NEW NYSHIP COVERED EMPIRE PLAN BENEFIT
NYS Retirees and PE Retirees, Vestees, Dependent Survivors and Enrolled Dependents, effective July 1, 2008.
For NYS Retirees, Vestees, and Dependent Survivors and their Dependents enrolled through Participating Agencies with Empire Plan CORE Plus Enhancements, effective January 1, 2009.
The Herpes Zoster (Shingles) Vaccine is a new Empire Plan network benefit. As with other adult vaccines, it is covered subject to an office visit co-payment, when received from a participating provider in accordance with established guidelines for medical necessity for individuals age 55 and over. There is no non-network benefit.
We had heard from some of our members that their doctors had no vaccine in stock. Or that their doctors required them to obtain the vaccine from their pharmacy and then bring it to the doctor’s office for injection. However, vaccines are not covered by the Empire Plan Prescription Drug Program. If enrollees fill the prescription at the pharmacy, they would be solely responsible for the cost of vaccine.
United Healthcare began notifying all network providers that enrollees should not be getting the vaccine at the pharmacy and that network providers should arrange to administer the vaccine at their offices.
We have heard that some providers will not be stocking the vaccine. Others have ordered it and are asking enrollees to sign up for a waiting list since the vaccine is back-ordered. If your physician is not stocking the vaccine, we have been advised that an enrollee should be referred to one who does.