Should I use the Summary of Benefits and Coverage to decide which NYSHIP option is best for my family?Ī. If you need a paper copy of the Summary of Benefits and Coverage or the Uniform Glossary for a NYSHIP HMO, please contact the HMO. ![]() Yes, if you need a paper copy of the Summary of Benefits and Coverage for The Empire Plan or the Uniform Glossary, call 1-877-7-NYSHIP (1-87) and select the Medical/Surgical Program. Can I get a paper copy of the Summary of Benefits and Coverage if I need one?Ī. Refer to Choices for 2019 and other plan material for more detailed information.Ĭlick on the link below to access the Summary of Benefits and Coverage for the following: We strongly encourage you to review other plan material before making a decision about the coverage you and your family will have for the next year. Click here for a table of the counties each HMO serves in 2018. To be eligible for coverage under a NYSHIP HMO, you must live or work in the HMO’s service area. Click the plan names below to view a Summary of Benefits and Coverage for each option. The New York State Health Insurance Program (NYSHIP) offers eligible employees the option of choosing either The Empire Plan or a NYSHIP HMO for health insurance coverage. The numbers are industry based using government guidelines and do not reflect the actual cost of the scenario. These examples are based on presumptions of what services a person may receive over a year of each scenario. There are four major sections – Important Questions, Common Medical Events, Excluded Services & Other Covered Services and Coverage Examples. The Summary of Benefits and Coverage is a standardized template and the cells cannot be altered, moved, or deleted by any plan. Refer to your plan material for the definition used by your plan.Ĭontents of the Summary of Benefits and Coverage These definitions are intended to help improve consumer understanding and do not necessarily reflect your plan’s definition of the same term. Click here to view a PDF copy that can be printed if necessary. ![]() These terms are defined in the Uniform Glossary, a non-customized companion document to the SBC. Some words on the Summary of Benefits and Coverage are shown in bold and underlined. ![]() Your HBA, usually located in your agency’s personnel office, can also print you a copy. If you need a paper copy, call 1-877-7-NYSHIP (1-87) and select the Medical/Surgical Program. All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan’s unique terms. The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA).
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