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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 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 • 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 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 • 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.
