Best Rehabs Accepting NYSHIP / The Empire Plan

The New York State Health Insurance Program, or NYSHIP, provides umbrella insurance coverage for addiction and mental health treatment for eligible New York public-sector employees, retirees, and their eligible dependents.

Browse and compare the treatment centers to find the right fit for your needs.

Using NYSHIP / The Empire Plan Insurance for Treatment

Under both federal and New York state law, most health insurance plans are required to provide mental health and substance use disorder benefits on terms that are comparable to medical and surgical benefits.¹ As a NYSHIP member, your plan may help cover the cost of addiction and mental health treatment, including inpatient rehabilitation, outpatient therapy, medication-assisted treatment, and other covered behavioral health services.

However, because coverage varies by plan, it is important to verify your benefits by reviewing your plan documents or speaking with a NYSHIP representative.² This can help you understand what services are covered and what out-of-pocket costs you may be responsible for.

NYSHIP / The Empire Plan Insurance Plan Options

NYSHIP offers coverage through two primary plan options:³

• The Empire Plan
• NYSHIP-approved Health Maintenance Organization (HMO).

Available nationwide, The Empire Plan encompasses various areas of your healthcare, including prescription drug coverage, through the administration of several insurance companies. For example, under The Empire Plan, UnitedHealthcare manages medical and surgical benefits, Anthem Blue Cross provides hospital coverage, and Carelon Behavioral Health administers mental health and substance use disorder benefits.⁴

Alternatively, NYSHIP-approved HMOs (which include options such as CDPHP, Independent Health, and MVP) offer coverage based on where you live or work.⁵ These plans are available only within each HMO's designated service area, and the plan you choose influences your provider network, whether referrals are required to see specialists, and your out-of-pocket costs for addiction treatment and mental health services.⁵

What NYSHIP / The Empire Plan Insurance May Cover

NYSHIP plans typically include coverage for a range of addiction and mental health services, though again, the extent of your coverage depends on your individual plan, including factors such as your exact benefits, copays, and network requirements.^2,3

Your insurance plan may cover:

• Medical detox
• Residential and inpatient treatment
• Partial hospitalization programs (PHP)
• Intensive outpatient programs (IOP)
• Outpatient therapy
• Medication-assisted treatment(MAT) for opioid use disorder, via medication-assisted treatment

To understand your specific benefits, review your plan documents or contact the NYSHIP health insurance department directly before beginning treatment.

What Affects Your Coverage?

The amount you pay for addiction treatment through NYSHIP is determined through a number of key variables associated with your plan. Some of the variables that can affect your coverage include the following:

• Your plan type: Your enrollment in either The Empire Plan or a NYSHIP-approved HMO determines your provider network, referral requirements, and covered services.³
• In-network vs. out-of-network care: Choosing an in-network treatment provider typically results in lower out-of-pocket costs than using an out-of-network facility.²
• Prior authorization: Some rehab services require precertification or prior authorization to confirm medical necessity before treatment begins.²
• Your out-of-pocket costs: How much you pay for treatment depends on your plan's deductible, copays, and coinsurance.²
• Mental health parity protections: Federal parity laws generally require NYSHIP plans to provide mental health and substance use disorder benefits on terms comparable to medical and surgical benefits, although your exact coverage still depends on your plan.¹

Being proactive and calling a NYSHIP representative can help you prevent any obstacles or stressors when the time comes for you to use your insurance coverage for these or similar services.

How to Verify Your Benefits

To verify your NYSHIP coverage, you can get started by calling the member services number on the back of your insurance ID card.

If you're enrolled in The Empire Plan, call 1-877-7-NYSHIP (1-877-769-7447) and select the Mental Health and Substance Use Program, which is administered by Carelon Behavioral Health. Representatives are available 24 hours a day, 7 days a week.³

If you're enrolled in a NYSHIP HMO, contact your HMO directly using the member services number on your insurance card.³

Many treatment centers can also verify your insurance on your behalf and walk you through expected costs. When you call, ask whether the facility is in-network, whether your recommended level of care requires prior authorization, and what your deductible, copay, or coinsurance will be. Reviewing your plan's official benefit summary ahead of time can help you avoid surprises.

There Is Hope for Recovery

Addiction is treatable, and a life of freedom is possible. Using our locator tool, search for providers who accept your insurance and that specialize in your specific needs, from holistic care to medication-assisted treatment.

Don’t wait another day to get help; find a recovery program that works for you.

Sources:

1. Centers for Medicare & Medicaid Services. (2026). The Mental Health Parity and Addiction Equity Act (MHPAEA).

2. New York State Department of Civil Service. (2026). Summary of Benefits and Coverage 2026 (NY Retiree, PA Active/Retiree, PE Active/Retiree).

3. New York State Department of Civil Service. (2026). Choices for 2026: NYSHIP plan comparison.

4. New York State Department of Civil Service. (2026). Empire Plan providers and pharmacy.

5. New York State Department of Civil Service. (2026). 2026 NYSHIP options by county.