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Empire BCBS 2014 Individual Products. Pathway Network. Key Facts: 75% the size of the larger HMO Provider network 75+ hospitals in the Pathway Network The network can be accessed through Provider Finder at www.empireblue.com 28 county New York Service Area for HMO products

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pathway network
Pathway Network

Key Facts:

  • 75% the size of the larger HMO Provider network
  • 75+ hospitals in the Pathway Network
  • The network can be accessed through Provider Finder at www.empireblue.com
  • 28 county New York Service Area for HMO products
  • 28 county New York Service Area for EPO products
  • Under the EPO, members who reside outside of the 28 county NY service area can use Blue Card.
consolidation of rating regions
Consolidation of rating regions
  • Empire’s operating area is dividing into five rating regions for all medical products
  • Rates are based on the following locations:
    • Albany (region 1):Albany, Columbia, Fulton, Green, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington
    • Long Island (region 8): Nassau and Suffolk
    • Mid-Hudson (region 3):Delaware, Dutchess, Orange, Putnam, Sullivan and Ulster
    • New York City (region 4):Bronx, Kings, New York, Queens, Richmond, Rockland and Westchester
    • Upstate (region 7):Clinton and Essex
empire s individual off marketplace p ortfolio n on child o nly p lans
Empire’s Individual OFF Marketplace portfolio(non-child only plans)

The above is a summary. See the Certificate of Coverage with the Schedule of Benefits and any riders associated with the plan for complete coverage details and related terms and conditions.

individual enrollment
Individual Enrollment
  • To be eligible, an individual must live in one of the 28 counties where Empire is licensed to sell
  • Open Enrollment:
    • Plans can be purchased once a year through an open enrollment period
      • 1/1/14 effective date – open enrollment from 10/1 to 12/15
      • Post 1/1/14 effective date – open enrollment from 12/16/13 to 3/31/14
  • Effective date assignment rules will be the same for ON and OFF theIndividual Marketplace
    • If application received 1st – 15th, effective 1st of next month
    • If application received 16th – EOM, effective 1st of following month
  • Exception: Newborns and adopted children can be added or enrolled in a plan as of the date of birth or placement as long as we are advised within 60 days.