Employees and non-Medicare eligible retirees should be aware that there are important changes to coverage through the Empire BlueCross BlueShield and GHI Comprehensive Benefit Plan (CBP) effective January 1, 2016. Benefits and co-pays are not changing, but many services provided on both an inpatient and outpatient basis, such as maternity care (pregnancy and delivery), radiation therapy and home health care, will now require precertification. This can be done by calling the NYC Healthline at 1-800-521-9574. (This is the same number that has always been used for inpatient precertification and it is on your member ID card.)
If a member is a patient of a provider who participates in the plan’s network, the provider will be responsible for taking care of the precertification process. Participating providers have been notified of the changes. Members using a non-participating provider are responsible for making sure that the precertification is obtained by calling the toll-free number.
All precertification requests must be made at least 10 days prior to any scheduled non-emergency service. Written notice of the determination will be mailed to members within 48 hours of Empire’s receipt of all necessary information. For more information, including a list of services that require precertification, please visit www.nyc.gov/hbp.