The New York State Health Insurance Program (NYSHIP) is one of the largest public employer health insurance programs in the United States, providing health insurance coverage to eligible New York State employees, retirees, and their dependents. The program was established in 1957, with the mission to offer affordable and comprehensive health benefits to its members. NYSHIP is operated by the New York State Department of Civil Service and serves hundreds of thousands of individuals, including state government employees and local government participants who opt into the program.
NYSHIP offers a variety of plan types to meet the diverse needs of its enrollees, including the Empire Plan and Health Maintenance Organization (HMO) options. The Empire Plan is a Preferred Provider Organization (PPO) that provides wide-ranging access to a large network of providers and offers out-of-network coverage, whereas the HMO plans emphasize in-network care from specific providers. Each plan is designed to provide essential health benefits, preventive services, and a range of medical, hospital, and prescription drug coverage. NYSHIP continually adapts its offerings to ensure comprehensive care for its members, focusing on both coverage and cost-efficiency.
An HMO (Health Maintenance Organization) plan typically requires you to use doctors and hospitals within its network and get a referral from your primary care physician (PCP) to see a specialist. A PPO (Preferred Provider Organization) plan offers more flexibility to see both in-network and out-of-network providers without a referral, usually at a higher cost.
The best way to find an in-network provider is to use the 'Find a Doctor' or 'Provider Directory' tool on the official New York State Health Insurance Program (NYSHIP) website. You can also call the member services number on the back of your insurance card for assistance.
A deductible is the amount you must pay out-of-pocket for covered health care services before your insurance plan starts to pay. For example, if you have a $1,000 deductible, you pay the first $1,000 of covered services yourself.
