The County created the Employee Medical Health Plan of Suffolk County (EMHP) in 1991, through collective bargaining with its then nine (9) municipal labor unions (there are currently ten (10) municipal labor unions), 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 firstname.lastname@example.org for more information.
The EMHP currently covers active employees, retirees, dependent survivors, employees on leave of absence, self-paying faculty, terminated vested, 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 use disorder benefits.
The hospital benefits currently provide enrollees with 365 days of coverage for both in-patient and outpatient services. The medical/surgical benefits currently provide enrollees with a preferred provider option subject to a co-payment and a traditional indemnity option subject to deductible, co-payments and charges above the Maximum Allowable Amount. The prescription drug benefits allow enrollees to use a retail pharmacy to fill up to a 21-day supply of non-maintenance medications only. Any prescriptions over 21 days and up to 90 days must be filled through the mail order pharmacy, only a 90 day prescription can be filled at a Smart 90 pharmacy. The mental health/substance use disorder 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 theSuffolk County Department of Human Resources, Personnel and Civil Services, 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 ten 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 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, 24/7 NurseLine, claims services, and printing and distribution of ID cards and claim forms, provider directories and educational information.
- Express Scripts Commercial (ESI) 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. Express Scripts Commercial (ESI) also provides mail order/Smart 90 prescription drug services for maintenance drugs. Administrative services include claims services, printing and distribution of claim forms, toll free telephone service/claim inquiry, concurrent and retroactive utilization review and reports.
- Express Scripts Medicare Prescription Drug Plan (PDP) currently provides prescription drug services to all Medicare eligible retirees. The Express Scripts Medicare PDP is comparable to the County's drug plan and offers better coverage than a standard Medicare Part D Plan. This prescription drug coverage is creditable coverage, which means it is at least as good as the standard Medicare prescription drug coverage.
- Optum Behavioral Health provides certain administrative services for the mental health/substance use disorder benefits. Administrative services include providing a toll free telephone 24 hour crisis line, referral services, claims services, utilization review and reports.
- Access Discount Health Tele-Medicine Provider provides urgent care for non-emergency conditions such as allergies, cough, ear problems, fever, flu, nausea, pink eye, rash, sinus infection, etc.
The County utilizes the services of an actuarial consultant for the EMHP. Segal Co. currently provides actuarial and benefits consulting services, which include assistance in developing short and long term objectives, advise on recent developments in the employee benefit field, plan improvements, coordination of the appeals process, attendance at EMHP committee and subcommittee 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, advice on recent developments in the employee benefits field, plan improvements, governmental rules and regulations and attendance at EMHP committee and sub-committee meetings.