PW_E168791

2017 Notification of Rate Change Request for Individual Grandfathered Plans

10/31/2016 

Individual Grandfathered Products – Sample Member Letter

 

NY Individual 2017 Discontinuance Notification

Some Empire individual plans are being discontinued effective January 1, 2017. Impacted subscribers will not be able to continue with these plans in 2017. These subscribers will have the opportunity to move to a different plan. Empire will continue to offer a range of comprehensive products in the market in 2017. 
The discontinuance impacts approximately 9,000 members. Impacted plans are both on and off the New York State of Health Marketplace. 
The New York State Department of Financial Services (DFS) has approved the discontinuance, and we have mailed discontinuance notices to impacted subscribers. Subscribers will receive them by August 1, 2016. Here are sample notices: 

On-Marketplace: upstate and downstate

Off-Marketplace: upstate and downstate

Impacted subscribers will also receive a discontinuance reminder notice in October.  

Individual plans being discontinued as of January 1, 2017: 

(Note: this lists all plan variations and metal levels being discontinued.)

 
On-Marketplace: 

Empire HMO 5850 X, Bronze, NS, INN, Pediatric Dental, Dep 25

Empire HMO 5850 X, Bronze, NS, INN, Pediatric Dental, Dep 29

Empire HMO 2750 X, for HSA, Silver, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 X, for HSA, Silver, NS, INN, Pediatric Dental, Dep 29

Empire HMO 2750 X, Silver CSR 2, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 X, Silver CSR 2, NS, INN, Pediatric Dental, Dep 29

Empire HMO 2750 X, Silver CSR 3, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 X, Silver CSR 3, NS, INN, Pediatric Dental, Dep 29

Empire HMO 5850 X, Bronze AI, NS, INN, Pediatric Dental, Dep 29

Empire HMO 2750 X, Silver AI, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 X, Silver AI, NS, INN, Pediatric Dental, Dep 29

Empire HMO 5850 X, Bronze AI, NS, INN, Pediatric Dental, Dep 25

Empire HMO 5850 X, Bronze, NS, INN, Pediatric Dental, Dep 25, $0 PCP Office Visit

Empire HMO 5850 X, Bronze, NS, INN, Pediatric Dental, Dep 29, $0 PCP Office Visit

Empire HMO 5850 X, Bronze AI, NS, INN, Pediatric Dental, Dep 25, $0 PCP Office Visit

Empire HMO 5850 X, Bronze AI, NS, INN, Pediatric Dental, Dep 29, $0 PCP Office Visit

Empire HMO 2750 X, Silver CSR 1, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 X, Silver CSR 1, NS, INN, Pediatric Dental, Dep 29

 
Off-Marketplace: 

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 25

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 29

Empire HMO 0, Platinum, ST, OON, Pediatric Dental, Dep 25

Empire HMO 0, Platinum, ST, OON, Pediatric Dental, Dep 29

Empire HMO 0, Platinum, Child Only, ST, OON, Pediatric Dental

Empire HMO 0, Platinum, ST, OON, Pediatric Dental, Dep 25, SNF

Empire HMO 0, Platinum, Child Only, ST, OON, Pediatric Dental, SNF

Empire HMO 0, Platinum, ST, OON, Pediatric Dental, Dep 29, SNF

Empire HMO 6000, Bronze, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 6000, Bronze, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 2750, Silver, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 2750, Silver, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 2250, Silver, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 2250, Silver, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 1000, Gold, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 1000, Gold, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 250, Platinum, NS, INN, Pediatric Dental, Dep 25, FM

Empire HMO 250, Platinum, NS, INN, Pediatric Dental, Dep 29, FM

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 25, $0 PCP Office Visit

Empire HMO 5850, Bronze, NS, INN, Pediatric Dental, Dep 29, $0 PCP Office Visit

Empire HMO 2750 for HSA, Silver, NS, INN, Pediatric Dental, Dep 25

Empire HMO 2750 for HSA, Silver, NS, INN, Pediatric Dental, Dep 29

 

NY Individual 2017 Proposed Rate Change/Notice of Filing

05/2016  
We have submitted a rate change request to the New York Department of Financial Services (NYDFS) to modify rates for our individual plans effective 1/1/2017 upon renewal. The requested amount of the increases ranges from 15.5% to 29.8%, depending on the plan and rating area, which is based on the county the subscriber, resides in. If approved, the rate increase will be effective January 1, 2017. The final, approved rates may differ from what we have requested.  

2017 INDIVIDUAL PRODUCTS 
 
Member Letter 
Narrative Summary 
 

NY Individual 2016 Proposed Rate Change/Notice of Filing

2016 Individual ACA Health Care Plans  

PRODUCT
Empire
BlueCross
Narrative
Summary

Empire
BlueCross
Member
Initial Letter

Empire
BlueCross
BlueShield
Narrative
Summary

Empire
BlueCross
BlueShield
Member
Initial
Letter

Rate
Grid

Proposed
Effective
Date

See Narrative Summary 
 
 
 
 
N/A 
1/1/2016 
 

2016 Notification of Rate Change Request for Individual Grandfathered Plans

11/9/2015  
Individual Grandfathered Products – Sample Member Letter
 
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  
 

2015 Notification of Rate Change Request for Individual Grandfathered 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. 
 
2015 Individual ACA 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 
 
WPNSF186M(Rev.6/13)-NY  
It’s important we treat you fairly  
That’s why we follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711). If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with our Compliance Coordinator in writing to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019 (TDD: 1-800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
 

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