Ebd form 543 2025

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The document is an authorization form from the New York State Employee Benefits Division, allowing individuals to request the release of their or another person's protected health information related to various health insurance programs. It outlines the necessary sections to be completed, including personal details, relationships, organizations authorized to release information, and the specific information being requested. The form also includes terms regarding expiration, revocation of authorization, and privacy protection laws.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is the empire plan the same as Nyship?

The New York State Health Insurance Program (NYSHIP) offers eligible employees the option of choosing either The Empire Plan or a NYSHIP HMO for health insurance coverage. Click the plan names below to view a Summary of Benefits and Coverage for each option.

How do I contact NYS employee benefits division?

If you have questions about your health insurance enrollment record, eligibility or NYSHIP requirements, contact the Employee Benefits Division (EBD) Call Center at 518-457-5754 or 1-800-833-4344 (United States, Canada, Puerto Rico, Virgin Islands).

Is Nyship the same as United HealthCare?

Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).

How do I contact Nyship insurance?

Enrollees may docHub Empire Plan carriers through one toll-free telephone number, 1-877-7-NYSHIP (1-877-769-7447).

How do I contact Empire Nyship insurance?

Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program.

nys form ebd 543

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Does Nyship have a group number?

Empire Plan enrollees register with a group number and an identification number. Your group number is 030500; your ID number is the first nine digits of your New York Government Employee Benefit Card. After you register, United HealthCare will mail you a personal password within five to ten business days.