Recreate Life Counseling accepts NYSHIP coverage, including The Empire Plan, for partial hospitalization, intensive outpatient and outpatient treatment in Boynton Beach, Florida. If you or a family member works for New York State, a participating local government or a school district, your health plan very likely covers treatment here.
Many New Yorkers choose out-of-state rehab. Distance from the people, places and routines tied to using is part of why it works. The question is whether your Empire Plan benefits travel with you. For most members they do, and the sections below explain the two ways that can happen and what each costs you.
Our admissions team verifies your Empire Plan benefits for free before you make any decision, and you get a written estimate rather than a promise.
NYSHIP and The Empire Plan: one program, two names
People use the two names interchangeably, and for most members that is fine, but they are not the same thing.
NYSHIP is the New York State Health Insurance Program, run by the Department of Civil Service. It is the umbrella that provides health coverage to about 1.2 million state employees, local government employees, retirees and their family members.
The Empire Plan is the main health plan offered through NYSHIP, and the one most members are enrolled in. It is not an insurance company. The State self-funds it and contracts a plan administrator for each piece: UnitedHealthcare for medical and surgical care, and Carelon Behavioral Health for the Mental Health and Substance Use Program. Carelon was previously called Beacon Health Options, and before that ValueOptions, so you may see any of those names on older paperwork.
NYSHIP also offers a set of regional HMOs as an alternative to The Empire Plan. If your card shows an HMO name (CDPHP, MVP, Independent Health, HIP and others) rather than The Empire Plan, your coverage rules are different and generally do not extend to out-of-state providers except in emergencies. The rest of this page is about Empire Plan members.
The Empire Plan is also not Empire Blue Cross Blue Shield, which was a commercial insurer in New York and is now called Anthem. If your card says Anthem or Empire BCBS, see our Blue Cross Blue Shield page instead.
Does The Empire Plan cover rehab in Florida?
Yes. The Empire Plan’s Mental Health and Substance Use Program has no geographic restriction. It covers medically necessary substance use disorder treatment anywhere in the United States, and it is one of the few public employee plans that pays for care at non-network providers as well as network ones. Federal parity protections also apply, so the plan cannot impose coverage restrictions on addiction or mental health care that are stricter than those on medical care. That matters because it means an out-of-state facility is an option under either benefit level, not only when it happens to be in network.
Network benefits (in-network coverage). Carelon maintains a national network of behavioral health providers. When you use a network provider, your cost is limited to a copay per visit or per day, and the provider handles prior authorizations and direct billing with Carelon.
Non-network benefits (out-of-network coverage). When you use a provider outside the Carelon network, the plan still pays, but you meet an annual deductible first and then pay coinsurance on the remainder, and the provider may bill you for charges above what the plan allows. You may also need to submit claims yourself, although most facilities will do that for you.
Under either benefit, Carelon must certify the level of care before PHP or IOP begins, and the same pre-authorization rule applies to inpatient coverage and outpatient coverage alike. Treatment that starts without certification is paid at a reduced rate or denied.
Recreate Life Counseling accepts Empire Plan members under both benefit levels. Our admissions team confirms which applies to you during the benefits check and quotes your cost accordingly. The non-network route can still be a sound choice when the right program is out of state; the difference is in what you pay, not whether you are covered.
What The Empire Plan covers
The Mental Health and Substance Use Program covers the full continuum of addiction and mental health care when Carelon certifies it as medically necessary. Recreate provides the outpatient levels. If you need detox or residential treatment first, we refer you to a partner program and bring you in when you are ready to step down.
| Level of care | Covered by The Empire Plan | At Recreate |
|---|---|---|
| Medical detox (drug detoxification services) | Yes, with certification | Referral to a partner detox |
| Residential treatment facility or inpatient rehab | Yes, with certification | Referral |
| Partial hospitalization program (PHP) | Yes, with certification | Yes |
| Intensive outpatient program (IOP) | Yes, with certification | Yes |
| Outpatient therapy, individual counseling and group therapy | Yes | Yes |
| Family therapy and family counseling programs | Yes | Yes |
| Dual diagnosis treatment | Yes | Yes |
| Medication-assisted treatment | Medication management and naltrexone, acamprosate, disulfiram or buprenorphine through the prescription drug program; counseling through the MHSU program | Coordinated with prescribing providers |
| Aftercare planning and alumni support | Yes, as outpatient care | Yes |
Mental health conditions without a substance use diagnosis are covered under the same program and the same rules, with no separate coverage limitations. Recreate treats depression, anxiety, trauma and related conditions at the PHP and IOP level alongside addiction.
What you will pay
The Empire Plan’s cost sharing depends on which benefit level applies, and on your enrollment group, because State, local government, retiree and some union-negotiated groups carry slightly different copayments and deductibles. The structure is the same for everyone.
| Network provider | Non-network provider | |
|---|---|---|
| Deductible | None | Annual deductible applies first |
| Your share after deductible | Flat copayment per visit or per day | Coinsurance, a percentage of the allowed amount |
| Charges above the allowed amount | Not permitted | May be billed to you |
| Claims | Filed by the provider | Often filed by you |
| Maximum out-of-pocket per year | Yes | Yes, separate and higher |
The exact figures are printed in your Empire Plan certificate and other policy documents and change with each plan year, so we do not list them here. Coverage levels differ by enrollment group, and your out-of-pocket expenses follow the group you are in. Our benefits check pulls the numbers for your group and converts them into an estimate for the program we recommend.
One cost that is often missed: Carelon certifies care in blocks and reviews progress every several days. If a review approves less time than our clinicians recommend, you can appeal, and we support the appeal with clinical documentation. We tell you before that situation arises, not after.
How to verify your Empire Plan benefits
- Have your Empire Plan card ready. We need the member ID and your enrollment group (State, local government, retiree) if you know it.
- Call or complete the confidential form on this site. An admissions counselor takes your insurance information and a few details about what is going on.
- We contact Carelon, confirm active coverage, whether network or non-network benefits apply at Recreate, your deductible status and copayment or coinsurance, and what certification is needed for PHP or IOP.
- You receive a written estimate for the level of care we recommend, before you agree to anything.
- If you move forward, our precertification support handles the Carelon request and we schedule your intake. Same-week admission is usual.
You can confirm independently by calling the Mental Health and Substance Use Program number on the back of your card and asking whether Recreate Life Counseling in Boynton Beach, Florida is a Carelon network provider, and what your benefits are for partial hospitalization and intensive outpatient treatment. We encourage members to check for themselves.
Empire Plan members also have access to a 24-hour clinical line through the same number, which can authorize an emergency assessment at any time. If you are in crisis, use it or call 988.
Choosing a rehab that accepts NYSHIP
Accepting The Empire Plan is the minimum. Many out-of-state facilities will take it, and the quality of what you get for it varies more than the coverage does. Six things separate reputable programs from the rest.
An accredited facility. Look for The Joint Commission or CARF, plus a current state license. Recreate Life Counseling is accredited by The Joint Commission, and you can check that record yourself.
Evidence-based treatments at the core. Cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, trauma-focused therapy and medication-assisted treatment have research behind them. Holistic interventions such as yoga, mindfulness and fitness are a useful complement, but a program that leads with them and cannot describe its clinical model is a warning sign.
A straight answer on network status. Ask whether the facility is an in-network facility with Carelon for The Empire Plan or bills as non-network. Either can be the right choice, but a program that is vague about it is hiding the number that decides your cost.
Insurance verification before you commit. You should have a written estimate of your out-of-pocket expenses in hand before you travel. If a facility wants you on a plane first, keep looking.
The right level of care, not the most expensive one. A good program assesses you and recommends from the full range of levels of care. Be cautious of anyone who quotes a fixed length of stay before meeting you.
Help with the paperwork. Prior authorizations, Carelon reviews and claims are the facility’s job. The admissions team should tell you who handles each and what happens if Carelon approves less time than the clinicians recommend.
Questions to ask on your first call:
- Are you a Carelon network provider for The Empire Plan, or non-network?
- Who requests certification, and before or after I arrive?
- What is my estimated cost for PHP and for IOP under my enrollment group?
- Who is my primary therapist and what is their license?
- What does aftercare look like when I return to New York?
Frequently asked questions
Is NYSHIP the same as The Empire Plan? NYSHIP is the program; The Empire Plan is its main health plan. Most NYSHIP members are in The Empire Plan. Members in an NYSHIP HMO have different rules.
Can I use The Empire Plan for rehab outside New York? Yes. The Mental Health and Substance Use Program covers care anywhere in the United States, at network providers and at non-network providers with higher cost sharing.
Do I need a referral from my doctor? No. The Empire Plan does not require a primary care referral for behavioral health. It does require Carelon to certify PHP, IOP and higher levels of care before they begin.
Will my employer find out? No. Claims are processed by Carelon, not by your agency. Your records are protected under HIPAA, and substance use treatment records have additional protection under 42 CFR Part 2.
Does The Empire Plan cover mental health treatment without a substance use problem? Yes, under the same program. PHP and IOP for depression, anxiety, trauma and related conditions are covered on the same terms.
What if Carelon denies or cuts short my treatment? You have the right to an internal appeal and, after that, an external review. We support appeals with clinical documentation. Our admissions team can walk you through the first step.
Written by: The Recreate Life Counseling Editorial Team
Published on: March 31, 2019
Updated on: October 30, 2026
