Finding the right health insurance can feel overwhelming. Empire Health Insurance, part of the New York State Health Insurance Program (NYSHIP), offers robust coverage for public employees.
It’s designed to provide comprehensive care with flexibility. This guide explains its benefits, costs, and how it works.
What Is Empire Health Insurance?
Empire Health Insurance, officially called The Empire Plan, is a health insurance program. It serves New York State public employees, retirees, and their families.
Administered by the Department of Civil Service, it covers nearly 1.2 million people. It’s one of the largest employer-sponsored plans in the U.S.
The plan partners with UnitedHealthcare, Anthem Blue Cross, Carelon, and CVS Caremark. It offers medical, hospital, mental health, and prescription drug coverage. Empire Health Insurance is known for its wide provider network. Enrollees enjoy flexibility in choosing doctors.
Why Choose Empire Health Insurance?
Empire Health Insurance stands out for its comprehensive benefits. It covers hospital stays, doctor visits, and prescriptions. Enrollees can access a network of over 1 million providers nationwide. This ensures care is available almost anywhere.
The plan is tailored for public employees. It offers stability and reliability for state workers and retirees. Flexible options suit both individuals and families. It’s a trusted choice for consistent coverage.
How Empire Health Insurance Works
Empire Health Insurance operates as a Preferred Provider Organization (PPO). You can choose in-network or out-of-network providers. In-network care has lower copays and no claim forms. Out-of-network care requires you to pay more and submit claims.
The plan includes four main programs. UnitedHealthcare handles medical and surgical care. Anthem Blue Cross covers hospital services. Carelon manages mental health and substance abuse. CVS Caremark oversees prescriptions.
Key Components of the Plan
- Medical/Surgical: Covers doctor visits and surgeries.
- Hospital Services: Includes inpatient and outpatient care.
- Mental Health: Offers therapy and substance abuse treatment.
- Prescription Drugs: Provides coverage through pharmacies like CVS.
These components ensure broad coverage for enrollees.
Coverage and Benefits
Empire Health Insurance offers extensive benefits. It covers hospital stays, emergency care, and preventive services. Doctor visits, lab tests, and surgeries are included. The plan also supports wellness programs.
Specialty programs enhance care. Centers of Excellence provide advanced treatment for cancer, transplants, and infertility. The Home Care Advocacy Program covers home care and equipment. These features make Empire comprehensive.
Additional Benefits
- Worldwide Coverage: Access care globally, not just for emergencies.
- Preventive Care: Free screenings and annual check-ups.
- Telehealth: Virtual visits for convenient care.
- Wellness Programs: Support for healthy lifestyle choices.
These benefits add value for members.
Costs of Empire Health Insurance
Costs vary based on coverage type and status. For active employees, monthly premiums range from $100 to $500 for individuals. Family plans cost $300 to $1,200 monthly. Employers often cover a portion of these costs.
Retirees may pay reduced MediPrime rates if Medicare-eligible. Copays range from $20 to $40 for in-network visits. Deductibles apply for out-of-network care. Check with your employer for exact rates.
Table: Sample Empire Plan Costs (Monthly, 2025)
| Coverage Type | Premium Range | Copay (In-Network) | Best For |
|---|---|---|---|
| Individual | $100–$500 | $20–$40 | Single employees |
| Family | $300–$1,200 | $20–$40 | Families with dependents |
| MediPrime (Retiree) | $80–$400 | $20–$40 | Medicare-eligible retirees |
This table shows estimated costs. Contact NYSHIP for precise figures.
Who Can Enroll in Empire Health Insurance?
Empire Health Insurance is for New York State public employees. This includes state workers, retirees, and their dependents. Local government employees may also qualify if their agency participates. Eligibility requires working at least 20 hours weekly.
Retirees can continue coverage post-employment. Medicare enrollment is required when eligible. Dependents, like spouses or children, are often covered. Check with your Health Benefits Administrator for details.
How to Enroll
Enrollment happens through your employer’s Health Benefits Administrator (HBA). New employees enroll within their first 60 days. You complete a NYSHIP enrollment form. Choose between The Empire Plan or a NYSHIP HMO.
Open enrollment occurs annually, typically in November. You can switch plans or add dependents then. Special enrollment applies for life events like marriage. Contact your HBA for guidance.
Tips for Enrollment
- Review Options: Compare Empire Plan with HMOs.
- Check Deadlines: Enroll within 60 days of hiring.
- Verify Dependents: Ensure family members are eligible.
- Ask Questions: Consult your HBA for clarity.
These steps ensure a smooth enrollment process.
Empire Health Insurance for Retirees
Retirees can keep Empire Health Insurance. You must enroll in Medicare Parts A and B when eligible. The Empire Plan becomes secondary to Medicare. This reduces premiums for MediPrime enrollees.
Medicare-primary retirees receive Part B reimbursement. Coverage remains comprehensive, including prescriptions. Retirees enjoy the same provider network. This ensures continuity of care.
Using Empire Health Insurance
To use Empire Health Insurance, find a participating provider. The online directory at empireplanproviders.com lists over 1 million options. In-network providers require only a copay. They handle claims for you.
For out-of-network care, you pay upfront and submit claims. Use the NYSHIP toll-free number (1-877-769-7447) for help. The Empire Plan app simplifies finding providers and managing benefits. Always carry your ID card.
Changes to Empire Health Insurance in 2025
Empire Health Insurance updated benefits on July 1, 2023. These changes continue in 2025, enhancing coverage. Updates include improved telehealth access and wellness programs. Some groups saw adjusted copays or coverage limits.
Check the NYSHIP website for details. The “Empire Plan Report” outlines recent changes. Providers and enrollees should review updates. This ensures compliance and maximizes benefits.
Comparing Empire to Other Plans
Empire Health Insurance differs from NYSHIP HMOs. HMOs restrict you to specific networks, but Empire offers nationwide access. HMOs may have lower premiums but less flexibility. Empire’s PPO structure suits those needing provider choice.
Marketplace plans are an alternative for non-state employees. They may offer subsidies but lack Empire’s network size. Compare costs and coverage before deciding. Empire excels for public employees.
Limitations of Empire Health Insurance
Out-of-network care is pricier. You pay higher deductibles and coinsurance. Claim forms are required for non-participating providers. This can be time-consuming.
Some services need pre-certification. For example, home care or certain surgeries require approval. Always check coverage details. This avoids unexpected costs.
Managing Costs with Empire
Empire Health Insurance keeps costs manageable. Use in-network providers to minimize copays. Preventive care, like screenings, is often free. This reduces long-term expenses.
Enrollees in the Pre-Tax Contribution Program (PTCP) save on taxes. Premiums are deducted before taxes, lowering your taxable income. Check your paycheck for PTCP enrollment. Ask your HBA about opting in.
Empire Health Insurance for Travel
Empire Health Insurance offers worldwide coverage. You can access care abroad, not just for emergencies. Use participating providers for lower costs. The “On the Road” guide lists key contacts.
Carry your ID card and the guide when traveling. Contact the toll-free number for provider help. This ensures seamless care away from home. Empire’s global reach is a major perk.
Planning for Long-Term Coverage
Empire Health Insurance supports long-term planning. Review your plan annually during open enrollment. Adjust coverage for life changes, like adding dependents. Retirees should confirm Medicare coordination.
Use NYSHIP resources like the General Information Book. These detail eligibility and benefits. Stay informed to maintain uninterrupted coverage. Empire ensures stability for years.
Summary
Empire Health Insurance, part of NYSHIP, serves New York State public employees. It offers comprehensive coverage through a PPO structure. Benefits include hospital care, doctor visits, and prescriptions. With over 1 million providers, it ensures flexibility and access.
Costs range from $100 to $1,200 monthly, depending on coverage. Retirees benefit from Medicare coordination and reduced rates. The plan’s worldwide coverage and wellness programs add value. Use NYSHIP resources to maximize benefits and plan wisely.
FAQ
What is Empire Health Insurance?
Empire Health Insurance, or The Empire Plan, is a PPO for New York State employees. It covers medical, hospital, and prescription drug costs. It’s part of NYSHIP, administered by UnitedHealthcare and others.
Who can enroll in Empire Health Insurance?
State employees, retirees, and their dependents are eligible. You must work 20+ hours weekly. Local government workers may qualify if their agency participates.
How much does Empire Health Insurance cost?
Premiums range from $100–$500 for individuals and $300–$1,200 for families. Copays are $20–$40 in-network. Retirees may pay reduced MediPrime rates.
Can I use Empire Health Insurance outside New York?
Yes, Empire offers worldwide coverage. Use in-network providers for lower costs. The plan covers non-emergency care globally, with over 1 million providers.
How do I find Empire Plan providers?
Use the online directory at empireplanproviders.com. It lists over 1 million participating providers. Call 1-877-769-7447 for help finding in-network care.