Skip Navigation
Search
2023 Benefit Summary Comparison Chart
UUP, MC, CSEA, PBANYS and NYSCOPBA
MY NYSHIP
| Description | Empire Network Hospital Benefits | Empire PPO 001 | Emblem Health HIP HMO – 050 |
|---|---|---|---|
| DescriptionOffice/Telehealth Co-Pay | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5.00/$10 Specialist |
| DescriptionSpecialist Co-Pay | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $10.00 |
| DescriptionOut of Network Option | Empire Network Hospital Benefits | Empire PPO 001Yes | Emblem Health HIP HMO – 050 No |
| DescriptionOut of State Coverage | Empire Network Hospital Benefits | Empire PPO 001Yes | Emblem Health HIP HMO – 050 No- Emergencies Only |
| DescriptionDIAGNOSTIC SERVICES | |||
| DescriptionRadiology | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5 PCP/$10 Specialist |
| DescriptionLab Tests | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5 PCP/$10 Specialist |
| DescriptionPathology | Empire Network Hospital BenefitsNo copay | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionEKG/EEG | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5 PCP/$10 Specialist |
| DescriptionRadiation | Empire Network Hospital BenefitsNo copay | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 $10.00 Specialist |
| DescriptionChemotherapy | Empire Network Hospital BenefitsNo copay | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 $5 PCP/ $10 Specialist |
| DescriptionWOMEN'S HEALTH (Copay’s may be waived if preventative) | |||
| DescriptionScreenings and Maternity-Related Lab Tests | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionMammogram | Empire Network Hospital BenefitsNo copay | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionPrenatal Visits | Empire Network Hospital Benefits | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionPostnatal Visit | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionBone Density Tests | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionBreastfeeding Services and Equipment | Empire Network Hospital Benefits | Empire PPO 001No-Copay | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionFamily Planning | Empire Network Hospital Benefits | Empire PPO 001$25.00/per visit | Emblem Health HIP HMO – 050 $5.00 PCP/$10 Specialist |
| DescriptionInfertility Services | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$25.00 (no copay if using a designated center for excellence) | Emblem Health HIP HMO – 050 $10.00 per visit |
| DescriptionContraceptive Drugs | Empire Network Hospital Benefits | Empire PPO 001No copayment for certain FDA approved oral contraception methods (including outpatient surgical implantation and counseling) | Emblem Health HIP HMO – 050 No-Copay |
| DescriptionInpatient Hospital Surgery | Empire Network Hospital BenefitsNo copay | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionOutpatient Surgery | Empire Network Hospital Benefits$75 or $95 per visit | Empire PPO 001$50/per visit, $75 or $95 Network hospital benefit | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionEmergency Room | Empire Network Hospital BenefitsApplicable inpatient hospital surgery or outpatient surgery copay (see above) | Empire PPO 001$100- Waived if admitted | Emblem Health HIP HMO – 050 $75- Waived if admitted |
| DescriptionUrgent Care | Empire Network Hospital Benefits$40 or $50 per outpatient visit | Empire PPO 001$30.00 | Emblem Health HIP HMO – 050 $25 |
| DescriptionAmbulance | Empire Network Hospital BenefitsNo copay | Empire PPO 001$70 per trip | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionOutpatient Mental Health | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 Unlimited |
| DescriptionInpatient Mental Health | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 Unlimited |
| DescriptionOutpatient Drug/Alcohol Rehab | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5 per visit |
| DescriptionInpatient Drug/Alcohol Rehab | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionDurable Medical Equipment | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionProsthetics | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionOrthotics | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 No- Copay |
| DescriptionREHAB CARE, PHYSICAL, SPEECH, & OCCUPATIONAL THERAPY | |||
| DescriptionInpatient | Empire Network Hospital BenefitsNo copay as inpatient; $25 per visit for outpatient2 | Empire PPO 001$25.00 per visit | Emblem Health HIP HMO – 050 No-Copay- max 30 day |
| DescriptionOutpatient | Empire Network Hospital Benefits | Empire PPO 001$25.00 | Emblem Health HIP HMO – 050 $5 PCP visit/$10 Specialist — 90 visits max |
| DescriptionDiabetic Supplies | Empire Network Hospital Benefits | Empire PPO 001No- Copay | Emblem Health HIP HMO – 050 $5- 34 day supply |
| DescriptionDiabetic Shoes | Empire Network Hospital Benefits | Empire PPO 001$500 annual max benefit | Emblem Health HIP HMO – 050 No-Copay when medically necessary |
| DescriptionHospice | Empire Network Hospital BenefitsNo copayment, no limit | Empire PPO 001No- Copay — No limit | Emblem Health HIP HMO – 050 No-Copay - max 210 day |
| DescriptionSkilled Nursing Facility | Empire Network Hospital BenefitsNo copay | Empire PPO 001No-Copay up to 120 benefit days | Emblem Health HIP HMO – 050 No-Copay No limit |
| DescriptionPrescription Drugs | Empire Network Hospital Benefits | Empire PPO 001$5/$30/$60 | Emblem Health HIP HMO – 050 $5/$20 |
| DescriptionMail Order Prescription Program | Empire Network Hospital Benefits | Empire PPO 001Yes | Emblem Health HIP HMO – 050 Yes |
| DescriptionHearing Aids | Empire Network Hospital Benefits | Empire PPO 001$1,500 per aid per year every 4 years (every 2 years for children) |
Emblem Health HIP HMO – 050 Cochlear implants only |
Empire PPO
Out of Network Coverage
Empire will pay 80% of “reasonable and customary” charges after the annual deductible has been satisfied. Once your deductible and out of pocket maximum have been met, Empire will pay 100% of reasonable and customary charges. The employee will be responsible for charges above the reasonable and customary rates. Annual Deductible for non-network coverage:
• Employee - $1,250
• Spouse/Domestic partner – $1,250
• All Children (combined) - $1,250
Empire PPO
In- Network Out of Pocket Limits
Once you reach the limit on your in-network benefit, you will have no additional copayments
for the
benefit calendar year.
| COVERAGE TYPE |
Prescription Drug Program |
Hospital, Medical/Surgical and Mental Health & Substance Abuse Programs, combined |
TOTAL | |
| PPO | Individual Coverage | $3,200 | $5,900 | $9,100 |
| Family Coverage | $6,400 | $11,800 | $18,200 | |
| HMO | Individual Coverage | $0 | $6,850 | $6,850 |
| Family Coverage | $0 | $13,700 | $13,700 | |
About Us
Contact Us
Our Mission & Vision
Our Mural
HR Now Initiative Website
Employee & Labor Relations
HR Services
HealthierU
Employee Assistance Program
Workplace Learning
Independent Contractors
Extra Service
Ethics
Info for
Faculty and Staff
Student Employees
New Employees
Separating Employees
Former Employees
Retirees
Why Work Here?
Total Rewards
A Great Place to Relocate
Why Work Here?
Virtual Campus Tour
How to Apply
HR Systems & Data
Access to HR Systems
HR Data in Peoplesoft
DocuSign Resources
TMS Resources
TMS DAR Change Form
POLICIES & GUIDELINES
University Policies
Fair Labor Standards Act
Workplace Visitor Guidelines
NYS Public Officer's Law
SUNY Policies and Procedures
Voter's Leave Law
Policies of the Board of Trustees
News and Events
Upcoming Events
Our Messages
Holiday Calendar
HR Now Initiative
Seasonal News