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Health Care Reform Impacts Member Policies Differently – September, 2010

The newly enacted health care reform legislation will be implemented in phases until it is fully effective in 2014. During the implementation process, we will strive to give you important information and clarify how these changes will impact your day to day business with Empire. 
It is important to understand that not all Empire policies are required to meet all the coverage requirements of the health care reform law. For instance, policies that are “grandfathered” under the law are exempt from some of the requirements of health care reform. Conversely, certain changes must be made to all plans, whether they are grandfathered or not.  
Because the health care reform provisions are implemented in many cases based on the plan or policy issue (or renewal) date, the date that provisions are effective will vary from member to member. The effective date will also be affected by the policy type (group or individual) and other factors. Note that all Empire small group policies will become subject to the health care reform that go into effect beginning September 23, 2001 on the “hard date” of September 23, 2010, rather than on the group’s renewal date. The provisions that take effect on September 23, 2010 will be implemented for large t group policies at the first renewal occurring on or after that date. Individual policies will have effective dates that are based on the policy year date, which is almost always January 1, 2011. Healthy New York small group individual policies will become subject to PPACA on the first recertification date after 9/23. 
As member coverage is modified to reflect the new benefits associated with health care reform, our systems will be updated to share the most up-to-date benefit information. We encourage you to continue verifying eligibility and benefits for your Empire patients by accessing empireblue.com, or by contacting Provider Services at 1-800-992-BLUE (2583). 
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