Coverage
Empire Plan vs Empire BCBS (Anthem): which one covers rehab?
The Empire Plan is NYSHIP's health plan for New York public employees; Empire BlueCross BlueShield was the former name of a private insurer, now Anthem Blue Cross and Blue Shield. Anthem administers one part of The Empire Plan, the Hospital Program. Substance use and mental health care runs through a different part, the Mental Health and Substance Use (MHSU) Program, administered by Carelon Behavioral Health (PE At A Glance, printed p. 1).
Published by the NYSHIP.rehab editorial resource · Updated
Are the Empire Plan and Empire BCBS the same thing?
No. The names sound alike, which is why people mix them up.
- The Empire Plan is the main health insurance plan offered through the New York State Health Insurance Program (NYSHIP) to many state and local public employees, retirees and their families. It is made up of several programs, each run by a different company.
- Empire BlueCross BlueShield was the brand name of a private insurer in New York. Anthem announced that Empire BlueCross BlueShield is now Anthem Blue Cross and Blue Shield, and Empire BlueCross is now Anthem Blue Cross.
Who administers each part of The Empire Plan?
| Empire Plan program | Administrator | What it covers (summary) | Phone menu option at 1-877-769-7447 |
|---|---|---|---|
| Hospital Program | Anthem Blue Cross | Inpatient and outpatient hospital services, skilled nursing facility and hospice care; preadmission certification of hospital admissions | Press or say 2 |
| Medical/Surgical Program | UnitedHealthcare | Office visits, surgery, diagnostic testing, urgent care, home care and related services | Press or say 1 |
| Mental Health and Substance Use (MHSU) Program | Carelon Behavioral Health | Inpatient and outpatient mental health and substance use care; precertification, concurrent review, case management and discharge planning | Press or say 3 |
| Prescription Drug Program | CVS Caremark | Prescription drugs through network pharmacies and mail service | Press or say 4 |
Which program handles rehab and addiction treatment?
For substance use treatment, the guides point members to the MHSU Program: call 1-877-769-7447 and press or say 3 before seeking services, for the highest level of benefits. The program administrator must certify covered services as medically necessary, for network and non-network care (printed p. 11).
Because the Hospital Program and the MHSU Program are separate, a hospital's network status with Anthem does not, by itself, tell you whether a substance use program is in network with Carelon. Ask the MHSU Program which program applies to your care and whether the provider is in network for that exact service. See how Empire Plan rehab coverage works and prior authorization.
What happened with Mount Sinai and Anthem in 2026?
A March 2026 Department of Civil Service notice said Mount Sinai Health System was no longer in network with the Empire Plan Hospital Program administrator, Anthem Blue Cross, as of March 4, 2026. It listed exceptions, including emergency care, previously preauthorized services, pregnancy through delivery and postpartum care, and cases with no in-network hospital within 30 miles or 30 minutes. It also said Medical/Surgical services under UnitedHealthcare were not affected.
Anthem later announced a new three-year agreement that returns Mount Sinai hospitals to Anthem's network retroactive to March 4, 2026 (update dated April 14, 2026).
What should you ask before starting treatment?
Questions to confirm with The Empire Plan
- Is my coverage The Empire Plan, and which group guide (for example PE or C-82) applies to me?
- Is this treatment handled by the MHSU Program, the Hospital Program or both?
- Is this facility or program in network for this level of care today?
- Does the stay or program need to be certified, and who requests it?
- If the network status changes during my care, what happens to my benefits?
For costs, see out-of-network rehab and inpatient rehab coverage.
Frequently asked questions
Is Empire BCBS the same as The Empire Plan?
No. The Empire Plan is NYSHIP's plan for public employees. Empire BlueCross BlueShield is now Anthem Blue Cross and Blue Shield, a private insurer that administers The Empire Plan's Hospital Program.
Does Anthem handle Empire Plan rehab coverage?
Substance use treatment runs through the MHSU Program, administered by Carelon Behavioral Health. Call 1-877-769-7447 and press or say 3 before seeking services (PE guide, printed p. 11).
Is Mount Sinai in network with The Empire Plan?
Anthem announced in April 2026 that Mount Sinai hospitals returned to its network retroactive to March 4, 2026. Network status can change, so confirm with the plan before planned care.
Related guides
- CoverageHow Empire Plan rehab coverage works in 2026How The Empire Plan's Mental Health and Substance Use Program covers rehab in 2026: who it applies to, network vs non-network rules, and what to confirm first.
- CoveragePrior authorization for NYSHIP rehab: who calls, and whenWhen Empire Plan substance use care needs certification, who requests it, what happens in emergencies and a call checklist for the MHSU Program.
- CoverageNYSHIP inpatient and residential rehab coverageHow Empire Plan inpatient and residential rehab coverage works: certification, network stays paid in full, non-network 10% of billed charges and what to ask.
- CostsOut-of-network rehab with NYSHIP in 2026How the Empire Plan pays out-of-network substance abuse treatment in 2026: allowed amounts, billed-charge coinsurance, balance bills and luxury rehab.
Sources and source dates
- The Empire Plan At A Glance — Participating Employers (PE), January 2026 (opens in a new tab) — January 2026 (AAG-PE-1/26). Printed page(s) 1, 11, 19. New York State Department of Civil Service.
- NYS Department of Civil Service — Anthem Blue Cross and Mount Sinai Health System Update and FAQ (opens in a new tab) — March 2026 notice; accessed October 20, 2026
- Anthem Blue Cross and Blue Shield — Anthem and Mount Sinai Health System reach new multi-year agreement (opens in a new tab) — Updated April 14, 2026; accessed October 20, 2026
- Anthem Provider News (New York) — Empire BlueCross BlueShield is now Anthem Blue Cross and Blue Shield (opens in a new tab) — Reference listed October 20, 2026
Plan guides are summaries and can change. Your Empire Plan Certificate and Certificate amendments control. This page is general education, not medical, legal or benefits advice. Read our editorial standards.