Health and Recovery Plan (HARP)

There are no copays for covered services

• 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 (mental and substance abuse services)
• Smoking cessation services
• Home health care services
• Disease management for asthma, diabetes and more

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

We believe good dental care is important to your overall health. 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

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 services, including:

• One eye exam every two years
• Prescription glasses every two years

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

You can get no-cost rides to your medical appointments. You or your provider should call to schedule your ride at least three days before your appointment.

Call Medical Answering Services (MAS) at 1-800-850-5340

You will need:

• Your Medicaid ID number
• Your appointment date and time
• The address where you’re going
• The name of the doctor you’re seeing

Healthy Rewards is a no-cost, optional program for eligible members enrolled in our health plan. The program encourages members to get the care they need to improve their health and create a healthy lifestyle.

Members can redeem these Healthy Rewards through the Benefit Reward Hub:

• Up to $40 for high blood pressure medication refills
• $50 for a diabetic retinal eye exam
• $5 for completing a What do you know about diabetes? quiz
• Up to $50 for viral load tests with their HIV care team
• $50 for spirometry testing for COPD
• $50 for a breast cancer screening (mammogram)
• $50 for a colorectal cancer screening
• $25 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)
• Up to $40 for ADHD medication refills
• $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 six well-baby visits within the first 15 months of life
• 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 Healthy Rewards. You can also call the Healthy Rewards Customer Service Line at 888-990-8681 (TTY 711) Monday to 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 on your Empire member ID card.

Starting April 1, 2023, your prescriptions will not be covered by Empire. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.

There are some treatments and services you need to get approval for before you receive them in order to be able to continue receiving them. This is called prior authorization. You or someone you trust can ask for this. The following treatments and services must be approved before you get them:

• Some ambulatory surgery
• Chemotherapy
• Dialysis
• Durable medical equipment
• Growth hormone evaluation and therapy
• Digital hearing aids
• Home care
• Hyperbaric oxygen therapy
• Inpatient services
• Lithotripsy
• Nonemergent fixed wing transportation
• Obstetrical services (except family planning services)
• Oxygen equipment — respiratory therapy
• Prosthetics and orthotics
• Some drugs
• Transplant evaluation

In Lieu of Services (ILS) are other physical and behavioral health services you may receive instead of those covered by your Medicaid state plan. ILS services:

• Are cost-effective substitutes for covered services and settings.
• Are approved by the State.
• Help us give you more options for your care. 

To learn more about ILS and what ILS services we offer, visit the New York State Department of Health website.