Empire Strikes Back – 2023 Health Plans
Empire Blue Cross Blue Shield has added a 3rd network – Empire Connections to their 2023 roster. The Downstate Network will be the smallest of the 3 features top hospitals & providers. The discounts are 8% and 12.5% 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 97% of #1 Empire EPO/PPO network. Empire Blue Cross New Network Trifecta_2020
Additionally, all 3 networks, Empire EPO/PPO, Blue Access, and Empire Connections will offer access to the national BlueCard PPO program. As a result of Empire Blue Cross’s participation in the BlueCard PPO program members enjoy an unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of the 28 plans below.
PPO/EPO Network – a traditional non-gatekeeper large network of approximately 91,000 physicians, 200 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). 98% 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, 12.5% 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. CVS Pharmacy is in-network but NOT Walgreens and Duane Reade. Connections 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: Livehealth Online will be $0 on all products except H.S.A. which will cost $59.
- Behavioral Telehealth: new and innovative behavioral health programs added. The following new vendors added this year: Headway, Alma, Talk Space, Talkiatry, Ophelia and Nocd.
- Dental: price competitive plans with 135,000 Dentists and 548,000 locations. 5% bundled discount-with new dental coverage when you add vision, life, or disability.
- Vision:39,000+ eye doctors at 29,000+ locations including independent providers, national vision retailers and online stores. 40%unlimites savings on extra pairs of glasses in-network and discounts on laser vision correction surgery through the Special Offers program.
- Life Benefits: easy claims intake via online, email or traditional paper/fax process. 24/7 phone counseling for 6 months. Legal consultations can assist with estate issues. Rated “A” by A/M. Best Ranking 2021.
- Absence & Disability Management: Full portfolio of products with flexible contracts and integrated absence management, integrated disability management and behavioral health. FASTER claims processing when clients have Empire medical and disability benefits. Integrated leave and disability communication with one call intake, one letter, and one point of contact.Seamless integration from short-term disability to long-term disability. 25% or $8,000 lower average medical claims. Rated “A” by A/M. Best Ranking 2021.
- 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. 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 are 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.
- Empire Link: Available on Connections Network only. Empire Link is part of a new generation of healthcare products designed to meet the desire for on-demand access to lower-cost, higher-value healthcare — playing a vital role in how consumers can now access and expect healthcare delivery.
- Anthem Link (Link) is an innovative, first-of-its-kind health plan that brings together the latest technology, integrated digital solutions, and access to top doctors, hospitals, and specialists. Award-winning App. Symptom triage. Text and video-based doctor visits. Find care (the ability to search for transparent, upfront pricing on services such as labs and outpatient procedures). $0 member out of pocket cost for virtual care on the non-HSA plan. Digital and telephonic well-being coach. Clinical programs. 360° digital electronic medical record (EMR) with automatic imports. Automated health insights and follow-up. Network of high performing providers-Curated group of providers. Select providers are in advanced payment model arrangements with downside risk. Required PCP selection. See video.
- Sydney Health – new mobile app. Virtual Primary Care. Integrated, 24/7 digital support through Sydney HealthSM
Uses artificial intelligence to meet members’ 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 cards that can be emailed or printed. 85% of virtual visits resolve the person’s needs.
- Gym Reimbursements Cash Rewards and Healthy Support – The wellness program offers easy ways to earn up to $600 per member, per year. Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150, and $50 Tobacco-free certification online.
Empire Blue Cross Enhanced Embedded Dental and Vision Plans **New for 2023**
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 2023 Top Plans
Small-Group Rates: 2023 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].