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HCAP non-network benefit provisions will remain. Covered expenses for

basic medical services, mental health and/or substance abuse treatments and

home care advocacy program services will be included in determining the
basic medical component deductible.
§9.9 Empire Plan Managed Physical Medicine Program

(a) The Empire Plan's medical care component will continue to offer a

comprehensive managed care network benefit for the provision of medically
necessary physical medicine services, including physical therapy and

chiropractic treatments. Authorized network care will be available, subject
only to the Plan's participating provider office visit copayment(s).

Unauthorized medically necessary care will also be available, subject to an
annual deductible of $250 per enrollee, $250 per spouse/domestic partner

and $250 for one or all dependent children and a maximum payment of 50%
of the network allowance for the service(s) provided.

Deductible/coinsurance payments will not be applicable to the Plan's annual
basic medical deductible/coinsurance maximums. The Joint Committee on

Health Benefits will work with the State on the ongoing administration of
this benefit. The participating provider office visit copayment(s) shall apply

to covered physical therapy visits received at the outpatient department of
the hospital.

§9.10 Empire Plan Infertility Benefits Program
Empire Plan participating provider and basic medical coverage for the

treatment of infertility will continue as follows:
(a) access to designated "Centers of Excellence" including travel benefit;

(b) enhance benefit to include the treatment of "couples" as long as both

partners are covered either as enrollee or dependent under the Empire Plan;
(c) lifetime coverage limit per individual of $50,000;
(d) covered services: patient education/counseling, diagnostic testing,

ovulation induction/hormonal therapy, surgery to enhance reproductive

capability, artificial insemination and Assisted Reproductive Technology
procedures;

(e) exclusions: experimental procedures, fertility drugs dispensed at a
licensed pharmacy, medical and other charges for surrogacy, donor

services/compensation in connection with pregnancy, storage of sperm,
eggs and/or embryo for longer than 6 months and high risk patients with no

reasonable expectation for pregnancy.

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