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Group Health Plans

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Health Plans
Product Types
Network Types
 
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
 
Product Types
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.
 
Network Options
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. 
Pathway Network
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/Upstate and review the detailed Summaries of Benefits and Coverage (SBC).  
 
 
©2017 Empire BlueCross BlueShield

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., and/or HealthPlus, LLC., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.