Information about Subrogation, Claims and Record Requests for NYSHIP Enrollees
Liens and Recovery:
While the Department of Civil Service’s (DCS) standard practice does not include asserting a lien or pursuing New York State Health Insurance Program (NYSHIP) enrollees directly for the purposes of claims recovery, subject to applicable state law, the third-party administers of the Empire Plan, whose contact information is noted below, may have the right to reimbursement related to any settlement, verdict, or insurance proceeds and pursue recovery.
Please Note:NYSHIP is a self-funded government plan and not subject to the Federal Employee Retirement Income Security Act (ERISA).
How to Obtain a Copy of the Empire Plan Certificate:
The Empire Plan Certificate and other benefit documents can be found at www.cs.ny.gov/employee-benefits. Select the employee group (for example, “New York State Active Employee”). Next, choose the employee union (for example, “Civil Service Employees Association – CSEA”). Then, select the appropriate health insurance plan. Click on “Using Your Benefits” and go to the tab “Current Publications.”
For Subrogation Information, Insurance Claims and Record Requests:
The DCS Employee Benefits Division (EBD) does not collect or maintain the following information: medical reports, insurance claims*, payroll or attendance records. Although EBD oversees the NYSHIP, records of health insurance claims are maintained by the third-party administrators and most medical records are maintained by medical providers. Depending on the nature of the records, any request for records must be directed to the appropriate Empire Plan third party administrator or Health Maintenance Organization (HMO).
* A valid, signed HIPAA-compliant release form and/or a valid subpoena or other order to release Protected Health Information (PHI) or other personal information (PI) is required before PHI or PI will be released.
Contact information for Empire Plan Administrators:
Note: The NYS Department of Financial Services only requires the retention of a claim file for six calendar years after all elements of the claim are resolved and the file is closed. https://www.dfs.ny.gov/insurance/ogco2002/rg207301.htm
Empire Plan Medical/Surgical Program:
To obtain medical claims information or subrogation information, contact:
UnitedHealthcare
P.O. Box 1600
Kingston, NY 12402-1600
Empire Plan Hospital Program:
To obtain hospital claims or subrogation information, contact:
Anthem Blue Cross (formerly Empire BlueCross)
P.O. Box 1407
Church Street Station
New York, NY 10008-1407
Empire Plan Mental Health and Substance Use Program:
To obtain mental health and substance use claims or subrogation information for services performed, contact:
- Between January 1, 2000, and December 31, 2008, or on or after January 1, 2014, to present:
Carelon Behavioral Health (formerly Beacon Health Options, Inc.)
P.O. Box 1850
Hicksville, NY 11802 - On or after January 1, 2009, and before January 1, 2014:
OptumHealth Behavioral Solutions
P.O. Box 5190
Kingston, NY 12402-5190
Empire Plan Prescription Drug Program:
To obtain prescription drug claims or subrogation information during the following dates, contact:
- From January 1, 2014, to present date for Medicare primary enrollees:
SilverScript Insurance Company
P.O. Box 52067
Phoenix, AZ 85072-2067 - From January 1, 2014, to present date for non-Medicare primary enrollees:
CVS Caremark Customer Care Correspondence
P.O. Box 6590
Lee’s Summit, MO 64064-6590 - On or after January 1, 2008, and before January 1, 2014 (all enrollees):
UnitedHealthcare
P.O. Box 1600
Kingston, NY 12402-1600 - On or after January 1, 2006, and before January 1, 2008 (all enrollees):
Empire BlueCross
P.O. Box 11826
Albany, NY 12211 - Before January 1, 2006 (all enrollees):
Express Scripts, Inc.
Bloomington Patient Care Contact Center
6301 Cecilia Circle
Bloomington, MN 55439
HMO Enrollees under NYSHIP
If the person for whom you are requesting records received health insurance coverage through a NYSHIP-participating Health Maintenance Organization (HMO), you must contact the appropriate HMO directly. Contact information for NYSHIP-participating HMOs can be found on the NYSHIP website. Select the employee group (for example, “New York State Active Employee”). Next, choose the employee group union (for example, “Civil Service Employees Association – CSEA”) and HMO. Click “Contact” on the side menu to view a full list of HMO contact numbers.