Managing Your Groups
PW_AD067482
Take care of your groups more efficiently, in less time.
Look here for information on how to manage the needs of your groups. But don't forget, the best way to manage accounts is by logging in or registering with Broker Online Services.
See below for information regarding:
 | Customers should use the worksheet attached to the bill to detail billing adjustments or billing discrepancies. |
| All credits or changes approved by Empire approximately two weeks prior to the date the next bill is prepared will be reflected on that bill. |
| All other approved credits or changes will appear on the subsequent bill. |
Empire grants groups a 30-day grace period after the due date, if payment is not received.
| If groups do not pay by the end of the 30-day grace period, we will cancel the group. |
| If Empire receives payment after the 30-day grace period and this is its first or second late payment, we will reinstate the group. |
| When a group is reinstated, Empire mails a letter to inform the group that it has been reinstated and to remind the group that we allow only two such reinstatements within a 12-month period. |
New Business Analysts
Empire has a team of new business analysts who review all credentialing materials prior to processing by Membership & Billing. The new business analysts will assist you in resolving any problems that may arise with the credentialing of new groups and will work closely with Broker Relations to ensure smooth processing of your new business.
| Submit changes ASAP to ensure accurate billing. The fastest way to submit changes is by logging in or registering to Broker Online Services. |
| Changes can be submitted using an Enrollment Form or Adjustment Worksheet. There is no need to submit paper forms if you have submitted the changes online. |
Getting Group Quotes for 2 – 50
There are two ways to get quotes for community-rated accounts:
The fastest way to get a quote is to visit Broker Online Services. | Get quotes instantly |
| Save, modify and compare quotes |
| Available 24/7 |
Empire Broker Relations
Call 1-877-222-7666 to request a quote.
Fax a Request for Proposal (RFP) to 1-718-312-6006 or 1-718-312-6007.
Contact your Empire Sales representative directly.
Getting Group Quotes for 51+
To get a quote, submit a Request for Proposal (RFP) to your Empire Sales representative.
Group accounts from 2 – 50 eligible employees are "community rated."
The New York State Insurance Department approves rates for these contracts. They are set on the basis of actuarial studies and the claims experience of a pool of persons covered under a similar contract in a similar geographic area, rather than on the experience of a specific group or individual.
Group Accounts from 51 – 249 are prospectively (incentive) rated.
Rates are developed using one of two methodologies:
| Manual rate — developed from standard rate tables |
| A blend of manual rates and the group's own claims experience |
Large Accounts of 250 and over are prospectively rated or ASO (Administrative Services Only, available to groups of 1000+).
Rates are developed using one of three methodologies:
| Manual rate — might be used if no claims experience is available |
| A blend of multiple years of the group's own claim experience |
| The group's latest year of claims experience |
The method used will vary depending on group size and the fluctuation and/or the consistency of the claim experience being used.
Termination Dates and Credit
Empire will not retroactively terminate a group member more than the total number of days indicated on the back of the group bill (based on the receipt date of the request).
One of the following forms of documentation will establish the date of our receipt of the group's request to terminate a member's coverage:
| Date stamped on faxed Adjustment Worksheet |
| Empire's date stamp |
Group Termination
Empire requires notification of a group termination 30 days prior to the date of cancellation.
Conversions and Renewal Changes for Groups 2 – 50
Required Documentation for Small Group Conversions and Changes
Adding/deleting a rider
| Letter from group |
One option to another option (same product)
| Letter from group, or |
| Group application |
Group address change
| Letter from group |
| Copy of utility bill |
Changes from one product to another*
| Master application |
| Credentialing documentation |
Tier change
| Letter from group |
Changing Rx option
| Letter from group |
Group Name Change
| Letter from group |
| Copy of New Business Certificate |
Send or fax your change to:
Groups 2 – 10
Fax: 1-800-780-1224
Attention: GBA and Broker Contact Center
Groups 11 – 50
Account Manager
Mailing Address:
Empire BlueCross BlueShield
3 Huntington Quadrangle - 4th Floor
Melville, NY 11747
Conversions and Renewal Changes for Groups 51 – 500
Your Empire account manager will assist you in processing the paperwork for all conversions and group renewal changes.
| Benefit changes (additions and deletions of riders) may occur only at the group's renewal date. |
| A group can change plans (e.g., conversion from an HMO to PPO) at any time. |
| The date of a conversion becomes the group's new renewal date. |
Every Empire group with more than 24 lives receives a dedicated Account Service representative (ASR). The ASR is responsible for helping to resolve any issues the group may have, including:
| Claims adjustments |
| Membership and/or billing issues |
| Access-to-care situations |
| Product/benefit interpretations |
| Clarification of medical policy |
| Resolution of provider/network issues |
| Assistance with open enrollments |
Empire grants groups a 30-day grace period after the due date.
| If groups do not pay by the end of the 30-day grace period, we will cancel the group. |
| If Empire receives payment after the 30-day grace period and this is its first or second late payment, we will reinstate the group. |
| When a group is reinstated, Empire mails a letter to inform the group that it has been reinstated and to remind the group that we allow only two such reinstatements within a 12-month period. |
|