Contract College Medical Plans
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- 2024 Choices Booklet
- 2024 Medical Rates (pdf) - effective January 1, 2024
- 2024 Medical Comparison Chart (pdf)
Also see: Covid-19 Benefits Info
The Empire Plan
The Empire plan provides hospital and related expense coverage through Empire Blue Cross for medically necessary elective, emergency or urgent care as long as your stay has been precertified. Medical/surgical benefits are provided through United HealthCare, administrator for Metropolitan Life Insurance Company, for a copayment, paid directly to the provider, when you choose a participating provider.
If you obtain services from a non-participating provider, you must pay the provider directly and then be reimbursed by United HealthCare for covered services, subject to a deductible and applicable coinsurance.
The Empire Plan Mental Health and Substance Abuse Program, administered by Carelon (formally Beacon Health), provides coverage for medically necessary inpatient and outpatient care through a network of participating providers; medically necessary non-network services are also covered. To ensure you receive the highest level of benefits, you should call Carelon at (877)-769-7447, option #3, before you seek mental health or substance abuse care, including treatment for alcoholism, even when a doctor refers you to the facility. Guaranteed access to network level of benefits is available if arranged through Carelon.
CVS Caremark administers prescription drug benefits.
Health Maintenance Organization (HMO)
An HMO provides health care services under the supervision of a primary care physician. In addition to the premium, there may be plan copayments. This option is available to you if you live or work within the HMO’s geographic service area. You are eligible for enrollment in HMO Blue CNY if you live or work in any of the following counties: Broome, Cayuga, Chemung, Cortland, Onondaga, Oswego, Schuyler, Steuben, Tioga, Tompkins.
Other HMO options are available for employees in other areas of the state and MVP if you live or work in any of the following counties: Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Otsego, Oswego, Tompkins and Tioga counties.
When you join an HMO, you agree to receive care from doctors and hospitals associated with the HMO. All primary care must be performed by or referred by your primary care physician.
Forms and Resources
Empire Plan
- Empire Plan Claim Form (pdf)
- Empire Plan "On The Road" booklet (pdf) info for travel or dependents living out of the area
NYSHIP
- NYSHIP Release of Protected Health Information Form (pdf)
- MyNYSHIP (employee self-service application)
- NYSHIP Privacy Notice (pdf)
- NYSHIP Young Adult Children Age 29 Coverage Option, and Rates
- NYSHIP Salary-based premium schedule
- NYSHIP Summary of Benefits and Coverage
- Cornell 2023 Empire Plan Benefit Summary (pdf)
Carelon (formally Beacon Health)
Weill Cornell Medicine
Transaction Forms (PS forms)
- PS-404 Health Insurance Transaction (pdf); PS-404 Instructions (pdf)
- PS-405 NYSHIP Sick Leave Credit Option Election Form (pdf)
- PS-406.2 NYSHIP Health Insurance Deferral Election Form (pdf)
- PS-410 NYSHIP Sick Leave Credit Preservation Form (pdf)
- PS-425 Domestic Partner Enrollment (pdf)
- PS-425.4 Termination of Domestic Partner (pdf)
- PS-451 NYSHIP Statement of Disability for Dependents (pdf)
- PS-457 (Statement of Dependence) (pdf)
- Affordable Care Act, Form 1095-C
Supporting Documentation
Note: Foreign documentation accepted if translated by the employee (i.e. marriage certification, birth certificate, divorce decree and death notice).