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What type of insurance is the Empire Plan?

Author

Michael Henderson

Updated on February 24, 2026

What type of insurance is the Empire Plan?

A. The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other covered medical expenses.

Besides, is the Empire Plan a PPO?

SUNY participates in the New York State Health Insurance Program (NYSHIP). This program offers a PPO, known as the Empire Plan, and several different HMOs, varying by geographic region around the State. Specific coverage provisions and plan design vary by health insurance plan and by employee bargaining unit.

Also, is the Empire Plan a HDHP? Empire can pair an HRA with a Consumer-Driven Health Plan (CDHP) or High Deductible Health Plan (HDHP) to help employees pay for covered costs.

Similarly one may ask, is the Empire Plan Medicare?

A. It is the combination of coverages under Medicare Parts A and B and NYSHIP that protects you. The Empire Plan pays for much of the Medicare Part A and B deductible and coinsurance amounts if you use The Empire Plan provider network, and may pay for some other medical expenses not paid by Medicare.

Is Nyship insurance Medicaid?

It is administered by the Social Security Administration and the Centers for Medicare and Medicaid Services (CMS). When you become eligible for primary Medicare coverage (“primary†means Medicare pays health insurance claims first, before NYSHIP), you must be enrolled in Medicare Part A and Part B.

Is Nyship Blue Cross Blue Shield?

Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).

How much does the Empire plan cost?

2019 Participating Agency Empire Plan Cost Estimate Calculator
Rate Per Coverage Type2019 Monthly RateTotal
Individual Coverage$1,042.85$
Family Coverage (Individuals & Dependents)$2,412.77$
Medicare-primary - Individual$403.27$
Medicare-primary - Family (with one Medicare)$1,773.19$

Is Blue Cross Blue Shield HMO or PPO?

What does Blue Cross offer? Blue Cross offers open access PPO plans to employer groups. Blue Plus is a licensed nonprofit HMO. These Blue Plus plans are open access, which means members can select any primary care physician or specialist in the network and do not need a referral.

What is the difference between Blue Cross Blue Shield PPO and EPO?

A PPO plan gives you more flexibility than an EPO by allowing you to attend out-of-network providers. On the other hand, an EPO will typically have lower monthly premiums than a PPO. But, if you're considering an EPO, you should check approved in-network providers in your area before you decide.

What is a PPO plan?

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You can use doctors, hospitals, and providers outside of the network for an additional cost.

What is Empire Blue Cross Blue Shield PPO?

The Empire Blue Cross PPO plan provides in-network benefits, including an extensive network of participating providers covering most medical specialties, as well as out-of-network (non-network) benefits. A number of diagnostic laboratories are participating providers under the Empire Blue Cross PPO plan.

What is the best Medicare Advantage plan?

Our Methodology — How We Chose the Best Medicare Advantage Plans and Companies for 2021
CompanyStates CoveredBest For
Kaiser9Best Overall
AARP UnitedHealthcare24Value
Humana47Extra Benefits
Aetna44Travelers

Does Blue Cross have a Medicare Advantage plan?

Blue Cross is one of several insurance companies that offer Medicare Advantage plans.

Is Medicare Advantage cheaper than original Medicare?

The costs of providing benefits to enrollees in private Medicare Advantage (MA) plans are slightly less, on average, than what traditional Medicare spends per beneficiary in the same county.

What is the difference between Blue Cross Blue Shield Medicare and Medicaid?

Here's an explanation of how they're different: Medicare is related to age and disability.Medicaid is related to income. Medicare covers people age 65 and older. It also covers people with certain disabilities who are on Social Security.

Does the Empire Plan include Silver Sneakers?

Empire offers SilverSneakers – as well as many other health plan benefits – to members enrolled in the following plans: Empire MediBlue Plus (HMO) Empire MediBlue Dual Advantage (HMO SNP)

What are Medicare premiums for 2021?

In 2021, the standard monthly premium will be $148.50, up from $144.60 in 2020. But if you're a high earner, you'll pay more. Surcharges for high earners are based on adjusted gross income from two years earlier.

What is the difference between Medicare and Medicaid?

Medicare is a federal program generally for people who are 65 or older or have a qualifying disability or medical condition. Medicaid is a state government program that helps pay health care costs for people with limited income and resources, and different programs exist for specific populations.

How does Nyship work with Medicare?

When Medicare is primary to NYSHIP, NYSHIP reimburses you for the standard Medicare Part B premium (excluding any penalty for late enrollment) and any IRMAA you must pay for Part B, unless you receive reimbursement from another source or if your Medicare premium is being paid by another entity on your behalf.

Who is eligible for Nyship?

To be eligible for NYSHIP coverage, you must meet all of the following requirements: • You must be appointed/elected to a position in State service. You must be working at least half time on a regular schedule. You are expected to work at least six continuous biweekly payroll periods.

What is the difference between a PPO and a POS?

In general the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans, have lower costs, but with fewer choices.

What is PPO out of pocket?

The PPO includes a medical out-of-pocket maximum, which is the most you will pay in the form of coinsurance in a given year. Once you reach the medical out-of-pocket maximum, the plan pays 100 percent of allowable costs for the rest of the year.

Does Empire Plan cover gym membership?

Eligible members have a total of $200 per family to use towards reimbursement for any fitness clubs or exercise centers of their choosing in their eligible coverage year. Family members must be eligible under the member's benefit coverage.

What is GHI HMO?

With GHI HMO, you get a wide range of covered services from GHI HMO network doctors and hospitals for a small copay. With this plan, you choose a regular doctor who will manage and oversee your care, including administering referrals to network specialists and arranging for hospital stays.

Whats the difference between an EPO and a PPO?

A PPO (or “preferred provider organizationâ€) is a health plan with a “preferred†network of providers in your area. An EPO (or “exclusive provider organizationâ€) is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO.

What is Direct HMO?

The direct payment HMO/POS program makes available to you benefits for both a traditional HMO program for network services AND the additional freedom to obtain non-network medical services from the provider of your choice even if the provider does not participate in the HMO provider network.

Does Nyship cover nutritionist?

Nutritional Counseling/Medical Nutritional Therapy – You are covered when the treatment is medically necessary and the provider is licensed in the state where the service is rendered.

Does Empire Plan cover massage therapy?

Massage Therapy

NYSHIP is the New York State Health Insurance Program – a comprehensive health insurance program for New York State public employees comprising The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs).

Does the Empire Plan cover weight loss surgery?

Empire Blue Cross Blue Shield does cover weight loss surgery, but your specific policy must include it in order for you get it covered.

Who has Nyship insurance?

Q. How many people does NYSHIP cover? A. NYSHIP protects over 1.2 million State and local government employees, retirees and their families in the United States.

Is the Empire Plan the same as Empire Blue Cross Blue Shield?

Empire BlueCross (Empire) is the trade name of Empire HealthChoice Assurance, Inc. and Empire BlueCross HMO is the trade name of Empire HealthChoice HMO, Inc. independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State.

What is coinsurance health plan?

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%. If you've paid your deductible: You pay 20% of $100, or $20.

Is the Empire Plan Accepted in Florida?

The Empire Plan offers an expanded physician network in Arizona, Connecticut, Florida, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia,Washington D.C., West Virginia and the greater Chicago area.

Does Medicare become primary at 65?

Medicare is primary when your employer has less than 20 employees. Medicare will pay first and then your group insurance will pay second. If this is your situation, it's important to enroll in both parts of Original Medicare when you are first eligible for coverage at age 65.

Does the Empire plan cover vision?

You'll be covered for check-ups and eye exams, and you'll get allowances for the glasses or contacts you rely on. With Empire, your vision insurance is always there when you need it.

Who is over Medicare?

People who are 65 or older. Certain younger people with disabilities. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What is the New York State health insurance Program?

NYSHIP—the “New York State Health Insurance Programâ€â€”is a benefit program established to provide health insurance coverage to state and local government employees. For any benefit or claims questions, consumers should contact NYSHIP directly at 1-877-7-NYSHIP (1-877-769-7447).

Does Nyship cover long term care?

The Empire Plan does not provide Skilled Nursing Facility benefits, even for short-term rehabilitative care, for Retirees, Vestees and Dependent Survivors or their Dependents who are eligible for primary benefits from Medicare. Conditions for skilled nursing facility care.

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