The Hope Institute works with the New York State Health Insurance Program (NYSHIP), including Empire Plan coverage. Your NYSHIP rehab coverage can apply to our partial care, intensive outpatient, outpatient rehab and medication-assisted treatment for drug and alcohol addiction, along with dual diagnosis care for co-occurring depression, anxiety and trauma.
NYSHIP covers public employees, retirees and their families, and Empire Plan behavioral health benefits run through a dedicated Mental Health and Substance Use Program. Our admissions team reviews your NYSHIP plan confidentially before treatment starts. Call (855) 659-2310 or use the form on this page to verify your NYSHIP drug and alcohol rehab benefits.
What Is NYSHIP?
NYSHIP covers eligible state employees, retirees and their dependents, along with employees of participating employers such as local governments, school districts and public authorities.
Members choose between the Empire Plan and NYSHIP-approved health maintenance organizations (HMOs). The Empire Plan is built from several programs, each run by a different company:
- Hospital Program: Anthem Blue Cross
- Medical/Surgical Program: UnitedHealthcare Insurance Company of New York
- Mental Health and Substance Use Program: Carelon Behavioral Health
- Prescription Drug Program: CVS Caremark
For addiction treatment, the Mental Health and Substance Use Program is the one that matters most. It manages benefits, approvals and network guidance for substance use care, while the Prescription Drug Program covers medications such as buprenorphine and naltrexone.
Does NYSHIP Cover Rehab?
Yes. NYSHIP plans include behavioral health benefits for substance use disorder treatment, covering outpatient therapy, structured outpatient programs such as IOP, partial hospitalization and medication for opioid and alcohol use disorders when care is medically necessary.
How you use those benefits depends on whether you have the Empire Plan or a NYSHIP HMO. Empire Plan members work through Carelon Behavioral Health for substance use care. HMO members follow the behavioral health rules and network of their HMO.
Federal parity rules apply here too, so substance use benefits must be at least as favorable as the medical side of your plan. Our team confirms your plan, your behavioral health benefits and how they apply to our programs before your first session, so you have clear answers on approvals and cost from the start.
Empire Plan Mental Health and Substance Use Program
The Empire Plan asks members to call its Mental Health and Substance Use Program before starting care with a mental health or substance use provider. That call is how you get the highest level of benefits, and it starts the approval process for structured care.
Carelon Behavioral Health reviews your needs and confirms which services are covered. Structured outpatient programs for substance use disorder and partial hospitalization for mental health or substance use require precertification, the Empire Plan’s term for prior authorization, before treatment begins.
The Empire Plan also includes non-network benefits. When care is outside the program’s network, coverage applies after the combined annual deductible, with the plan paying a set share of the allowed amount (80% in the Empire Plan’s 2024 benefit summary) up to a yearly coinsurance maximum. Our admissions team can make the call with you or for you and walks you through what the program approves, including whether your care counts as network or non-network.
NYSHIP IOP and Outpatient Rehab Coverage
NYSHIP plans commonly cover our outpatient levels of care when they are medically necessary:
| Level of care | Weekly schedule | NYSHIP coverage notes |
|---|---|---|
| Partial care (PHP) | Daytime, Monday to Friday | Covered; Empire Plan requires precertification |
| Intensive outpatient (IOP) | 3 to 4 sessions, about 3 hours each | Covered as a structured outpatient program; Empire Plan requires precertification |
| Outpatient (OP) | 2 to 3 sessions, 45 to 60 minutes each | Covered as outpatient behavioral health visits; costs depend on network status |
| Aftercare | Continued groups and check-ins | Depends on the services included |
NYSHIP IOP coverage suits public employees who want to keep working during treatment, since our day, evening and virtual IOP tracks fit around a work schedule. Many NYSHIP members also use telehealth therapy, which we confirm during verification.
NYSHIP Heroin Rehab and Alcohol Treatment Coverage
Two of the most common reasons NYSHIP members contact us are opioid and alcohol use. NYSHIP heroin rehab coverage usually includes medication-assisted treatment with counseling, and NYSHIP alcohol treatment coverage includes outpatient rehab with naltrexone when it fits your care.
Our heroin addiction treatment combines buprenorphine (Suboxone) or naltrexone with CBT and group counseling. Our alcohol addiction treatment pairs naltrexone with relapse prevention and therapy. We also treat cocaine, meth and prescription drug addiction.
NYSHIP drug and alcohol rehab coverage applies across these substances, because the benefit is based on the diagnosis and the level of care. If detox is needed first, we arrange it with a trusted detox facility and start your outpatient care once you are stable.
NYSHIP Coverage for Medication-Assisted Treatment
NYSHIP coverage for medication-assisted treatment generally includes both medication and counseling. For Empire Plan members, medications such as buprenorphine and naltrexone are covered through the Prescription Drug Program, while provider visits and counseling fall under the Mental Health and Substance Use Program.
Our MAT program uses buprenorphine (Suboxone) and naltrexone, including the monthly Vivitrol injection, for opioid and alcohol use disorders. Some medications or doses may have their own prescription rules, which we check before you start.
Because MAT draws on two parts of your plan, we confirm both together. If you already take buprenorphine or naltrexone from another prescriber, tell us at the assessment, so your care continues smoothly.
NYSHIP Coverage for Dual Diagnosis and Therapy
NYSHIP behavioral health benefits cover treatment for substance use and co-occurring mental health conditions together. Our dual diagnosis treatment treats both with one clinical team, in the same plan.
Empire Plan and HMO benefits typically cover individual therapy, group therapy, cognitive behavioral therapy and family sessions. Public service jobs such as teaching, corrections, public safety and health care can carry heavy stress, and treatment covers the work strain, sleep and mood issues that often sit underneath substance use.
Your NYSHIP benefits extend to eligible dependents as well, so spouses and children on your plan can use the same coverage for their own treatment. Eligible retirees keep NYSHIP coverage too, and the same Mental Health and Substance Use Program rules apply.
NYSHIP HMOs and Addiction Treatment
Some NYSHIP members choose an approved HMO instead of the Empire Plan. HMO members use their HMO’s behavioral health benefits for addiction treatment, with the HMO’s own network, copays and approval rules.
HMOs often route care through a primary care provider and may ask for a referral or prior authorization before IOP or partial care begins. Network rules also tend to be stricter than the Empire Plan’s, so where you receive care can change what your plan pays.
Your HMO card lists a behavioral health phone number. Our team uses it to confirm your benefits, referral rules and authorization steps for our programs before you start, and we coordinate any paperwork with your HMO directly.
In-Network and Out-of-Network NYSHIP Rehab Coverage
In-network and out-of-network NYSHIP rehab coverage work differently, and the Empire Plan calls them network and non-network benefits.
Network care through the Mental Health and Substance Use Program usually carries a set copay per visit. Non-network care is paid after the combined annual deductible, with coinsurance up to a yearly maximum. NYSHIP HMOs generally limit coverage to their own network, so HMO members check network status first. Retirees and dependents follow the same network rules as the enrollee’s plan.
Our team confirms with Carelon or your HMO how our partial care, IOP and outpatient programs are classified, then explains your costs under each benefit before you start.
What You Pay for Rehab With NYSHIP
Your NYSHIP costs depend on your plan option and whether care is network or non-network:
- Empire Plan network care: a copay per outpatient visit at network providers, with structured programs covered after precertification
- Empire Plan non-network care: coverage after the combined annual deductible, with the plan paying a set share of the allowed amount (80% in the Empire Plan’s 2024 benefit summary) up to a yearly coinsurance maximum
- NYSHIP HMOs: copays and network rules set by your HMO
- Prescriptions: copays through the Prescription Drug Program or your HMO
Outpatient rehab costs less than residential treatment because you live at home and pay for treatment only. Private pay options are available if any part of your care falls outside your plan, and we confirm your costs before treatment begins. Network and non-network costs can differ a lot, so we check how your care is classified first.
How to Start Rehab With NYSHIP
- Verify your NYSHIP benefits: call (855) 659-2310, use the form on this page or visit our insurance verification page.
- Call the Mental Health and Substance Use Program: Empire Plan members contact Carelon before care, and our team can help with the call.
- Clinical assessment and precertification: a clinician reviews your needs, and we submit any required precertification.
- Begin treatment: treatment starts once the program approves your care, in person or by telehealth.
Have your Empire Plan or HMO card and medication list ready when you call. Public employees comparing options often ask about the best health insurance for addiction treatment, and our team can explain where NYSHIP fits. Call (855) 659-2310 to use your NYSHIP rehab coverage for IOP, partial care, outpatient rehab or MAT. Every call is confidential.
Frequently Asked Questions About NYSHIP Rehab Coverage
Does NYSHIP cover drug and alcohol rehab?
Yes. NYSHIP plans cover medically necessary substance use treatment, including outpatient therapy, structured outpatient programs, partial hospitalization and MAT.
Does the Empire Plan cover addiction treatment?
Yes. The Empire Plan Mental Health and Substance Use Program, administered by Carelon Behavioral Health, covers substance use treatment.
Do I need precertification for rehab with the Empire Plan?
Structured outpatient programs for substance use and partial hospitalization require precertification. Members should call the program before starting care.
Does NYSHIP cover heroin rehab?
Yes. NYSHIP covers heroin and opioid treatment, including buprenorphine or naltrexone with counseling.
Does NYSHIP cover alcohol treatment?
Yes. NYSHIP covers outpatient alcohol treatment, including counseling and naltrexone when it fits your care.
Does NYSHIP cover IOP?
Yes. IOP is covered as a structured outpatient program when it is medically necessary, with precertification under the Empire Plan.
Does the Empire Plan cover non-network providers?
Yes. The Empire Plan includes non-network benefits after the combined annual deductible, with coinsurance.
Who is covered by NYSHIP?
Eligible state employees, retirees, dependents and employees of participating employers such as local governments and school districts.
What is the difference between in-network and out-of-network NYSHIP coverage?
In-network care uses rates agreed with NYSHIP and usually costs less. Out-of-network benefits, where your plan includes them, often carry a separate deductible and higher coinsurance.