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50+ Renewals
2-50 UW Guidelines
51-99 New Business
Ease of Doing Business??
Misc Empire
100
Empires OON Reimbursement on Large Group Prism Plans.
What is 150% of Medicare?
100
As of 1/1/11, The amount of enrolled subscribers needed to offer dual option.
What is 6?
100
This very strict guideline is :75% of all eligibles must enroll.
What is large group participation requirement?
100
Claims processeed for members are adjudicated at different claim centers throughout the US.
How does Empire's national network handles claims processing?
100
Empire proposed this offer to these significantly large partners, none of which accepted.
What are a GA contracts?
200
This large group product is no longer actively marketed.
What is the Empire Large Group HMO?
200
As of 1/1/11, this is the minimum # of enrolled subscribers necessary to offer a triple option.
What is 15?
200
This is the maximum number of plans that Empires UW's will allow on a 51-99 group.
What is 2?
200
This "credit" is unavailable to a group when moving from current carrier to Empire
What is Prior Carrier Deductible Credit?
200
They are responsible for all service, new business submissions & renewals on 2 -50
What is the 2-50 small group sales rep?
300
This is what will happen to a group that grows to over 50 enrolled.
What is forced migration to large group?
300
Participation guidelines for all NON HMO small group products
What is 60%?
300
This discount is not offered on any new business cases.
What is a New Business discount?
300
Type of change that takes Empire 30 days to review.
What are off cycle changes?
300
30 days prior to renewal date
What is time required to release 2-50 renewals?
400
This actuarial element is used in determining if a group is eligible for rate relief.
What is experience?
400
Minimum amount Empire requires Employers to contribute.
What is 50%?
400
The maximum percentage spread allowed between 2 plans.
What is 10%?
400
Must be in-house 15 days prior to the effective date
What is a 2-50 new business submission?
400
Special OE from Sept 23rd thru Oct 31st 2010
What is the special OE period for all groups to add age 26 dependents?
500
Similar to OXHP's renewal guidelines, Empire will make a group do this if they fall below participation guidelines.
What is re-certify?
500
A labor union must exist for this length of time before Empire will allow them enroll.
What is 2 years?
500
This is Empire's hottest selling large group product
What is Prism?
500
All community rated groups must do this prior to renewing with Empire
What is re-certify/ re-credential ?
500
On cost share plans, Oxford's benefit is 100% at a par facility. Empire's is subject to D&C
What are laboratory procedures?