Medical & Pharmacy Benefits

Medical Network Benefits

NYSIF offers a medical provider network for workers’ compensation claimants.

Locate a medical network provider in New York State.

Locate a medical network provider in all other states (select Coventry Integrated Network in the Networks drop-down menu).

Request a local provider listing at 1-800-842-2917.

Medical benefits cover hospitalization, doctor services, dentistry, physical therapy, chiropractic, x-rays, laboratory tests, nursing services, and durable medical goods.

Claimants have the right to choose any medical provider authorized by the Workers’ Compensation Board to provide medical care for work-related injuries or illnesses.

Pharmacy Network Benefits

Claimants pay no out-of-pocket expenses for prescription medication for work-related injuries or illnesses when they use NYSIF's prescription benefits program through the CareComp Network of CVS Caremark.

If a claimant is prescribed medication for a work-related injury or illness, it must be filled at a pharmacy within the CareComp pharmacy network.

Use the CVS Caremark Pharmacy Locator or call CVS Caremark at 1-866-493-1640 to find a local network pharmacy. Claimants who have not received a CVS Caremark card should contact their NYSIF case manager.

Exceptions to the mandate for claimants to fill prescriptions in-network are listed below. Claimants must obtain medication from a network pharmacy unless they qualify under one of the following exceptions:

  • The claimant is refilling an existing prescription – they must switch to an in-network pharmacy within 60 days for a non-controlled substance and 90 days for a controlled substance.
  • The claimant lives in either (a) a rural area, and there is not a network pharmacy within 15 miles or (b) a non-rural area, and there is not a network pharmacy within five miles, and one of these two circumstances applies:
    • the claimant is unable to order by mail or telephone in the network, and no pharmacy in the network will deliver to the claimant; or
    • the claimant has a medical emergency, and it is not reasonably possible for a network remote pharmacy to deliver medications needed for that emergency within the time prescribed by the doctor

 

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