Hospital and Medical Benefits

The Health and Benefit Trust Fund offers hospital and medical benefits to eligible participants. Medical benefits include coverage for preventive care, doctor visits, hospital stays and other medical services. The Health and Benefit Trust Fund shares most of the cost of medical services when you visit in-network providers, meaning you pay less out-of-pocket for your health care.

The hospital benefits and medical benefits not administered by the Fund Office are administered by Empire BlueCross BlueShield. You can visit Empire at

Eligibility and Enrollment

Learn more about eligibility and enrollment for all Health and Benefit Trust Fund plans.

Membership ID Card When you become eligible to participate in the PPO plan, you receive a membership card from Empire. Your card has your member ID, group ID and important contact information. If you do not receive a card from Empire after becoming eligible, or to print a temporary card, visit Empire’s website at

Hospital and Medical Network

PPO stands for “Preferred Provider Organization,” which is the network of doctors, specialists, hospitals and other medical providers who offer services at discounted rates for Plan participants. Empire’s PPO network consists of thousands of medical providers in New York State and around the country. While you can visit any medical provider you choose, visiting providers in the PPO network will cost you substantially less than visiting providers outside the network.

Find a Network Provider
To find a network provider in your area, visit Empire’s website at You can search for providers by name, address, specialty and hospital affiliation.

Hospital and Medical Covered Services

Empire’s PPO plan covers many hospital and medical services, including basic preventive screenings, doctor and specialist visits, surgical services and more.

To see a summary of certain current deductibles, coinsurances and copayments for covered hospital and medical services, download and read the schedules of benefits for the Health and Benefit Fund Hospital and Medical Plans.


Hospital and Medical Costs

As a participant, you share the cost of medical services with the Health and Benefit Trust Fund. There are three main ways you and the Fund split the cost:

  • Deductible—A deductible is an initial amount of money you pay for certain medical services out of your own pocket before the Plan starts to pay benefits. You start by paying the full cost of medical services until you meet the deductible.
  • Coinsurance—For certain services, you pay a percentage of the cost of the medical service while the Fund pays the rest. Usually, the percentage you pay when going to an In-Network provider is less than going to an Out-of-Network provider. Not every service requires you pay coinsurance.
  • Copayments—For some services, you only pay a copayment, or a small, one-time fee that covers the cost of a visit. Copayments do not apply to deductibles and the amount of the copayment may differ depending on the service.

To see a summary of certain current deductibles, coinsurances and copayments for covered hospital and medical services, download and read the schedules of benefits for the Health and Benefit Fund Hospital and Medical Plans.

Services provided In-Network typically cost you less than if you were to visit an Out-of-Network provider. While some services are covered when going Out-of-Network, other services may not be covered at all, meaning you pay the full cost out of your own pocket.


Typically, an In-Network provider files your medical claims for you. When visiting an Out-of-Network provider, you usually fill out and file the medical claim. You must file your medical claim within one year of your visit in order to be reimbursed.

If you have to file a medical claim with Empire for reimbursement, download and fill out the Empire Claim Form (PDF). Once you fill out the form, mail it and any applicable documents to:

Empire BlueCross BlueShield
P.O. Box 1407
Church Street Station
New York, NY 10008-1407

Visit Empire’s Member Website

Empire’s member website lets you access tools and information to help you live a healthier life. The site is available 24/7. At Empire’s member website you can:

  • Look up your health care claims
  • Find a medical provider
  • Chat with an Empire members service representative
  • Use Empire’s 360 Health® wellness program
  • Visit the MyHealth wellness portal administered by WebMD

To access the site, visit and click on the “Member” tab. If you haven’t registered, sign up and log in to start enjoying Empire’s online benefits.

More Information

To obtain more information on how your hospital and medical benefits works and what the Empire BlueCross BlueShield PPO Plan covers, you can visit the Summary Plan Description (SPD) Active & Retiree Members - Commercial Division or the Summary Plan Description (SPD) Active & Retiree Members - School Division or contact the Fund Office.

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