Blues Basics
Empire is a member of this Association
What is the BCBS Association?
Find Care, Virtual Care, Check Claims, View Digital ID Cards, My Health Dashboard, Community Resources, Live Chat and My Health Records
What is Sydney?
The mobile app is the one place to keep track of health and benefits.
It can be downloaded on GooglePlay or App Store.
28 (downstate) counties
What is Empire's regional service area?
Empire's annual gym reimbursement amount
What is $400?
The name of Empire's prescription drug list
What is the National Drug List?
Link: https://www.empireblue.com/ms/pharmacyinformation/home.html
Prospects may be excluded due to HQ location or % of subscribers living outside NY.
What are Empire's Eligibility rules?
The largest BCBS organization selling plans in numerous states; it is a for-profit company.
What is Anthem (Elevance Health)?
The copay for virtual care on traditional and HDHP plans.
What is $5 and $59*?
$59 - medical virtual care
$80 - Therapist
$95 - Psychologist
$175 (initial)/$75 (follow-up) - Psychiatrist
70,000 unique
What is the number of unique providers in Empire's PPO/EPO network in New York?
Empire's Wellness program
What is Be Active Rewards?
A resource members and providers use to to find info and guidelines on coverage details
What is the Medical Policies and Clinical Utilization Management Guidelines link
Includes up-to-date medical necessity details; CPT, ICD-10 codes; etc.
Applies to dependents<30, unmarried, not insured by or eligible for coverage through their own employer sponsored policy and lives or works in NY
What is overage dependent coverage?
Remember, the OAD is billed separately but must enroll in the same plan as the WSE/Subscriber.
Includes approximately 95% of all doctors and 96% of all hospitals in the U.S.
What is BlueCard PPO Program/Network?
This is the national network our members used when traveling or living outside of Empire's 28 county service area.
The number of ExtensisHR Empire plans offered
What is 15?
4 plans on the PPO/EPO network
11 plans on the Blue Access network
Plans EMP 5/6 and EMP 10/11 are mirror plans; same plan design, different network.
Blue Access provider match compared to PPO/EPO network in New York
What is 98%?
The amount a member can earn up to as part of Empire's Be Active Rewards program
What is up to $1,100?
This program includes flu shots + wellness visit ($100), My Health Rewards ($150), Future Moms ($200), Condition Care ($300) OR Wellbeing Telephonic Coaching ($300) and Gym Membership ($200)
Updated in January and June and includes 97% of drugs in all therapeutic categories.
What is Empire's National Drug List?
The process of having any in-network and out of network deductible and coinsurance expenses incurred under the prior carrier being applied to the ExtensisHR Empire plan.
What is the deductible credit process?
New WSEs outside of OE will NOT have their deductible/coinsurance applied.
The number of doctors and hospitals contracted with Blue Cross Blue Shield companies - closest answer wins.
What is 1.7 million?
The ability for new members undergoing active treatment to continue with a non-participating provider on a case by case basis.
What is transition of care?
This MIGHT allows a new member undergoing active treatment with a non-participating provider to receive continuity in care as they transition to the plan. Examples would be a pregnant member in the 2nd or 3rd trimester, a member schedule for surgery, or a member with a very serious condition.
Blue Access' premium decrement compared to Empire's PPO/EPO network
What is 8%?
The payment amount and schedule for Empire's Gym reimbursement
What $200 every 6 months?
Also requires members to have 35 visits every 6 months and applies to spouse and dependents.
Can be used with at-home, virtual workouts (e.g. Peloton, etc.)
Empire's Pharmacy Benefit Manager
Who is IngenioRx?
The process of NOT allowing credit for Rx deductibles met by prior carriers.
What is the deductible credit process?
The % of claims paid in-network (closest answer wins)
What is 97%?
The method used to calculate the out of network reimbursement rate.
What is % of Medicare and UCR?
Empire uses both depending on the plan; range from 150% MC, 285% MC, 70% FAIR Health and 80% FAIR Health
Health/hospital system excluded from Blue Access
What University of Stony Brook?
Coverage to assist Empire members traveling or living outside of the U.S., Puerto Rico and the U.S. Virgin Islands in obtaining medical services.
What is the Global Core Program?
1500+ facilities 7,000+ providers in 190 countries
A single point of contact for medical assistance 24.7, 365
Members pay out of pocket and are reimbursed based on plan design.
Preventive medications list for HDHPs
What is the PreventiveRx Plus?
This list can be found with the overall drug list, National Drug List, on empireblue.com
Adult Dependent Election and Eligibility Form and Enrollment Change/Change Form
What are the overage dependent coverage forms?
Dependent needs to complete both forms.
Sales can obtain forms from BenOps