Empire Strikes Back – 2021 Health Plans
Empire Blue Cross Blue Shield has added a 3rd network – Empire Connections to their 2021 roster. The Downstate Network will be the smallest of the 3 featuring top hospitals & providers. The discounts are 11% and 20% discount off of #1 Empire EPO/PPO and Blue Access networks respectively. The middle network Blue Access has expanded significantly adding Memorial Sloan Kettering. Blue Access shares 92% of #1 Empire EPO/PPO network. Empire Blue Cross New Network Trifecta_2020
Additionally, all 3 networks, Empire EPO/PPO, Blue Access, Empire Connections will offer access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
PPO/EPO Network – a traditional non-gatekeeper large network of approximately 91,000 physicians, 160 facilities, and the BlueCard PPO. This is the #1 broadest network. All major NY hospitals. National Access with Blue Card PPO. Uses the Traditional Open Formulary (except for one PPO Fair Health Plan)
Blue Access Network –hybrid of broad PPO/EPO 160 facilities and 83,000 physicians network. BlueCard PPO Access from home. All of #1 Empire EPO/PPO Hospitals except Stoney Brook Hospital in Suffolk County. Uses the Traditional Open Formulary (this is better than the Select Formulary from 2019). 96% Provider match with PPO/EPO.
Connections Network-will have a 70% provider match with PPO/EPO network. Network tailored to deliver the greatest premium savings, 20%-25% off EPO/PPO. Available in 9 downstate counties (Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester). Offers the BlueCard PPO National Access, however, Gated plans must have PCP referral for Out-of-Network coverage. Uses the Select Formulary (mostly generic). Examples of hospitals:
- NY Columbia Presbyterian
- Mt Sinai Health System
- Westchester Medical Center
- Staten Island University Hospital
- Northwell Health (formerly North Shore LIJ)
- Telemedicine will be $0 on all products except H.S.A. which will cost $49.
- Vision – Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
- Dental – price competitive plans with 127,000 Dentists and 385,000 locations.
- New Pharmacy – Empire will be using their own Ingenio Rx as Pharmacy Benefit Management. With Pharmacy becoming a 22% average expense and close second only to hospitalization its novel focus on whole-health cost management is crucial. Enhanced digital tools, 24/7 support with no intermediary is a welcome All plans use their large BCBS formulary Except Empire Connections. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
- Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
- Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
- Online Resources – wellness coaching, discounts, health assessments, and The Weight Center.
- Travel – BlueCard PPO national access and Blue Cross Blue Shield Global Core Program.
- Sydney Health – new mobile app. Uses artificial intelligence to meet member’s needs. A personalized dashboard that recommends programs and contact based on claims. Interactive smart chat feature to help members find what they need faster.A complete view of medical, pharmacy, dental, and vision benefits.Access to the member’s well-being programs and incentives Digital ID card that can be emailed or printed.
- Gym Reimbursements Cash Rewards and Healthy Support – Industry #1 highest cash reward incentives. The wellness program offers easy ways to earn up to $600 per member, per year. Gym Reimbursement of $400 single + $400 for dependents 18+, $50 Wellness + Flu Shot, and up to $150 MyHealth rewards incentives.
Empire Blue Cross Enhanced Embedded Dental and Vision Plans **New for 2021**
Empire’s new model – Enhanced Embedded Dental & Vision Plans – is a care ecosystem where plans work together seamlessly to coordinate care Empire can afford to add these benefits at 50% discount below the stand-alone plan. For example, an individual Gold Blue Access Plan with Dental/Vision is only $20/month.
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BENEFITS SUMMARY: Empire Blue Cross 2021 Top Plans
Small-Group Rates: 2021 Small Group NYC
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability, and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll, and HR @ (855) 667-4621 or [email protected].