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Health Benefits
EPO, POS, and PPOs > Empire EPO



Empire EPO

Empire EPO Empire’s EPO, an Exclusive Provider Organization, provides all active and non-Medicare retirees nationally a health plan choice where they live, work, study (dependent students) or travel. Empire’s local network provides access to over 70,000 provider locations and 215 hospitals. Nationally over 668,000 physicians and over 5,700 participating hospitals are available through BlueCard, the national network of Blue Cross and Blue Shield plans. You do not need to choose a primary care physician, there are NO REFERRALS NECESSARY to see a specialist and no claim forms to complete.

Inpatient hospital care is covered in full when arranged for and authorized by Empire’s Medical Management Program with a $250 co-payment per individual, and a maximum of $625 co-payment per family. Office visits are covered with a $15 co-payment. Other benefits include office, specialist and chiropractic visits, allergy testing, diabetes supplies, diabetes education and management, physical therapy, physical rehabilitation, occupational, speech and vision therapy, one annual physical examination, well-woman care, skilled nursing facility care, hospice care, home health care visits including home infusion, durable medical equipment, X-rays, MRI, lab tests, chemotherapy, radiation therapy, diagnostic screening tests, pap smears, mammography, maternity and related maternity care, and well-child care including immunizations visits. There is a $35 co-payment for use of the emergency room, which is waived if admitted within 24 hours.

360° HealthSM -- Empire’s Health Services Program is a comprehensive suite of preventive care programs, wellness information, case management and care coordination services, all seamlessly integrated to achieve optimal health outcomes for our members.

Empire HealthLineSM gives members access to health care information through a toll-free, confidential phone service. Specially trained registered nurses are on hand 24 hours a day, 7 days a week, to help with your medical questions and concerns. Members have access to an audio library of more than 1,100 health care topics in English and Spanish.

SARA Early Risk Management (Systematic Analysis Review and Assistance) is a program that identifies patients at risk for potentially serious medical conditions. It analyzes and cross-references existing medical, laboratory, pharmacy and hospital claims data and provides your physicians with added support.

Empire Maternity Care Program -- By working with your choice of medical professionals, this program follows your pregnancy’s progress from the first trimester through delivery.  

Empire provides ongoing management and coordination of services for chronic conditions. Members with certain chronic conditions can receive individualized care to help them maintain their full potential for good health. Once Empire identifies you as a candidate, they will mail you program information. Participation in the program is voluntary, and at no additional cost.

Building Better Health -- The depression management program was specially designed to educate members about the warning signs of depression, as well as assist them with identifying treatment options and helping them learn how to improve the quality of their lives.

Transplant Program -- Through the national BlueCross and BlueShield Association’s Blue Quality Centers for Transplant (BQCT), Empire offers you one of the best local and national organ and tissue transplant networks in the world. Medical Management -- Rely on our rigorous medical management program to get you access to the care you need and deserve.

Prescription Drugs
A prescription drug rider offers access to over 4,200 pharmacy network providers in the New York tri-state area, and over 54,000 network pharmacies nationwide. There is a $10 co-payment for generic drugs, $25 co-payment for brand drugs on the formulary list and $50 co-payment for drugs not on the formulary list. After Empire Pharmacy Management has paid $3,000 in drug expenses, all drugs have a 50% coinsurance for each benefit year.

Cost
Please see rate chart for payroll and pension deductions.
See the rate page

For More Information
Call (800) 767-8672 8:30 am - 5:00 pm, Monday through Friday. You can also write to the plan at:

Empire BlueCross BlueShield
City of New York
Dedicated Service Center
PO Box 1407
Church Street Station
New York, NY 10008-1407
Visit the Plan Web site

 

Spotlight

Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

 Learn More
Quick Links

 PICA Program
 NYC Employee Blood Program
 Collective Bargaining Agreements
 OPA Web site
 NYC.gov