Members who are enrolled in the New York State Health Insurance Program (either the Empire Plan or Health Maintenance Organization) are entitled to reimbursement once annually for NYSHIP prescription drug co-pays and covered prescriptions less than the co-pay for themselves and their dependents.

  • Only one claim per calendar year (January – December) is processed. Once your co-pays reach $300, the next $100 in prescription drug co-pays is reimbursable. To obtain the maximum benefit of $100, wait until your co-pay expenses reach $400 before filing your claim.
  • If you do not accumulate $400 before the end of the year, submit your claim AFTER DECEMBER 31 for what you did pay over $300. The deadline for submission is March 31 of the following year for the co-pays accumulated during the previous Calendar Year.