Using the Empire Plan for virtual intensive outpatient mental health care.

New York State and local government employees on the Empire Plan have mental health benefits administered by Carelon Behavioral Health. We check your out-of-network benefit free by phone and tell you the real cost before you commit.

Status

Where we stand.

We are out of network with the Empire Plan. Mental health and substance use benefits on the Empire Plan are administered by Carelon Behavioral Health, and non-network care can require Carelon approval. We handle that request for you.

The program

Evening and morning groups by video, built around a state work schedule.

Schedule (Pacific time)

Evening groups Monday, Tuesday and Thursday, 5:30 to 8:30 PM PT (8:30 to 11:30 PM ET)
Morning groups Monday, Tuesday and Friday, 10:00 AM to 1:00 PM PT (1:00 to 4:00 PM ET)
Afternoon groups by arrangement at intake
9 group hours a week plus a weekly individual session
All by secure video

What we do on the benefits side

Call the number on the back of your card and pull your actual out-of-network mental health benefit.
Translate it into what a week of care would cost you, before you start.
Handle the authorization and stay on it through review.
Medicaid and Medicare plans are not eligible for this program.

Your plan

Empire Plan, Excelsior Plan or a union plan.

NYSHIP members are on the Empire Plan, the Excelsior Plan or an HMO. Many state employees also have union-negotiated plan terms. Your card and enrollment tell us which rules apply.

Empire Plan

Carelon Behavioral Health administers mental health

We call Carelon, confirm your non-network benefit and any approval step, and give you the cost.

Start the benefit check Excelsior Plan or HMO

Different out-of-network rules

Coverage outside the network can be limited. We check and tell you plainly.

Start the benefit check

Licensure

You attend from where you are physically located.

Telehealth licensure follows the state where you are physically located during the session. Mental health care is available to members physically in New York and New Jersey, with clinicians licensed in those states. Substance use treatment is for people in California.

Questions members ask first

Plain-English answers.

Are you in network with the Empire Plan?

No. We are out of network. Empire Plan mental health benefits are administered by Carelon Behavioral Health, and we check your non-network benefit free before you start.

What times are the groups in New York?

Evening groups run Monday, Tuesday and Thursday, 8:30 to 11:30 PM Eastern (5:30 to 8:30 PM Pacific). Morning groups run Monday, Tuesday and Friday, 1:00 to 4:00 PM Eastern. Afternoon groups are arranged at intake.

Can I attend from New York?

Yes. Mental health care is available to members physically in New York, with clinicians licensed in New York.

Does Medicaid or Medicare work for this program?

No. This program is for job, union and self-bought PPO plans, including the Empire Plan. Medicaid and Medicare are not eligible.

How do I find out what my plan covers?

Send us the member ID and group number on your card, or call 805-815-6777. We call Carelon, pull your non-network benefit and tell you the cost before you start.