The Empire Plan - News from the NIC

Enrollee benefits have changed for certain groups in The Empire Plan effective July 1, 2023.  We have included information relative to massage therapy and acupuncture, for those NYSCA members who provide these services in their office.  Please note: The New York State Health Insurance Program (NYSHIP) Empire Plan for NY state and local government employees is not Empire Blue Cross Blue Shield.

Elimination of multiple participating provider copayments per visit

The $25 participating provider copayment amount remains the same, with multiple copayments for the same provider and same visit eliminated.  Just 1 copayment of $25 is required for all covered office visits, office surgery, radiology and/or laboratory services received by the same enrollee from the same provider on the same date of service.  Historically, NYSHIP enrollees who received radiographic services in addition to an office visit during the same visit were subject to 2 copayments.

Change in maximum allowed amount for nonparticipating providers

Claims from nonparticipating providers will now utilize Medicare rates as the fee basis.  For those NYSCA members who do not participate with The Empire Plan, your NYSHIP patients may be responsible for a higher portion of the visit.  Note that participating providers should continue to refer patients to network providers in accordance contractual obligations.

Visit limit added for out-of-network acupuncture services

Coverage is now limited to a maximum of 20 visits per calendar year for acupuncture services by nonparticipating providers. This is a combined total for all nonparticipating providers, regardless of how many nonparticipating providers are visited. 

Visit limit added for massage therapy services

Coverage is also limited to a maximum of 20 visits per calendar year for massage therapy services. This is a combined total for all massage therapy visits, regardless of how many providers are visited. 

Further detail can be found at:

Watch for additional information on UnitedHealthcare in our next News From The NIC

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