As part of the implementation of the Affordable Care Act (aka “ObamaCare”), Empire today has released their on and off-exchange, 2014 individual and small group rates for New York.
Plan Offerings
Empire will be offering 25 on-exchange plans, as well as 38 off-exchange plans. Rates will be based on plan type, whether it’s written for an individual or a small group, tier of coverage selected, as well as the NY region where the subscriber resides or the where business is located. For small groups, Empire will be offering off-exchange plans only.
All individual plans will be HMO-based, requiring the subscriber to select a Primary Care Physician (PCP), and referrals are required to see a specialist. Small group plans can be written in either an HMO or EPO format.
Healthy NY
Individuals who are currently enrolled in Healthy NY plans will need to select an individual plan on the exchange. Small group Healthy NY plans will be modified to the Gold standard off-exchange plan.
Eligible Regions
Empire will be offering plans in the following New York State regions:
-Long Island: Nassau, and Suffolk counties
-New York City: Bronx, Kings, New York, Queens, Richmond, Rockland, and Westchester counties
-Mid-Hudson: Delaware, Dutchess, Orange, Putnam, Sullivan, and Ulster counties
-Albany: Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington counties
-Upstate: Clinton and Essex counties
Provider Network
Empire will be introducing their new “Pathway” provider network for all plans beginning with 2014 effective dates. This is different from their existing HMO or national BlueCard EPO network. It is recommended that you check with your doctors/providers to see if they participate with Empire’s new network. Empire small group off-exchange plans can be written using either the Pathway HMO network, or the BlueCard EPO network.
Plan Structures
Below are Empire’s on and off-exchange plan structures for individuals:
Plan Structures – Downstate – On Exchange
Plan Structures – Downstate – On Exchange – Child Only
Plan Structures – Downstate – Off Exchange
Plan Structures – Downstate – Off Exchange – Child Only
Plan Structures – Upstate – On Exchange
Plan Structures – Upstate – On Exchange – Child Only
Plan Structures – Upstate – Off Exchange
Plan Structures – Upstate – Off Exchange – Child Only
Plan Rates
Below are Empire’s on and off-exchange plan rate for individuals:
Individual Rates – Downstate – On Exchange
Individual Rates – Downstate – Off Exchange
Individual Rates – Upstate – On Exchange
Individual Rates – Upstate – Off Exchange
Open Enrollment
Open enrollment for all individual small group Empire plans will be from 10/1/13 through 12/15/2013. First day of available coverage is 1/1/14 no matter when you enroll in the initial open enrollment period.
How To Enroll
No matter what your situation is, it is strongly recommended that you seek the assistance of a licensed insurance broker to assist you with selecting a plan best suited for your needs, and enrolling in coverage. Avoid working with “navigators” or exchange personnel as these are unlicensed state employees, who are not subject to a background check, and who cannot make plan recommendations.
Individuals wishing to enroll in on-exchange plans (those needing subsidy assistance) must be written through the New York State health benefits marketplace. Assistance with state exchange enrollments can be provided by a licensed insurance broker.
Individuals seeking to enroll in off-exchange plans must work directly with a licensed insurance broker since these plans are not available on the New York State health benefits marketplace. Also, since all Empire small group plans are also only available off-exchange, business owners must work directly with a licensed insurance broker for enrollment assistance.