We help you live your healthiest life by offering:
Care that’s about you
You come first, so we built your health plan around you. You can go to doctors and pick up your prescriptions close to home. You can also get answers about your benefits straight from us, because we’re right in your neighborhood! Visit any of our offices to talk with associates in your preferred language.
Care when you need it
We’re here for you anytime, day or night! Simply call our 24/7 NurseLine to get answers from our nurses.
Care for our community
We believe a healthier community makes a happier, healthier you. That’s why our associates volunteer with local organizations to build up our area. This year, we’re fighting hunger with the food bank. We’re also delivering clothing and supplies to nearby shelters. And we’re hosting neighborhood health fairs and food workshops to bring healthier choices to those in need.
Get Medicaid benefits to help you meet your health goals like:
- A primary care provider (PCP) to help you get the care you need
- Wellness visits and immunizations
- Dental and vision care
- Mental health services
- Substance use treatment
- Psychiatric services
- Specialty physician services
- Disease management for asthma, diabetes and more
- Smoking cessation
- Maternal depression screening
- Coping and life skills training
- Family support training
- Stress management
- Crisis prevention
*Copays may apply for medications. There are no copays for services that are part of your benefits.
When you need a referral or preapproval
For some services, you’ll 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 see your PCP before:
- Going to a hospital for nonemergency care
- Getting medicine your PCP can’t give you
Get these services from Empire BlueCross BlueShield HealthPlus without a referral
For most services, you'll go to your PCP or another doctor in your plan. Even if you get some services from a doctor who isn’t in your plan, we’ll pay for some services, including:
- Family planning
- Pregnancy services
- Emergency services
- School-based health center services
- Adult dental care (ages 21 and over)
- Behavioral health and substance use disorder services
- Certain doctors for children with special health care needs
We'll also pay for the lab work and medicine related to these services.
Family planning services
You can choose to go to a doctor who isn’t in your plan for any of these family planning services:
- Family planning office visit
- Pap smear
- Special contraceptive supplies
- Diaphragm fitting
- IUD insertion and removal
- FDA-approved contraceptives, as well as emergency contraceptives
You can choose to keep seeing a doctor that isn’t in your plan if you:
- Were pregnant when you joined Empire.
- Saw a doctor who isn’t in your plan for at least one complete prenatal checkup.
As long as the doctor agrees, you can keep seeing this doctor for:
- Checkups and prenatal care throughout your pregnancy.
- Follow-up care for up to two months after the baby is born.
If you have a medical emergency, you don’t need a referral to go to the emergency room. A medical emergency is a condition that could end in death or very serious bodily harm. If you’re not sure if you should go to the emergency room, call your PCP for help. You can also speak to a registered nurse if you call the 24/7 NurseLine at 1-800-300-8181.
After you’ve been treated for an emergency condition, you may need extra services to make sure the emergency condition doesn’t return (these are called post-stabilization services). We’ll work with the hospital staff to decide if you need these services. If you would like to know more about how we make this decision, call Member Services at 1-800-300-8181 (TTY 711).
School-based health center services
For children who go to schools with health centers, there are some services they can get without a referral:
- Office visits and treatment for acute or urgent physical illness, along with needed medicine
- Follow-up visits to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) visits when needed
- Family planning services listed on the previous page
Adult dental care (age 21 and over)
Dental services don’t need a referral from your PCP. Empire offers services managed by Healthplex. Call 1-800-468-9868 (TTY 1-800-662-1220) for more information. The state provides dental care for individuals under 21 years old.
Adult vision care (age 21 and over)
Vision services don’t need a referral from your PCP. Empire offers services managed by Superior Vision. Call 1-800-879-6901 for more information. Vision services for individuals under 21 years old require preapproval.
Certain doctors for children with special health care needs
To keep getting the right plan of care, children with special health care needs may go to a doctor outside of their plan if the child’s doctor gives the plan of care to us for review and approval within 30 days of the child’s effective date.
A child may ask for a specific doctor outside of the plan if:
- He or she is already enrolled in Empire when diagnosed as having a special health care need.
- His or her need calls for a plan of care that includes specific types of services.
We’ll approve your request unless we have a local specialty doctor in the plan with the same training and skills that is reasonably on hand and gives the same services.
Some Empire services and benefits require preapproval. This means that you and/or your doctor must ask Empire to approve those services or benefits before you get them. Empire requires preapproval for these services:
- Ambulance transportation (emergency air and nonemergency)
- Chiropractic services
- Diagnostic testing
- Durable medical equipment
- End-stage renal disease services
- Eye/vision care and services for people age 20 and younger
- Home health extended services for people age 20 and younger
- Home health services for people age 21 and over: registered/skilled nurse, physical therapy, occupational therapy, speech therapy, home health aide and IV therapy
- Hospice services: inpatient, home and hospice facility
- Inpatient acute care hospitalization
- Medicines (See the Empire Preferred Drug List. Low copays for over-the-counter medicine require a prescription from your doctor.)
- Mental health rehab services: family therapy, crisis stabilization, assertive community treatment
- Nurse-midwifery services
- Organ transplant services
- Outpatient hospital services: physical therapy, occupational therapy, speech therapy and surgical procedures
- Pediatric Day Health Care (PDHC) for people ages 20 and older
- Personal Care Services (PCS) for people ages 20 and older
- Physician services: medical assessments, treatments and surgical services (includes behavioral health physicians)
- Podiatry services
- Post-stabilization care services: from doctors inside or outside the Empire plan
- Radiology services
- Rehabilitation services: physical therapy, occupational therapy and speech therapy
- Transportation services
- If you live in NYC, nonemergency transportation is provided through the state’s vendor, LogistiCare. To arrange a ride, please contact LogistiCare at 1-877-564-5922 (TTY 1-866-288-3133).
- For members who live in Nassau, please call LogistiCare at 1-844-678-1103 (TTY 1-866-288-3133).
- All other counties, please call Medical Answering Services at 1-800-850-5340.
For more information, call Member Services at 1-800-300-8181 (TTY 711). All services from doctors outside of your plan require preapproval from Empire.
Call Member Services at 1-800-300-8181 (TTY 711) to learn more about qualifying for Medicaid and getting your benefits through Empire.
To learn more about applying for health insurance including Child Health Plus and Medicaid through NY State of Health, The Official Health Plan Marketplace, visit nystateofhealth.ny.gov or call 1-855-355-5777.