Prior Approval Rate Changes

PW_B155700

2015 Notification of Rate Change Request for Small Groups

06/2014  
We have submitted a rate change request to the New York Department of Financial Services (NYDFS) to modify premium rates for our Small Group plans. 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 small group 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 June 2014 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 have any other questions, you can contact us by sending an email to Empire at premiumratechange@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/healthinsurancepremiums or by contacting:  

NYS Department of Financial Services
Health Bureau — Premium Rate Adjustments
1 State Street
New York, NY 10004

 
You may also reach the DFS at premiumrateincreases@dfs.ny.gov or by calling (800) 342-3736. 

SMALL GROUP PRODUCTS
Employer
Letter

Member
Letter

Narrative
Summary

• Empire Preferred Guided Access Plus
HMO with HSA – ghab 
• Empire Core Guided Access Plus
EPO with HSA – gugb 
• Empire Essential Guided Access Plus
EPO – gwoa  
• Empire Essential Guided Access Plus
EPO (with adult dental) – gwoa 
• Empire Essential Guided Access Plus
EPO with HSA – gbcb  
• Empire Core Guided Access Plus
EPO with HSA – gwgb  
• Healthy New York HMO – gpbf 
 

NY Small Group 2014 Changes

We began mailing the second round of required notifications to impacted Small Groups and members in October 2013 to tell them about their mapped product, rates and other 2014 options.  Notifications will be mailed 60-90 days prior to the group's renewal date, starting with January 2014 renewals.   
 
Sample Small Group 2nd Discontinuance Notice: 

Small Group Product
Group Notice
Group Benefit / Rate Grid (rates differ by quarter)
Supporting Materials
Member Notice
Member Benefit / Rate Grid (rates differ by quarter)
Vision Benefit Grid
(only applies to groups with a vision plan)

Empire Direct HMO/HMO 
Empire PPO
Option 1 
Empire PPO
Option 2 
Empire Essential EPO Option 10 
Empire Total Blue H.S.A Option 3 

 
09/15/2013  
We will roll out a new product portfolio beginning January 1, 2014 that meets the 2014 requirements of the Affordable Care Act (ACA). Eligible small groups may transition to a new small group plan that will comply with the requirements of the ACA, including offering all “Essential Health Benefits”. We will designate a new policy that meets the ACA rules to small groups to replace their policy that is being withdrawn. Groups will be free to pick any other coverage we offer or to purchase coverage on the New York Health Benefit Exchange if they choose.  
Starting January 1, 2014, all existing small group policies will end and be replaced with a new policy and new premium rates. This change will take effect on the group’s renewal / issuance date in 2014.  
We began mailing the required notifications to impacted small group policyholders in September 2013 to announce the upcoming changes for 2014. There will be a second notice later this year with more details about available products and rates.  

PRODUCT
Employer Letter
Member Letter
Small Group Direct HMO/HMO Option 12
Small Group PPO Options 1 and 2
Small Group Total Blue PPO H.S.A Option 3
Small Group Essential EPO Option 10
Groups with renewal date changes  
Small Group Direct HMO/HMO Option 12
Small Group PPO Options 1 and 2
Small Group Total Blue PPO H.S.A Option 3
Small Group Essential EPO Option 10

 

Healthy NY Small Group Changes Effective January 1, 2014

We began mailing the second round of required notifications to impacted Healthy NY groups and group members in September 2013 with details about the new HNY plan, available products and rates.  

PRODUCT
Employer Letter
Member Letter
Benefit Comparison Grids
Healthy NY Group 

 

2013 – 2014 Changes

The New York Department of Financial Services has advised New York health insurance carriers of major changes to the Healthy NY program. Beginning January 1, 2014, Healthy NY will no longer be available for individuals or sole proprietors and the program for small employers will change. All current Healthy NY coverage in place at 11:59 PM on December 31, 2013 will be discontinued. This includes grandfathered coverage. Eligible small groups may transition to a new small group Healthy NY plan that will comply with the requirements of the Affordable Care Act, including offering all “Essential Health Benefits”. (The new Healthy NY small group plan will be the standard HMO plan at the “gold metal” level. Different premium rates will apply.) Individuals and families will be able to shop for and enroll in coverage on the New York Health Benefit Exchange beginning in October 2013 for coverage starting January 1, 2014.  
We began mailing the required notifications to impacted Healthy NY policyholders on June 21, 2013 to announce the upcoming coverage and premium changes for 2014.  There will be a second notice later this year with more details about available products and rates. 

PRODUCT
Employer Letter
Member Letter
Healthy NY Group 
Healthy NY Individual 
N/A 
 

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

 
Based on Reg 145: "(iii) For the second year, if no rate adjustment has been approved or filed as part of a second year rate adjustment (as appropriate), then the highest first-year rate (106.12 in the above example) remains in effect."  
 

PRODUCT
Employer Letter
Rate Grid
Member Letter
Narrative Summary
Healthy NY Group 

PDF Format

PDF Format

PDF Format

PDF Format

Healthy NY Individual 

N/A

PDF Format

PDF Format

PDF Format

Small Group Essential EPO Option 10 

PDF Format

PDF Format

PDF Format

PDF Format

Small Group Direct HMO/HMO 

PDF Format

PDF Format

PDF Format

PDF Format

Small Group PPO Options 1 and 2 

PDF Format

PDF Format

PDF Format

PDF Format

Large Group Direct HMO/HMO 

N/A

PDF Format

N/A

PDF Format

 

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 

PDF Format

N/A

PDF Format

PDF Format

Healthy NY Individual 

N/A

N/A

PDF Format

PDF Format

Small Group Essential EPO Option 10 

PDF Format

PDF Format

PDF Format

PDF Format

Small Group Direct HMO/HMO 

PDF Format

PDF Format

PDF Format

PDF Format

Large Group Direct HMO/HMO 

PDF Format

PDF Format

PDF Format

PDF Format

Small Group PPO Options 1 and 2 

PDF Format

PDF Format

PDF Format

PDF Format

         
 

2012 Notification of Rate Change Request

10/31/11 

PRODUCT
Employer Letter
Rate Grid
Member Letter
Narrative Summary
Healthy NY 

PDF Format

PDF Format

PDF Format

PDF Format

Healthy NY Individual 

N/A

PDF Format

PDF Format

PDF Format

Essential EPO Option 10 

PDF Format

PDF Format

PDF Format

PDF Format

HMO Downstate 1 & 2
(April renewal effective date) 

PDF Format

PDF Format

PDF Format

PDF Format

HMO MidHudson
(April renewal effective date) 

PDF Format

PDF Format

PDF Format

PDF Format

HMO Capital Upstate 1 & 2
(April renewal effective date) 

PDF Format

PDF Format

PDF Format

PDF Format

HMO Downstate 1 & 2
(May renewal effective date) 

PDF Format

PDF Format

PDF Format

PDF Format

HMO MidHudson
(May renewal effective date) 

PDF Format

PDF Format

PDF Format

PDF Format

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

PDF Format

PDF Format

PDF Format

PDF Format

PPO Option 1 

PDF Format

PDF Format

PDF Format

PDF Format

PPO Option 2 

PDF Format

PDF Format

PDF Format

PDF Format

 
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 

PDF Format

PDF Format

Empire EPO Essential Option 10 

PDF Format

PDF Format

HMO Downstate 1 & 2
(April renewals)  

PDF Format

PDF Format

HMO MidHudson
(April renewals)  

PDF Format

PDF Format

HMO Capital Upstate 1 & 2
(April renewals)  

PDF Format

PDF Format

HMO Downstate 1 & 2
(May renewals)  

PDF Format

PDF Format

HMO MidHudson
(May renewals)  

PDF Format

PDF Format

HMO Capital Upstate 1 & 2
(May renewals)  

PDF Format

PDF Format

Healthy NY 

PDF Format

PDF Format

Healthy NY Individual 

PDF Format

N/A


 
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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