Group Health Plans
Small Group products from Empire
A small group is defined as having 1 to 100 employees*.
Our small group plans are well-positioned for the changing market. They cover all of the essential health benefits (EHBs) required by the Affordable Care Act (ACA or health care reform law), including:
| Preventive, wellness and chronic disease management services|
| Outpatient care|
| Emergency services, including emergency room or urgent care|
| Hospital stays|
| Laboratory services|
| Prescription drugs|
| Mental health and substance abuse treatment|
| Maternity and newborn care|
| Gym reimbursement|
| Pediatric services, including dental and vision care|
| Rehabilitative and habilitative services and devices |
| Gender discrimination prevention|
| Oral chemotherapy|
Preferred provider organization (PPO)
Our PPO plans allow members to see providers in-network or out-of-network. Members pay substantially less out of pocket when they use a provider in the PPO network. There’s no need to get a referral to see a specialist.
Exclusive provider organization (EPO)
Our EPO plans only cover services received from providers in the EPO network. Members don’t need a referral from a primary care physician (PCP) to see a specialist. If services are received from an out-of-network provider, coverage is not available or limited.
Health maintenance organization (HMO)
Our HMO plans only cover services from providers in the HMO plan network. Members must choose a PCP in the network. If a specialist is needed, the PCP provides a referral. If services are received from an out-of-network provider, coverage is not available or limited.
Consumer-driven health plans (CDHP)
Our CDHPs feature higher deductibles than traditional insurance plans. They can be paired with a health savings account allowing members to pay for qualified out-of-pocket medical expenses. CDHPs are available as an HMO, EPO or PPO.
| Health savings account (HSA) is a member-owned savings account that employers and their employees can fund with pre-tax dollars to help pay for qualified health care expenses, including prescriptions.|
Preferred Provider Organization (PPO)/Exclusive Provider Organization (EPO) Network
Comprehensive coverage within the Empire service area1
Blue Priority Network
An EPO network, our EPO solution, with comprehensive coverage and access to in-network doctors that participate in our Enhanced Personal Health Care program. Its personalized care and strong benefits at a lower price.
An HMO network, our HMO solution, with comprehensive coverage through Empire’s 28-county service area. You get lower or no copays. It’s good care at a competitive cost.
Learn more about our small group health care plans. Check out our small group product guide Downstate
and review the detailed Summaries of Benefits and Coverage