Notice

EmpireBlue

PW_E168791

As required by state law, Empire has submitted a premium rate change to the New York State Department of Financial Services (DFS). The rate change request is for new or renewing members. Please note that a second notice will also be sent when the final rates are approved by the New York State Department of Financial Services (DFS). The letters are meant to alert members of their right to comment about rate changes and/or request additional information.

Medicare Supplement Products

PRODUCT	Narrative Summary 1992 Standardized Plans	Narrative Summary 2010 Standardized Plans	Member Pre-Notice Letter	Rate Grid	Proposed Effective Date
Empire BlueCross BlueShield Medicare Supplement products*					01/01/2013
Empire BlueCross Medicare Supplement products **					01/01/2013

Individual Health Care Plans

PRODUCT	Narrative Summary	Member Pre-Notice Letter	Rate Grid	Proposed Effective Date
Empire BlueCross BlueShield Individual HMO and HMO/POS*			N/A	2013 ***
Empire BlueCross Individual HMO and HMO/POS**			N/A	2013 ***
Empire BlueCross BlueShield Indemnity Plans			N/A	01/01/2013
Empire BlueCross Indemnity Plans			N/A	01/01/2013

* If you reside in any of the following counties, please refer to the Empire BlueCross BlueShield information: Bronx, Dutchess, Kings, Nassau, New York (Manhattan), Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, and Westchester.

** If you reside in any of the following counties, please refer to the Empire BlueCross information: Albany, Clinton, Columbia, Delaware, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.

*** The effective date for your rate change is based on your 2013 "anniversary month," which is the anniversary date of the month you first enrolled in your health plan.

WPNSF186M(Rev.5/12)-NY

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