The Empire Plan Expands Use of UnitedHealthcare Network

Last modified: October 28, 2020

The Empire Plan members have nationwide network access, starting Jan. 1, 2021.

Starting Jan. 1, 2021, members of The Empire Plan will have in-network access to the UnitedHealthcare Options preferred provider organization (PPO) network for all states and U.S. territories outside of New York.

The Empire Plan Supplement will be included with the 2021 UnitedHealthcare Care Provider Administrative Guide. When the guide is posted, the supplement will apply to care providers in all markets outside New York, as well as national care providers and a limited number of providers in New York with The Empire Plan specifically added to their UnitedHealthcare Participation Agreement.

Identifying members of The Empire Plan

Members are New York State government employees, local government employees with Empire Plan or Excelsior Plan benefits, graduate student employees in the Student Employee Health Plan (SEHP), retirees and their dependents. Empire Plan benefit ID cards have “New York State Health Insurance Program (NYSHIP)” and “The Empire Plan” on the front of the card. Recent cards also have the UnitedHealthcare logo. Cards aren’t replaced each year and some valid cards may look different. 

You’ll be able use UHCprovider.com tools to verify member eligibility and coverage, submit prior authorization requests and advance notification, submit claims and check claim status.

Different carriers manage coverage for The Empire Plan

• UnitedHealthcare administers the Medical/Surgical Program, including the PPO network.
• Empire BlueCross administers the Hospital Program.
• Beacon Health Options, Inc., administers the Mental Health and Substance Abuse Program and behavioral health services benefit.
• CVS Caremark administers the Prescription Drug Program and pharmacy benefit.

Learn more

• The 2021 Administrative Guide Empire Plan Supplement will include the services, such as advanced radiology procedures, which will require prior notification.  UHCprovider.com tools already identify these services.
• Referrals won’t be required.
• Empire Plan participating care providers will be listed in the online directory at empireplanproviders.com.
• At UHCprovider.com/news, you’ll find The Empire Plan Copay Guide and formularies.

We’re here to help

There is one consolidated phone number for The Empire Plan, 877-7-NYSHIP (877-769-7447) that you can call to contact the different programs and carriers.

If you have other questions, please contact your UnitedHealthcare provider advocate or network contact. Thank you.