NYSCOPBA Empire Plan Enhancements. In addition to the basic Empire Plan benefits, the Empire Plan for NYSCOPBA enrollees shall include:
(a) The State agrees to continue to provide alternative Health Maintenance Organization (HMO) coverage.
(b) The annual and lifetime maximum for each covered person under the basic medical component shall be unlimited.
(c) Routine pediatric care including all preventive pediatric immunizations, both oral and injectable, shall be considered a covered medical expense under the participating provider component and the basic medical component. Influenza vaccine will be on the list of pediatric immunizations, subject to appropriate protocols, under the participating provider and basic medical components of the Empire Plan.
(d) The newborn care allowance under the basic medical component shall not be subject to deductible or coinsurance.
(e) The Pre-Tax Contribution Program will continue unless modified or exempted by the Federal Tax Code.
(f) An employee retiring from State service may delay commencement or suspend his/her retiree health coverage and the use of the employee's sick leave conversion credits, provided that the employee applies for the delay or suspension, and furnishes proof of continued coverage under the health care plan of the employee's spouse, or from post-retirement employment. The surviving spouse of a retiree who dies while under a delay or suspension may transfer back to the State Health Insurance Plan on the first of any month coinciding with or following the retiree's death. For Interest Arbitration eligible employees only, retirements occurring on and after October 1,2012, the actuarial table used to calculate the employees sick leave credit toward health insurance in retirement shall be the life expectancy tables for corrections officers.
(g) Office visit charges by participating providers for well childcare will be excluded from the office visit copayment.
(h) Charges by participating providers for professional services for allergen immunotherapy in the prescribing physician's office or institution and chronic care services for chemotherapy, radiation therapy, or hemodialysis will be excluded from the office visit copayment.
(i) In the event that there is both an office visit charge and office surgery charge by a participating provider in any single visit, the covered individual will be subject to a single copayment.
