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Choices 2010 Booklet

VIEWS: 5 PAGES: 34

									Health Insurance
Choices for 2010




October 2009
For Employees of the State of
New York who are unrepresented
or in Negotiating Units that have
agreements/awards with New York
State beginning April 1, 2007,
Employees of Participating Employers
and for COBRA enrollees with their
NYSHIP benefits (Check with your
agency Health Benefits Administrator
or union if you are uncertain.)
    Contents
    Pre-Tax Status, November 30 Deadline .............1          Questions and Answers..................................11
    Biweekly Premium Contribution.........................1      Terms to Know ...............................................12
    Information and Reminders............................1-2     Making a Choice ...........................................13
    Choosing Your Health Plan ...............................2   Plans by County .......................................14-15
    Benefits All NYSHIP Plans Provide .....................3     The Empire Plan Summary ........................16-21
    Medicare and NYSHIP .....................................4   NYSHIP Health Maintenance
                                                                 Organizations ..........................................22-43
    The Empire Plan or a NYSHIP HMO ..............5-8
                                                                 New York State Department of Civil Service
    Similarities and Differences .........................9-10
                                                                 Web Site..................................................44-45



    During the Option Transfer Period, you may
    make two important choices for 2010
    Choose Your Health Insurance Plan                            Civil Service web site at https://www.cs.state.ny.us as
                                                                 soon as they are approved. Click on Benefit Programs,
    This booklet explains the options available to you
                                                                 then on NYSHIP Online. Select your group if
    under the New York State Health Insurance Program
                                                                 prompted, and then click on Health Benefits & Option
    (NYSHIP). Choose either The Empire Plan or one of the
                                                                 Transfer. Choose Rates and Health Plan Choices. Your
    NYSHIP-approved Health Maintenance Organizations
                                                                 agency Health Benefits Administrator (HBA) can help
    (HMOs) in your area. Consider your health insurance
                                                                 if you have questions. COBRA enrollees may contact
    options carefully. You may not change your health
                                                                 the Employee Benefits Division at 518-457-5754
    insurance option after the deadline except in special
                                                                 (Albany area) or 1-800-833-4344 (U.S., Canada,
    circumstances. (See your NYSHIP General Information
                                                                 Puerto Rico and the Virgin Islands).
    Book and Empire Plan Reports or HMO Reports for
    details about changing options outside the Option
    Transfer Period.) If you still have specific questions
    after you’ve read the plan descriptions, contact
    The Empire Plan carriers and HMOs directly.
                                                                    See your agency Health Benefits Administrator
    Rates for 2010                                                  to change your health insurance option,
    and Deadline for Changing Plans                                 enrollment or pre-tax status.
    The Empire Plan and HMO rates for 2010 are mailed               NO ACTION IS REQUIRED IF YOU
    to your home and posted on our web site as soon as              DO NOT WISH TO MAKE CHANGES.
    they are approved. (Participating Employers, such
    as the Thruway Authority and MTA, will notify their             Changes are not automatic and deadlines apply.
    enrollees of 2010 rates.) The rate flyer announces              You must report any change that may affect your
    the option change deadline and paycheck deduction               coverage to your agency Health Benefits
    dates. You have 30 days from the date your agency               Administrator. See pages 1-3 in this booklet and
    receives rate information to make a decision. Rates             your NYSHIP General Information Book for
    are posted on the New York State Department of                  complete information.


i   Choices 2010/Actives Settled
Choose Your Pre-Tax Contribution Program                   Your Biweekly Premium Contribution
Status by November 30, 2009                                The following does NOT apply to employees of
The following does NOT apply to employees of               Participating Employers. Participating Employers will
Participating Employers. Ask your agency Health            provide premium information. It also does not apply
Benefits Administrator (HBA) if a Pre-Tax Contribution     to COBRA enrollees.
Program (PTCP) is available to you. Pre-tax does not       New York State helps pay for your health insurance
apply to COBRA enrollees.                                  coverage. After the State’s contribution, you are
Under the Pre-Tax Contribution Program, your health        responsible for paying the balance of your premium
insurance premiums are deducted from your pay              through biweekly deductions from your paycheck.
before taxes are taken out. This lowers your taxable       • For Empire Plan enrollees, the State pays 90 percent
income and increases your spendable income. Only             of the cost of the premium for enrollee coverage and
the portion of the premium that pays for Individual          75 percent of the premium for dependent coverage.
coverage may be deducted on a pre-tax basis for
employees who provide health benefits for non-             • For HMO enrollees, the State pays 90 percent of
federally qualified domestic partners. Your paycheck         the premium for enrollee coverage and 75 percent
stub shows whether or not you are enrolled in PTCP.          for dependent coverage. However, the State’s
                                                             dollar contribution for the non-prescription drug
• Regular Before Tax Health appears in the Before Tax        components of the HMO premium will NOT exceed
  Deductions section if your health insurance premium is     its dollar contribution for the non-prescription drug
  deducted from your wages before taxes are withheld.        components of The Empire Plan premium.
• Regular After Tax Health appears in the After            As soon as they are available, 2010 rates will be
  Tax Deductions section if your health insurance          mailed to your home and posted on our web site at
  premium is deducted from your wages after taxes          https://www.cs.state.ny.us. Click on Benefit Programs,
  are withheld.                                            then on NYSHIP Online. Select your group if prompted,
• Regular Before Tax Health appears in the Before          and then click on Health Benefits & Option Transfer.
  Tax Deductions section AND Regular After Tax             Choose Rates and Health Plan Choices.
  Health appears in the After Tax Deductions section
  if you have elected pre-tax and have a non-federally     Information and Reminders
  qualified domestic partner or same sex spouse.
  Under federal law, the premium for such dependents
                                                           Let Your Agency Know about Changes
  cannot be deducted before taxes are withheld.            You must notify your agency HBA if your home address
                                                           or phone number changes. If you are an active or retired
Under PTCP, you can make the following changes only
                                                           employee of New York State or are retired from a
in November each year:
                                                           Participating Employer and registered for MyNYSHIP,
• Change from Family to Individual coverage while          you may also make address and option changes online.
  your dependents are still eligible for coverage,
                                                           Changes in your family status, such as gaining or
• Voluntarily cancel your coverage while you are           losing a dependent, may mean you need to change
  still eligible for coverage, or                          your health insurance coverage from Individual to
• Opt out of PTCP.                                         Family or from Family to Individual. If you submit a
                                                           timely request, you can make most changes any time,
Under Internal Revenue Service (IRS) rules, you may        not just during the Option Transfer Period. See your
change your health insurance deduction during the tax      NYSHIP General Information Book for details. Inform
year only after a PTCP-qualifying event. For a list of     your agency HBA about any change promptly to
PTCP-qualifying events, see your NYSHIP General            ensure it is effective on the actual date of change in
Information Book. To change your pre-tax selection         family status.
for 2010, see your agency HBA and complete a
health insurance transaction form (PS-404) by
November 30, 2009.

                                                                                           Choices 2010/Actives Settled   1
    Retiring or Vesting in 2010?                             Benefits
    You may change your health insurance plan when           The Empire Plan and NYSHIP HMOs
    you retire or vest your health insurance. Retirees and
    vestees who continue their NYSHIP enrollment may         • All NYSHIP plans provide a wide range of hospital,
    change health insurance options at any time once           medical/surgical, and mental health and substance
    during a 12-month period. For more information on          abuse coverage.
    changing options as a retiree, ask your agency HBA       • All plans provide prescription drug coverage if you do
    for Choices for 2010 for Retirees.                         not receive it through a union Employee Benefit Fund.

    Eligible for Medicare?                                   Benefits differ among plans. Read this booklet and the
                                                             certificate/contracts carefully for details.
    If you or a dependent is eligible for Medicare because
    of age or disability, see “Medicare and NYSHIP” on
    page 4 for important information. Also, please read      Exclusions
    this section if you or a dependent will be turning age   • All plans contain exclusions for certain services and
    65 in 2010 or if you are planning to retire in the         prescription drugs.
    coming year and will be Medicare-eligible.               • Workers’ compensation-related expenses and
    Choosing Your Health Plan                                  custodial care generally are excluded.
    Choosing the health insurance plan to cover your         For details on a plan’s exclusions, read the
    needs and the needs of your family requires careful      NYSHIP General Information Book and Empire
    research. As with most important purchases, there is     Plan Certificate, the HMO contract, or check with
    more to consider than cost. Selecting a health plan is   the plan directly.
    an important and personal decision. Only you know
    your family lifestyle, health, budget and benefit        Geographic Area Served
    preferences. Think carefully about what you need from
    your health plan so you are better prepared to make
                                                             The Empire Plan
    a choice.                                                Benefits for all covered services – not just urgent and
                                                             emergency care – are available worldwide.
    The first step in making a good choice is
    understanding the similarities and the differences       Health Maintenance Organizations (HMOs)
    between your NYSHIP options. There are two types of      • Coverage is available in the HMO’s specific
    health insurance plans available to you under NYSHIP:      service area.
    The Empire Plan and NYSHIP Health Maintenance
    Organizations (HMOs). The Empire Plan is available       • An HMO may arrange care outside its service area,
    to all employees. Specific NYSHIP HMOs are available       at its discretion in certain circumstances.
    in the various geographic areas of New York State.
    Depending on where you live or work, one or several
    NYSHIP HMOs will be available to you. The Empire
    Plan and NYSHIP HMOs are similar in many ways,
    but also have important differences.




2   Choices 2010/Actives Settled
Benefits Provided by The Empire Plan and All NYSHIP HMOs
Please see the individual plan descriptions in this booklet to review the differences in coverage and out-of-pocket
expenses. See plan documents for complete information on benefits.

• Inpatient medical/surgical hospital care                     • Outpatient mental health services
• Outpatient medical/surgical hospital services                • Alcohol and substance abuse detoxification
• Physician services                                           • Inpatient alcohol rehabilitation
• Emergency services                                           • Inpatient drug rehabilitation
• Laboratory services                                          • Outpatient alcohol and drug rehabilitation
• Radiology services                                           • Family planning and certain infertility services
• Diagnostic services                                            (Call The Empire Plan carriers or HMO for details.)

• Diabetic supplies                                            • Out-of-area emergencies

• Maternity, prenatal care                                     • Hospice benefits (at least 210 days)

• Well child care                                              • Home health care in lieu of hospitalization

• Chiropractic services                                        • Prescription drug coverage including injectable
                                                                 medications, self-injectable medications,
• Physical therapy                                               contraceptive drugs and devices and fertility drugs
• Occupational therapy                                           (unless you have coverage through a union
                                                                 Employee Benefit Fund)
• Speech therapy
                                                               • Enteral formulas covered through either HCAP for
• Prosthetics and durable medical equipment
                                                                 The Empire Plan or the HMO’s prescription drug
• Orthotic devices                                               program (unless you have coverage through a union
• Bone density tests                                             Employee Benefit Fund)

• Mammography                                                  • Second opinion for cancer diagnosis

• Inpatient mental health services




                                                                                                 Choices 2010/Actives Settled   3
    Medicare and NYSHIP                                          for original Medicare benefits if you receive treatment
                                                                 outside your HMO.
    If you are an active employee, NYSHIP (The Empire
    Plan or a NYSHIP HMO) provides primary coverage             • If you are enrolled in The Empire Plan and join
    for you and your dependents, regardless of age or             a Medicare Advantage Plan that is not part of
    disability.                                                   NYSHIP: If you receive services that are not
                                                                  authorized by your Medicare Advantage Plan,
    Exceptions: Medicare is primary for your domestic
                                                                  The Empire Plan will not pay for Medicare-covered
    partner age 65 or over, or for an active employee or
                                                                  services that would have been covered by the
    dependent with end-stage renal disease (waiting
                                                                  Medicare Advantage Plan.
    period applies).
                                                                Medicare Part D is the Medicare prescription drug
    NYSHIP requires you and your dependents to be
                                                                benefit for Medicare-eligible persons. NYSHIP
    enrolled in Medicare Parts A and B when first eligible
                                                                provides prescription drug benefits to you and your
    for Medicare coverage that pays primary to NYSHIP.
                                                                dependents under The Empire Plan or a NYSHIP
    If you are planning to retire, and you or your spouse       HMO. Enrolling in a Medicare Part D plan separate
    is 65 or older, contact your Social Security office three   from your NYSHIP coverage may drastically reduce
    months before active employment ends to enroll in           your benefits overall. For example:
    Medicare Parts A and B. Medicare becomes primary
                                                                • If you are Medicare-primary and enrolled in both
    to your NYSHIP coverage the first day of the month
                                                                  The Empire Plan and a Medicare Part D plan, you
    following a “runout” period of 28 days after the
                                                                  will not be able to use your Empire Plan coverage to
    payroll period in which you retire.
                                                                  receive benefits at the pharmacy. You must use your
    If you or a dependent is eligible for Medicare                Medicare drug coverage first. To receive secondary
    coverage primary to NYSHIP but fails to enroll in             drug coverage, you must submit a claim to The
    Parts A and B, The Empire Plan or HMO will not                Empire Plan Prescription Drug Program along with
    provide benefits for services Medicare would have             documentation of the amount covered by Medicare.
    paid if you or your dependent had enrolled.
                                                                • If you are enrolled in a NYSHIP Medicare
    If you are planning to retire or vest in 2010, know           Advantage HMO and then enroll in a Medicare
    how your NYSHIP benefits will be affected when                Part D plan or another Medicare Advantage Plan
    Medicare is your primary coverage:                            outside of NYSHIP, Medicare will terminate your
    • If you are enrolled in original Medicare                    enrollment in the NYSHIP HMO.
      (Parts A and B) and have secondary coverage               If you are eligible for the extra help from the Medicare
      under The Empire Plan: The Empire Plan coordinates        Part D Low Income Subsidy, or if you are interested in
      benefits with Medicare. Since Medicare does               additional drug coverage offered by a Medicare
      not provide coverage outside the United States,           Part D plan, be sure you understand how joining a
      The Empire Plan pays primary for covered services         Medicare prescription drug plan will change your
      received outside the United States.                       NYSHIP coverage before enrolling. If you do enroll in
    • If you enroll in a NYSHIP HMO Medicare                    Medicare Part D, you will not be reimbursed for the
      Advantage Plan: You replace your original fee-for-        Medicare Part D premium.
      service Medicare coverage with benefits offered by        If you receive prescription drug coverage through
      the Medicare Advantage Plan. Benefits under the           a union Employee Benefit Fund, contact the fund for
      HMO’s Medicare Advantage Plan may differ from             information about Medicare Part D.
      your benefits as an active employee. To qualify for
                                                                For more information about NYSHIP and Medicare,
      benefits, you must follow plan rules (except for
                                                                see your NYSHIP General Information Book or ask
      emergency or out-of-area urgently needed care).
                                                                your agency HBA for a copy of Choices for 2010 for
    • If you enroll in a NYSHIP HMO that coordinates            Retirees, Planning for Retirement, Medicare & NYSHIP
      coverage with Medicare: You receive the same benefits     or Medicare for Disability Retirees.
      from the HMO as an active employee and still qualify


4   Choices 2010/Actives Settled
The Empire Plan or a NYSHIP HMO


What’s New in 2010?                                          The Empire Plan
All NYSHIP Plans                                             The Empire Plan is a unique plan designed exclusively
                                                             for New York State’s public employees. The Empire
• Effective July 1, 2009, continuation coverage              Plan has many managed care features, but enrollees
  has been extended from 18 to 36 months for all             are not required to choose a primary care physician
  COBRA enrollees.                                           and do not need referrals to see specialists. However,
• Effective January 1, 2010, unmarried children of           certain services, such as hospital and skilled nursing
  NYSHIP enrollees who are under age 30 and not              facility admissions, certain outpatient radiological
  eligible for health insurance through their own            tests, mental health and substance abuse treatment,
  employer may enroll in the same NYSHIP option              home care and some prescription drugs, require
  as their parents if they live or work in the NYSHIP        preapproval. Coverage is available worldwide. It is
  plan’s service area. These young adult dependents          not limited to your geographic area. The New York
  will pay the full cost of Individual coverage. NYSHIP      State Department of Civil Service contracts with major
  enrollees will receive detailed information regarding      insurance companies (carriers) to insure and administer
  eligibility, cost and enrollment for young adult           different parts of the Plan.
  children through age 29 in October 2009.                   The Empire Plan provides:
• On January 1, 2010, the federal parity law for             • Network and non-network inpatient and outpatient
  substance abuse benefits takes effect. The law requires      hospital coverage for medical, surgical and
  that benefit levels for substance abuse care must be the     maternity care;
  same as those for hospital/medical benefits.
                                                             • Medical and surgical coverage. Coverage under the
NYSHIP HMOs                                                    Participating Provider Program or the Basic Medical
Effective January 1, 2010                                      Program and Basic Medical Provider Discount
• Univera Healthcare will no longer be offered under           Program if you choose a non-participating provider;
  NYSHIP. If you are enrolled in Univera Healthcare, you     • Home care services, durable medical equipment and
  must enroll in The Empire Plan or a NYSHIP-approved          certain medical supplies (including diabetic and
  HMO in the area where you live or work. If you do            ostomy supplies), enteral formulas and diabetic shoes
  not take action, you will automatically be enrolled          through the Home Care Advocacy Program (HCAP);
  in The Empire Plan for the 2010 program year.
                                                             • Physical medicine (chiropractic treatment and
• Oneida County returns to CDPHP’s Medicare                    physical therapy) coverage;
  Advantage Plan (NYSHIP code number 300).
                                                             • Inpatient and outpatient mental health and
• MVP Central Region (NYSHIP code number 330)                  substance abuse coverage;
  expands into Tompkins County.
                                                             • Prescription drug coverage;
• Preferred Care changed its name to MVP Health
                                                             • Centers of Excellence Programs for cancer,
  Care as of April 30, 2009.
                                                               transplants and infertility;


                                                                                             Choices 2010/Actives Settled   5
    • 24-hour Empire Plan NurseLineSM for health
      information and support; and
                                                                     Consider Cost
    • Worldwide coverage.
                                                                     Although New York State pays most of the
    Cost Sharing                                                     premium cost for your coverage regardless of
    Under The Empire Plan, benefits are available for                which plan you choose, differences in plan
    covered services when you use a participating or                 benefits among the various health insurance
    non-participating provider. However, your share of               options result in different employee contributions
    the cost of covered services depends on whether the              for coverage. (See Your Biweekly Premium
    provider you use is participating or non-participating           Contribution on page 1.) However, when
    under the Plan.                                                  considering cost, think about all your costs
    If you use an Empire Plan participating or network               throughout the year, not just your biweekly
    provider for medical, surgical, mental health or                 paycheck deduction. Keep in mind out-of-pocket
    substance abuse services, you pay a copayment for                expenses you are likely to incur during the year,
    certain services; some are covered at no cost to you.            such as copayments for prescriptions and other
    The provider files the claim and is reimbursed by                services, coinsurance and any costs of using
    The Empire Plan.                                                 providers or services not covered under the
    You are guaranteed access to network benefits for                plan. Add the annual premium for that plan to
    certain services when you contact the program before             these costs to estimate your total annual cost
    receiving services and follow program requirements:              under that plan. Do this for each plan you are
                                                                     considering and compare the costs. Watch for
    • Inpatient hospital stays;
                                                                     the NYSHIP Rates & Deadlines for 2010 flyer
    • Mental Health and Substance Abuse                              that will be mailed to your home and posted on
      Program services;                                              our web site, https://www.cs.state.ny.us, as
    • Managed Physical Medicine Program services                     soon as rates are approved. Along with this
      (physical therapy and chiropractic care); and                  booklet, which provides copayment information,
                                                                     NYSHIP Rates & Deadlines for 2010 will
    • Home Care Advocacy Program (HCAP) services
                                                                     provide the information you need to figure your
      (home care and services, including durable medical
                                                                     annual cost under each of the available plans.
      equipment).
    If you use a non-participating provider for medical
    and surgical services, benefits for covered services
    are paid under the Basic Medical Program. After you         Basic Medical Provider Discount Program
    satisfy an annual deductible:                               If you are Empire Plan-primary, The Empire Plan
    • The Empire Plan pays 80 percent of the reasonable         also includes a program to reduce your out-of-pocket
      and customary charge.                                     costs when you use a non-participating provider. This
                                                                program, The Empire Plan Basic Medical Provider
    • You are responsible for the 20 percent coinsurance
                                                                Discount Program, offers discounts from certain
      and charges in excess of the reasonable and
                                                                physicians and providers who are not part of The
      customary charge.
                                                                Empire Plan participating provider network. These
    • After you reach the out-of-pocket maximum, you will       providers are part of the nationwide MultiPlan
      be reimbursed up to 100 percent of the reasonable and     group, a provider organization contracted with
      customary charge. See the chart on page 8 for the Basic   UnitedHealthcare. Empire Plan Basic Medical Provider
      Medical deductible and coinsurance maximum amounts        Discount Program provisions apply and you must meet
      that apply to you, based on your employee group.          the annual deductible.
    • You are responsible for paying the provider and           Providers in the Basic Medical Provider Discount
      will be reimbursed by the Plan for covered charges.       Program accept a discounted fee for covered services.
                                                                Your 20 percent coinsurance is based on the lower of

6   Choices 2010/Actives Settled
the discounted fee or the reasonable and customary          • Coverage outside the specified geographic area is limited.
charge. The provider submits your claims and                • Enrollees usually choose a primary care physician
UnitedHealthcare pays The Empire Plan portion of              (PCP) from the HMO’s network for routine medical
the provider fee directly to the provider if the services     care and for referrals to specialists and hospitals
qualify for the Basic Medical Provider Discount               when medically necessary.
Program. Your Explanation of Benefits, which details
claims payments, shows the discounted amount                • HMO enrollees usually pay a copayment as a
applied to billed charges.                                    per-visit fee or coinsurance (percentage of cost).

To find a provider in The Empire Plan Basic Medical         • HMOs have no annual deductible.
Provider Discount Program, ask if the provider is an        • Referral forms to see network specialists usually
Empire Plan MultiPlan provider or call The Empire Plan        are required.
toll free at 1-877-7-NYSHIP (1-877-769-7447),
                                                            • Claim forms rarely are required.
choose The Empire Plan Medical Benefits Program and
ask a representative for help. You can also visit the       • HMO enrollees who use doctors, hospitals or
New York State Department of Civil Service web site at        pharmacies outside the HMO’s network must, in
https://www.cs.state.ny.us. Click on Benefit Programs,        most cases, pay the full cost of services (unless
then on NYSHIP Online. Select the group if prompted,          authorized by the HMO or in an emergency).
and then click on Find a Provider.                          All NYSHIP HMOs provide a wide range of health
The best savings are with participating providers.          services. Each offers a specific package of hospital
If you choose a non-participating or non-network            medical, surgical and preventive care benefits. These
provider for services covered under the Mental Health       services are provided or arranged by the primary care
and Substance Abuse Program, the Managed Physical           physician selected by the enrollee from the HMO’s staff
Medicine Program or the Home Care Advocacy                  or physician network.
Program, benefits for non-network coverage are lower        All NYSHIP HMOs cover inpatient and outpatient
and subject to separate deductibles and coinsurance.        hospital care at a network hospital and offer
Under the Managed Physical Medicine Program, non-           prescription drug coverage unless it is provided
network coverage is also subject to benefit limits. For     through a union Employee Benefit Fund.
more information on coverage provided under The
Empire Plan, see the publication, Reporting on              NYSHIP HMOs are organized in one of two ways:
Network Benefits. You can find this publication on our      • A Network HMO provides medical services that can
web site at https://www.cs.state.ny.us. Or, ask your          include its own health centers as well as outside
agency HBA for a copy.                                        participating physicians, medical groups and
                                                              multi-specialty medical centers.
Providers
                                                            • An Independent Practice Association (IPA) HMO
Under The Empire Plan you can choose from over 275,000
                                                              provides medical services through private practice
participating physicians and other providers nationwide,
                                                              physicians who have contracted independently with
and from more than 50,000 participating pharmacies
                                                              the HMO to provide services in their offices.
across the United States or a mail service pharmacy.
                                                            Members enrolling in Network and IPA model HMOs
Medically necessary visits to specialists are covered
                                                            may be able to select a doctor they already know if that
without referral or prior authorization. Basic Medical
                                                            doctor participates with the HMO.
or non-network benefits are available for covered
services received from non-participating providers,         See the individual HMO pages in this booklet for
depending on the type of service.                           additional benefit information and to learn if the HMO
                                                            serves your geographic area.
NYSHIP Health Maintenance Organizations
A Health Maintenance Organization (HMO) is a
managed care system in a specific geographic area that
provides comprehensive health care coverage through a
network of providers.
                                                                                              Choices 2010/Actives Settled   7
                       Empire Plan Basic Medical Program and
            Non-Network Mental Health/Substance Abuse Practitioner Services
                              Effective January 1, 2010

                  Employee Group                            Annual Deductible1                             Coinsurance Maximum1
                                                       (per enrollee; per spouse or                      (Out-of-Pocket Expense per
                                                         domestic partner; per all                  contract for Council 82, ALESU and
                                                      dependent children combined)                    NYSCOPBA (Contract Affected)
                                                                                                          or per enrollee; per spouse
                                                                                                         or domestic partner; per all
                                                                                                        dependent children combined
                                                                                                      for all other groups listed below)

        Executive Branch
          CSEA                                                      $250                                     $500/$3003
          DC-37                                                   $290 CPI2                               $620 CPI2/$3003
          PBA - Troopers                                          $375 CPI2                                   $826 CPI2
          PBA - Supervisors                                       $375 CPI2                                   $826 CPI2
          PIA                                                     $375 CPI2                                   $826 CPI2
          Council 82                                              $375 CPI2                                  $1,389 CPI2
          ALESU                                                   $375 CPI2                                  $1,389 CPI2
          NYSCOPBA (Contract Affected)                            $375 CPI2                                  $1,389 CPI2
          NYSCOPBA (Represented)                                  $375 CPI2                                      $800
          UUP                                                     $375 CPI2                                  $1,033 CPI2
          PEF                                                     $375 CPI2                                  $1,033 CPI2
          M/C                                                     $375 CPI2                                  $1,033 CPI2
        Legislature                                               $375 CPI2                                  $1,033 CPI2
        Participating Employers                                   $375 CPI2                                  $1,033 CPI2
        Unified Court System                                        $250                                     $500/$3003
        Retirees, Vestees,
        Dependent Survivors                                       $375 CPI2                                  $1,033 CPI2
        and Preferred List

    1 Each program’s deductible, coinsurance and maximum coinsurance amount for medical, MPN, mental health and substance abuse services
      is separate and not combined with any other deductible, coinsurance or maximum coinsurance amount.
    2 These changes reflect the 3.3% increase in the medical care component of the Consumer Price Index for Urban Wage Earners and Clerical
      Workers, all Cities (C.P.I.-W.) for the period July 1, 2008 through June 30, 2009.
    3 The coinsurance maximum out-of-pocket expense will be reduced to $300 for calendar year 2010 for employees in (or equated to) salary
      grade 6 or below on January 1, 2010. This reduction is not available to Judges and Justices.

    Note: You have no deductible or coinsurance when you use Empire Plan participating providers.




8   Choices 2010/Actives Settled
       The Empire Plan and NYSHIP HMOs: Similarities and Differences

   The Empire Plan                                            NYSHIP HMOs
Can I use the hospital of my choice?
   Yes. You have coverage worldwide, but your benefits        Except in an emergency, you generally do not have
   differ depending on whether you choose a network           coverage at non-participating hospitals unless
   or non-network hospital1. Your benefits are highest at     authorized by the HMO.
   network hospitals participating in the BlueCross and
   BlueShield Association BlueCard® PPO Program, or
   for mental health or substance abuse care in the
   OptumHealth network.
   Network hospital inpatient: Paid-in-full hospitalization
   benefits.
   Network hospital outpatient and emergency care:
   Subject to network copayments.
   Non-network hospital inpatient and outpatient:
   10 percent coinsurance2 up to an annual maximum
   of $1,500 per enrollee; per spouse or domestic
   partner; per all dependent children combined.
   Note: $500 of $1,500 coinsurance maximum is
   reimbursable under the Basic Medical Program.




If I am diagnosed with a serious illness, can I see a physician or go to a hospital that specializes in
my illness?
   Yes. You can use the specialist of your choice.            You should expect to choose a participating
   You have Basic Medical Program benefits for non-           physician and a participating hospital. Under certain
   participating providers and Basic Medical Provider         circumstances, you may be able to receive a referral
   Discount Program benefits for non-participating            to a specialist care center outside the network.
   providers who are part of The Empire Plan MultiPlan
   group1. (See pages 6 and 7 for more information on
   the Basic Medical Provider Discount Program.) Your
   hospital benefits will differ depending on whether
   you choose a network or non-network hospital1.
   (See above for details.)




Can I be sure I will not need to pay more than my copayment when I receive medical services?
   Yes. Your copayment should be your only expense            Yes. As long as you follow HMO requirements and
   if you:                                                    receive the appropriate referral, your copayment
   • Choose a participating provider;                         (or coinsurance) should be your only expense.
   • Receive inpatient or covered outpatient hospital
      services at a network hospital and follow Benefits
      Management Program requirements1.
                                                                                           Choices 2010/Actives Settled   9
           The Empire Plan                                             NYSHIP HMOs

     Will I be covered for care I receive away from home?
           Yes. Under The Empire Plan, your benefits are the            Under an HMO, you are covered away from home
           same wherever you receive care.                              only for emergency care. Some HMOs provide
                                                                        coverage for routine care if the HMO has reciprocity
                                                                        with another HMO. Some HMOs provide coverage
                                                                        for college students away from home if the care is
                                                                        urgent or if follow-up care has been preauthorized.
                                                                        See the Out of Area Benefit description on each
                                                                        HMO page for more information.




     What kind of care is available for physical therapy and chiropractic care?
           You have guaranteed access to unlimited medically            Coverage is available for a specified number of
           necessary care when you choose participating                 days/visits each year, as long as you follow the
           providers and follow Plan requirements.                      HMO’s requirements.




     What if I need durable medical equipment, medical supplies or home nursing?
           You have guaranteed, paid-in-full access to medically        Benefits are available and vary depending on the
           necessary home care, equipment and supplies3                 HMO. Benefits may require a greater percentage
           through the Home Care Advocacy Program (HCAP)                of cost-sharing.
           when preauthorized and arranged by the Plan.




     1   Applies only to Empire Plan-primary enrollees
     2   Greater of 10 percent coinsurance or $75 for outpatient
     3   Diabetic shoes have an annual maximum benefit of $500.

     Note: These responses are generic and highlight only general differences between The Empire Plan and NYSHIP HMOs.
     Details for each plan are available on individual plan pages beginning on page 16 of this booklet, in the Empire Plan
     Certificate (available from your agency Health Benefits Administrator) and in the HMO contract (available from each HMO).




10 Choices 2010/Actives Settled
Questions and Answers                                        to have the provider’s services covered. In most
                                                             circumstances, HMOs do not provide benefits for
Q: Can I join The Empire Plan or any NYSHIP-
                                                             services by non-participating providers or hospitals.
   approved HMO?
                                                             Under The Empire Plan, you have benefits for
A: The Empire Plan is available worldwide, wherever          participating and non-participating providers.
   you live or work. To enroll or continue enrollment in
                                                             Participating providers change. You cannot change
   a NYSHIP-approved HMO, you must live or work in
                                                             your plan outside the Option Transfer Period
   that HMO’s service area. If you move permanently
                                                             because your provider no longer participates.
   out of and/or no longer work in your HMO’s
   service area, you must change options. See Plans        Q: I have a preexisting condition. Will I have
   by County on pages 14 and 15 and the individual            coverage if I change options?
   HMO pages in this booklet to check the counties         A: Yes. Under NYSHIP, you can change your option
   each HMO will serve in 2010.                               and still have coverage for a preexisting condition.
Q: How do I find out which providers and hospitals            There are no preexisting condition exclusions in any
   participate? What if my doctor or other provider           NYSHIP plan. However, coverage and exclusions
   leaves my plan?                                            differ. Ask the plan you are considering about
                                                              coverage for your condition.
A: Check with your providers directly to see whether
   they participate in The Empire Plan for New York        Q: What if I retire in 2010 and become eligible
   State government employees or in a NYSHIP HMO.             for Medicare?

  For Empire Plan providers:                               A: Regardless of which option you choose, as a
                                                              retiree, you and your dependent must be enrolled
  • Visit https://www.cs.state.ny.us; click on Benefit
                                                              in Medicare Parts A and B when either of you first
    Programs, then on NYSHIP Online. Select your
                                                              becomes eligible for primary Medicare coverage.
    group if prompted, and then click on Find a
                                                              Please read about Medicare and NYSHIP and
    Provider.
                                                              Medicare Part D on page 4.
  • Ask your agency Health Benefits Administrator for
                                                             Please note, especially, that your NYSHIP benefits
    The Empire Plan Participating Provider Directory.
                                                             become secondary to Medicare and that your benefits
  • Call The Empire Plan toll free at 1-877-7-NYSHIP         may change when you enroll in some HMOs.
    (1-877-769-7447) and select the appropriate
                                                           Q: I am a COBRA dependent in a Family plan.
    program for the type of provider you need.
                                                              Can I switch to Individual coverage and select a
  For HMO providers:                                          different health plan from the rest of my family?
  • Visit the web sites (web site addresses are            A: Yes. As a COBRA dependent, you may elect to
    provided on the individual HMO pages in this              change to Individual coverage in a plan different
    booklet) for provider information.                        from the enrollee’s Family coverage. During the
  • Call the telephone numbers on the HMO pages in            Option Transfer Period, you may enroll in The
    this booklet. Ask which providers participate and         Empire Plan or choose any NYSHIP-approved
    which hospitals are affiliated.                           HMO in the area where you live or work.

  If you choose a provider who does not participate
  in your plan, check carefully whether benefits would
  be available to you. Ask if you need authorization




                                                                                           Choices 2010/Actives Settled   11
     Terms to Know                                               Practice Association (IPA), that are offered
                                                                 under NYSHIP.
     • Coinsurance: The enrollee’s share of the cost of
       covered services; a fixed percentage of medical         • Managed Care: A health care program designed to
       expenses.                                                 ensure you receive the highest quality medical care
                                                                 for the lowest cost, in the most appropriate health
     • Copayment: The enrollee’s share of the cost of
                                                                 care setting. Most managed care plans require you
       covered services that is a fixed dollar amount paid
                                                                 to select a primary care physician employed by (or
       when medical service is received, regardless of the
                                                                 who contracts with) the managed health care system.
       total charge for service.
                                                                 He/she serves as your health care manager by
     • Deductible: The dollar amount an enrollee is              coordinating virtually all health care services you
       required to pay before health plan benefits begin         receive. Your primary care physician provides your
       to reimburse for services.                                routine medical care and refers you to a specialist
     • Fee-for-service: A method of billing for health care      if necessary.
       services. A provider charges a fee each time an         • Medicare: A federal health insurance program
       enrollee receives a service.                              that covers certain people age 65 or older, disabled
     • Formulary: A list of preferred drugs used by a            persons under 65, and those who have end-stage
       health plan. If a plan has a closed formulary, you        renal disease (permanent kidney failure). Medicare
       have coverage only for drugs that appear on the list.     is directed by the federal Centers for Medicare &
       An incented formulary encourages use of preferred         Medicaid Services (CMS) and administered by the
       drugs to non-preferred drugs based on a tiered            Social Security Administration.
       copayment schedule. In a flexible formulary,            • Medicare Advantage Plan: Medicare option wherein
       brand-name prescription drugs may be assigned             the HMO agrees with Medicare to accept a fixed
       to different copayment levels based on value to the       monthly payment for each Medicare enrollee. In
       plan and clinical judgment. In some cases, drugs          exchange, the HMO provides or pays for all medical
       may be excluded from coverage under a flexible            care needed by the enrollee. If you join a Medicare
       formulary if a therapeutic equivalent is covered          Advantage Plan, you replace your original Medicare
       or available as an over-the-counter drug.                 coverage (Parts A and B) with benefits offered by
     • Health Benefits Administrator (HBA): Personnel            the HMO and all of your medical care (except for
       located in each State agency, often in the Human          emergency or out-of-area urgently needed care)
       Resources or Personnel Office, who work with the          must be provided, arranged or authorized by the
       Employee Benefits Division in the Department of           Medicare Advantage Plan. Most Medicare
       Civil Service to process enrollment transactions          Advantage Plans include Medicare Part D drug
       and answer health insurance questions. You are            coverage. The benefits under these HMOs are set in
       responsible for notifying your agency HBA of              accordance with Medicare’s guidelines for Medicare
       changes that might affect your enrollment.                Advantage Plans.

     • Health Maintenance Organization (HMO): A                • Network: A group of doctors, hospitals and/or other
       managed care delivery system organized to deliver         health care providers who participate in a health
       health care services in a geographic area. An HMO         plan and agree to follow the plan’s procedures.
       provides a predetermined set of benefits through a      • New York State Health Insurance Program
       network of selected physicians, laboratories and          (NYSHIP): NYSHIP covers over 1.2 million public
       hospitals for a prepaid premium. Except for               employees, retirees and dependents and is one of the
       emergency services, you and your enrolled                 largest group health insurance programs in the country.
       dependents may have coverage only for services            The Program provides health care benefits through The
       received from your HMO’s network. See NYSHIP              Empire Plan or a NYSHIP-approved HMO.
       Health Maintenance Organizations on page 7 for
                                                               • Option: A health insurance plan offered through
       more information on HMOs including descriptions
                                                                 NYSHIP. Options include The Empire Plan and NYSHIP-
       of the two different types, Network and Independent
                                                                 approved HMOs within specific geographic areas.

12 Choices 2010/Actives Settled
Making a Choice                                              your group if prompted and then choose Health
                                                             Benefits & Option Transfer. Click on Rates and Health
Decision-Making Checklist                                    Plan Choices and then NYSHIP Plan Comparison.
Choosing a health insurance plan is an important             Select your group and the counties in which you live
decision. Think about what health care you and your          and work. Then, check the box next to the plans you
family might need during the next year. Review the           want to compare and click on Compare Plans to
plans and ask for more information. Here are several         generate the comparison table.
questions to consider:
                                                             Things to Remember
• What benefits does the plan have for doctor visits
                                                             • Gather as much information as possible.
  and other medical care? How are durable medical
  equipment and other supplies covered? What is my           • Consider the unique needs of yourself and your family.
  share of the cost?                                         • Compare the coverage and cost of your options.
• What benefits does the plan have for prescription          • Look for a health plan that provides the best balance
  drugs? Will the medicine I take be covered under             of cost and benefits for you.
  the plan? (Employees of Participating Employers:
  If you receive your drug coverage from a union             What You Need to Do
  Employee Benefit Fund, that coverage will not be           The Empire Plan and NYSHIP HMOs are summarized
  affected by a change in your health insurance plan.)       in this booklet. The Empire Plan is available to all
  What is my share of the cost? What type of formulary       employees. NYSHIP HMOs are available to employees
  does the plan have? Am I required to use the mail          in areas where they live or work. Pick the plans that
  service pharmacy?                                          would serve your needs best and call each for details
• What choice of providers do I have under the plan?         before you choose.
  (Ask if the provider or facilities you use are covered.)   If you decide to change your benefit plan:
  How would I consult a specialist if I needed one?
                                                             • See your agency Health Benefits Administrator
  Would I need a referral?
                                                               before the Option Transfer deadline announced
• What is my premium for the health plan?                      in the rate flyer.
• What will my out-of-pocket expenses for health             • Complete the necessary PS-404 form. Or change
  care be?                                                     your option online using MyNYSHIP if you are
• Does the plan cover special needs? Are there any             an active employee of a New York State agency.
  benefit limitations? (If you or one of your dependents     How to Use the Choices
  has a medical or mental health/substance abuse             Benefit Charts, Pages 16 – 43
  condition requiring specific treatment or other
  special needs, check on coverage carefully. Don’t          All NYSHIP plans must include a minimum level
  assume you’ll have coverage. Ask The Empire Plan           of benefits (see page 3). For example, The Empire Plan
  carriers or HMOs about your specific treatment.)           and all NYSHIP HMOs provide a paid-in-full benefit
                                                             for medically necessary inpatient medical/surgical
• Are routine office visits and urgent care covered for      hospital care at network hospitals.
  out-of-area college students, or is only emergency
  health care covered?                                       Use the charts to compare the plans. The charts list
                                                             out-of-pocket expenses and benefit limitations effective
• How much paperwork is involved in the health               on or about January 1, 2010. See plan documents for
  plan – do I have to fill out forms?                        complete information on benefit limitations.
To generate an easy-to-read side-by-side comparison
                                                             A Reminder
of the benefits provided by each of the NYSHIP plans
in your area, use the NYSHIP Plan Comparison tool,           Most benefits described in this booklet are subject
available on the Department of Civil Service web site.       to medical necessity and may involve limitations or
Go to our home page at https://www.cs.state.ny.us,           exclusions. Please refer to plan documents, or call
click on Benefit Programs then NYSHIP Online. Select         the plans directly for details.

                                                                                             Choices 2010/Actives Settled   13
     Plans by County                                                                                                                                   Health Maintenance Organizations (HMOs)
     The Empire Plan                                                                                                                                   Most NYSHIP enrollees have a choice among HMOs.
                                                                                                                                                       You may enroll, or continue to be enrolled, in any
     The Empire Plan is available to all enrollees in the                                                                                              NYSHIP-approved HMO that serves the area where
     New York State Health Insurance Program (NYSHIP).                                                                                                 you live or work. You may not be enrolled in an HMO
     You may choose The Empire Plan regardless of where                                                                                                outside your area. This list will help you determine which
     you live or work. Coverage is worldwide. See pages                                                                                                HMOs are available by county. The pages indicated will
     16-21 for a summary of The Empire Plan.                                                                                                           describe benefits available from each HMO.


        Page in Choices   16 22 24 26 26 26 28                                                                     30                  30                 30              32 32 34 36 36 38 40 40 40 40 42




                                                                                                                                                                                                                         Independent Health*
                                                                                                                 Empire BlueCross


                                                                                                                                    Empire BlueCross


                                                                                                                                                       Empire BlueCross
                                                                                               Community Blue*


                                                                                                                 BlueShield HMO


                                                                                                                                    BlueShield HMO


                                                                                                                                                       BlueShield HMO
                          The Empire Plan



                                                     Blue Choice*




                                                                                                                                                                          GHI HMO

                                                                                                                                                                                    GHI HMO



                                                                                                                                                                                                     HMOBlue

                                                                                                                                                                                                               HMOBlue
                                                                    CDPHP*

                                                                             CDPHP*

                                                                                      CDPHP*
                                            Aetna*




                                                                                                                                                                                                                                               MVP*

                                                                                                                                                                                                                                                      MVP*




                                                                                                                                                                                                                                                                         MVP*
                                                                                                                                                                                                                                                             MVP

                                                                                                                                                                                                                                                                   MVP
                                                                                                                                                                                              HIP*
                          001

                                            210

                                                     066

                                                                    063

                                                                             300

                                                                                      310

                                                                                               067

                                                                                                                      280


                                                                                                                                         290


                                                                                                                                                            320

                                                                                                                                                                          220

                                                                                                                                                                                    350

                                                                                                                                                                                              050

                                                                                                                                                                                                     072

                                                                                                                                                                                                               160

                                                                                                                                                                                                                         059

                                                                                                                                                                                                                                               060

                                                                                                                                                                                                                                                      330

                                                                                                                                                                                                                                                             340

                                                                                                                                                                                                                                                                   360

                                                                                                                                                                                                                                                                         058
        NYSHIP CODE

        Albany              •                                       •                                                •                                                    •                                                                    •
        Allegany            •                                                                  •                                                                                                                          •
        Bronx               •               •                                                                                            •                                                    •
        Broome              •                                                •                                                                                                                       •                                                •
        Cattaraugus         •                                                                  •                                                                                                                          •
        Cayuga              •                                                                                                                                                                        •                                                •
        Chautauqua          •                                                                  •                                                                                                                          •
        Chemung             •                                                                                                                                                                        •
        Chenango            •                                                •                                                                                                                                 •                                      •
        Clinton             •                                                                                        •                                                                                         •
        Columbia            •                                       •                                                •                                                    •                                                                    •
        Cortland            •                                                                                                                                                                        •                                                •
        Delaware            •                                                •                                       •                                                    •                                    •                                      •
        Dutchess            •                                                         •                                                                     •                       •                                                                        •
        Erie                •                                                                  •                                                                                                                          •
        Essex               •                                                •                                       •                                                                                         •
        Franklin            •                                                                                                                                                                                  •                                                   •
        Fulton              •                                       •                                                •                                                                                         •                               •
        Genesee             •                                                                  •                                                                                                                          •                                              •
        Greene              •                                       •                                                •                                                    •                                                                    •
        Hamilton            •                                                •                                                                                                                                                                 •
        Herkimer            •                                                •                                                                                                                                 •                                      •
        Jefferson           •                                                                                                                                                                                  •                                      •
        Kings               •               •                                                                                            •                                                    •
        Lewis               •                                                                                                                                                                                  •                                      •
        Livingston          •                        •                                                                                                                                                                                                                   •
        Madison             •                                                •                                                                                                                                 •                                      •

     *Medicare-primary NYSHIP enrollees will be enrolled in this HMO’s Medicare Advantage Plan. For more information about
      NYSHIP Medicare Advantage Plans, ask your agency Health Benefits Administrator for a copy of Choices for 2010 for Retirees.

14 Choices 2010/Actives Settled
  Page in Choices   16 22 24 26 26 26 28                                                                     30                  30                 30              32 32 34 36 36 38 40 40 40 40 42




                                                                                                                                                                                                                   Independent Health*
                                                                                                           Empire BlueCross


                                                                                                                              Empire BlueCross


                                                                                                                                                 Empire BlueCross
                                                                                         Community Blue*


                                                                                                           BlueShield HMO


                                                                                                                              BlueShield HMO


                                                                                                                                                 BlueShield HMO
                    The Empire Plan



                                               Blue Choice*




                                                                                                                                                                    GHI HMO

                                                                                                                                                                              GHI HMO



                                                                                                                                                                                               HMOBlue

                                                                                                                                                                                                         HMOBlue
                                                              CDPHP*

                                                                       CDPHP*

                                                                                CDPHP*
                                      Aetna*




                                                                                                                                                                                                                                         MVP*

                                                                                                                                                                                                                                                MVP*




                                                                                                                                                                                                                                                                   MVP*
                                                                                                                                                                                                                                                       MVP

                                                                                                                                                                                                                                                             MVP
                                                                                                                                                                                        HIP*
                                                                                                                280


                                                                                                                                   290


                                                                                                                                                      320
                    001

                                      210

                                               066

                                                              063

                                                                       300

                                                                                310

                                                                                         067




                                                                                                                                                                    220

                                                                                                                                                                              350

                                                                                                                                                                                        050

                                                                                                                                                                                               072

                                                                                                                                                                                                         160

                                                                                                                                                                                                                   059

                                                                                                                                                                                                                                         060

                                                                                                                                                                                                                                                330

                                                                                                                                                                                                                                                       340

                                                                                                                                                                                                                                                             360

                                                                                                                                                                                                                                                                   058
  NYSHIP CODE

  Monroe              •                        •                                                                                                                                                                                                                   •
  Montgomery          •                                       •                                                •                                                                                         •                               •
  Nassau              •               •                                                                                            •                                                    •
  New York            •               •                                                                                            •                                                    •
  Niagara             •                                                                  •                                                                                                                          •
  Oneida              •                                                •                                                                                                                                 •                                      •
  Onondaga            •                                                                                                                                                                        •                                                •
  Ontario             •                        •                                                                                                                                                                                                                   •
  Orange              •               •                                         •                                                                     •                       •                                                                        •
  Orleans             •                                                                  •                                                                                                                          •                                              •
  Oswego              •                                                                                                                                                                        •                                                •
  Otsego              •                                                •                                                                                                                                 •                                      •
  Putnam              •               •                                                                                                               •                       •                                                                        •
  Queens              •               •                                                                                            •                                                    •
  Rensselaer          •                                       •                                                •                                                    •                                                                    •
  Richmond            •               •                                                                                            •                                                    •
  Rockland            •               •                                                                                            •                                          •                                                                        •
  Saratoga            •                                       •                                                •                                                    •                                                                    •
  Schenectady         •                                       •                                                •                                                    •                                                                    •
  Schoharie           •                                       •                                                •                                                                                                                         •
  Schuyler            •                                                                                                                                                                        •
  Seneca              •                        •                                                                                                                                                                                                                   •
  St. Lawrence        •                                                                                                                                                                                  •                                                   •
  Steuben             •                                                                                                                                                                        •                                                                   •
  Suffolk             •               •                                                                                            •                                                    •
  Sullivan            •               •                                                                                                               •                       •                                                                        •
  Tioga               •                                                •                                                                                                                       •                                                •
  Tompkins            •                                                                                                                                                                        •                                                •
  Ulster              •                                                         •                                                                     •                       •                                                                        •
  Warren              •                                       •                                                •                                                    •                                                                    •
  Washington          •                                       •                                                •                                                    •                                                                    •
  Wayne               •                        •                                                                                                                                                                                                                   •
  Westchester         •               •                                                                                            •                                                    •
  Wyoming             •                                                                  •                                                                                                                          •                                              •
  Yates               •                        •                                                                                                                                                                                                                   •
  New Jersey          •               •

*Medicare-primary NYSHIP enrollees will be enrolled in this HMO’s Medicare Advantage Plan. For more information about
 NYSHIP Medicare Advantage Plans, ask your agency Health Benefits Administrator for a copy of Choices for 2010 for Retirees.

                                                                                                                                                                                                                        Choices 2010/Actives Settled                      15
                                  The Empire Plan
                                  NYSHIP Code Number 001

     This section summarizes benefits available under each          Under The Empire Plan Benefits Management
     portion of The Empire Plan as of January 1, 20101. You         Program, you must call UnitedHealthcare for
     may also visit https://www.cs.state.ny.us, or call toll free   certification before an elective (scheduled) Magnetic
     1-877-7-NYSHIP (1-877-769-7447), the one number                Resonance Imaging (MRI), Magnetic Resonance
     for The Empire Plan carriers. Call to connect to:              Angiography (MRA), Computerized Tomography (CT),
                                                                    Positron Emission Tomography (PET) scan or Nuclear
     The Empire Plan Medical Benefits Program                       Medicine test unless you are having the test as an
     UnitedHealthcare                                               inpatient in a hospital.
     Medical and surgical coverage through:                         When arranged by UnitedHealthcare, voluntary,
     • Participating Provider Program – More than                   paid-in-full Specialist Consultant Evaluation is available.
       160,000 physicians and other providers participate;          Voluntary outpatient Medical Case Management
       certain services are subject to a $15 or $20                 is available to help coordinate services for
       copayment, depending on your group.                          serious conditions.
     • Basic Medical Program – If you use a non-                    The Empire Plan Hospital Benefits Program
       participating provider. See Cost Sharing
       (page 6) for an explanation of reimbursement                 Empire BlueCross BlueShield
       under The Empire Plan Basic Medical Program.                 The following benefit level applies when covered
     • Basic Medical Provider Discount Program – If you             services are received at a BlueCross and BlueShield
       use a non-participating provider who is part of The          Association BlueCard® PPO network hospital:
       Empire Plan MultiPlan group (see pages 6 and 7).             • Medical or surgical inpatient stays are covered at
     Home Care Advocacy Program (HCAP) –                              no cost to you.
     Paid-in-full benefit for home care, durable medical            • Hospital outpatient and emergency care are subject
     equipment and certain medical supplies (including                to network copayments.
     diabetic and ostomy supplies), enteral formulas and            • When you use a network hospital, anesthesiology,
     diabetic shoes. Diabetic shoes have an annual maximum            pathology and radiology provider charges for
     benefit of $500. Guaranteed access to network benefits           covered hospital services are paid in full under
     nationwide. Limited non-network benefits available.              the Medical Benefits Program if The Empire Plan
     (See the Empire Plan Certificate/Reports for details).           provides your primary coverage.
     Managed Physical Medicine Program – Chiropractic               • Certain covered outpatient hospital services provided at
     treatment and physical therapy through a Managed                 network hospital extension clinics are subject to hospital
     Physical Network (MPN) provider are subject to a                 outpatient and emergency care copayments. Other
     $15 or $20 copayment, depending on your group.                   provider charges will be paid in full if using a network
     Unlimited network benefits when medically necessary.             provider. Non-network provider charges will be paid in
     Guaranteed access to network benefits nationwide.                accordance with the Basic Medical portion of the
     Limited non-network benefits available.                          Medical Benefits Program.


16 Choices 2010/Actives Settled
The following benefit level applies for services received       • All charges for any day determined not to be
at non-network hospitals (for Empire Plan-primary                 medically necessary.
enrollees only 2):                                              Voluntary inpatient Medical Case Management is
• Non-network hospital inpatient stays and outpatient           available to help coordinate services for serious
  services – 10 percent coinsurance3 up to an annual            conditions.
  maximum of $1,500 per enrollee; per spouse or
  domestic partner; per all dependent children
                                                                The Empire Plan Mental Health
  combined. Up to $500 of the coinsurance may                   and Substance Abuse Program
  be reimbursed under the Basic Medical Program.                UnitedHealthcare/OptumHealth
The Empire Plan will approve network benefits at                The Empire Plan Mental Health and Substance Abuse
a non-network facility if:                                      Program offers two levels of benefits. If you call
                                                                OptumHealth before you receive services and follow
• Your hospital care is emergency or urgent.
                                                                their recommendations, you receive:
• You do not have access to a network facility
                                                                Network Benefits
  within 30 miles of your residence.
                                                                (unlimited when medically necessary)
• No network facility can provide the medically
                                                                • Inpatient (paid in full)
  necessary services.
                                                                • Crisis intervention (up to three visits per crisis paid in full)
• Another insurer or Medicare provides your
  primary coverage (pays first).                                • Outpatient including office visits, home-based or
                                                                  telephone counseling and nurse practitioner services
Preadmission Certification Requirements
                                                                  $15 or $20 copayment, depending on your group.
Under The Empire Plan Benefits Management
                                                                • Outpatient rehabilitation to an approved Structured
Program, if The Empire Plan is your primary coverage,
                                                                  Outpatient Rehabilitation Program for substance abuse
you must call Empire BlueCross BlueShield for
                                                                  subject to a $15 or $20 copayment, depending on
certification of any inpatient stay:
                                                                  your group.
• Before a maternity or scheduled (non-emergency)
                                                                If you do NOT follow the requirements for network
  hospital admission,
                                                                coverage, you receive:
• Within 48 hours after an emergency or urgent
                                                                Non-Network Benefits4
  hospital admission, and
                                                                (unlimited when medically necessary)
• Before admission or transfer to a skilled nursing facility.
                                                                • For Practitioner Services: OptumHealth will consider
If you do not follow the preadmission certification               up to 80 percent of reasonable and customary charges
requirement, you must pay:                                        for covered services after you meet the applicable
• A $200 hospital deductible if it is determined                  mental health care annual deductible and the
  any portion was medically necessary, and                        applicable substance abuse annual deductible for
                                                                  outpatient practitioner services per enrollee; per

                                                                                                       Choices 2010/Actives Settled   17
       spouse or domestic partner; per all dependent children              • For a 31- to 90-day supply of a covered drug
       combined5. After the applicable coinsurance maximum                   through a participating retail pharmacy, you pay
       is reached per enrollee, per spouse or domestic                       a $10 copayment for Level 1 or generic drugs, $30
       partner, per all dependent children combined5,                        copayment for Level 2 or preferred brand-name
       the Plan pays up to 100 percent of reasonable                         drugs and $70 copayment for Level 3 or non-
       and customary charges for covered services.                           preferred brand-name drugs.
     • For Approved Facility Services: You are responsible                 • For a 31- to 90-day supply of a covered drug
       for 10 percent coinsurance up to an annual maximum                    through the mail service pharmacy, you pay a
       of $1,500 per enrollee; per spouse or domestic                        $5 copayment for Level 1 or generic drugs, $20
       partner; per all dependent children combined. Each                    copayment for Level 2 or preferred brand-name
       coinsurance maximum is applied as follows:                            drugs and $65 copayment for Level 3 or non-
       • You pay the first $500 of coinsurance, then                         preferred brand-name drugs.

       • The Program reimburses you for the next $500 of                   • When you fill a prescription for a covered brand-
         coinsurance, upon written request of the enrollee, then             name drug that has a generic equivalent, you pay
                                                                             the Level 3 or non-preferred brand-name copayment
       • You pay the final $500 of coinsurance.                              plus the difference in cost between the brand-name
       After the coinsurance maximum is met, the Plan pays                   drug and the generic equivalent, not to exceed the
       100 percent of billed charges for covered services.                   full retail cost of the drug. Exceptions apply. Please
                                                                             contact your agency HBA for more information.
     Outpatient treatment sessions for family members of
     an alcoholic, alcohol abuser or substance abuser are                  • The Empire Plan has a flexible formulary that excludes
     covered for a maximum of 20 visits per year for all                     a small number of brand-name drugs from coverage
     family members combined.                                                (does not apply to CSEA, Courts, Council 82, ALESU,
                                                                             NYSCOPBA (Contract Affected)). Coverage for
     Note: The amount you pay for inpatient and outpatient
                                                                             prescription drugs excluded under The Empire Plan
     services does NOT count toward meeting your Basic
                                                                             benefit plan design are not subject to exception.
     Medical deductible or Basic Medical and non-network
     hospital coinsurance maximum. Deductibles,                            • Prior authorization is required for certain drugs.
     coinsurance and maximum coinsurance amounts are                       • A pharmacist is available 24 hours a day to answer
     separate and not combined with any other deductible,                    questions about your prescriptions.
     coinsurance or maximum coinsurance amounts.
                                                                           • You can use a non-participating pharmacy or pay
     The Empire Plan Prescription Drug Program                               cash at a participating pharmacy (instead of using
     UnitedHealthcare/Medco Health Solutions                                 your Empire Plan benefit card) and fill out a claim
                                                                             form for reimbursement. In almost all cases, you
     • When you use a participating retail pharmacy or
                                                                             will not be reimbursed the total amount you paid
       the mail service pharmacy for up to a 30-day supply
                                                                             for the prescription, and your out-of-pocket expenses
       of a covered drug, you pay a $5 copayment for
                                                                             may exceed the usual copayment amount. To reduce
       Level 1 or generic drugs, $15 copayment for Level 2
                                                                             your out-of-pocket expenses, use your Empire Plan
       or preferred brand-name drugs and $40 copayment
                                                                             benefit card whenever possible.
       for Level 3 or non-preferred brand-name drugs.

        1   These benefits are subject to medical necessity and to limitations and exclusions described in the Empire Plan Certificate
            and Empire Plan Reports/Certificate Amendments.
        2   If Medicare or another plan provides primary coverage, you receive network benefits for covered services at both network
            and non-network hospitals.
        3   Greater of 10 percent or $75 for outpatient.
        4   You are responsible for obtaining OptumHealth certification for care obtained from a non-network practitioner or facility.
        5   Annual deductibles and coinsurance maximums vary by group. See page 8 for details.



18 Choices 2010/Actives Settled
The Empire Plan NurseLine            SM


Provides 24-hour access to health information
and support.                                                     The Empire Plan Centers of
                                                                 Excellence Programs
Empire Plan Benefits Are Available Worldwide
                                                                 The Centers of Excellence for Cancer Program
The Empire Plan gives you the freedom to choose a
                                                                 includes paid-in-full coverage for cancer-related
participating provider or a non-participating provider.
                                                                 expenses received through Cancer Resource
Teletypewriter (TTY) numbers                                     Services (CRS). CRS is a nationwide network
For callers who use a TTY device because of a hearing            including many of the nation’s leading cancer
or speech disability. All TTY numbers are toll free.             centers. The enhanced benefits, including travel
                                                                 reimbursement, are available only when you
UnitedHealthcare
                                                                 are enrolled in the Program.
 TTY only:.....................................1-888-697-9054
Empire BlueCross BlueShield
 TTY only:.....................................1-800-241-6894    The Centers of Excellence for Transplants
OptumHealth                                                      Program provides paid-in-full coverage for
 TTY only:.....................................1-800-855-2881    services covered under the Program and
The Empire Plan Prescription Drug Program                        performed at a qualified Center of Excellence.
  TTY only:.....................................1-800-759-1089   The enhanced benefits, including travel
                                                                 reimbursement, are available only when you
                                                                 are enrolled in the Program and The Empire
                                                                 Plan is your primary coverage. Precertification
                                                                 is required.


                                                                 Infertility Centers of Excellence are a select
                                                                 group of participating providers contracted by
                                                                 UnitedHealthcare and recognized as leaders in
                                                                 reproductive medical technology and infertility
                                                                 procedures. Benefits are paid in full, subject
                                                                 to the lifetime maximum benefit of $50,000.
                                                                 A travel allowance is available. Precertification
                                                                 is required.




                                                                   For details on The Empire Plan Centers
                                                                   of Excellence Programs, see the Empire
                                                                   Plan Certificate/Reports and Reporting
                                                                   on Centers of Excellence available at
                                                                   https://www.cs.state.ny.us or from your
                                                                   agency HBA.




                                                                                           Choices 2010/Actives Settled   19
                                                                                                          The Empire Plan
                                  Benefits                                   Network Hospital Benefits1     Participating Provider                          Non-Participating Provider
                                  Office Visits                                                             $15 or $20/visit2                               Basic Medical3
                                  Specialty Office Visits                                                   $15 or $20/visit2                               Basic Medical3
                                  Diagnostic/Therapeutic Services
                                     Radiology                               $40/outpatient visit           $15 or $20/visit2                               Basic Medical3
                                     Lab Tests                               $40/outpatient visit           $15 or   $20/visit2                             Basic Medical3




20 Choices 2010/Actives Settled
                                     Pathology                               No copayment                   $15 or $20/visit2                               Basic Medical3
                                     EKG/EEG                                 $40/outpatient visit           $15 or   $20/visit2                             Basic Medical3
                                     Radiation, Chemotherapy, Dialysis       No copayment                   No copayment                                    Basic Medical3
                                  Women’s Health Care/OB GYN
                                     Pap Tests                               $40/outpatient visit           $15 or $20/visit2                               Basic Medical3
                                     Mammograms                              $40/outpatient visit           $15 or   $20/visit2                             Basic Medical3
                                     Pre and Postnatal Visits                                               No copayment                                    Basic Medical3
                                     Bone Density Tests                      $40/outpatient visit           $15 or $20/visit2                               Basic Medical3
                                  Family Planning Services                                                  $15 or   $20/visit2                             Basic Medical3
                                  Infertility Services                       $40/outpatient visit           $15 or             No copayment at designated
                                                                                                                     $20/visit2;                            Basic Medical3
                                                                                                            Centers of Excellence4 ($50,000 lifetime
                                                                                                            allowance for Qualified Procedures)
                                  Contraceptive Drugs and Devices                                           $15 or $20/visit2                               Basic Medical3
                                  (also covered under The Empire Plan
                                  Prescription Drug Program5
                                  subject to drug copayment)
                                  Emergency Room                             $60 or $70/visit2              No copayment                                    Basic Medical3,6
                                  Urgent Care                                                               $15 or $20/visit2                               Basic Medical3
                                  Ambulance                                  No   copayment7                $35 copayment                                   $35 copayment
                                  Mental Health Practitioner Services                                       $15 or $20/visit2                               Applicable annual deductible2, 80% of
                                                                                                            (OptumHealth)                                   reasonable and customary; after applicable
                                                                                                                                                            coinsurance max2, 100% of reasonable and
                                                                                                                                                            customary (See pages 17-18 for details.)
                                  Approved Facility Mental Health Services                                  No copayment; unlimited when                    90% of billed charges; after $1,500 coinsurance
                                                                                                            medically necessary (OptumHealth)               max, covered in full (See pages 17-18 for details.)
                                  Outpatient Drug/Alcohol Rehabilitation                                    $15 or $20/visit2                               Applicable annual deductible2, 80% of
                                                                                                            to approved Structured Outpatient               reasonable and customary; after applicable
                                                                                                            Rehabilitation Program; unlimited when          coinsurance max2, 100% of reasonable and
                                                                                                            medically necessary (OptumHealth)               customary (See pages 17-18 for details.)
                                  Inpatient Drug/Alcohol Rehabilitation                                     No copayment; unlimited when                    90% of billed charges; after $1,500 coinsurance
                                                                                                            medically necessary (OptumHealth)               max, covered in full (See pages 17-18 for details.)
                                  Durable Medical Equipment                                                 No copayment (HCAP)                             50% of network allowance
                                                                                                                                                            (See the Empire Plan Certificate/Reports)
                                  Prosthetics                                                               No copayment8                                   Basic Medical3,8 $1,500 lifetime maximum
                                                                                                                                                            benefit for prosthetic wigs
                                  Orthotic Devices                                                          No copayment8                                   Basic Medical3,8
                                   External Mastectomy Prostheses                                                                                                          Covered in full benefit for one single or double
                                                                                                                                                                           prosthesis per calendar year under Basic Medical,
                                                                                                                                                                           not subject to deductible or coinsurance3,8
                                                                                                                                                                           (precertification may be required)
                                   Rehabilitative Care – Acute                  No copayment when an inpatient;        Physical or occupational therapy                    $250 annual deductible,
                                   Care Facility                                $15 or $20/visit2 for outpatient       $15 or $20/visit (MPN)2                             50% of network allowance
                                                                                physical therapy following related     Speech therapy $15 or $20/visit2                    $1,500 annual maximum benefit
                                                                                surgery or hospitalization                                                                 Basic Medical3
                                   Diabetic Supplies                                                                   No copayment (HCAP)                                 50% of network allowance
                                                                                                                                                                           (See the Empire Plan Certificate/Reports)
                                   Insulin and Oral Agents
                                   (covered under The Empire Plan
                                   Prescription Drug Program
                                   subject to drug copayment)
                                   Hospice                                      No copayment, no limit
                                   Skilled Nursing Facility                     No copayment up to
                                                                                365 benefit days4
                                                                                No benefits if Medicare-primary
                                   Prescription Drugs (see page 18)
                                   Additional Benefits
                                     Dental (preventive)                                                               Not covered                                         Not covered
                                     Vision (routine only)                                                             Not covered                                         Not covered
                                     Hearing Aids                                                                      Up to $1,200 or $1,500 per aid per ear              Up to $1,200 or $1,500 per aid per ear
                                                                                                                       every 4 years (every 2 years for children)          every 4 years (every 2 years for children)
                                                                                                                       if medically necessary                              if medically necessary
                                     Diabetic Shoes                                                                    $500 annual maximum benefit                         75% of network allowance
                                                                                                                                                                           up to an annual maximum benefit of $500
                                                                                                                                                                           (See the Empire Plan Certificate/Reports)
                                     Out of Area Benefit                        Under The Empire Plan, your benefits are the same wherever you receive care.
                                     Inpatient Hospital                         No copayment4                          No copayment                                        Basic Medical3
                                     Outpatient   Surgery9                      $40 or $60 per   visit2                $15 or   $20/visit2                                 Basic Medical3
                                   24-hour NurseLineSM for health information and support
                                   Voluntary Disease Management Programs available for conditions such as asthma, attention deficit hyperactivity disorder (ADHD), cardiovascular disease, chronic kidney disease
                                   (CKD), chronic obstructive pulmonary disease, congestive heart failure, depression, diabetes and eating disorders.
                                   Diabetes Education Centers available to enrollees who have a diagnosis of diabetes.

                               1 Services provided by Empire HealthChoice Assurance, Inc., a licensee of the BlueCross            6 Attending emergency room physicians and providers who administer or interpret
                                 and BlueShield Association. Inpatient stays at network hospitals are paid in full. Provider        radiological exams, laboratory tests, electrocardiograms and/or pathology services
                                 charges are covered under the Medical Benefits Program. Non-network hospital                       are paid in full. Other providers covered subject to deductible and coinsurance.
                                 coverage provided subject to coinsurance (see page 9).                                           7 If service is provided by admitting hospital.
                               2 Copayments, annual deductibles, coinsurance maximums and/or some benefits vary                   8 Benefit paid up to cost of device meeting individual’s functional need.
                                 depending on your group.                                                                         9 In outpatient surgical locations, the copayment for the facility charge is $40 or $60
                               3 See page 6 for an explanation of reimbursement under the Basic Medical Program.                    per visit or Basic Medical benefits apply depending upon the status of the center.
                               4 Preadmission certification required.                                                               (Check with the center or The Empire Plan carriers.)
                               5 Coverage excludes contraceptive intrauterine devices (IUDs) that do not contain any
                                 FDA-approved hormone prescription drug products.




Choices 2010/Actives Settled
21
                                                                     Benefits                                  Enrollee Cost
                                                                     Prosthetics                              50% coinsurance
                                                                     Orthotics                                50% coinsurance
                                                                     Rehabilitative Care, Physical, Speech and
                                                                     Occupational Therapy
     Benefits                                  Enrollee Cost           Inpatient, max 60 days                No copayment
                                                                       Outpatient Physical, Speech, Occupational and
     Office Visits                                $25 per visit        Pulmonary Therapy
      Routine Adult Physicals                       $5 per visit         max 30 visits combined                $40 per visit
      Well Child Care                            No copayment
      PCP visits for sick children to age 19        $5 per visit     Diabetic Supplies                            $25 per item

     Specialty Office Visits                       $40 per visit     Insulin and Oral Agents                      $25 per item

     Diagnostic/Therapeutic Services                                 Hospice, max 210 days                       No copayment
       Radiology                               $40 per visit         Skilled Nursing Facility
       Lab Tests                               $25 per visit           max 45 days per admission
       Pathology                               $25 per visit           360-day lifetime max                      No copayment
       EKG/EEG                                 $40 per visit
                                                                     Prescription Drugs
       Radiation                               $25 per visit
                                                                       Retail, 30-day supply
       Chemotherapy                     $25 for injection Rx
                                                                                           $10 Tier 1/$30 Tier 2/$50 Tier 33
       and $25 office copayment. Max 2 copayments per day.
                                                                       Mail Order, up to 90-day supply
     Women’s Health Care/OB GYN                                                           $20 Tier 1/$60 Tier 2/$100 Tier 33
      Pap Tests1                                     $5 per visit    There is a separate copayment for each 30-day supply
      Mammograms                                     $5 per visit    purchased at a retail pharmacy. You can order up to
      Pre and Postnatal Visits                       $5 per visit    a 90-day supply through our mail order program with
                                            (first 10 visits only)   two copayments per 90-day supply. Coverage includes
       Bone Density Tests                           $25 per visit    contraceptive drugs and devices and fertility drugs,
     Family Planning Services Applicable copayment applies           injectable and self-injectable medications and enteral
                                                                     formulas.
     Infertility Services         Applicable copayment applies
                                                                     Specialty Drugs
     Contraceptive Drugs and Devices                                 Designated specialty medications are covered only when
                          Applicable Rx copayment applies            purchased at a participating network specialty pharmacy.
     Emergency Room                              $100 per visit      Medications purchased from a specialty pharmacy are
                                                                     subject to the same days supply and cost-sharing
     Urgent Care                                   $35 per visit     requirements that apply to the retail pharmacy benefit.
     Ambulance2                                   $100 per trip      Mail order does not apply and these medications cannot
                                                                     be filled at mail order.
     Outpatient Mental Health                                        A current list of specialty medications and participating
      unlimited visits                             $40 per visit     specialty pharmacies is available on our web site at
     Inpatient Mental Health                                         www.excellusbcbs.com.
       unlimited days                            No copayment
                                                                     1
                                                                       There are two services rendered for a Pap Test – the
     Outpatient Drug/Alcohol Rehab
                                                                       professional service by the OB GYN and the lab exam of the
      unlimited visits                             $25 per visit
                                                                       pap smear. There is a $5 copayment for the OB GYN exam,
     Inpatient Drug/Alcohol Rehab                                      while the pap smear test is covered in full. NYSHIP members
       unlimited days                            No copayment          will see a $5 copayment for the “Pap Test.”
                                                                     2
                                                                       Air ambulance coverage is excluded.
     Durable Medical Equipment                 50% coinsurance       3
                                                                       Should a doctor select a brand-name drug when an FDA-
                                                                       approved generic equivalent is available, the member will
                                                                       have to pay the difference between the cost of the generic
                                                                       and the brand-name plus any applicable copayments.

24 Choices 2010/Actives Settled
Additional Benefits                                                        Pharmacies and Prescriptions
Dental ......................................................Not covered   Blue Choice members may have their prescriptions filled
Vision ...................................................$40 for exams    at any of our over 60,000 participating pharmacies
                         associated with disease or injury only            nationwide. Simply show the pharmacist your ID card.
Hearing Aids................Children to age 19: $600 max,                  Blue Choice offers an incented formulary. Call
                                                           every 3 years   PrimeMail at 1-866-260-0487 for mail order
Diabetic Shoes                                                             prescriptions. Fertility, injectable and self-injectable
  up to 3 pairs per calendar year...........No copayment                   prescription drugs are covered.
Out Of Area....................................Our BlueCard and
  Away From Home Care Programs provide routine and                         Medicare Coverage
  urgent care coverage while traveling, for students
                                                                           Medicare-primary enrollees are required to enroll in
  away at school, members on extended out-of-town
                                                                           Medicare Blue Choice, the Excellus BlueCross BlueShield
  business and for families living apart.
                                                                           Medicare Advantage Plan. To qualify, you must be
Surgery
                                                                           enrolled in Medicare Parts A and B and live in one of
  Physician-inpatient.............Lesser of $200 copayment
                                                                           the counties listed below. Once you become eligible for
                                                  or 20% coinsurance
                                                                           Medicare, some of your Medicare Blue Choice
  Physician-outpatient at a hospital,
                                                                           copayments will vary from the copayments of NYSHIP-
  facility or surgery center ....................$40 copayment
                                                                           primary enrollees. Please call the Medicare Blue Choice
  Physician’s office .................Lesser of $50 copayment
                                                                           number below for further details.
                                                  or 20% coinsurance
Outpatient Surgical Care (Facility) ........$50 copayment
Maternity
  Physician’s charge for delivery .................Lesser of $200
                                 copayment or 20% coinsurance

Plan Highlights for 2010
With Blue Choice, count on us to deliver the high-quality
coverage you want and the value you need. Rely on Blue
Choice for discounts on services that encourage you to
develop a healthy lifestyle.
• Two copayments for up to a 90-day supply for
  prescription drugs through PrimeMail.
• Well child care is covered in full.
• Pay a $5 copayment for PCP visits for sick children to                      NYSHIP Code Number 066
  age 19.
• Pay a $5 copayment for preventive services such                             A Network HMO serving individuals living or working
  as adult routine physicals, mammograms, OB GYN                              in Livingston, Monroe, Ontario, Seneca, Wayne and
  exams and prostate screenings.                                              Yates counties.

Participating Physicians                                                      Blue Choice
With over 3,200 providers available, Blue Choice offers                       165 Court Street
you more choice of doctors than any other area HMO.                           Rochester, NY 14647
Talk to your doctor about whether Blue Choice is the
right plan for you.                                                           For information:
                                                                              Blue Choice: 585-454-4810 or 1-800-462-0108
Affiliated Hospitals                                                          TTY: 1-877-398-2282
All operating hospitals in the Blue Choice service area                       Medicare Blue Choice: 1-877-883-9577
are available to you. Others outside the service area are                     Web site: www.excellusbcbs.com
also available. Please call the number to the right for a
directory, or check our web site at: www.excellusbcbs.com.



                                                                                                           Choices 2010/Actives Settled   25
                                                                 Benefits                                    Enrollee Cost
                                                                 Rehabilitative Care, Physical, Speech
                                                                 and Occupational Therapy
                                                                   Inpatient, max 45 days                      No copayment
                                                                   Outpatient, max 20 visits                    $10 per visit
                                                                 Diabetic Supplies                               $10 per item
     Benefits                             Enrollee Cost
                                                                 Insulin and Oral Agents                         $10 per item
     Office Visits                          $10 per visit
      Well Child Care                      No copayment          Hospice, unlimited                            No copayment

     Specialty Office Visits                 $10 per visit       Skilled Nursing Facility, max 50 days         No copayment

     Diagnostic/Therapeutic Services                             Prescription Drugs
       Radiology                            $10 per visit          Retail, 30-day supply                      $5 generic/
       Lab Tests                           No copayment1                       $15 formulary brand/$35 non-formulary
       Pathology                           No copayment            Mail Order, 90-day supply                $15 generic/
       EKG/EEG                              $10 per visit                     $45 formulary brand/$105 non-formulary
       Radiation                            $10 per visit        Coverage includes contraceptive drugs and devices,
       Chemotherapy                         $10 per visit        prenatal vitamins and vitamins with fluoride, fertility
                                                                 drugs, injectable/self-injectable medications, enteral
     Women’s Health Care/OB GYN                                  formulas, insulin and oral diabetic agents. Most
      Pap Tests                            No copayment          injectable drugs are subject to prior approval. Member
      Mammograms                           No copayment2         communication materials will be mailed to the member
      Pre and Postnatal Visits             No copayment3         upon enrollment explaining the mail order process and
      Bone Density Tests                    $10 per visit        how to submit a mail order prescription.
     Family Planning Services                $10 per visit       Specialty Drugs
     Infertility Services                    $10 per visit   4   Specialty drugs are available through mail order at the
                                                                 applicable copayment.
     Contraceptive Drugs and Devices
       Approved generic oral contraceptives covered at 100%      1
                                                                     For services at a stand-alone lab (must use Quest) or
     Emergency Room                          $50 per visit           outpatient hospital that participates as a Quest
                                                                     Diagnostics hospital draw site. Lab services performed in
     Urgent Care                             $10 per visit           conjunction with outpatient surgery or an emergency room
     Ambulance                                $50 per trip           visit will also be paid in full.
                                                                 2
                                                                     Routine only
     Outpatient Mental Health                                    3
                                                                     $10 copayment will only be taken on the initial office visit
      unlimited visits5                      $10 per visit           to confirm the pregnancy.
                                                                 4
     Inpatient Mental Health                                         For services to diagnose and treat infertility.
                                                                 5
       unlimited days5                     No copayment              Subject to medical necessity.

     Outpatient Drug/Alcohol Rehab
      unlimited visits5                      $10 per visit
     Inpatient Drug/Alcohol Rehab
       unlimited days5                     No copayment
     Durable Medical Equipment           20% coinsurance
     Prosthetics                         20% coinsurance
     Orthotics                           20% coinsurance




28 Choices 2010/Actives Settled
Additional Benefits                                                      Pharmacies and Prescriptions
         6
Dental ...................................................20% discount   Community Blue members may obtain prescriptions from
              at select providers, free second annual exam               a nationwide network of nearly 45,000 participating
Vision ....................VisionPLUS Program (details below)            pharmacies. Prescriptions are filled for up to a 30-day
Hearing Aids ............................................Not covered     supply (including insulin) when filled at a participating
Diabetic Shoes..........................................Not covered      pharmacy. Community Blue offers an incented
Out Of Area ................................Worldwide coverage           formulary. Member’s copayment will reflect $5
  for emergency and urgent care through the BlueCard                     formulary generic, $15 formulary brand, $35 non-
  Program, a network of BlueCross and BlueShield                         formulary prescriptions. Enrollees may also take
  providers across the country and around the world.                     advantage of the convenience of obtaining a 90-day
  Guest membership for routine care away from home                       supply of their medications through mail order.
  that enables members on extended business trips or
  family members away at school to join a nearby Blue                    Medicare Coverage
  HMO and enjoy the same benefits they do at home.
                                                                         Medicare-primary enrollees are required to enroll in
VisionPLUS Program ...............Community Blue members
                                                                         Senior Blue HMO, the Community Blue Medicare
  are entitled to a complete eyecare program that includes
                                                                         Advantage Plan. To qualify you must be enrolled in
  routine eye exams and discounts from participating
                                                                         Medicare Parts A and B and live in one of the counties
  VisionPLUS providers. Discounts included on frames,
                                                                         listed below.
  lenses, contact lenses and supplies.
Artificial Insemination ........................20% coinsurance 7

6
    Preventive
7
    Other artificial means to induce pregnancy (in-vitro,
    embryo transfer, etc.) are not covered.


Plan Highlights for 2010
Members have access to our BlueLife wellness programs,
which provide innovative wellness and health
management programs through online and community-
based resources. Discounts are available on acupuncture,
massage therapy, nutritional counseling, fitness centers
and spas. Members also have access to a 24/7 patient
advocacy program – Health Advocate – which assists                          NYSHIP Code Number 067
patients with locating providers and scheduling
appointments and offers a variety of other services.
                                                                            An IPA HMO serving individuals living or working in
                                                                            Allegany, Cattaraugus, Chautauqua, Erie, Genesee,
Participating Physicians                                                    Niagara, Orleans and Wyoming counties.
Community Blue has over 3,000 physicians and health
care professionals in our network who see patients in                       Community Blue
their private offices throughout our service area.                          The HMO of BlueCross BlueShield of Western New York
                                                                            P.O. Box 80
                                                                            Buffalo, NY 14240-0080
Affiliated Hospitals
Community Blue contracts with all Western New York
hospitals to provide health care services to our members.                   For information, call
Community Blue members may be directed to other                             Buffalo: 716-887-8840 or 1-877-576-6440
hospitals to meet special needs when medically necessary.                   Olean: 716-376-6000 or 1-800-887-8130
                                                                            Jamestown: 716-484-1188 or 1-800-944-2880
                                                                            TTY: 1-888-249-2583
                                                                            Web site: www.bcbswny.com




                                                                                                          Choices 2010/Actives Settled   29
                                                              Benefits                                   Enrollee Cost
                                                              Prosthetics                                 No copayment
                                                                          2
                                                              Orthotics                                   No copayment
                                                              Rehabilitative Care, Physical, Speech
                                                              and Occupational Therapy
     Benefits                            Enrollee Cost          Inpatient, max 45 days                    No copayment
                                                                Outpatient, max 20 visits
     Office Visits                           $10 per visit        combined per year                          $15 per visit
     Specialty Office Visits                 $10 per visit    Diabetic Supplies
     Diagnostic/Therapeutic Services                            Retail, 30-day supply                       $10 per item
       Radiology                            $15 per visit       Mail Order                                  Not available
       Lab Tests                           No copayment       Insulin and Oral Agents               $10 per item or
       Pathology                           No copayment                  applicable pharmacy rider, whichever is less
       EKG/EEG                              $10 per visit
       Radiation                            $15 per visit     Hospice, unlimited                          No copayment
       Chemotherapy                         $10 per visit     Skilled Nursing Facility, max 45 days       No copayment
     Women’s Health Care/OB GYN                               Prescription Drugs
      Pap Tests                            No copayment          Retail, 30-day supply $5 tier I, most generic drugs/
      Mammograms                           No copayment                   $15 tier II, most preferred brand-name drugs/
      Pre and Postnatal Visits             No copayment                                         $30 tier III, all other drugs
      Bone Density Tests                   No copayment          Mail Order, 90-day supply                 2.5 copayments
     Family Planning Services                $10 per visit                                         for maintenance drugs
                                                              Coverage includes contraceptive drugs and devices,
     Infertility Services                    $10 per visit    injectable and self-injectable medications, fertility drugs and
     Contraceptive Drugs and Devices                          enteral formulas. Tier I oral contraceptives covered in full.
                          Applicable Rx copayment applies     Specialty Drugs
     Emergency Room                          $50 per visit    Benefits are provided for specialty drugs by two
                                                              contracted specialty pharmacy vendors, Curascript
     Urgent Care                             $10 per visit1   Pharmacy and OptionCare Pharmacy. Specialty drugs,
     Ambulance                               $50 per trip     available through the prescription drug benefit, include
                                                              select high-cost injectables and oral agents such as oral
     Outpatient Mental Health                                 oncology drugs. Specialty drugs require prior approval
      unlimited visits                       $10 per visit    and are subject to the applicable Rx copayment based on
     Inpatient Mental Health                                  the formulary status of the medication. Members pay one
       unlimited days                      No copayment       copayment for each 30-day supply.

     Outpatient Drug/Alcohol Rehab                            1
                                                                  Within the service area. Outside the service area - $10
      unlimited visits                       $10 per visit
                                                                  copayment plus the difference in cost between Independent
     Inpatient Drug/Alcohol Rehab                                 Health’s payment and the provider’s charges, if any. $35
       unlimited days                      No copayment           per visit to a participating After Hours Care Facility.
                                                              2
                                                                  Excludes shoe inserts.
     Durable Medical Equipment           50% coinsurance




38 Choices 2010/Actives Settled
Additional Benefits                                                  Medicare Coverage
         3
Dental ..................$50 per cleaning and 20% discount           Independent Health Medicare-primary retirees must
                    on additional services at select providers       enroll in Medicare Encompass, a Medicare Advantage
Vision4 ...................$10 per visit once every 12 months        Plan. Copayments will differ from the copayments of a
Hearing Aids .......Discounts available at select locations          NYSHIP-primary enrollee. Call for detailed information.
Diabetic Shoes
  one pair per calendar year .................No copayment
Out Of Area .............................While traveling outside
  the service area, members are covered for emergency
  and urgent care situations only.
Home Health Care, max 40 visits ..............$10 per visit
Eyeglass lenses ......................$35/single vision lenses;
  Frames 50% off retail price up to $130 and member
  pays 80% of balance over $130 (if any).
Urgent Care in Service Area
for After Hours Care ................................$35 per visit

3
    Preventive
4
    Routine only


Plan Highlights for 2010
Independent Health has led the way in providing
Western New York with innovative solutions that set the
standard for quality and service for health plans. We’ve
consistently earned top ratings from NCQA, which is
why you can feel comfortable and confident choosing us
for your health coverage needs.

Participating Physicians
Independent Health is affiliated with over 3,000
physicians and health care providers throughout the
eight counties of Western New York.

Affiliated Hospitals                                                    NYSHIP Code Number 059
Independent Health members are covered at all Western                   An IPA HMO serving individuals living or working in
New York hospitals to which their physicians have                       Allegany, Cattaraugus, Chautauqua, Erie, Genesee,
admitting privileges. Members may be directed to other                  Niagara, Orleans and Wyoming counties.
hospitals when medically necessary.
                                                                        Independent Health
Pharmacies and Prescriptions                                            511 Farber Lakes Drive
Over 350 pharmacies including many national chains.                     Buffalo, NY 14221
Members may obtain prescriptions out of the service
area by using our National Pharmacy Network.                            For information:
Independent Health offers an incented formulary.                        Customer Service:1-800-501-3439
                                                                        TTY: 716-631-3108
                                                                        Web site: www.independenthealth.com




                                                                                                     Choices 2010/Actives Settled   39
                                                                  Benefits                                 Enrollee Cost
                                                                  Durable Medical Equipment               20% coinsurance
                                                                  Prosthetics                             20% coinsurance
                               serving the Rochester area         Orthotics                               20% coinsurance
                                                                  Rehabilitative Care, Physical, Speech
     Benefits                                  Enrollee Cost      and Occupational Therapy
     Office Visits                          $20 per visit           Inpatient, unlimited                    No copayment
      PCP Sick Visits for Children age 0-4 No copayment             Outpatient, max 30 visits combined       $20 per visit
      PCP Sick Visits for Children age 5-18 $10 per visit         Diabetic Supplies
     Specialty Office Visits                      $20 per visit     Retail, 30-day supply                    $20 per item
                                                                    Mail Order, 90-day supply                $50 per item
     Diagnostic/Therapeutic Services
       Radiology                                 $20 per visit    Insulin and Oral Agents
       Lab Tests                                   $5 per day       Retail, 30-day supply                    $20 per item
       Pathology                                   $5 per day       Mail Order, 90-day supply                $50 per item
       EKG/EEG                                   $20 per visit    Hospice, unlimited                        No copayment
       Radiation                                No copayment
                                                                  Skilled Nursing Facility
       Chemotherapy                              $20 per visit
                                                                    max 120 days/year; 360 days/life        No copayment
     Women’s Health Care/OB GYN
                                                                  Prescription Drugs
      Pap Tests                                   $15 per visit
                                                                    Retail, 30-day supply                      $10 Tier 1/
      Mammograms                                No copayment
                                                                                                    $30 Tier 2/$50 Tier 3
      Pre and Postnatal Visits                 $50 copayment
                                                                     Mail Order, up to 90-day supply           $20 Tier 1/
                                                per pregnancy
                                                                                                   $60 Tier 2/$100 Tier 3
       Bone Density Tests                         $20 per visit
                                                                  If a member requests a brand-name drug to the
     Family Planning Services                     $20 per visit   prescribed generic drug, he/she pays the difference
     Infertility Services                         $20 per visit   between the cost of the generic and the brand-name plus
                                                                  the Tier 1 copayment. Coverage includes fertility drugs,
     Contraceptive Drugs and Devices            No copayment      injectable and self-injectable medications and enteral
     Emergency Room                               $50 per visit   formulas. Approved prescription generic contraceptive
                                                                  drugs and devices and those without a generic equivalent
     Urgent Care                                  $25 per visit   are covered at 100 percent under retail and mail order.
     Ambulance                                    $50 per trip    Specialty Drugs
     Outpatient Mental Health                                     MVP Rochester works with CuraScript, a specialty
      unlimited visits                            $20 per visit   pharmacy services company that provides specialty
                                                                  injectable medications to our members with chronic
     Inpatient Mental Health                                      conditions to maximize their medication management.
       unlimited days                           No copayment      Prescriptions are delivered by next-day service to the
     Outpatient Drug/Alcohol Rehab                                member’s home or office. Refer to www.curascript.com
      unlimited visits                            $20 per visit   for additional information.

     Inpatient Drug/Alcohol Rehab
       unlimited days                           No copayment




42 Choices 2010/Actives Settled
Additional Benefits                                                        Pharmacies and Prescriptions
Dental ......................................................Not covered   MVP Rochester offers an incented formulary. MVP
Vision.....................................$20 per visit for routine;      Rochester members simply present their card at any
                                       $20 per visit for diagnostic        pharmacy in our extensive network. At an out-of-network
Hearing Aids.......................................$600 allowance/         pharmacy, members pay their copayment plus the costs
                            three calendar years/up to age 19              above the MVP Rochester network rate.
Diabetic Shoes, unlimited pairs............20% coinsurance
Out Of Area ...............................Coverage is provided            Medicare Coverage
  for urgent and emergent care when traveling outside
                                                                           Medicare-primary enrollees must enroll in the Gold Plan,
  of the MVP Rochester service area.
                                                                           MVP Rochester’s Medicare Advantage Plan. Once you
Eye Wear................................................20% discount
                                                                           become eligible for Medicare, some of the Gold Plan’s
Home Health Care, max 40 visits ..............$20 per visit
                                                                           copayments will differ from the copayments of NYSHIP-
Acupuncture, max 10 visits.................50% coinsurance
                                                                           primary enrollees. Please call for more details.

Plan Highlights for 2010
MVP Rochester is not just an insurance plan – we’re a
health plan committed to helping you live well. We work
closely with our community’s physicians to make sure you
receive the quality, value and service you should expect
from a health plan. Below are just a few of the many
reasons to choose MVP Rochester in 2010:
• Our Commercial HMO plans are rated among
  “America’s Best Health Plans 2008-09” by U.S. News
  & World Report and the National Committee for
  Quality Assurance.
• No referral required! See any specialist in the MVP
  Network without a referral.
• Each MVP Rochester subscriber receives $50
  HealthDollars to spend on health, wellness and
  fitness programs!

Participating Physicians
MVP Rochester takes the quality of your medical care
seriously. That’s why we make sure the more than 27 ,500                      NYSHIP Code Number 058
physicians and other health care professionals in our                         An IPA HMO serving individuals living or working in
network have the proper training and licenses. We respect                     Genesee, Livingston, Monroe, Ontario, Orleans, Seneca,
their knowledge – therefore, they are key to developing                       Steuben, Wayne, Wyoming and Yates counties.
our medical policies. And, should a serious health
problem arise, MVP Rochester will work closely with you                       MVP Rochester
and your doctor to make sure you get the care you need.                       220 Alexander Street
                                                                              Rochester, NY 14607
Affiliated Hospitals
MVP Rochester members are covered at area hospitals                           For information:
to which their participating physicians have admitting                        MVP Rochester’s Member Services Department:
privileges. Members may be directed to other hospitals                        585-325-3113 or 1-800-950-3224
to meet special needs.                                                        TTY: 585-325-2629
                                                                              Web site: www.mvphealthcare.com




                                                                                                           Choices 2010/Actives Settled   43
     NYSHIP Online


     NYSHIP Online is designed to provide you with targeted information about your NYSHIP benefits. Visit the
     New York State Department of Civil Service web site at https://www.cs.state.ny.us and click on Benefit Programs,
     then NYSHIP Online. Select your group if prompted. If the group at the top of the NYSHIP Online home page is
     not your employee group, be sure to choose Change Your Group.
     If you do not have access to the internet, your local library may offer computers for your use.
     Ask your agency HBA for a copy of the NYSHIP Online flyer that provides helpful navigation information.




     Reminder: If you are an active or retired employee of New York State or are retired from a Participating Employer and
     a registered user of MyNYSHIP, you may change your option online during the Option Transfer Period. See your
     agency HBA if you have questions.

44 Choices 2010/Actives Settled
How to find answers to your benefit questions and gain access to additional important information:
• If you are an active State employee, contact your agency Health Benefits Administrator (HBA), usually
  located in your agency’s Personnel Office.
• If you have questions regarding health insurance claims for The Empire Plan, call 1-877-7-NYSHIP (1-877-769-7447)
  toll free and choose the appropriate program on the main menu. HMO enrollees should contact their HMO directly.
• A comprehensive list of contact information for HBAs, HMOs, government agencies, Medicare and
  other important resources is available on NYSHIP Online in the Using Your Benefits section.




                                                                                        Telephone Numbers




                                                                             Health Benefits Administrators




                                                                                            Choices 2010/Actives Settled   45
New York State
Department of Civil Service
Alfred E. Smith State Office Building
Albany, NY 12239
https://www.cs.state.ny.us




It is the policy of the State of New York Department of Civil Service to provide reasonable accommodation to ensure effective communication
of information in benefits publications to individuals with disabilities. These publications are also available on the Department of Civil Service web
site (https://www.cs.state.ny.us). Click on Benefit Programs then NYSHIP Online for timely information that meets universal accessibility standards
adopted by New York State for NYS Agency web sites. If you need an auxiliary aid or service to make benefits information available to you,
please contact your agency Health Benefits Administrator. COBRA Enrollees: Contact the Employee Benefits Division.

       Choices was printed using recycled paper and environmentally sensitive inks.                          AL0929 Choices 2010/Actives Settled




The New York State Department of Civil Service, which administers NYSHIP, produced this booklet in
cooperation with The Empire Plan carriers and Joint Labor/Management Committees on Health Benefits.
Care has been taken to ensure the accuracy of the material contained in this booklet. However, the HMO contracts
and the certificate of insurance from The Empire Plan carriers with amendments are the controlling documents for
benefits available under NYSHIP.

								
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