You want more: Plans. Access. Value. SMALL BUSINESS HEALTH PLANS that live up to New York’s tough standards
You want more:Plans. Access. Value.
SMALL BUSINESS HEALTH PLANS that live up to New York’s tough standards
Empire Advantages
Empire has the largest networks in New York, which allows them to leverage their size to get deeper provider discounts and savings for you and your employees
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NETWORK DISCOUNTS
LARGENETWORKS
GREATSAVINGS
HIGHMEMBER
SATISFACTION RATINGS
=+ +
Three distinct network optionsProviding a great balance of choice, access and value
Empire’s strong networks have got you covered:
1Blue Cross and Blue Shield Association PPO/EPO network comparison data from websites of other national carriers as of 2016. Network data include the BlueCard program’s extensive networks of doctors, hospitals and other providers that participate in independent Blue Cross and Blue Shield plans across the country.2Empire’s 28-county service area: Albany, Bronx, Clinton, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington and Westchester.
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PPO/EPO
Comprehensive coverage1 and a broad network within the
Empire service area.2
An EPO network with comprehensive coverage and
access to in-network doctors. It’s personalized care and strong
benefits at a lower price.
An EPO network with comprehensive coverage
through Empire’s 28-county service area. Members get
lower or no copays. It’s good care at a competitive cost.
BLUE PRIORITY PATHWAY
And a variety of plan options
PPOA preferred provider organization gives members the most flexibility with both in-network and out-of-network coverage.
EPOAn exclusive provider organization covering in-network providers only. No referrals are needed to see a specialist.
CDHPConsumer-driven health plans 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.
HSAA health savings account is a member-owned savings account that you and your employees can fund with pre-tax dollars to help pay for qualified health care expenses, including prescriptions.
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And, for all plans, preventive care visits are covered 100% with in-network providers.
HRAA health savings account is a member-owned, employer-funded savingsaccount that helps pay for employees’ costs when they need care. Employees decide how to pay for care — either out of pocket or with their HRA debit card, plus they can earn rewards by taking certain steps to improve their health.
Medical plans at a glance
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ONEEncompassing networkWith BlueCard, members benefit from a seamless, consistent experience—no matter where they are.
• Coast-to-coastin-network accessto 96% of U.S. hospitals and 93% of U.S. doctors
• Cost savingsno-balance billing
• No claims forms
The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross® and Blue Shield® companies. The Association owns and manages the Blue Cross and Blue Shield trademarks and names in more than 170 countries and territories around the world. The Association grants licenses to independent companies to use the trademarks and names in exclusive geographic areas. http://www.bcbs.com/about-the-association.
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Empire is changing the way they work with doctors• Paying doctors for value over volume when they improve patient
health, meet quality standards and lower costs• Giving doctors added support with the right tools and strategies
to help strengthen the doctor-patient relationship so they can spend more time with patients and coordinate their care with other doctors
• Improving the patient experience with better access to a primary care physician (PCP) who cares for the whole person, becomes their health care champion and helps them navigate the health care system
Enhanced Personal Health CarePersonalized care, empowering doctors
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It all adds up to real results.DELIVERED.
1.6%decrease in E.R. visits
7.8%fewer acute inpatient admissions
Anthem, Inc. composite states data, 2016
Enhanced Personal Health CareEmpire believes a strong patient-provider relationship is at the center of a high-performing health care system
Members with a primary care physician are:
3.5%decrease in overall E.R. costs
40% more likely to have had their cholesterol checked
33% more likely to have been tested for diabetes
30% more likely to have received a flu shot
Empire Whole Health ConnectionMedical, pharmacy and specialty working together
LIFECaring one-on-one support,reliable service, a full suite of valuable extras
VISIONMarket-changing integration, deep discounts, superior customer service
DENTALOne of the nation’s largest networks, great pricing, flexibility
DISABILITYSuperior service and personalized support, quick and accurate payments, enhanced clinical coordination
PHARMACYThe most widely used benefit, even more than medical
MEDICAL
Medical
Dental
VisionLife and Disability
Pharmacy
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Pediatric dental and vision benefits are included in all medical plans. Basic adult vision is also included in plans at no additional cost.*
*Excludes Healthy New York Small Group plans
1American Journal of Preventive Medicine's Impact of Periodontal Therapy on General Health Study, June 2014 2Empire Productivity Solutions Quantifying Value Study, 2015
40% lower
41.6Mannual
25% lower
Empire Whole Health Connection
medical costs with integrated dental and medical1
average of care gaps closed with integrated pharmacy, specialty, wellness and medical
medical costs with integrated disability and medical2
Connecting medical, pharmacy, dental, vision, life and disability data to total population health management
MOREdata, insights and member engagement opportunities
BIGGERand more complete picture of a member’s health
VALUE-ADDED BENEFITat no cost and with no vendor fees
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Empire offers 2 Formularies and 1 best-in-class Pharmacy networkEmployees use their pharmacy benefit more frequently than any other health benefit. The average person:
• Fills 12 prescriptions per year
• Only goes to the doctor three times a year
Empire’s pharmacy benefits include:
• Traditional Open Drug List — A broad, open drug list that includes most generic and brand-name drugs.
• Select Drug List — Cost-effective prescription drugs that meet or exceed the Affordable Care Act (ACA) requirements.
Home delivery pharmacy savings :• NEW! Save on up to a 30-day supply through either a local
or home delivery pharmacy.• NEW! All plans with drug copays have a money-saving
discount for 90-day supplies of maintenance drugs. • When purchased through the home delivery pharmacy, a 90-
day supply is just 2.5X the 30-day retail copay. Includes tier 2 and 3 drugs.
Strongest Rx in New York9 of Empire’s Top-32 most utilized drugs aren’t covered under Oxford’s formularyDrug Empire
TraditionalOxford
TraditionalHARVONI HUMIRA PEN COPAXONE CRESTOR TRUVADA ENBREL NUTROPIN AQ NUSPIN ATRIPLA ORKAMBI Not coveredREVLIMID TECFIDERA METFORMIN HCL ER JANUVIA ARIPIPRAZOLE ADVAIR DISKUS FOLLISTIM AQ Not coveredVICTOZA 3-PAK SOVALDI GLUMETZA Not coveredLANTUS SOLOSTAR GILENYA TAGRISSO Not coveredBETASERON HUMATROPE Not coveredSTELARA GLEEVEC XALKORI Not coveredTRIUMEQ AVONEX NEULASTA Not coveredAPOKYN Not coveredAFINITOR Not covered
Vision planA bottom line you can clearly read
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BLUE VIEWSM
VISION
Big discountsThe industry’s best discounts and incentives, including 35%–40% off extra glasses
Less hassleSimplified administration from enrollment through claims processing
Lots of doctorsOver 37,000 doctors at more than27,000 locations nationwide
IN-NETWORK PROVIDERS
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Empire’s dental networkCoverage from sea to shining sea. And then some.
One of the largest in the nation
with 124,000+unique dentists(3,655 in New York)
33%average savings on covered services
370,000access points(10,125 in New York)
Resource Advisoroffers emotional, legal and financial support, including
grief counseling and identify-theft recovery
Beneficiary Companionprogram assists family members with death certificates, notifying third parties, creditors and more
Travel Assistancegives support for employees
and their families if an emergency arises while they’re more than 100 miles from home
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MEMBER ASSISTANCE PROGRAMS
Anthem LifeQuality service from a caring staff—providing support to employees and their families during times of need
DisabilityBack-to-work strategies that really work
SOURCE: Empire Life pilot results, 2014.16
of claims received before absence
of claims received before end of first week
of employees return to work early
lower disability costs
35%
36%
21%
9%
Voluntary portfolioFor Dental, Vision, Life and Disability
• Voluntary plans offer groups a way to strengthen the value of their benefits plans and improve satisfaction, at no extra cost.
• Groups pick the plan designs. Employees choose the coverage at affordable group rates.
• Employees pay 100% of the costs.
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LOW MINIMUM PARTICIPATION REQUIREMENTS
DENTAL5 enrollees
LIFE& DISABILITY10 enrollees
VISION5 enrollees
Memberresources
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Empire delivers member solutionsso that no one falls through the cracks
• Lifestyle improvement programs
• Preventive alerts• 24/7 NurseLine• Health and wellness incentives
• Health assessment• Discounts• Provider cost/quality information• Online wellness coaching• Communication campaigns • The Weight Center
• Medical management• Health coaching/advocacy• Disease management• Behavioral health• Maternity• Gaps in care
CLINICAL PROGRAMS WELLNESS PROGRAMS ONLINE RESOURCES
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Health and wellness incentivesSimple health steps can lead to big rewards.
Sometimes a little incentive is all we need to take that extra healthy step. And that’s why we’re offering employees and their spouse or partner financial incentives for taking simple steps to live well.
Your employees can earn up to $700 per year1:
Preventive wellnessexam and flu shot
$100 Employees must complete both the wellness exam ($50) and the flu shot ($50) to receive the $100 reward. Activities can be completed in any order. Once the second of the two activities is complete, two separate rewards will be given.
Tobacco-freecertification
$50 Employees complete the online tobacco-free certification after they register and log in at empireblue.com.
Online wellness toolkit
Up to $150 Employees earn rewards by using online wellness tools that help them achieve nutrition, exercise, stress and other personal health goals.
Gym reimbursement
Up to $400 Employees who meet reimbursement qualifications (complete 50 visits every six months within the benefit plan year) can earn up to $200 every six months. Employees’ covered spouses or partners can earn $100 every six months.
Employees and their covered spouses or partners must be 18 or older to earn rewards.
1Employees can earn up to $700 per year. Employees’ covered spouses or partners can earn up to $500 per year. Up to $1,200 annual benefit per family.
92%reasonable wait time
89%easy to use
89%doctors were professional and helpful
1LiveHealth Online Consumer Post-Visit Survey Results 2Results based on internal LIveHealth Online study during 2014 and Q1 of 2015 for the most common conditions
ER
6.35XHigher cost than LHO
URGENT CARE
1.45XHigher cost than LHO
DOCTOR’S OFFICE
1.6XHigher cost than LHO
RETAIL HEALTH
1.14XHigher cost than LHO
$201Per-episode savings2
This is the definition of “increased access.”LiveHealth OnlineMembers can easily and conveniently connect to a board-certified doctor any time, anywhere.
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92%given enoughtime for visit
Personalized member website experience
empireblue.comNo hassle. No jargon. Just super-useful information.
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Find a doctorSearch for a doctor, specialist, urgent care or hospital close by.
Get your ID cardShare, fax, or email your ID card right from your smartphone.
Check your claimsFind out what your doctor billed, how much was paid and if youowe anything.
Estimate your costsSee what nearby doctors and facilities charge for a procedure. You can compare providers on cost and quality.
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Download the Empire appYou’re on the go and so are we!
Empire AnywhereDownload the Empire Anywhere app today!
View your medical benefitsSee your copays, deductibles, your percentage of the costs,and other important plan benefit information.
Manage prescription benefitsCheck the cost of drugs, find a participating pharmacy, get refills, check order status, or switch to our home delivery program.
Access your mobile Health RecordView your Health Record and share with your doctors whenever you go.
Exceptional service
Our Results %2
CLAIMS
Claims Timeliness in 30 Days 98.80
Claims Processing Accuracy 99.07
Claims Financial Accuracy 99.07
Total Claims
TOTAL
Through strong customer service and innovative tools, Empire helps employers and their employees get the most from their plan and focus on what’s important − keeping people healthy while reducing costs.
91.5% CUSTOMER SATISFACTION RATING1 and near-perfect record for claims processing speed and accuracy.2
12015, Member Satisfaction survey performed by Convergys. 22015, Empire internal data.
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YOU DEMAND MORE.EMPIRE DELIVERS.