Presentation on theme: "Empire BCBS 2014 Individual Products. 22 Key Facts: 75% the size of the larger HMO Provider network 75+ hospitals in the Pathway Network The network."— Presentation transcript:
22 Key Facts: 75% the size of the larger HMO Provider network 75+ hospitals in the Pathway Network The network can be accessed through Provider Finder at www.empireblue.com www.empireblue.com 28 county New York Service Area for HMO products 28 county New York Service Area for EPO products Under the EPO, members who reside outside of the 28 county NY service area can use Blue Card. Pathway Network
33 Empire’s operating area is dividing into five rating regions for all medical products Rates are based on the following locations: Albany (region 1): Albany, Columbia, Fulton, Green, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington Long Island (region 8): Nassau and Suffolk Mid-Hudson (region 3): Delaware, Dutchess, Orange, Putnam, Sullivan and Ulster New York City (region 4): Bronx, Kings, New York, Queens, Richmond, Rockland and Westchester Upstate (region 7): Clinton and Essex Consolidation of rating regions
44 Empire’s Individual OFF Marketplace portfolio (non-child only plans) Plan Name Deductible Single/ Family Office Visit Network Coins Annual Out of Pocket Max Single/ Family Pharmacy Inpatient Hospital Emergency Room (Facility) Urgent Care PCPSpecialist BRONZE Empire Core Guided Access - caat $5,800/ $11,600 $45 2 OV with copay; 3+ OV Ded/Coins Ded/ Coins20% $6,350/ $12,700 Ded/ Coins $1000 Copay then Ded/ Coins $200 Copay then Ded/ Coins $50 Copay then Ded/ Coins Empire Core Guided Access - cabs $4,000/ $8,000 $35 3 OV with copay; 4+ OV Ded/Coins Ded/ Coins40% $6,350/ $12,700 Ded/ Coins $1,000 Copay then Ded/ Coins $200 Copay then Ded/ Coins $50 Copay then Ded/ Coins SILVER Empire Essential Guided Access w/HSA - cbib $2,450/ $4,900 Deductible/ Coinsurance10% $6,350/ $12,700 Ded/ Coins Ded then $1,000 Copay & Coins Ded then $200 Copay & Coins Ded then $50 Copay & Coins Empire Essential Guided Access - cbjw $2,250/ $4,500 $30 Copay (No Ded) Ded/ Coins25% $5800/ $11,600 Ded/ Coins $1,000 Copay then Ded/ Coins $200 Copay then Ded/ Coins $50 Copay then Ded/ Coins GOLD Empire Preferred Guided Access - cecb $1,000/ $2,000 $30 Copay (No Ded) Ded/ Coins10% $6,250/ $12,500 Tier 1 - $15 Tier 2 - $40 Tier 3 - Ded/Coins $1,000 Copay then Ded/ Coins $200 Copay then Ded/ Coins $50 Copay then Ded/ Coins PLATINUM Empire Premier Guided Access - cazd $200/ $400 $25 Copay (No Ded) Ded/ Coins5% $3,400/ $6,800 Tier 1 - $15 Tier 2 - $40 Tier 3 - Ded/Coins $500 Copay then Ded/ Coins $200 Copay then Ded/ Coins $50 Copay then Ded/ Coins The above is a summary. See the Certificate of Coverage with the Schedule of Benefits and any riders associated with the plan for complete coverage details and related terms and conditions.
55 To be eligible, an individual must live in one of the 28 counties where Empire is licensed to sell Open Enrollment: ▪Plans can be purchased once a year through an open enrollment period 1/1/14 effective date – open enrollment from 10/1 to 12/15 Post 1/1/14 effective date – open enrollment from 12/16/13 to 3/31/14 Effective date assignment rules will be the same for ON and OFF the Individual Marketplace ▪If application received 1 st – 15th, effective 1st of next month ▪If application received 16th – EOM, effective 1st of following month Exception: Newborns and adopted children can be added or enrolled in a plan as of the date of birth or placement as long as we are advised within 60 days. Individual Enrollment