It is difficult enough to be diagnosed with an illness, but not knowing where to turn can be devastating. For members who participate in the Empire Plan, access is available to some of the best medical facilities in the world.

The Empire Plan currently offers Centers of Excellence for cancer, transplants and infertility services.

Cancer Program—Members must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose United Healthcare or call the Cancer Resources Center toll free at 1-866-936-6002 and register to participate.

Paid-in-full benefits are available for cancer services at a designated Center of Excellence when arranged through United Healthcare. You will also receive nurse consultations and assistance in locating cancer centers.

If a member doesn’t want to use a Center of Excellence, benefits will be provided in accordance with The Empire Plan hospital and/or medical/surgical program coverage.

This Center of Excellence program is available to all Empire Plan enrollees, even if Medicare or another health insurance plan is primary.

Transplant Program—Members who are enrolled in The Empire Plan as their primary insurance coverage can take advantage of this transplant program.

Members must call The Empire Plan and choose Empire BlueCross BlueShield for preauthorization of the following transplants provided through the Center of Excellence for Transplants Program: bone marrow, peripheral stem cell, cord blood stem cell, heart, liver, lung, heart/lung, kidney and pancreas/kidney.

Paid-in-full benefits are available for the following transplant services when authorized by Empire BlueCross BlueShield and received at a designated Centers of Excellence: pre-transplant evaluation, inpatient and outpatient hospital and physician services, and up to 12 months of follow-up care.

If a transplant is authorized but you do not use a designated Center of Excellence, benefits will be provided in accordance with The Empire Plan hospital and/or medical/surgical coverage. If you choose to have your transplant in a facility other than a designated Center of Excellence, or if you require a pancreas, small bowel or multivisceral transplant, you may still take advantage of the Empire BlueCross BlueShield case management services for transplant patients as long as you enroll in the Centers of Excellence for Transplants Program. A case management nurse will help you through the transplant process.

To enroll in the program and receive these benefits, The Empire Plan must be your primary insurance coverage.

Infertility Treatment—Members must call The Empire Plan and choose United Healthcare for preauthorization and a list of qualified procedures before receiving services.

Paid-in-full benefits are available subject to the lifetime maximum of $50,000 per covered person for qualified procedures, including any travel allowance, when you choose a Center of Excellence for Infertility Treatment and receive prior authorization.

If a qualified procedure is authorized, but you decide not to use a Center of Excellence, benefits will be provided in accordance with The Empire Plan hospital and/or medical/surgical coverage.

All authorized procedures are subject to the lifetime maximum for qualified procedures. If you do not receive prior authorization, no benefits are available for qualified procedures under The Empire Plan’s hospital and/or medical/surgical coverage. You will have to pay the full cost, regardless of the provider.

Program requirements apply even if Medicare or another health insurance plan is primary.

All Centers of Excellence programs have a travel benefit. Travel, lodging and meal allowance is available for you and one travel companion if the center is more than 100 miles (200 miles for airfare) from the patient’s residence.

Reimbursement for travel, lodging and meals will be limited to the U.S. General Services Administration per diem rate. Reimbursement for automobile mileage will be based on the Internal Revenue Service medical rate.

Only the following travel expenses are reimbursable: meals, auto mileage (personal or rental car), economy class airfare, train fare, taxi fare, parking, tolls, and shuttle or bus fare from lodging to the Center of Excellence. Save your original receipts for reimbursement.

As always, don’t hesitate to contact the UUP Benefit Trust Fund at (800) 887-3863 with any questions.

— Doreen Bango, Manager, Member Benefits and Services