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What is Empire's 360° Health® program?
A total health solution that helps members become more healthy, or live better with a condition, while lowering the cost of health care.
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MediBlue PPO

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MediBlueSM PPO Plans

MediBlue PPO Essential 
MediBlue PPO Plus 
MediBlue PPO is a family of Medicare Advantage PPO plans for Medicare beneficiaries.

Available to all Medicare beneficiaries through a contract with the federal government

Access to our entire network of physicians

No requirement to select a PCP

Use doctors outside of our network

For information about the new Medicare Part D Prescription Drug benefit click here.

 
Eligibility

MediBlue PPO Plus is our Medicare Advantage Prescription Drug (MAPD) PPO Plan.

MediBlue PPO Essential is our Medicare Advantage (MA) PPO plan (without prescription drug coverage).

MediBlue PPO is available to anyone who is a resident of Albany, Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Sullivan, Ulster and Westchester.

If you don’t have Medicare Part A, you must purchase it from Social Security.I

 
Benefits
MediBlue includes all of the benefits offered under Medicare Part A (hospital) and Part B (medical) plus many other important benefits that Medicare beneficiaries may need, as highlighted below. II* 

Unlimited routine physical exams.

Immunizations.

Annual routine gynecological exams.

Annual vision exam and glasses (frames and lenses) every two years. III

Annual hearing exam and no co-payments on hearing aids, coverage up to $1000 towards the purchase of two hearing aids (one for each ear) every three years.III

Unlimited days for inpatient hospital medical care as medically necessary.

Emergency and urgently needed care anywhere in the world.*

Copayments for most in-network and out-of-network services.

Enrollment in the Silver Sneakers Fitness Program®1 offering fitness center membership, including group exercises classes, at no additional cost to you. Go to www.silversneakers.com for more information and to locate a participating fitness facility near you.

Toll-free, 24-hour telephone access to a health information service with specially trained registered nurses to help with your health concerns.

 
Using in-network doctors and services helps keep your costs low. Please note that using out-of-network services may have higher cost sharing.  
 
Part D Medicare Prescription Drug Benefit
MediBlue PPO Plus offers the Medicare Part D prescription drug benefit. This plan offers prescription drug coverage with no annual deductible and easily defined co-payments  
Click here for more information on the Medicare prescription drug benefit, or click on our Summary of Benefits below for the plans available in your area. For more details regarding the benefits offered by our plans, please review our Evidence of Coverage.  

    Region
 
  Downstate
Upstate
MediBlue PPO Plan Brochure 

PDF Format

PDF Format

Evidence of Coverage 2008  
   
 
MediBlue PPO Plus  
(Dutchess, Orange, Putnam, Rockland, Suffolk, Sullivan, Ulster and Westchester counties) 

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N/A

 
MediBlue PPO Plus  
(Bronx, Kings, Nassau, New York, Queens and Richmond counties) 

PDF Format

N/A

 
MediBlue PPO Plus  
(Albany, Rensselaer, Saratoga and Schenectady counties) 

N/A

PDF Format

 
MediBlue PPO Essential 

PDF Format

PDF Format

MediBlue PPO Plus Prescription Drug Formulary 

PDF Format

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Grievance & Appeals Information (for plans with prescription drug benefits) 

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Quality Assurance (for plans with prescription drug benefits) 

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Prescription Drug Claim Form 

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How to Enroll
If you are enrolling in MediBlue or would like more information  
If you live in Albany, Rensselaer, Saratoga or Schenectady, click here for the enrollment application.
If you live in Nassau, Suffolk, Rockland, Westchester, Putnam, Orange, Duchess, Ulster or Sullivan county you may choose our PPO Essential or PPO Plus plan. If you live in Bronx, New York, Richmond, Kings or Queens county you may choose our PPO Plus plan. Click here for the enrollment application.
If you have questions or would like a MediBlue Enrollment Kit sent to you within 7-10 days email MediBlue@empireblue.com
Write to:

Enrollment Processing Center
P.O. Box 5007
Middletown, NY 10940-9007

Call 1-800-809-7328, seven days a week 8am-8pm. Our hours of operation after March 1 are Monday – Friday, 8a.m. – 8 p.m.
For the hearing impaired, the TTY/TDD number is 1-800-241-6894
Learn more about MediBlue PPO and Medicare by attending one of our seminars
 
Cost
Premiums and cost sharing vary by plan. Please click on the county in which you reside to access the Summary of Benefits for the plans available in your area. 

 

Bronx, Kings, New York, Queens and Richmond Counties

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Westchester, Rockland, Dutchess, Putnam, Orange, Ulster and Sullivan Counties

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Nassau County MediBlue PPO Plus

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Nassau County MediBlue PPO Essential

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Suffolk County

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Albany, Schenectady, Saratoga and Rensselaer Counties

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LIS Premium Summary Chart – Downstate

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LIS Premium Summary Chart  - Upstate

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As a member, you must continue to pay your Medicare Part B monthly premium. 
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