Empire Blue Cross Network Option

Beginning May 1, 2021, the Benefits Fund will be partnering with Empire Blue Cross as an alternative medical benefits administrator. As a result, all participants currently have the option to remain with the Fund's current medical benefits administrator, Oxford, or switch to Empire Blue Cross.

The Empire Blue Cross option was created primarily in response to the in-network coverage gap created by Oxford when it dropped the Montefiore Health System as an in-network provider effective January 1, 2021. Our partnership with Empire Blue Cross will allow participants who wish to see Montefiore providers to do so on an in-network basis and pay lower out-of-pocket costs.

Your Choice

  • Empire Blue Cross
    • If you want to access Montefiore Health System providers on an in-network basis, you may consider switching to Empire Blue Cross
  • Oxford Health Plans
    • If you don't need to have access to Montefiore providers on an in-network basis, you may choose to remain covered through Oxford. However, if you use providers or services through the Montefiore Health System, you will pay more out-of-pocket for this care 

There are absolutely no changes to your NYSNA Benefits Fund medical benefits regardless of whether you choose to remain with Oxford or change to Empire.

If you switch to Empire Blue Cross, you will be changing the provider network for yourself and your spouse and any dependents that are currently covered. This is not an open enrollment period for Fund benefits and it’s not intended for the enrollment of new dependents.

On March 1, the Fund mailed all Benefits Fund participants a letter regarding this option and a Network Selection Form. If you wish to switch to Empire Blue Cross, you must complete and submit the form to the Benefits Fund no later than April 1, 2021. If you choose to remain with Oxford, you don't need to do anything at this time.

Download Empire Selection Form    Submit Your Form

General Questions

Who can make the switch to Empire Blue Cross?

Participants employed by any Benefits Fund-participating facility are eligible to switch to the Empire Blue Cross network. Participants covered by the Fund through the Bridge to Medicare program may also switch to Empire Blue Cross. The Trustees created this option primarily to allow participants who wish to see Montefiore Health System medical providers to do so on an in-network basis through Empire Blue Cross, since the Montefiore Health System is no longer in-network under Oxford.

Can I remain with Oxford?

Yes. You may continue receiving your medical benefits through the Oxford network. If you choose to remain with Oxford, you don’t have to complete the selection form and return it to the Fund.

Dependent Questions

If I switch to Empire Blue Cross, will my dependents need to switch as well?

Yes. You will be changing the medical network for yourself and your spouse and any dependents that are currently covered by the Benefits Fund.

Can my dependents stay with Oxford and I switch to Empire?

No. Whatever medical network you choose for yourself will also be the medical network for all the dependents you have enrolled in the Fund.

Can I add new dependents to my coverage when I make this change?

No. You may not enroll new dependents for coverage at this time or remove any dependents from Fund coverage.

Enrollment Questions

How and when can I switch to Empire Blue Cross?

As soon as you receive your network selection form in the mail, you may complete the form and submit it via the post office, fax, or submit it electronically (secure upload or e-mail). You must submit the form to us by April 1 for an effective date of coverage with the new medical provider of May 1. If you don’t complete the form and return it to us by April 1, your medical coverage will remain with the Fund under Oxford .

What happens if I don't fill out the Selection form?

If you don’t complete the Selection form and submit it to the Fund office by April 1, you will remain covered under the Oxford network.

Do I have to fill out the Selection form if I want to stay with Oxford?

No. If you want to stay with Oxford, you don’t have to do anything and you’ll remain covered under the Oxford network.

Will I be able to switch later in the year if I change my mind?

No. During 2021, the Benefits Fund will be conducting a comprehensive search for a single medical network partner that meets our needs for a long-term partnership. You will receive more information later this year regarding any anticipated changes in our medical benefits provider.

Benefit Coverage Questions

If I change to Empire Blue Cross, will my benefits change?

No. All of your medical benefits through the Benefits Fund will remain the same. The only thing that will change is your provider network. By changing to Empire Blue Cross, you'll no longer have access to the Oxford network - you'll access care through the Empire Blue Cross network of medical providers.

Will I receive new medical ID cards if I switch to Empire?

Yes. You'll receive new identifications cards for you and any eligible dependents if you switch to Empire Blue Cross.

Is my doctor in-network with Empire Blue Cross?

To find out if your doctor is in the Empire Blue Cross network, you can go to empireblue.com/findadoctor. Please see instructions on how to search for a provider in the "Is Your Provider In-Network" section below.

Are my prescription drug benefits changing?

No. All your health benefits offered through the Benefits Fund remain the same, including medical, prescription drugs, vision, and dental.

I was billed several hundred dollars for an appointment I had with my Montefiore provider a few weeks ago. Will my coverage with Empire be retroactive to cover that visit?

No. Coverage will not be retroactive if you switch to Empire Blue Cross. If you’re switching to Empire, coverage will begin on May 1 or later for new hires. Any visits or services received from a Montefiore Health System provider from January 1 through April 30 will be covered on an out-of-network basis through the Oxford network.

Will I pay the same for my benefits or doctor's visits through the Fund?

Yes. All copayments and coinsurance for provider visits and medical services will remain the same regardless if you’re covered under Empire or Oxford. Your cost for benefits also remains the same. However, if you stay with Oxford and receive services from a Montefiore Health System provider, your costs will be higher than if you see the same provider and are covered under Empire. Montefiore Health System providers are considered out-of-network under Oxford and in-network under Empire.

What if I already met my out-of-network deductible under Oxford?

You won’t need to meet any deductibles again in the same year if you switch to Empire Blue Cross. If you have any specific questions regarding your deductibles, please call the Fund office for assistance.

What happens if I'm in the middle of a care plan and want to switch to Empire?

If you change to Empire and your doctor is in-network, any prior authorizations should be honored by Empire and you shouldn’t see any disruption in your care or benefits.

 

Is Your Provider In-Network?

To find out if your doctor is in the Empire Blue Cross network of providers follow these steps:

Step 1 –

Step 2 – Complete the following fields

  • What type of care are you searching for? Select “Medical”
  • What state do you want to search in?
  • What type of plan do you want to search with? Select “Medical Networks”
  • Select plan/network – Select “PPO/EPO (Employer-Sponsored)
  • Click “Continue”

Step 3 – Enter your zip code or city and then click “Physicians & medical Professional,” depending on the plan you’re searching

Step 4 – View your search results

Learn More

View Presentation

This presentation featuring Sharron Carlson, the Benefits Fund's communications representative,  provides more details about:

  • the Fund's partnership with Empire Blue Shield
  • what this partnership means to you
  • what you should consider before making a decision
  • important dates to remember
  • and much more!