Notice of Proposed Rate Action

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*

PDF Format

PDF Format

PDF Format

PDF Format

01/01/2015

Empire BlueCross Medicare Supplement products **

PDF Format

PDF Format

PDF Format

PDF Format

01/01/2015  
 
Individual Health Care Plans  

PRODUCT
Empire BC** Narrative Summary
Empire BC** Member Initial Letter
Empire BCBS* Narrative Summary
Empire BCBS* Member Initial Letter
Rate
Grid

Proposed Effective Date

Empire Catastrophic Guided Access, $6350 Single Deductible

PDF Format

PDF Format

N/A  
1/1/2015 

Empire Bronze/Core Guided Access, $5800 Single Deductible

PDF Format

PDF Format

N/A  
1/1/2015 
Empire Bronze/Core Guided Access w/HSA, $3000 Single Deductible  

PDF Format

PDF Format

N/A  
1/1/2015 
Empire Bronze/Core Guided Access, $4000 Single Deductible  

PDF Format

PDF Format

N/A  
1/1/2015 
Empire Silver/Essential Guided Access, $2250 Single Deductible  

N/A 
1/1/2015 
Empire Silver/Essential Guided Access w/ HSA, $2450 Single Deductible  

N/A 
1/1/2015 
Empire Silver/Essential Guided Access, $2000 Single Deductible  

N/A 
1/1/2015 
Empire Gold/Preferred Guided Access, $600 Single Deductible 

N/A 
1/1/2015 
Empire Gold/Preferred Guided Access, $1000 Single Deductible  

N/A 
1/1/2015 
Empire Platinum/Premier Guided Access, $200 Single Deductible 

N/A 
1/1/2015 
Empire Platinum/Premier Guided Access, $0 Single Deductible 

N/A 
1/1/2015 
Empire Silver/Essential Guided Access w/ HSA, $2450 Single Deductible, a Multi-State Plan 

N/A 
1/1/2015 
Empire Gold/Preferred Guided Access, $1000 Single Deductible, a Multi-State Plan 

N/A 
1/1/2015 
Empire Core Guided Access, $5800 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Core Guided Access, $3000 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Core Guided Access, $4000 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Essential Guided Access, $2250 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Essential Guided Access w/ HSA, $2450 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Essential Guided Access, $2000 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Preferred Guided Access, $600 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Preferred Guided Access, $1000 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Premier Guided Access, $200 Single Deductible with Child Dental 

N/A 
1/1/2015 
Empire Premier Guided Access, $0 Single Deductible with Child Dental 

N/A 
1/1/2015 
 
Individual Health Care Plans  

PRODUCT
Empire BC** Narrative Summary
Empire BC** Member Initial Letter
Empire BCBS* Narrative Summary
Empire BCBS* Member Initial Letter
Proposed Effective Date

Tradition Plus Comprehensive

PDF Format

PDF Format

PDF Format

PDF Format

02/01/2015

Tradition Plus Wraparound

PDF Format

PDF Format

PDF Format

PDF Format

02/01/2015  
 
* If you reside in any of the following counties, please refer to the Empire BlueCross BlueShield information: Bronx, Columbia, Delaware, Dutchess, Greene, 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, Essex, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington. 
 
WPNSF186M(Rev.6/13)-NY 

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