NY EBC 2019 SG Guide
NY_EBC_2019_SG_Guide
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YOUR TIME MATTERS.
So we’re making everything work harder for you.
�
New, more affordable plan designs for your clients
�
Simplified electronic process, from quoting through enrollment, for you
Small Group product guide I Effective January 1, 2019
This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Empire representative.
* Non-ACA compliant plans may may not qualify for single bill when combined with other coverages.
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.
107469NYBENEBC 05/18
HELPING CHOOSE THE RIGHT PLAN FOR YOUR CLIENTS SHOULDN’T KEEP YOU UP AT NIGHT
Your clients want their employees to have the right plan for their needs, while balancing the cost. We get it. We created a wider range of plan
options with everything your clients and their employees need to make smarter health care choices, save time and manage costs. And our plans
work together – medical, pharmacy, dental, vision, life, disability and behavioral health. You and your clients should feel good with that choice.
� More plan choices to meet more budgets
� A lower cost of care because of the strength and quality of our
networks, so members can see doctors who deliver the most
effective, efficient care
� Expanded medical and pharmacy portfolios:
—ACA-compliant medical and pharmacy plans offering
a wide range of member cost share options
—Integrated Act Wise consumer-driven health plans
that manage the medical benefits and the
spending accounts
� A 5% discount on dental premiums when clients purchase dental
for the first time along with vision, life and/or disability
—Members get whole-person coverage. Because our products
are connected, doctors can work together behind the scenes
to see a person’s overall health, leading to earlier detection of
possible health issues
� Better health and engagement for members – our digital health
care platform integrates benefit information, clinical and claims
data, and other digital tools to create a more personalized
member experience
MAKING IT ALL EASIER. YOU SPOKE, WE LISTENED.
We know it hasn’t always been easy to work with us. From complicated and inconsistent processes to long implementation times, you’re
frustrated and we hear you. We’ve been working hard to invest in, and develop, market-leading tools and technology with one goal in mind:
to streamline, so you can save time and worry. The changes you’ll see:
� Reimagined Producer Tool-box where you can do it all—in one
place, no more going back and forth between portals
� Simplified quoting so you can easily show your clients the cost
of any combination of our medical, dental, vision, life and
disability coverage
� Online enrollment submission for your clients and their
employees that drastically reduces implementation times; no
more paperwork
� Full transparency on your clients’ status in the implementation
process – no more guessing games
� Integrated EmployerAccess makes it easier for you to perform
maintenance on all of your clients with a single sign-on
But we didn’t change everything. You will continue to enjoy the support from the service teams you know and trust. And we’ve made their jobs
easier with streamlined processes that are consistent across our company and technology that’s flexible so they can quickly answer your
questions. It’s the best of both worlds so you can rest easy.
PharmacyMedical Dental DisabilityLifeVision Behavioral Health
MAKING IT EASIER
FOR YOU AND YOUR CLIENTS
Your time should be focused on supporting your clients, consulting with them on the right health plan
for their unique needs. What if it could be easier? Instead of paperwork, what if you could focus on
building your business?
WELCOME TO A BETTER WAY.
>
Empire offers plans for all NY Small Business Owners
Running a small business takes courage and a lot of hard work. You make important decisions every day. And choosing the right
health plan is def nitely one of them. i
We've added new enhanced and more affordable EPO products with no deductible on many health care services. These new
plans include medical physician visits with LiveHealth Online covered in full.
Blue Access offers an expansive provider and hospital network for your employees. Access to New York's highly rated physicians
and state of the art healthcare facilities. Coordination of care is a top priority to physicians in our network.
Health and Wellness incentives for employees working to improve themselves. These offerings are available for their family
members as well.
Signing up for LiveHealth Online is free. We offer medical doctors visits on most plans, covered in full. Your employees can have
face to face visits with a board certif ed doctor on their personal computer or mobile device with a web cam. i
Enhanced Care Plus Dental Standalone Plan includes access to many services beyond preventive care, without barriers.
An integrated Act Wise HSA offering! Give your clients and their employees one smart debit card, one place to manage benef tsi
and spending accounts and one customer service team.
Expanded f tness center reimbursement! Now all members age 18+ eligible to receive up to $400 cash a year when theyi
exercise at a qualifying f tness center! i
It's your purpose that's at the heart of our promise: To build the ultimate benef ts package for every type of small business and fori
every type of employee who works to keep your dream alive.
For more information contact your
Empire representative or broker.
For employer groups with 1 TO 100 employees
New York
SMALL BUSINESS ENHANCED PRODUCTS,
TOOLS & NETWORKS
OUR NEW EPO PRODUCTS
FOR SMALL BUSINESS
OWNERS
A new generation of plans to consider
If you thought you couldn't afford an Empire plan before or
changed plans because of cost, our new EPO products may
be just for you. Here's what makes these plans a great option.
There's no deductible for many services when your
employees get them from providers in our expanded Blue
Access network.
Services not subject to deductible on these plans are:
Primary care doctor off ce visits i
Specialist off ce visits i
Urgent care
Tier 1 prescriptions
To learn more about our new EPO products
contact your Empire representative or broker
today.
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Working together to make health care easier for
everyone, everywhere
EMPIRE AND SMALL
BUSINESS OWNERS
1 in 3 Americans are covered by a Blue
Cross and Blue Shield plan1
More than 106 million members
96% of hospitals in the U.S. are in
our plans
95% of providers in the U.S. are in
our plans
Local focus in 14 states with our
aff liate Blues plans i
Our local networks offer access to New
York's best doctors and state of the art
hospitals and health care facilities.
When using network doctors members
save big! And we reward our doctors for
the quality of care they give not the
number of patients they see. So members
get more attention and better care.
Benef ts that travel i
Members have access to medically necessary care
across the country and urgent and emergency care
around the world with the BlueCard® and Blue Cross
Blue Shield Global Core program.
1 Blue Cross and Blue Shield Association website: About Blue Cross and Blue Shield Association
(accessed May 2018): bcbs.com.
Manage chronic conditions
Address medication gaps
Improve medication aherence
Save money
Our pharmacy data is delivered daily
Medical Pharmacy More effective and
affordable health care
The results speak for themselves
PHARMACY DRIVES
BETTER HEALTH
AND SAVINGS
Medical and pharmacy programs work together so
members receive holistic, coordinated care that leads
to their better health and employer savings.
This helps us close pharmacy care gaps sooner
and increase engagement. It ultimately helps
members:
28% MORE gaps in care identif ed i
32% MORE members are compliant with their
medications
26% MORE care gaps closed within 12 months
10% FEWER hospital stays
Care gap outcomes for MyHealth Advantage using our pharmacy data compared to carve-out pharmacy
data, compliance results based on 12-months clinical and cost-of-care programs for Commercial business,
and reduction in hospital visits based on Anthem 2014 integrated analysis.
3
VISION AND DENTAL
BENEFITS FOR WHOLE-
PERSON HEALTH
Empire Blue View VisionSM offers members access to
one of the largest networks in the nation — along with
signif cant savings. i
1 Except when discounting of non-covered services is prohibited by state law.
2 Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses, or
$130 contact lens allowance.
3 Applies to Anthem Dental Essential Choice members who are actively engaged in an Anthem Care
Management program for the following conditions: cancer, pregnancy, diabetes, certain heart
conditions, organ or bone marrow transplants, stroke, end stage renal disease (kidney disease), and
suppressed immune systems (HIV/AIDS).
38,000 doctors and 27,000 locations
40% off an additional pair of glasses from
providers in the plan1
63% average retail savings for Blue View
VisionSM members using network providers 2
Our Dental benef ts i offer members easy access to a
large number of dentists. That includes discounts and
services to help them keep up their dental health and
prevent long-term problems.
127,000 dentists and 385,000 places to
get care
35% average discount on covered dental
services when using a dentist in the plan
Extra cleaning or periodontal maintenance for
members in one of our medical care
management programs for certain conditions3
Retail and online partners
Within the United States
}
Outside of the United States
BLUECARD® MAKES
GETTING CARE EASY
ALMOST ANYWHERE
Members take health care benef ts with them across thei
country and around the world.
The BlueCard® program gives members access to doctors
and hospitals almost everywhere, giving them peace of
mind that they can f nd the health care provider they needi
no matter where they are in the world.
Members have coverage for urgent and
emergency care. The Blue Cross Blue Shield
Global Core Program makes it easy for
members to locate a preferred provider
through online tools and 24/7 Customer
Service.
Check plan documents for details about care
outside of our service area.
Members are covered for medically
necessary care in all 50 states, whether
care is needed in a rural or urban area.
When you see a network provider there are:
No claims forms to complete
No payment upfront for medical services
except for the usual out-of-pocket
expenses.
Explanation of benef ts received from thei
members’ plan.
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Why LiveHealth Online?
LIVEHEALTH ONLINE:
ACCESS TO CARE
ANYTIME, ANYWHERE
Convenience. Access to care right from
the home or off ce. i
Choice. Members can select from a range
of doctors and therapists.
Cost. Most plans cover medical doctor
visits in full.
Members can use LiveHealth Online to have video visits
with board-certif ed doctors from a computer with ai
webcam or mobile device. In minutes, doctors can
address common health issues such as colds, allergies
and headaches. They’ll then assess conditions, provide a
treatment plan and send prescriptions to a pharmacy, if
needed. Spanish-speaking doctors are available by
appointment from 7 a.m. to 11 p.m., 7 days a week using
Cuidado Médico.
LiveHealth Online also has professionals available to
address mental health, allergies, wellness, and some
that specialize in kids’ health. Members can see a
licensed therapist or board certif ed psychiatrist in justi
a few days.1
Members can register at
livehealthonline.com or download the
free mobile app.
1 Appointments subject to availabiity of the mental health professional.
Act Wise offers:
One-stop support from one implementation
team and one customer service number.
Easy set-up - whether it’s a new plan or a
renewal from another consumer-driven health
plan, it’s never been easier.
ACT WISE
CONSUMER-DRIVEN
HEALTH PLANS
Welcome to Empire’s one team, one solution
consumer-driven health plan!
Act Wise makes it easier for your clients to administer
their health savings account because now Empire
manages both the medical benef ts and the spendingi
accounts. We’re streamlining everything – for you, your
clients and even their employees.
One website and mobile app for members to
review claims in real time and access benef ti
and account information.
Simple tools and messaging to help both
employers and members understand their
coverage and manage their health benef tsi
and spending.
5
Improving care while keeping costs down
Enhanced Personal Health Care (EPHC) holds providers
accountable for cost and quality outcomes. This
patient-centered approach:
Rewards doctors for managing and improving
overall patient health, meeting quality
standards and lowering costs
Improves patient experience with 24/7
access to care, extended office hours,
same-day and weekend appointments, better
phone and email access to doctors
Why EPHC matters
}
}Better disease management and care coordination that
can reduce hospitalizations and unnecessary tests
ENHANCED PERSONAL
HEALTH CARE
* Cost and utilization metrics based on a difference in difference analysis of members with a relationship
to an EPHC provider compared to a matched sample control group. Data range from 4/1/13 - 9/30/16.
1 Per attributed member per month. Gross medical savings. Net savings is $10.39 after provider gain
share and clinical coordination payments. Excludes RX.
Gives providers support, data and incentives to
help them deliver improved care coordination
that’s more eff cient and effective i
The results*
$15.42 (4.1%) savings per member per month1
1.9% savings on ER visits
8.9% savings on inpatient care
5.8% savings in outpatient surgery costs
7.6% decrease in inpatient admissions
Better health outcomes for
and lower costs for your clients
PRESCRIPTION
DRUG PLANS
Select Drug List — Offers cost-effective drugs
and meets or exceeds the Affordable Care Act
(ACA) requirement.
Traditional Open Drug List — Includes most
generic and brand-name drugs.
Retail90 — Members can get up to a 90-day
supply of most maintenance drugs from
participating local pharmacies.
PreventiveRx Plus — Members can get certain
drugs, used to treat and manage conditions
like asthma, diabetes, high cholesterol and
osteoporosis at a lower cost on our HSA plans.
Pharmacy is the most used benef t – four timesi
more than medical — and often the f rst benef tii
members access.1
1 Retail Prescription Drugs Filled at Pharmacies (Annual per Capital) (accessed 2/16/2017): kff.org;
Ambultaory Care Use and Physician off ce visits, US Centers for Disease control and Prevention (accessedi
2/16/2017), https://www.cdc.gov/nchs/fastats/physician-visits.htm;
https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm; and
http://www.statista.com/chart/2689/americans-dont-like-visiting-the-doctor (accessed 7/17/2015)
6
2019 ENHANCED EMPIRE
HEALTH REWARDS
PROGRAM
Reward members for healthy behavior
Members will now receive a Health Rewards card, which is a
reloadable debit card that can be used anywhere major credit
cards are accepted. As members earn rewards, they will
automatically be credited to their Health Rewards card. When
a member completes their f rst Health Rewards activityi
fulf llment of a Health Rewards card will automatically triggeri
and be mailed to the member's address on f le. i
Get a preventive wellness exam and f u shot, receive $100 onl
their Health Rewards card.
Complete a tobacco-free certif cation, receive up to $50 oni
their Health Rewards card.
Use the online Wellness Toolkit and receive up to $150 on
their Health Rewards card.
As members complete additional Health Rewards activities,
reward dollars will be automatically deposited on their Health
Rewards card. Members can review their Health Rewards card
usage, balance and report a lost or stolen card on the
Rewards tab of the member portal.
To learn more, contact your Empire sales
representative or broker today.
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LET’S DO THIS, TOGETHER
Choosing a health plan isn’t easy, but we want it to be. The plans you’re about to see have been
created to be easy for you to quote and administer and easy for your clients and their employees
to use.
Select the links below to view Empire’s products for 2019.
As you view our portfolio, you’ll see all types of plan designs that are as unique and different as
your clients.
Medical plan grid
Dental plan grid
Vision plan grid
Life & Disability plan grid
YOUR TIME MATTERS.
So we’re making everything work harder for you.
�
New, more affordable plan designs for your clients
�
Simplified electronic process, from quoting through enrollment, for you
Small Group product guide I Effective January 1, 2019
This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Empire representative.
* Non-ACA compliant plans may may not qualify for single bill when combined with other coverages.
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.
107469NYBENEBC 05/18
