Offers the benefits of both a traditional HMO (Health Maintenance Organization) for in-network services and the additional freedom to obtain out-of-network POS (Point of Service) medical services
Eligibility
A New York State resident residing within our 28-county service area.
Ineligible for group health insurance coverage.
Between the ages of 18 and 65 and not eligible for Medicare. If you are under age 19, you may be eligible to enroll in Empire's Child Health Plus plan.
Benefits
Under the HMO portion of your Direct Pay HMO/POS contract, you receive full coverage for services that are obtained “in-network”; except for emergency room services. Most covered HMO services require a co-payment. The POS portion of your plan provides coverage for when you choose a provider without a written referral from your PCP or when you choose to see a provider who is out-of-network. This coverage is subject to a deductible, co-insurance, and balance billing (the difference between your Empire coverage and the physician's actual charge).
Covered services include:
Inpatient hospital services consisting of daily room and board, general nursing care and miscellaneous hospital services and supplies
Outpatient hospital services consisting of diagnostic and treatment services
Outpatient surgical facility charges related to a covered surgical procedure
Or contact sales at 888-721-2583, Monday – Friday 8:30 a.m. – 5:00 p.m. EST for more information.
A completed application received by the 15th of the month will be effective the first day of the following month. Applications received after the 15th of the month will be effective the first day of the month after that.
Please be sure to indicate your coverage choice for the HMO/POS contract in question # 11.
Cost
No payment is required with your application; a bill for the cost of your monthly premium rate will be mailed to you once you are enrolled.
