Empire's HMO, available to New York State
residents in our 28-county service area, the 8 bordering counties in New Jersey:
Essex, Hudson, Union, Sussex, Passaic, Monmouth, Middlesex, and Bergen, and the
2 bordering counties in Connecticut: Fairfield and Litchfield, lets you choose
from over 65,000 local provider locations and over 147 participating hospitals
in our 28-county New York service area and the 10 bordering counties in New
Jersey and Connecticut. This program features a full range of benefits with low
out-of-pocket costs, no claim forms, and access to quality health care for you
and your family.
With Empire's HMO, every family member can choose his or
her own Primary Care Physician (PCP). The PCP must participate in Empire's HMO
network and may be selected in any of the following areas of specialization:
internists, family practitioners, general practitioners, or pediatricians. Your
PCP helps manage your care by making the necessary referrals to specialists in
Inpatient hospital care is covered in full when arranged for
and authorized by your PCP, except for a $250 co-payment per individual, with a
maximum of $625 co-payment per family. Office visits are covered with a $15
Office, specialist, and chiropractic visits
Diabetes supplies, education, and management
Physical therapy and rehabilitation
Occupational, speech, and vision therapy
One annual physical examination
Skilled nursing facility
Home health care visits, including home infusion
Durable medical equipment
X-rays, MRI, and lab tests
Chemotherapy and radiation therapy
Diagnostic screening tests
Pap smears and mammography
Maternity and related maternity care
Well child care, including immunizations visits
HMO Guest membership through the Away from Home
Program available for you and/or your eligible
dependents while temporarily living away from your home HMO for at least 90
Urgent & emergency care are available to members
and their eligible dependents nationwide through the BlueCardÂ® program's
traditional provider network.
There is a $35 co-payment for use of the emergency room,
which is waived if admitted within 24 hours.
Empireâ€™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
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
Empire Maternity Care
Program-- By working with your choice of
medical professionals, this program follows your pregnancyâ€™s progress from the
first trimester through delivery.
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. Remember, participation in the program is voluntary, and at no
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.
Program -- Through the national BlueCross and BlueShield Associationâ€™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
A prescription drug rider is available through
Empire Pharmacy Management, which is comprised of 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.
Please see rate chart for payroll and pension deductions.
See the rate page
Please call (800) 767-8672, 8:30 am -
5:00 pm, Monday through Friday. You may contact the plan at:
Empire BlueCross BlueShield
City of New York Dedicated Service Center
PO Box 1407
Church Street Station
New York, NY
Visit the Plan Web site