City of New York Offers NYC Medicare Advantage Plus Medicare Advantage Option

The City of New York has awarded their group retiree business to the Retiree Health Alliance, an alliance between Empire BlueCross BlueShield (Empire) and EmblemHealth. Effective January 1, 2022, approximately 240,000 Medicare eligible City of New York retirees will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan. The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO plan that allows retirees to receive services from both in-network and out-of-network providers. Out-of-network providers must be eligible to receive Medicare payments to provide care to NYC retirees. Under this new plan, City of New York retirees will have no difference in cost share for both in-network and out-of-network services. NYC Medicare Advantage Plus offers the same hospital and medical benefits Medicare covers as well as additional benefits Medicare does not provide such as an annual routine physical exam, hearing, health and fitness tracker, LiveHealth Online* and SilverSneakers.*

 

Currently, City of New York retirees’ claims are processed by Medicare as primary and then by Empire for facility services and EmblemHealth for professional services as supplemental coverage under the GHI/Empire Senior Care plan.

 

As of January 1, 2022, the network arrangement for the NYC Medicare Advantage Plus plan will be as follows:

• EmblemHealth participating professional providers including chiropractors, occupational therapists, physical therapists, and speech therapists
• Empire participating facilities and behavioral health facilities and professional providers
• Empire and EmblemHealth Network arrangement is applicable in New York, Bronx, Kings, Queens, Richmond, Nassau, Suffolk, Westchester, Orange, Rockland, Putnam, Dutchess and Sullivan counties
• BlueCross and BlueShield Medicare Advantage PPO professional and facility providers outside of the counties listed above will be considered participatingNYC Medicare Advantage Plus members have access to Medicare Advantage PPO providers contracted with Blue Cross Blue Shield Association plans across the nation. Member ID cards will also display the Medicare Advantage PPO suitcase logo.

 

Beginning January 1, 2022, under the NYC Medicare Advantage Plus plan, providers will change billing processes as follows:

• Providers will submit all claims (facility, professional and ancillary) to Empire and Empire BlueCross or local Blue plan depending on the service location
• Providers will not transmit any claims to Original Medicare or EmblemHealth
• Claims can be submitted electronically utilizing existing payer ID’s already established for Empire and Empire BlueCross or paper submission (UB-04 or CMS-1500 form) to your local Blue plan

Additional information regarding the NYC Medicare Advantage Plus plan will be made available during focused provider webinar offerings during the months of November and December. Please have key staff register for one or more of the sessions once they are announced via Empire’s Provider Newsletter. You will be given an opportunity to have questions addressed during each live session.

 

* LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Empire BlueCross BlueShield.

 

* Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Empire BlueCross BlueShield.

 

EBSCRNU-0191-21 August 2021