NEW YORK EDITION

FEBRUARY 2009

100% coverage of in-network preventive care is expanding!

We want to give you a preview of an important change that we are making to our medical plans that will be effective for new groups and existing groups upon renewal beginning June 1, 2009. This will be effective for fully-insured small and large groups. 

Coverage of preventive care is expanding: Empire EPO, Value EPO, PPO, Direct POS and DirectShareSM POS plans will cover preventive benefits at 100 percent for covered services in-network with no member copayment. These services include, among others: annual physical exams, well-woman and well-child care, and certain preventive vaccinations.

As required, Empire will notify all renewing groups 74 days prior to their effective date, of the upcoming changes to their plan. For your convenience, here is a sample of the letter being mailed.  

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INDEX

 

> 100% coverage of in-network preventive care is expanding!

 

> Important update: HMO and Direct HMO changes delayed

 

> COBRA Benefits Affected by American Recovery and Reinvestment Act

 

> Have you heard? Selling Prism EPO is now as easy as 1-2-3!

 

> Direct deposit for commissions is still available!

Update: HMO and Direct HMO changes delayed

The changes to preventive care cost sharing to provide for 100% in-network coverage and the application of certain cost-sharing increases for other services for our Large Group and Small Group HMO and Direct HMO plans that we recently advised you of have been delayed.   We want you to know that, although we fully intend to make these changes, they will not take effect beginning with April 1, 2009 renewals.

Prior to the decision to delay these changes, we had notified HMO/Direct HMO groups that have renewals dates in the month of April. Shortly, we will re-mail these groups with an update on this delay. A sample of this letter is available for your reference.

Later this year, we plan to begin to implement the changes for these plans, which will be effective upon the groups' renewal dates effective in 2010. We will notify you prior to their implementation.

COBRA Benefits Affected by American Recovery and Reinvestment Act

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act (the "Act"), which includes several important changes to COBRA.

The Act provides for a federal subsidy of 65 percent of the COBRA continuation coverage premiums for qualified beneficiaries receiving COBRA continuation coverage due to the covered employee's involuntary termination of employment between September 1, 2008, and December 31, 2009.

Please see the attached overview for more information.

Have you heard? Selling Prism EPO is now as easy as 1-2-3!

We recently introduced a new PRISM EPO option to our Small Group Prism plans. Based on feedback and results, it's already a winner! This additional option, along with a wide range of pharmacy drug plans, gives your clients more choices - and more ways to potentially help them lower their year-over-year increase in 2009.

Quoting is available on HealthConnect and Empire Broker Online Services. Quote Prism EPO Opition 3 today!

New Small Group Prism EPO Option 3 highlights:

  • $45 Primary Care Physician and Specialist copay 
  • In-patient Hospital copay: $500/day with three-day maximum 
  • Radiology (MRI/MRA, PET, CT scan, etc) & X-rays: $45 copay

As with all Small Group EPO Prism options, enrolled members benefit from:

  • No deductible with 100% preventive care coverage in network
  • No referrals - specialist referrals are not required
  • Wide-reaching network - access to 668,000 physicians and hospitals across the country, as well as 82,000 doctors, hospitals and specialists in New York and bordering counties in New Jersey and Connecticut through the BlueCard® PPO program1
  • More of the best doctors - more of New York Magazine's Top Doctors the ninth year in a row2
  • Most of the best hospitals - 95% of the "best" hospitals as listed in U.S. News & World Report3
  • A whole suite of health and wellness offerings - Empire's 360o Health® program offers 24/7 NurseLine, Care Management, health and fitness discounts and more

Please contact your Empire sales representative with questions.

1 Blue Cross and Blue Shield Association PPO/EPO network-comparison data and data from websites of other national carriers as of August 2007. Network data includes the BlueCard® program, an extensive network of doctors, hospitals and other providers that participate in independent BlueCross and BlueShield plans across the country.

2 Based on lists in New York magazine's 6/08/08 issue and searches of competitors' websites.
3 Most of the "Best Hospitals" included in the 2006 U.S. News & World Report list.  

 

 

Are you utilizing Direct Deposit for commissions?

Save a trip to the bank! Have your Empire commission payments automatically deposited into your bank account for faster, easier access.

To take advantage of commission direct deposit, you must use the Automatic Deposit Enrollment Form that will be included with your Commission Statement. Look for it in your next commission mailing! Specific instructions will be included on the form. It will take up to two payment cycles to process the form.

Please call your Empire Sales Representative if you have questions.









Empire BlueCross BlueShield Producer Newsletter


 

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State.