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PATIENT RELATIONSHIP TO INSURED Self PLACE State 30500 a. INSURED S DATE OF BIRTH c. INSURANCE PLAN NAME OR PROGRAM NAME EMPIRE PLAN d.

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and Empire BlueCross HMO is the trade name of Empire HealthChoice HMO, Inc. independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State.

Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).

Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).

What is NYSHIP? A. NYSHIP is the New York State Health Insurance Program – a comprehensive health insurance program for New York State public employees comprising The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs). The New York State Department of Civil Service administers NYSHIP.

What is NYSHIP? A. NYSHIP is the New York State Health Insurance Program – a comprehensive health insurance program for New York State public employees comprising The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs). The New York State Department of Civil Service administers NYSHIP.

Eligible members have a total of $200 per family to use towards reimbursement for any fitness clubs or exercise centers of their choosing in their eligible coverage year. Family members must be eligible under the member's benefit coverage.

POLICY. An unmarried dependent child who is age 19 or over, but under age 25, is eligible for NYSHIP dental and vision coverage if he or she is a full-time student at an accredited secondary or preparatory school, college or other educational institution.

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232