NYSHIP: Who provides which service?

The New York State Employee Insurance Plan (NYSHIP) is the overall health insurance plan under which you’re covered as an adjunct, graduate assistant, or other kind of graduate student employee. The specific NYSHIP plan you’re included in is the Student Employee Health Plan (SEHP).

NYSHIP SEHP (hereafter just NYSHIP) is just the umbrella for all the medical services you’re eligible to receive as a member of this plan. The different kinds of benefits (hospital care, surgery, dentistry, etc.) are administered by a number of different service providers, all of which are listed below. (All of your benefits, except for vision and dental, are administered by the Empire Plan, who in turn sub-contracts specific services out to various providers.)

General NYSHIP information

For all NYSHIP links, you will need to select the Graduate Student option—I am a Graduate Student Enrolled in the Student Employee Health Plan (SEHP)—on your first visit each session. To get to the correct NYSHIP page, close that tab/window in which you just selected the SEHP option, and click the link you chose on this page a second time.

• Summary of benefits for all NYSHIP services (check this very carefully to ensure you use only covered services)
• Exclusions to NYSHIP benefits can be found on p. 24 of the 2016 Benefits Summary
• Guide to using your various NYSHIP benefits: benefits, contact details, forms, and other details
• Claim forms for the various insurance companies
• 2016 Empire Plan Preventive Care Coverage Chart: NYSHIP SEHP lost grandfathered status under the federal Patient Protection and Affordable Care Act (PPACA), which includes provisions for expanded coverage of preventive health care services. These charts summarize preventive services covered with no copayment when received from an Empire Plan participating provider.

Medical benefits (excluding vision and dental)—administered by
the Empire Plan

All of your health benefits, except for vision and dental, are administered by the Empire Plan. However, Empire sub-contract the different types of benefits out to various different service providers, as detailed below.

• General guide to the various Empire health providers, pharmacies, and services

 

Hospital benefits service provider: Empire BlueCross BlueShield

• Benefits summary for hospital benefits on pages 5-7
• Hospitals, hospital-based ambulatory surgical centers, hospice care, and skilled nursing facilities provider directory

 

Medical/Surgical benefits service provider: UnitedHealthcare

• Benefits summary for medical benefits on pages 7-13
• Physicians provider directory
• Laboratories and other facilities provider directory
• Sign up with myUHC.com to track and manage provider visits and claims

 

Mental Health and Substance Abuse Program service provider: ValueOptions

• Benefits summary for mental health and substance abuse on pages 14-15
• Use ValueOptions (now Beacon Health) MemberConnect to check benefits & coverage and to find a provider (You must create a ValueOptions account.  List New York State as your employer)
• Group code: NYS023

 

Prescription Drug Program service providers: CVS Caremark

• Benefits summary for prescription drugs on pages 16-19
• Flexible Formulary
• Plan website
• The first time you fill a prescription at your drugstore, give these numbers to the pharmacist:
  • RxBIN: 004336
  • RxPCN: ADV
  • RxGRP: RX6027
  • Issuer (80840): 9151014609

 

Dental benefits: GHI

• Benefits summary
• Provider directory (enter the ID number on your GHI card to search, or search as a visitor–your plan under NYSHIP is GHI Dental Access)

 

Vision benefits: David Vision (new provider, which has replaced EyeMed)

• Benefits summary
• Davis Vision website
• Provider directory

 

NYSHIP presentation for the joint DSC Health & Wellness / Adjunct Project NYSHIP Student-led Workshop

Download (PPTX, Unknown)