How Empire Plan rehab coverage works in 2026

Which NYSHIP members does this guide describe?

NYSHIP offers more than one health plan, and The Empire Plan publishes different At A Glance summaries for different groups. This site focuses on two January 2026 summaries:

• PE (Participating Employers): active employees, retirees, vestees and dependent survivors enrolled in The Empire Plan through a participating employer (such as many local governments and school districts), plus their dependents, COBRA and Young Adult Option enrollees.
• C-82: New York State employees represented by Council 82, their enrolled dependents, and related COBRA and Young Adult Option enrollees.

Union and employer groups: Many New York State employees — for example, those represented by PEF, CSEA or NYSCOPBA, and many SUNY employees — are covered by their own Empire Plan At A Glance guides, and Participating Agency (PA) enrollees have separate guides too. Council 82 members use the C-82 guide described here. The dollar figures on this site come only from the PE and C-82 guides, so check your group's guide before relying on them.

What does the MHSU Program cover for substance use?

Both 2026 guides describe inpatient services, outpatient services such as office visits and outpatient substance use rehabilitation programs, emergency care and medically necessary ambulance transport to a mental health or substance use facility (PE and C-82 At A Glance, printed pp. 11–12).

The key word is certified. The guides state that the program administrator must certify all covered services as medically necessary, whether you use network or non-network care. If treatment is not certified, the guide says you will not receive Empire Plan benefits and may owe the full cost (printed p. 11).

For level-specific detail, see detox and withdrawal management coverage, inpatient and residential rehab coverage and outpatient, PHP and IOP coverage.

Treatment often differs by substance. See our guides to alcohol use disorder treatment, opioid treatment and medications, cocaine and stimulant treatment and benzodiazepine tapering and treatment with NYSHIP.

Carelon Behavioral Health rehab authorization: Carelon administers the MHSU Program and handles certification for both mental health and substance use care under the same rules. This guide does not assess how mental health parity laws apply to The Empire Plan; ask the plan directly if you have parity questions about substance abuse benefits.

How do network and non-network benefits differ?

Non-network outpatient math is the most common source of confusion. Our out-of-network rehab guide walks through it step by step.

Network status depends on the Empire Plan's own administrators — not on whether a hospital accepts "Empire" or Anthem cards. See how the Empire Plan differs from Empire BCBS (Anthem) and who administers each part of the plan. Before choosing a program, read how to find drug rehabs that take NYSHIP in network.

NYSHIP out-of-state rehab coverage: If you are considering a program outside New York, ask the MHSU Program before admission whether that facility is in network and whether the stay will be certified. Otherwise non-network rules apply. See what to do if no network provider is nearby.

Who should you call before starting treatment?

The guides tell members to call The Empire Plan at 1-877-769-7447 (official plan number) and press or say 3 for the MHSU Program before seeking services, to receive the highest level of benefits and avoid possible penalties. Selecting option 3 from the MHSU menu reaches the Clinical Referral Line, which the guides describe as available 24 hours a day (printed p. 11).

In an emergency, go to the nearest emergency department or call 911. The guides say the facility should contact the MHSU Program within 48 hours of an emergency admission, or as soon as reasonably possible. Read more in our prior authorization guide.

How do you find in-network addiction treatment near you?

This site does not list or recommend treatment centers. The official route for finding Empire Plan network care for substance use or mental health is the plan itself: call 1-877-769-7447 (official plan number), press or say 3 for the MHSU Program, then choose option 3 for the Clinical Referral Line (printed p. 11). Your HBA can also point you to the plan's provider directory.

1. Say what you need: detox, inpatient, outpatient, IOP or virtual IOP, and whether it is for substance use, mental health or both.
2. Give your location and how far you can travel, or ask about telehealth options.
3. Ask for the names of network providers at that level of care, then call each program to confirm it is in network for that exact service.
4. Write down the date, the representative's name and any reference number.

A website appearing in a "rehab near me" search does not mean it is in network. Confirm before admission — see prior authorization.

What will rehab cost with The Empire Plan?

Costs depend on network status, level of care and how many separate cost-sharing rules apply. The in-network out-of-pocket limit, the non-network combined deductible and the combined annual coinsurance maximum are three different numbers. See the 2026 deductibles, copays and maximums page and the step-by-step rehab cost guide.