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Health Benefits
HMOs > Empire HMO



Empire HMO

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 the network.

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 co-payment.

Other benefits include:

  • Office, specialist, and chiropractic visits
  • Allergy testing
  • Diabetes supplies, education, and management
  • Physical therapy and rehabilitation
  • Occupational, speech, and vision therapy
  • One annual physical examination
  • Well-woman care
  • Skilled nursing facility 
  • Hospice care
  • 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 Care®
  • Program available for you and/or your eligible dependents while temporarily living away from your home HMO for at least 90 days
  • Urgent & emergency care are available to members and their eligible dependents nationwide through the BlueCard® 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.

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. Remember, 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 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.

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

For More Information
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 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