+f_2:2US>V5M`S3h(M6, u'!:;=#NYC(>_jvV5y Do I have to pay for the COVID-19 vaccine if I go to a provider who is not a participating provider under my NY insurance policy? If you test positive for COVID-19, you have to isolate in accordance with Department of Health guidelines. 0000003021 00000 n 0000004520 00000 n This Empire Plan pays for covered hospital services, physicians' bills, prescription drugs, and various other medical treatments including massage therapy. NY Coverage. COBRA or continuation coverage is only available if your employer keeps the group policy after you lose your job. Individual and Small Group Coverage. You have at least 60 days to elect to continue your coverage from the later of (1) the date your coverage terminates or (2) the date you are sent notice of your right to continue your coverage. 1536 0 obj <>stream 0000006649 00000 n ps{YyPlW=VC7xa=x/x` 6-@ #?b2COS65gz6FJrmS:5R33i36Ci3:^Y The HCSA, which helps state employees pay for health-related expenses with tax-free dollars, will now allow up to $550 of remaining balances from your 2021 HCSA to go toward eligible expenses incurred during the 2022 calendar year. The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and choose the appropriate program The New York State Department of Civil Service, Employee Benefits Division at 518-457-5754 or 1-800-833-4344 The New York State Department of Financial Services at 518-474-6600 or 1-800-342-3736 0000048148 00000 n The extended benefits are only available to treat the condition causing your disability. Finally, individuals enrolled in or eligible for COBRA or state continuation coverage may qualify for a temporary 100% premium subsidy beginning on April 1 through September 30. All Empire Plan and HMO enrollees and dependents are eligible for this benefit. Employers that provide group health insurance coverage must offer employees (and their dependents) who lose coverage because of a loss of employment, loss of eligibility for coverage, or reduction in hours the right to continue the coverage under the employers health plan. g 9B#SRa/P~u$Av(?m. 0000006209 00000 n The Workers Compensation Board issued Emergency Adoption of Amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 (Telemedicine)regarding telemedicine under No-Fault coverage.
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