Y0114_18_37167_U CMS ACCEPTED 09/25/2018
Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Empire HealthChoice HMO, Inc. (Empire) is the legal entity that has contracted with the Centers for Medicare & Medicaid Services (CMS) to offer the HMO plan noted above or herein. Empire is the risk-bearing entity licensed under applicable state law to offer the HMO plan(s) noted. Empire has retained the services of its related companies and the authorized agents/brokers/producers to provide administrative services and/or to make the HMO plan(s) available in this region. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent or insurance company.
Once enrolled into your Medicare Supplement insurance plan, your coverage is guaranteed for the life of the plan with only two exceptions/restrictions: nonpayment of premiums and material misrepresentation.
This policy meets the minimum standards for MEDICARE SUPPLEMENT INSURANCE as defined by the New York State Department of Financial Services. The expected benefit ratio for this policy is 65%. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy.
Products offered are not connected with or endorsed by any division or agency of the state of New York, the United States government, or the Federal Medicare program.
The policy form numbers are: APLANAM(17)-NY BCBS; APLANBM(17)-NY BCBS; APLANFM(17)-NY BCBS; APLANGM(17)-NY BCBS; and APLANNM(17)-NY BCBS.
IMPORTANT NOTICE - A CONSUMER’S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY OFFICE OR FROM THIS INSURER
This information is not a complete description of benefits. Call Customer Service, (TTY:711) for more information.
Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意：如果您使用非英語的其他語言，您可以免費獲得語言援助服務。請致電聯絡客戶服務部（聽語障用戶請致電：711）。