New York State Employees Health Plans

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For those that are eligible for CDPHP Group Medicare Choices (HMO) click here.

CDPHP HMO for active employees, the benefits are extensive, the cost little to nothing.

  • Low $20 copay.
  • No deductibles and easy paperless referrals.
  • Nearly 10,000 practitioners and providers. To find a participating doctor, specialist, laboratory, or pharmacy near you, go to Find-A-Doc.
  • Worldwide coverage for urgent and emergency care when you travel.
  • Out-of-area coverage for college students while school is in session.
  • Out-of-pocket maximum added for 2014.

Summary Information for active employees - 2014

Services are provided by CDPHP participating physicians and coordinated by the member’s primary care physician.

On the Road
Wherever you travel, whether for school, work or vacation, CDPHP covers urgent and emergency care.

In College
CDPHP covers college students attending school out of the service area for emergencies and pre-authorized urgent and follow-up care when school is in session. Please contact CDPHP at (518) 641-4100 or 1-800-273-2332 between 8 a.m. and 6 p.m., Monday through Friday. If you call after hours or on a weekend or holiday, please let the answering service know you have an urgent need, and a CDPHP nurse will call you right back. Otherwise, your call will be returned during normal business hours.

Prescription Drugs
CDPHP offers a three-tier prescription drug plan for New York State employees. For your convenience, covered prescriptions can be filled at any Caremark network pharmacy throughout the United States (includes virtually all chain stores and most independent pharmacies). To find a participating pharmacy near you, please go to Pharmacy Locator.

  • Prescription drug copay for a 30-day supply: $5 generic, $30 brand formulary and $50 non-formulary.
  • Mail order prescription plan: Obtain a 90-day supply of maintenance medications. For more information on mail order benefits as well as a list of formulary (covered) drugs, please go to RX Corner
  • Rx for Less: CDPHP members with prescription drug benefits can get deep discounts on specific generic drugs when purchased at any CVS, Walmart, or Price Chopper pharmacy.

More Reasons to Choose CDPHP

  • Single-Source Referral Line - Looking for wellness support and advice? CDPHP has a variety of programs that might help. Call our new single-source referral line - 1-888-94-CDPHP (23747) - and leave a confidential message about your helath concern. An expert professional will call you back with suggestions for CDPHP programs that can help fulfill your unique needs.
  • Free Wellness Programs - Members learn how the combined power of good nutrition, regular exercise, and stress management can help them move toward optimal health and well-being.
  • CDPHP Health Coach ConnectionSM program - Talk personally to a Health Coach any time, day or night; access health tools, decision support tools, and an online encyclopedia with thousands of easy-to-understand health articles.
  • Complementary and Alternative Medicine Discount Program - Free access to Web-based resources and discounts for alternative forms of therapy such as yoga, acupuncture, massage and holistic medicine; discounts on vitamins, health magazine subscriptions, and more.
  • Weigh 2 Be - Weight loss support program for adult members; includes a rebate up to $65 on a completed 10-week session of Weight Watchers.
  • CVS ExtraCare® Health Card - CDPHP partners with CVS Caremark to offer members special savings on 1,300 commonly used health products. Once you enroll, you'll receive a CVS ExtraCare® Health card in the mail. Present the card at a CVS retail store and get a 20 percent discount off the already low prices on CVS brand health-related items. Each subscriber receives two key tags so spouses and dependents can cash in on the discounts, too.
  • Health e-Updates is a news brief that arrives periodically in your email inbox. To subscribe, simply log in securely and supply an updated email address. Or, simply call member services to subscribe.
  • Healthy Babies:
    CDPHP partners with the National Healthy Mothers, Healthy Babies Coalition to offer text4baby. This is a free text messaging service. Text4baby sends timely tips on topics such as nutrition and immunizations to women from the first trimester of pregnancy through the newborn's first year. Women may sign up for the service by texting BABY to 511411 (or BEBE for Spanish).
  • Visit Us On Social Media: Keep up with CDPHP via Facebook, Twitter, or LinkedIn and participating providers on our My CDPHP Mobile app.

At Your Service
CDPHP member service representatives are available to answer inquiries, respond to concerns, and provide materials quickly and efficiently. Simply call 518.641.3700 or 1-877-777-2273, Monday through Friday, 8 a.m. to 8 p.m., or alternatively on our contact page

Spanish speaking representatives and a translation service for other languages are available. A TDD system for the hearing-impaired is available at 1-877-261-1164.

No Habla Inglés
Nao falar inglés. Ikke taler Engelsk. Non parlare Inglese. Sprechen Sie Englisch nicht. Ne pas parler anglais.

To help non-English speaking members, CDPHP's member services staff includes Spanish speaking representatives. CDPHP also makes available a telephone translation service for other languages. Member services staff also can help you find a PCP who speaks your language.

Para ayudar a los miembros que no hablan ingles, CDPHP tiene representantes que hablan español. CDPHP también hace disponsible un servicio telefonico que traduce varios idiomas. Las personas en el departamento de servicios para los miembros, también le pueden ayudar a encontrar un PCP (doctor primario, o doctor de cabecera) que habla español

Group Medicare Plans

CDPHP is a plan for life. We are pleased to offer our Medicare Advantage Plans, the CDPHP Group Medicare Choices Rx (HMO) and Group Medicare Choices (HMO) for Medicare-primary NYSHIP retirees and their spouses. Medicare-primary NYSHIP retirees who are currently enrolled in the CDPHP HMO for active employees and reside in NYSHIP Code Numbers 063, 300 and 310 are required to enroll in a CDPHP Group Medicare plan. To qualify, you must be enrolled in Medicare Parts A and B and live in the service area.

CDPHP Medicare Choices Group Plans make healthcare easy. Employees receive all the benefits of Medicare, and more, from CDPHP.

  • No deductibles and easy paperless referrals.
  • More than 10,000 practitioners and providers. To find a participating doctor, specialist, laboratory, or pharmacy near you, go to Find-A-Doc.
  • Worldwide coverage for urgent and emergency care when you travel.

Summary Information for Medicare eligibles - 2015

Summary Information for Medicare eligibles - 2014

Services are provided by CDPHP participating physicians and coordinated by the member's primary care physician.

On the Road

Wherever you travel, CDPHP covers urgent and emergency care. Please contact CDPHP at (518) 641-4100 or 1-800-274-2332 between 8 a.m. and 6 p.m., Monday through Friday. If you call after hours or on a weekend or holiday, please let the answering service know you have an urgent need, and a CDPHP nurse will call you right back. Otherwise, your call will be returned during normal business hours

Prescription Drugs

CDPHP offers a five-tier prescription drug plan for New York State Medicare-eligible retirees. For your convenience, covered prescriptions can be filled at any Caremark network pharmacy throughout the United States (includes virtually all chain stores and most independent pharmacies). To find a participating pharmacy near you, please go to Pharmacy Locator.

Prescription drug benefits as follows:

  • No deductible
  • No "coverage gap."
  • Tier 1: $0 copayment for preferred generic drugs
  • Tier 2: $5 copayment for non-preferred generic drugs.
  • Tier 3: $30 copayment for preferred brand drugs.
  • Tier 4: $50 copayment for non-preferred brand drugs.
  • Tier 5: $55 copayment for specialty drugs.
  • Once the total yearly Part D drug costs* reach $2,960:
    • You pay the above stated copayments for all generic drugs on Tiers 1 though 4. You pay the above stated copayments for all brand-name drugs (as defined by CMS*) on Tiers 3, 4, and 5 until your Part D total out-of-pocket spending reaches $4,700.
  • When your total Part D out-of-pocket spending reaches $4,700, “catastrophic coverage” begins:
    • You continue to pay $0 for Tier 1 Preferred Generic Drugs. You pay the greater of 5% coinsurance or $2.65 for generic and multisource brand drugs on tiers 2 through 4 and the greater of 5% coinsurance or $6.60 for all other brand drugs. For Tier 5 drugs, youpay the lesser of 5% coinsurance or the above stated cost share.
  • Tier 5 drugs limited to a 30-day supply.
  • Mail order: 90-day supply available for two copayments for Tier 1, 2, 3, and 4 drugs.
  • Retail pharmacy: 90-day supply available for three copayments for Tier 1, 2, 3, and 4 drugs.
  • CDPHP Medicare Choices Part D Formulary and Enhanced Formulary apply.

*The Medicare Coverage Discount Program provides the manufacturer discounts on brand name drugs to Part D enrollees who have reached the Coverage Gap and are not already receiving "Extra Help." A 50% discount on the negotiated price (excluding the dispensing fee and vaccine administration fee, if any) is available for those brand name drugs from manufacturers that have agreed to pay the discount. Although you pay the same copayments in the "Coverage Gap" as during the initial coverage stage, the 50% manufacturer discount still applies. Both the amount you pay, and the 50% discounted by the manufacturer, count toward your out-of-pocket costs as if you had paid them and moves you through the coverage gap.

More Reasons to Choose CDPHP

  • Medicare Star Ratings - CMS recently rated CDPHP Medicare Choices plans 4.5 out of a possible 5 stars for 2014. Star ratings are based on quality and performance in several different categories (for example, detecting and preventing illness, ratings from patients, and customer service). Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change one year to the next.
  • CDPHP Medicare Choices plans are first in New York state and ninth in the country in NCQA’s Medicare Health Insurance Plan Rankings, 2013 - 2014.
  • No Cost Wellness Programs — Members learn how the combined power of good nutrition, regular exercise, and stress management can help them move toward optimal health and well-being.
  • No-cost access to the Sunnyview Lifestyle Wellness Center, Capital District and Glens Fall YMCA, Silver Sneakers®, and most Curves® locations through CDPHP Senior Fit®.
  • CDPHP® Health AllySM, a personalized program that meets your unique needs through support, education, and access to CDPHP benefits and community-based services.
  • Single-Source Referral Line - Looking for wellness support and advice? CDPHP has a variety of programs that might help. Call our new single-source referral line - 1-888-94-CDPHP (23747) - and leave a confidential message about your helath concern. An expert professional will call you back with suggestions for CDPHP programs that can help fulfill your unique needs.
  • CDPHP Health Coach ConnectionSM program - Talk personally to a Health Coach any time, day or night; access health tools, decision support tools, and an online encyclopedia with thousands of easy-to-understand health articles.
  • Complementary and Alternative Medicine Discount Program - Free access to Web-based resources and discounts for alternative forms of therapy such as yoga, acupuncture, massage and holistic medicine; discounts on vitamins, health magazine subscriptions, and more.
  • Weigh 2 Be - Weight loss support program for adult members; includes a rebate up to $65 on a completed 10-week session of Weight Watchers.
  • CVS ExtraCare® Health Card - CDPHP partners with CVS Caremark to offer members special savings on 1,300 commonly used health products. Once you enroll, you'll receive a CVS ExtraCare® Health card in the mail. Present the card at a CVS retail store and get a 20 percent discount off the already low prices on CVS brand health-related items. Each subscriber receives two key tags so spouses and dependents can cash in on the discounts, too.
  • Health e-Updates is a news brief that arrives periodically in your email inbox. To subscribe, simply log in securely to www.cdphp.com and supply an updated email address. Or, simply call member services to subscribe.
  • Visit Us On Social Media
    Keep up with CDPHP via Facebook, Twitter, or LinkedIn! and participating providers on our CDPHP® Find-A-Doc Mobile app.

At Your Service

CDPHP member service representatives are available to answer inquiries, respond to concerns, and provide materials quickly and efficiently. Simply call 518.641.3700 or 1-877-777-2273, Monday through Friday, 8 a.m. to 8 p.m., or alternatively on our contact page.

Spanish speaking representatives and a translation service for other languages are available. A TDD system for the hearing-impaired is available at 1-877-261-1164.

No Habla Inglés

Nao falar inglés. Ikke taler Engelsk. Non parlare Inglese. Sprechen Sie Englisch nicht. Ne pas parler anglais.

To help non-English speaking members, CDPHP's member services staff includes Spanish speaking representatives. CDPHP also makes available a telephone translation service for other languages. Member services staff also can help you find a PCP who speaks your language.

Para ayudar a los miembros que no hablan ingles, CDPHP tiene representantes que hablan español. CDPHP también hace disponsible un servicio telefonico que traduce varios idiomas. Las personas en el departamento de servicios para los miembros, también le pueden ayudar a encontrar un PCP (doctor primario, o doctor de cabecera) que habla español

 

All benefits of this plan are subject to coordination of benefits. These summaries are designed to highlight the benefits of the plan and do not detail all benefits, limitations or exclusions. It is not a contract and may be subject to change. For more detailed information a Membership Certificate is available for your review upon request.

Note: All non-emergency health services must be provided by a Capital District Physicians’ Health Plan, Inc. participating physician/provider (including hospital admissions) unless otherwise pre-authorized by Capital District Physicians’ Health Plan, Inc.