Prior
PW_B155700
2013 Prior Approval Decision Notice
02/18/2013
In November 2012, we communicated our rate increases planned for 2013. Since then, Empire has received approval from the New York Department of Financial Services (DFS) to modify premium rates for new and renewing groups starting on May 1, 2013 for Small Group & Healthy New York and July 1, 2013 for Large Group.
Impacted plans are:
Small Group (SG):
 | Effective 5/1/2013 for new business and upon renewal for existing |
 | (Applies to Small Group’s with renewal dates between 5/1/13 – 3/31/14) |
 |  | Empire Direct HMO / HMO |
 |  | Empire Essential EPO option 10 |
 |  | Empire PPO options 1 and 2 |
 | Effective on 5/1/2013 |
 |  | Healthy NY: Group and IIP Individuals (direct pay) |
Large Group (LG)
 | Effective 7/1/2013 for new business and upon renewal for existing |
 | (Applies to Large Group’s with renewal dates between 7/1/13 – 3/31/14) |
 |  | Empire Direct HMO / HMO |
PRODUCT
|
Employer Letter
|
Rate Grid
|
Member Letter
|
Narrative Summary
|
Healthy NY Group
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Healthy NY Individual
|
N/A
|

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Small Group Essential EPO Option 10
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Small Group Direct HMO/HMO
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Small Group PPO Options 1 and 2
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Large Group Direct HMO/HMO
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N/A
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N/A
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2013 Notification of Rate Change Request
11/08/12
Rising medical costs and the growing use of medical goods and services continue to drive health care costs higher. Due to these increasing costs, we have submitted a rate change request to the New York Department of Financial Services (NYDFS) to modify premium rates. New York State law requires that health insurance carriers provide an initial notice to you when we submit requests for premium rate changes to the NYDFS. The law also requires that we explain any proposed rate change. Therefore, the below grid outlines the requested rate changes for specific products. The submitted rate change requests are pending NYDFS approval. A narrative, which explains the proposed rate change requests, can be found in the below grid.
Since the NYDFS must approve all community rates, the actual rate increase will not be available until approval is received. At that time, we will send you another notice. The second notice, which we will send to you at least 60 days prior to the effective date of the rate change, will include the approved rate changes. You have 30 days from the date of our filing to contact Empire or the DFS to ask for more information about the rate-change filing, or to submit written comments to the DFS. If you would like to know the dates of the 30 day comment period, or for any other questions, you can contact us by sending an email to Empire at mpremiumratechange@empireblue.com. If you are an employee, call the customer service number on the back of your member ID card. Written comments submitted to the DFS will be posted on the website of the DFS with all personal identifying information removed. Comments may be submitted to the DFS online at www.dfs.ny.gov/insurance/health/prior_app/prior_app.htm or by contacting:
Department of Financial Services
Health Bureau-Premium Rate Adjustments
25 Beaver Street, New York, NY 10004
You may also reach the DFS at premiumrateincreases@dfs.ny.gov or (800) 342-3736.
PRODUCT
|
Employer Letter
|
Rate Grid
|
Member Letter
|
Narrative Summary
|
Healthy NY Group
|

|
N/A
|

|
|
Healthy NY Individual
|
N/A
|
N/A
|

|
|
Small Group Essential EPO Option 10
|

|
|

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Small Group Direct HMO/HMO
|

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Large Group Direct HMO/HMO
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Small Group PPO Options 1 and 2
|

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2012 Notification of Rate Change Request
10/31/11
PRODUCT
|
Employer Letter
|
Rate Grid
|
Member Letter
|
Narrative Summary
|
Healthy NY
|

|
|

|
|
Healthy NY Individual
|
N/A
|

|
|

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Essential EPO Option 10
|

|
|

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HMO Downstate 1 & 2
(April renewal effective date)
|

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HMO MidHudson
(April renewal effective date)
|

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HMO Capital Upstate 1 & 2
(April renewal effective date)
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HMO Downstate 1 & 2
(May renewal effective date)
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HMO MidHudson
(May renewal effective date)
|

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HMO Capital Upstate 1 & 2
(May renewal effective date)
|

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PPO Option 1
|

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PPO Option 2
|

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2012 Rate Increases
 | Premium rates for some of the remaining Small Group products will increase beginning April 1, 2012. Below are the letters, which also include the rate grids that were mailed to groups, 60 days prior to their renewal date. |
PRODUCT
|
Member Prior Approval Letter
|
Employer Prior Approval Letter
|
Empire PPO Options 1 & 2
|

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|
Empire EPO Essential Option 10
|

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|
HMO Downstate 1 & 2
(April renewals)
|

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HMO MidHudson
(April renewals)
|

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HMO Capital Upstate 1 & 2
(April renewals)
|

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HMO Downstate 1 & 2
(May renewals)
|

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HMO MidHudson
(May renewals)
|

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HMO Capital Upstate 1 & 2
(May renewals)
|

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Healthy NY
|

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Healthy NY Individual
|

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N/A
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Rate notices have been included in Empire’s Healthy NY pre-enrollment kits. Click here to view pre-enrollment rate notice.
Here are a few details about the plans Empire will continue to offer:
Product
|
In-network deductible
|
In-network coinsurance
|
In-network
out of pocket max
|
PCP office visit cost share
|
Specialist office visit cost share
|
Inpatient
cost share
|
Direct HMO Option 12
|
$0
|
$0
|
$0
|
$30
|
$50
|
$1,000
|
HMO Opt. 12 (Gatekeeper)
|
$0
|
$0
|
$0
|
$30
|
$50
|
$1,000
|
PPO Option 1
|
$1,000
|
10%
|
$3,000
|
$45
|
$60
|
Ded/
Coinsurance
|
PPO Option 2
|
$1,500
|
20%
|
$4,500
|
$45
|
$60
|
Ded/
Coinsurance
|
EPO Essential Option 10
|
$4,000
|
20%
|
$10,000
|
$30
|
$50
|
Ded/
Coinsurance
|
Total Blue HSA Option 3
|
$2,000
|
20%
|
$5,000
|
Ded/
Coinsurance
|
Ded/
Coinsurance
|
Ded/
Coinsurance
|
You may purchase any of these products with or without prescription drug coverage. Empire will also continue to offer the Healthy New York product.
December 2011
The plans listed directly below are being discontinued on renewal starting April 2012. We’re withdrawing some products as part of an effort to reduce financial losses in our Small Group plans. We’re also applying rate increases to the products that will remain available.
Small Group Product Withdrawals
Starting April 1, 2012, Empire will no longer offer these plans effective on a group’s renewal date:
 | Empire Point of Service (POS) |
 | Empire PPO Plus |
 | Empire Prism EPO |
 | Empire EPO Essential Options 1-9 |
 | Empire EPO Stepped |
 | Value EPO |
 | Empire Total Blue PPO with Health Savings Account (HSA) Options 2, 5, 6 |
 | – As a reminder, Empire stopped offering Empire Total Blue PPO Options 7 and 8 with HSA, starting 10/1/11 upon renewal. |
To view the letter that was mailed to employers, click here.
To view the letter that was mailed to impacted members, click here.
Small Group Products Remaining
We will still offer these Small Group products:
 | Direct HMO Option 12 |
 | HMO Option 12 (Gatekeeper) |
 | Empire PPO Option 1 |
 | Empire PPO Option 2 |
 | Empire EPO Essential Option 10 |
 | Empire Total Blue (CDHP) Option 3 |
Empire will also continue to offer Healthy New York to eligible Small Groups. Starting January 1, 2012, the state has advised that only the high-deductible Healthy New York plan is available for new sales. Groups that already have the Healthy New York standard plan may keep it.
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