Health insurance plans

With The Empire Plan, you can choose a participating provider or non-participating provider for medical services. When you choose a participating provider, you pay only your copay for covered services, and the provider files the claim. Using participating providers can greatly reduce your out-of-pocket expenses and help contain premium costs.

If you choose a non-participating provider or non-network provider, you will need to submit claim forms and pay a higher share of the cost.

Read your Empire Plan documents carefully for complete information on your Empire Plan benefits and responsibilities. You can view Empire Plan coverage documents and publications at the New York State Health Insurance Program (NYSHIP) website.

The Empire Plan Home Care Advocacy Program offers coverage for home care services, including skilled home nursing, home infusion, durable medical equipment and supplies.

To receive these benefits, you must call the Home Care Advocacy Program for authorization prior to receiving services. When you call, you will receive assistance making arrangements for covered services, durable medical equipment and supplies.

Call 1-877-7-NYSHIP (1-877-769-7447); press or say 1 for UnitedHealthcare and then 3 for the Home Care Advocacy Program.

For chiropractic treatment, physical therapy, and occupational therapy, call the Managed Physical Medicine Program. The Empire Plan Managed Physical Medicine Program is administered in partnership with Managed Physical Network (MPN). It offers coverage for chiropractic treatment, physical therapy, and occupational therapy and guarantees access to network benefits. If there are no network providers in your area, you must contact MPN prior to receiving services to arrange for network level benefits.

Call 1-877-7-NYSHIP (1-877-769-7447); press or say 1 for UnitedHealthcare and then 1 for help finding an MPN provider or 2 for all other questions regarding the Managed Physical Medicine Program.

The Medical/Surgical Program offers you two Center of Excellence Programs.

The Center of Excellence for Cancer Services Program provides paid-in-full benefits for cancer services at a designated Center of Excellence. You will also receive nurse consultations, assistance locating cancer centers and a travel allowance, when applicable.

The Center of Excellence for Infertility Program provides paid-in-full benefits for infertility services at a designated Center of Excellence, subject to the New York State mandated 3 cycle minimum and a lifetime maximum benefit for Qualified Procedures, including any applicable travel allowance.

For assistance with either program, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447). Press or say 1 for UnitedHealthcare and then 1 for the Infertility Program or 5 for Cancer Resources. You can also call the Cancer Resources Center directly at 1-866-936-6002. Both calls are toll-free.

Traveling out of town, out of state, or even out of the country? No matter where you go, you can have peace of mind knowing The Empire Plan goes with you.

Empire Plan coverage is available worldwide, and not just for emergencies. Most parts of The Empire Plan have two levels of benefits. If you use one of the many Empire Plan participating providers available throughout the United States, Puerto Rico and US Virgin Islands, you will receive medically necessary covered services and supplies at little or no cost and have no claim forms to fill out. If you use a covered nonparticipating provider anywhere in the world, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply.

Both participating and nonparticipating providers can use the online directory to search for network providers. They can also both access resources and tools for providers and health care professionals at uhcprovider.com. This includes tools to verify member eligibility and coverage, submit prior authorization requests and advance notification, and submit and check claims. And participating providers can update their demographic information there as well.