Last update: January 24, 2023, 10:15 a.m. CT
The Empire Plan is a self-funded, non-ERISA health insurance option available to those eligible to participate in the New York State Health Insurance Program (NYSHIP) - primarily New York State government employees, retirees, and their dependents. Nationwide, the plan covers over one million members.
The top priority of UnitedHealthcare and The Empire Plan is the health and well-being of the people we serve. A team of experts is working quickly to make sure our members and their care providers have what they need to respond to the COVID-19 public health emergency. We understand the urgency and sensitivity during this time and want to do everything we can to support your needs.
The information provided on this page is intended to supplement the general COVID-19 information provided at UHCprovider.com/covid19 and offer Empire Plan-specific guidance when needed. Be sure to check back here and at UHCprovider.com often for updates.
As with any public health emergency, UnitedHealthcare and The Empire Plan will work with and follow all COVID-19 guidance and protocols issued by the U.S. Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and state and local public health departments. For the latest news and guidance on the virus, please visit cdc.gov/coronavirus/2019-ncov.
In accordance with current regulations, UnitedHealthcare will waive Empire Plan member copays, coinsurance and deductibles for:
Members should not be billed copayments or have any cost sharing for the above services.
To help ensure proper claim payment, please follow the coding/billing guidance below.
| Service | Code(s) to bill | Additional information |
|---|---|---|
| Testing-related services, including visits | Appropriate service code, including Evaluation and Management (E&M) codes Place of service: (23) Emergency room (20) Urgent care (11) Office visits/telehealth (02) Telehealth, as of Jan. 1, 2021 |
Cost share will be waived when billed with appropriate ICD-10 diagnosis code Z03.818, Z11.52, Z11.59, Z20.822 or Z20.828. |
| Specimen collection | HCPCS codes: G2023 and G2024 | Cost share will be waived for these COVID-19-specific specimen collection codes. |
| CPT® code: 99001 | Cost share will be waived for specimen collection when billed with appropriate ICD-10 diagnosis code Z03.818, Z11.52, Z11.59, Z20.822, or Z20.828. | |
| C9803 | Outpatient hospital facility only. Submit to The Empire Plan Hospital Program (BlueCross). |
If you have previously submitted claims where you believe UnitedHealthcare incorrectly applied a copayment, submit a corrected claim or contact customer care at 877-7-NYSHIP (877-769-7447). If you have any questions, contact your Empire Plan network representative.
Regarding Empire Plan Timely Filing
UnitedHealthcare is following the IRS/DOL regulation related to the National Emergency declared by the president. This regulation pauses the time clock for claim submission during the national emergency period that began on March 1, 2020. For Empire Plan claims, the timeframe is extended 60 days from the end date of the national emergency period, up to a maximum of one year after the normal deadline.
The normal Empire Plan filing deadline is 120 days after the end of the calendar year in which covered services are performed. Based on the IRS/DOL regulation, the Empire Plan timely filing deadlines are as follows:
The Empire’s policyholder is the State of New York, and each aspect of the plan (hospital, prescription drugs, medical, behavioral health) is awarded separately via a Request for Proposal process, meaning multiple carriers are involved in plan administration. The UnitedHealthcare portion of the plan includes a non-hospital-based PPO component for in-network benefits. In addition to the use of UnitedHealthcare’s nationally contracted providers nationwide, UnitedHealthcare’s Options PPO network providers serve as the participating providers for the in-network component in U.S. states and territories outside New York.