The state regulatory agency that has the responsibility to review and oversee customer contracts , rates and many other aspects of the corporation's operations and activities. For the EPO and PPO programs, this term refers to care not rendered by a PPO network provider. Precertification A review of a proposed hospital or healthcare facility admission or of certain services or procedures prior to receiving the services or procedures to determine whether the proposed admission or services meets the medical necessity criteria for payment and to receive the maximum benefits available under an Empire healthcare plan. A network of doctors, hospitals and other healthcare providers who provide healthcare services to plan members. Members have the flexibility to choose a network provider or to select any provider outside the network, each time they need healthcare.
Members save money when they use in-network providers.
Riders Riders are extended coverage on a contract that can increase or decrease the scope of coverage.