Employee Medical Health Plan of Suffolk County, New York

About EMHP

The County created the Employee Medical Health Plan of Suffolk County (EMHP) in 1991, by legislative resolution, with an effective starting date of January 1, 1992. County employees have the option of being covered by the EMHP or one of the Health Maintenance Organizations (HMO) offered. Contact the Employee Benefits Unit, (631) 853-4866 or email ebu@suffolkcountyny.gov. for more information.

The EMHP currently covers active employees, retirees, dependent survivors, employees on leave of absence, self-paying faculty, terminated vesteds, union benefit fund employees and COBRA participants.

The EMHP offers enrollees and their covered dependents a full range of benefits. These benefits include hospital benefits, major medical benefits, prescription drug benefits and mental health/substance abuse benefits.

The hospital benefits currently provides enrollees with 365 days of coverage for both in-patient and outpatient services. The major medical benefits currently provides enrollees with a preferred provider option subject to a co-payment and a traditional indemnity option subject to deductible, co-payments and charges above reasonable and customary limits. The prescription drug benefits currently provides enrollees with options to use participating pharmacies or mail order. The mental health/substance abuse benefits currently provides enrollees with a managed care program covered at a higher level of benefits. All of these benefits are as set forth in the EMHP Booklet.

Enrollment and COBRA administration and coordination with third party administrators is the responsibility of the Suffolk County Department of Civil Service/Human Resources, Employee Benefits Unit.

Responsible for the oversight of the Employee Medical Health Plan is the Labor Management Committee composed of a representative from each of the nine Suffolk County bargaining units and an equal number of County representatives appointed by the County Executive. In general, this joint committee is responsible for addressing all policy issues regarding the health benefits plan. It meets monthly to consider disputes over claimed benefit levels, monitor the performance of providers, and consider changes in the administration of the plan.

The County is currently utilizing the services of the following third party administrators to administer the EMHP:

Empire Blue Cross/Blue Shield, as of November 1, 2005 provides certain administrative services for both hospital benefits and major medical benefits. Administrative services include utilization review and quality assurance, administration of the preferred provider network, claims services, and printing and distribution of ID cards and claim forms, provider directories and educational information.
Express Scripts, Inc. (ESI) currently provides prescription drug services through a network of participating pharmacies and reimburses covered enrollees through a claims submission process for drugs purchased from non-participating pharmacies. ESI also provides mail order prescription drug services for maintenance drugs through its CFI division. Administrative services include claims services, printing and distribution of claim forms, toll free telephone service/claim inquiry, concurrent and retroactive utilization review and reports.
ValueOptions, Inc. as of April 1, 2006 provides certain administrative services for the mental health/substance abuse benefits. Administrative services include providing a toll free telephone 24 hour crisis line, referral services, claims services, utilization review and reports.

The County utilizes the services of an actuarial consultant for the EMHP. PricewaterhouseCoopers, LLP currently provides actuarial and benefits consulting services, which include assistance in developing short and long term objectives, advise on recent developments in the employee benefits field, plan improvements, HMO alternatives, coordination of the appeals process, attendance at EMHP committee and sub-committee meetings, and audits of claims administrators.

The County utilizes the services of a legal consultant for the EMHP. Mirkin & Gordon, P.C. currently provides legal consulting services, which include assistance in developing short and long term objectives, advise on recent developments in the employee benefits field, plan improvements, governmental rules and regulations and attendance at EMHP committee and sub-committee meetings.

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