Child Health Plus (CHPlus)

There are no copays for covered services, including:

• Primary care provider (PCP) visits
• Immunizations and wellness visits
• Specialist visits
• Urgent care
• Emergency care
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care
• Physical therapy
• Speech and hearing services
• Behavioral health care
• Autism spectrum disorder services

See your member handbook for a full list of benefits in your plan.

We believe that good dental care is important to your overall health care. There are no copays for covered dental services, including:

• Teeth cleaning twice a year
• Oral exams
• X-rays
• Extractions
• Fillings
• Emergency care
• Dentures (removable or partial)
• Orthodontics

See your member handbook for a full list of benefits in your plan.

Empire offers dental care through LIBERTY Dental, an expert in providing high quality dental services. To find or change your dentist, call LIBERTY Dental at 1-833-276-0847, or visit their website.

There are no copays for covered vision benefits, including:

• One eye exam each year
• Prescription glasses each year
• Contact lenses (if medically necessary)

See your member handbook for a full list of benefits in your plan.

Extra Benefits and Healthy Rewards are no-cost, optional programs for eligible members enrolled in our health plan. The programs encourage members to get the care they need to improve their health and create a healthy lifestyle.

Members can redeem these Extra Benefits through the Benefit Reward Hub:

• Diaper program
• Hypoallergenic bedding
• Stroller
• Oral hygiene kit
• Chromebook
• Smartphone gift card

Members can redeem these Healthy Rewards (gift cards) through the Benefit Reward Hub:

• $10 per test result, up to $40 annually, for blood pressure screening
• $50 for a diabetic retinal eye exam
• $5 for completing a What do you know about diabetes? quiz
• $25 per test result, up to $50 annually, for viral load tests with their HIV care team
• $50 for a breast cancer screening (mammogram)
• $50 for a colorectal cancer screening
• $25 every 36 months for a cervical cancer screening (Pap smear)
• $25 for a chlamydia screening
• $25 for a follow-up visit with their provider within seven days of a behavioral health hospitalization
• $25 for yearly well-child visits
• $25 for yearly childhood dental visits
• $25 for Combo 2 adolescent immunizations (shots)
• $25 for Combo 3 childhood immunizations (shots)
• $25 for pregnant members who go to a prenatal visit in their first trimester, or within 42 days of joining our plan
• $50 for a postpartum visit within 7–84 days of delivering their baby
• $50 for five well-baby visits within the first 15 months of life
• $20 per visit, up to $40, for two well-baby visits between 15 and 30 months of life

Log in to the Benefit Reward Hub to redeem your Extra Benefits and Healthy Rewards. You can also call the Healthy Rewards at 888-990-8681 (TTY 711), Monday through Friday from 9 a.m. to 8 p.m. Eastern time. 

If you need help setting up your Empire online account, call Member Services at the number listed on the back of your Empire member ID card.

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these benefits. There are no copays for covered drugs.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is on the Preferred Drug List (PDL).

Referrals

Some services need a referral from your primary care provider (PCP) before getting care. When you need a referral, your PCP will sign a referral form and send you to a doctor in your plan.

You will need to get a referral from your PCP before:

• Going to a hospital for nonemergency care
• Getting medicine from a doctor other than your PCP

You do not need a referral for:

• Women’s health care
• Pregnancy services
• Family planning services
• Emergency services
• School-based health center services
• Behavioral health and substance use disorder services
• Certain doctors for children with special health care needs

Preapprovals

Some services require preapproval or prior authorization. This means that you or your doctor must ask Empire to approve those services or benefits before you get them.

You will need preapproval for:

• Ambulance transportation (emergency air and nonemergency)
• Chiropractic services
• Diagnostic testing
• Durable medical equipment
• End-stage renal disease services
• Home health extended services for people age 20 and younger
• Hospice services
• Inpatient acute care hospitalization
• Certain medicines
• Mental health rehab services
• Nurse-midwifery services
• Organ transplant services
• Outpatient hospital services including physical therapy, occupational therapy, speech therapy and surgical procedures
• Physician services, such as medical assessments, treatments and surgical services
• Podiatry services
• Post-stabilization care services
• Radiology services
• Rehabilitation services: physical therapy, occupational therapy and speech therapy