What You Need to Know About NYSHIP

If you are experiencing bone, tendon, or muscle pain and need to see a local orthopedic specialist, you’ll want to make sure that your insurance will cover the care you need. Depending on your treatment plan or insurance coverage, you may wonder – does NYSHIP insurance help pay for any tests, treatments, or surgeries required to correct your orthopedic issues?
This article will cover what NYSHIP is, who is eligible for NYSHIP coverage, and what kinds of care can be covered under NYSHIP. Then if you experience back, neck, ankle, hip, shoulder, or knee pain and need to see an orthopedic doctor, you’ll know if NYSHIP will help with your treatment and recovery. Our Concierge Team at NJ Spine & Orthopedic can help you through each step of the treatment plan, including looking into insurance questions.

What Is NYSHIP?

The New York State Health Insurance Program (NYSHIP) is an all-inclusive health insurance plan that is also called the Empire Plan. The Empire Plan covers any medical expenses that any other insurance would cover, but premiums are competitive. Instead, copayments or a share of the costs will be all that is necessary for the patient to pay. 

The Empire Plan is a conglomerate of NYSHIP-approved Health Maintenance Organizations (HMOs) to maintain the health of patients cost-effectively. This conglomerate provides various medical services from participating care providers registered with the HMOs. Eligible participants in the plan can choose from participating care providers and pay only copayments. In contrast, those who select non-participating care providers will pay a higher share of the total cost of the insurance.

Who Is Eligible for NYSHIP Coverage?

New York state and local government and public employees, retirees, and their families are eligible for coverage under the Empire Plan. To be a government or public employee eligible for the plan, you must:

  • Work at least three months or more
  • Be paid a yearly salary of $2,000 or more per year.
  • Work 20 hours or more a week regularly

You are eligible for NYSHIP if public employment is the primary family income source. In addition, participating in government service as a local elected official, a paid public legislative body member, an elected school board member, or an unpaid board member of a public authority with at least six months on the board will meet the requirements for eligibility.

Eligible dependents of government and public employees include natural children, stepchildren, children of domestic partners, and legally adopted children. Even children that are in a waiting period before the finalization of adoption are eligible to be covered under the NYSHIP. These dependents will be eligible for coverage until the end of the month when they turn 26

The Kinds of Care Covered Under NYSHIP

Because of the vast conglomerate of HMOs participating in the Empire Plan, this offers a wide range of medical services that are covered under the plan. The plan includes services such as:

  • Hospital stays
  • Doctor visits
  • Prescription medications
  • Mental health services

And, as the network is so vast, there are many doctors and specialists, such as oncology, cardiology, and orthopedics, that you can select from. 

For example, if you need an orthopedic specialist, the medical services that can be covered are specialist visits, radiology services, and imaging services like CT scans or MRIs.

Contact Your Local NJ Spine & Orthopedic Office About Any Insurance Concerns You May Have

If you have any doubts about whether your insurance will cover care and treatment from the NJ Spine & Orthopedic doctors specializing in orthopedic issues, get in touch with us today. We can tell you if the care we provide will be covered under your NYSHIP insurance program.

NJ Spine & Orthopedic doctors specialize in bone, muscle, and tendon issues that cause back, neck, hip, knees, ankles, or shoulder pain. If you’re experiencing pain in any of these areas of your body and want relief, call us at (866) 553-0612 or complete our contact form.

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