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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.

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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:

1 Empire BCBS 2014 Individual Products

2 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  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

3 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

4 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.

5 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

6 66 6 Empire BCBS 2014 Individual Rates Plan NameNYC Single Rate Bronze Core Guided Access (caat)$ Core Guided Access (cabs)$ Silver Essential Guided Access (cbjw)$ Essential Guided Access w/ HSA (cdib)$ Gold Preferred Guided Access (cecb)$ Platinum Premier Guided Access (cazd)$615.61


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