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What You Need to DoPlease share the enclosed memo with your employees who are enrolled in the PROD MRKTG NM health plan. We recommendthat you provide any additional information with this notice, such as expected changes in employee contribution levels, that may helpyour employees better understand this notice.30-day Comment PeriodYou can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The commentsmust be made within 30 days from the date of this notice.You can contact Empire for additional information at:Email: premiumratechange@empireblue.comTelephone: Small Group Contact Center, 1-866-422-2583Mail: Empire BlueCross BlueShieldSmall Group Call Center (SG Prior Approval)3 Huntington Quadrangle – 3rd FloorMelville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS via e-mail, by visiting the DFSWebsite or via standard mail as follows:DFS Website: www.dfs.ny.gov/healthinsurancepremiumsEmail: PremiumRateIncreases@dfs.ny.govUnited States Postal Service:NYS Department of Financial ServicesHealth Bureau – Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY 12257If you choose to submit comments to DFS, please include the following information:1.2.3.4.The name of your insurer, which is EmpireThe name of your Empire benefit plan as shown on your Empire ID cardIndicate you have small group coverageYour HIOS identification number, which is HOISID Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.Plain English Summary of Rate ChangeWe have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change isbeing requested. You can find this information at the following websites:Empire website: empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/healthinsurancepremiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, you will receive final rate information at least 60 days before your 2018 renewal date.Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employeehealth benefits plan.Sincerely,Lawrence G. SchreiberPresident, New York CommercialServices provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, anassociation of independent Blue Cross and Blue Shield plans.EBS JAN-MAY filing0517

EnclosureEmpire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date IMPORTANT: Notice of Proposed 2018 Premium Rate ChangeProduct Name: PROD MRKTG NM Health Insurance Oversight System (HIOS) Identification Number: HOISID Important News About Your Empire Health PlanEmpire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group healthinsurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests forpremium rate changes to DFS.DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.Proposed Premium Rate Change The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on RNWL DT .Your group’s current plan:Your group’s rating region:New 2018 plan name:If approved, the percentage change to your group’spremium:*Subject to DFS approval. PROD MRKTG NM Region 2018 Plan Name Rate Increase *Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount youand your employer contribute to your premium cost may be different from the percentage listed above.The actual premium rate change will not be available until we receive approval from the DFS. At that time, we will send you anothernotice. The second notice will be sent to you at least 60 days prior to the start date of the rate change and will show the approved ratechanges.Why We Are Requesting a Rate ChangeThese are the main reasons we are requesting a rate change: Our 2018 rate filings reflect the rising cost of medical care, a changing pool of customers, the ACA insurer fee and ourexperience with provider networks.

In 2018, there will be coverage changes to some deductible, copays, coinsurance, benefit limits, and/or annual out-of-pocketmaximum amounts.30-day Comment PeriodYou can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The commentsmust be made within 30 days from the date of this notice.You can contact Empire for additional information at:Email: premiumratechange@empireblue.comTelephone: Small Group Contact Center, 1-866-422-2583Mail: Empire BlueCross BlueShieldSmall Group Call Center (SG Prior Approval)3 Huntington Quadrangle – 3rd FloorMelville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to:NYS Department of Financial ServicesHealth Bureau — Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY, 12257Email: PremiumRateIncreases@dfs.ny.govDFS website: www.dfs.ny.gov/healthinsurancepremiumsIf you want to submit comments to DFS, please include the following:1. The name of your insurer, which is Empire2. The name of your Empire benefit plan as shown on your Empire ID card3. Indicate you have small group coverage4. Your Health Insurance Oversight System (HIOS) Identification number, which is HOISID Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.Plain English Summary of Rate ChangeEmpire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has beenrequested. You can find this information at the following websites:Empire website: empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/healthinsurancepremiumsNotice of Approved Premium RateAfter DFS approved the final premium rate, you will recevie final rate informaiton at least 60 days before your 2018 renewal date.Thank you for choosing Empire for your health benefits plan.Sincerely,Lawrence G. SchreiberPresident, New York CommercialServices provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, anassociation of independent Blue Cross and Blue Shield plans.EBS JAN-MAY filing0517

Empire BlueCrossPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com BNFTS MNGR NM Group Name LINE 1 ADRS TXT LINE 2 ADRS TXT GrpCity , GrpState ZIP CD Re: Date Notice of Proposed 2018 Premium Rate ChangeProduct Name: PROD MRKTG NM Health Insurance Oversight System (HIOS) identification number: HOISID Dear Group Benefits Administrator:Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group healthinsurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests forpremium rate changes to DFS.DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.Proposed Premium Rate ChangesThe chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your ratingregion. If approved, this rate change will apply to your RNWL DT renewal.Your group’s current plan:Your group’s rating region:New 2018 plan name:If approved, the percentage change to yourgroup’s premium:*Subject to DFS approval. PROD MRKTG NM Region 2018 Plan Name Rate Increase *Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based onthe benefit plan design and other features you select on renewal. Also, the final, approved rate may differ because DFS may modify theproposed rate.Why We Are Requesting a Rate ChangeThese are the main reasons we are requesting a rate change: Our 2018 rate filings reflect the rising cost of medical care, a changing pool of customers, the ACA insurer fee and ourexperience with provider networks.

What You Need to DoPlease share the enclosed memo with your employees who are enrolled in the PROD MRKTG NM health plan. We recommendthat you provide any additional information with this notice, such as expected changes in employee contribution levels, that may helpyour employees better understand this notice.30-day Comment PeriodYou can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The commentsmust be made within 30 days from the date of this notice.You can contact Empire for additional information at:Email: premiumratechange@empireblue.comTelephone: Small Group Contact Center, 1-866-422-2583Mail: Empire BlueCrossSmall Group Call Center (SG Prior Approval)3 Huntington Quadrangle – 3rd FloorMelville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS via e-mail, by visiting the DFSWebsite or via standard mail as follows:DFS Website: www.dfs.ny.gov/healthinsurancepremiumsEmail: PremiumRateIncreases@dfs.ny.govUnited States Postal Service:NYS Department of Financial ServicesHealth Bureau – Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY 12257If you choose to submit comments to DFS, please include the following information:1.2.3.4.The name of your insurer, which is EmpireThe name of your Empire benefit plan as shown on your Empire ID cardIndicate you have small group coverageYour HIOS identification number, which is HOISID Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.Plain English Summary of Rate ChangeWe have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change isbeing requested. You can find this information at the following websites:Empire website: empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/healthinsurancepremiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, you will receive final rate information at least 60 days before your 2018 renewal date.Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employeehealth benefits plan.Sincerely,Lawrence G. SchreiberPresident, New York CommercialEnclosureServices provided by Empire HealthChoice HMO, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and BlueShield plans.EBC HNY JAN-MAY filing0517

Empire BlueCrossPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date IMPORTANT: Notice of Proposed 2018 Premium Rate ChangeProduct Name: PROD MRKTG NM Health Insurance Oversight System (HIOS) Identification Number: HOISID Important News About Your Empire Health PlanEmpire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group healthinsurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests forpremium rate changes to DFS.DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.Proposed Premium Rate Change The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on RNWL DT .Your group’s current plan:Your group’s rating region:New 2018 plan name:If approved, the percentage change to your group’spremium:*Subject to DFS approval. PROD MRKTG NM Region 2018 Plan Name Rate Increase *Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount youand your employer contribute to your premium cost may be different from the percentage listed above.The actual premium rate change will not be available until we receive approval from the DFS. At that time, we will send you anothernotice. The second notice will be sent to you at least 60 days prior to the start date of the rate change and will show the approved ratechanges.Why We Are Requesting a Rate ChangeThese are the main reasons we are requesting a rate change: Our 2018 rate filings reflect the rising cost of medical care, a changing pool of customers, the ACA insurer fee and ourexperience with provider networks.

30-day Comment PeriodYou can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The commentsmust be made within 30 days from the date of this notice.You can contact Empire for additional information at:Email: premiumratechange@empireblue.comTelephone: Small Group Contact Center, 1-866-422-2583Mail: Empire BlueCrossSmall Group Call Center (SG Prior Approval)3 Huntington Quadrangle – 3rd FloorMelville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to:NYS Department of Financial ServicesHealth Bureau — Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY, 12257Email: PremiumRateIncreases@dfs.ny.govDFS website: www.dfs.ny.gov/healthinsurancepremiumsIf you want to submit comments to DFS, please include the following:1. The name of your insurer, which is Empire2. The name of your Empire benefit plan as shown on your Empire ID card3. Indicate you have small group coverage4. Your Health Insurance Oversight System (HIOS) Identification number, which is HOISID Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.Plain English Summary of Rate ChangeEmpire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has beenrequested. You can find this information at the following websites:Empire website: empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/healthinsurancepremiumsNotice of Approved Premium RateAfter DFS approved the final premium rate, you will recevie final rate informaiton at least 60 days before your 2018 renewal date.Thank you for choosing Empire for your health benefits plan.Sincerely,Lawrence G. SchreiberPresident, New York CommercialServices provided by Empire HealthChoice HMO, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and BlueShield plans.EBC HNY JAN-MAY filing0517

Empire BlueCrossPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com BNFTS MNGR NM Group Name LINE 1 ADRS TXT LINE 2 ADRS TXT GrpCity , GrpState ZIP CD Re: Date Notice of Proposed 2018 Premium Rate ChangeProduct Name: PROD MRKTG NM Health Insurance Oversight System (HIOS) identification number: HOISID Dear Group Benefits Administrator:Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group healthinsurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests forpremium rate changes to DFS.DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.Proposed Premium Rate ChangesThe chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your ratingregion. If approved, this rate change will apply to your RNWL DT renewal.Your group’s current plan:Your group’s rating region:New 2018 plan name:If approved, the percentage change to yourgroup’s premium:*Subject to DFS approval. PROD MRKTG NM Region 2018 Plan Name Rate Increase *Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Please note that while we try to provide you with the most accurate information possible, the final approved rate may differ based onthe benefit plan design and other features you select on renewal. Also, the final, approved rate may differ because DFS may modify theproposed rate.Why We Are Requesting a Rate ChangeThese are the main reasons we are requesting a rate change: Our 2018 rate filings reflect the rising cost of medical care, a changing pool of customers, the ACA insurer fee and ourexperience with provider networks. In 2018, there will be coverage changes to some deductible, copays, coinsurance, benefit limits, and/or annual out-of-pocketmaximum amounts.

What You Need to DoPlease share the enclosed memo with your employees who are enrolled in the PROD MRKTG NM health plan. We recommendthat you provide any additional information with this notice, such as expected changes in employee contribution levels, that may helpyour employees better understand this notice.30-day Comment PeriodYou can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The commentsmust be made within 30 days from the date of this notice.You can contact Empire for additional information at:Email: premiumratechange@empireblue.comTelephone: Small Group Contact Center, 1-866-422-2583Mail: Empire BlueCrossSmall Group Call Center (SG Prior Approval)3 Huntington Quadrangle – 3rd FloorMelville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS via e-mail, by visiting the DFSWebsite or via standard mail as follows:DFS Website: www.dfs.ny.gov/healthinsurancepremiumsEmail: PremiumRateIncreases@dfs.ny.govUnited States Postal Service:NYS Department of Financial ServicesHealth Bureau – Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY 12257If you choose to submit comments to DFS, please include the following information:1.2.3.4.The name of your insurer, which is EmpireThe name of your Empire benefit plan as shown on your Empire ID cardIndicate you have small group coverageYour HIOS identification number, which is HOISID Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.Plain English Summary of Rate ChangeWe have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change isbeing requested. You can find this information at the following websites:Empire website: empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/healthinsurancepremiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, you will receive final rate information at least 60 days before your 2018 renewal date.Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employeehealth benefits plan.Sincerely,Lawrence G. SchreiberPresident, New York CommercialEnclosureServices provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc.,

Services provided by Empire HealthChoice HMO, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_HNY JAN-MAY_filing0517 What You Need to Do Please share the enclosed memo with your employees who are enrolled in the PROD_MRKTG_NM health plan. We recommend