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Empire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date Group Name LINE 1 ADRS TXT LINE 2 ADRS TXT GrpCity , GrpState ZIP CD Re:Notice of Proposed 2020 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 2020. 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 2020 plan name: PROD MRKTG NM Your group’s rating region is based on your group’s currentregion of operation 2020 Plan Name Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Services 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.
2020 Plan Name2nd QuarterEmpire Platinum PPO 20/0%/3500 80th Percentile FAIR HealthEmpire Platinum PPO 500/10%/6500Empire Platinum PPO 5/0%/2500Empire Platinum EPO 5/0%/2500Empire Platinum EPO 20/0%/2500Empire Platinum Blue Access EPO 20/0%/4600Empire Platinum Blue Access GEPO 250/10%/3000Empire Gold EPO 25/0%/7000Empire Gold EPO 35/10%/7000Empire Gold EPO 1250/20%/5000Empire Gold EPO 1000/10%/7000Empire Gold PPO 1000/20%/5500Empire Gold PPO 1500/10%/4000 w/HSAEmpire Gold EPO 2000/30%/7900Empire Gold Blue Access EPO 25/0%/7000Empire Gold Blue Access EPO 35/10%/7000Empire Gold Blue Access GEPO 40/30%/6000Empire Gold Blue Access EPO 1400/0%/3000 w/HSAEmpire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair HealthEmpire Silver PPO 3000/0%/5250 w/HSAEmpire Silver PPO 3000/20%/6850 w/HSAEmpire Silver EPO 1600/30%/8150Empire Silver EPO 2100/30%/6850 w/HSAEmpire Silver EPO 2500/30%/8150Empire Silver EPO 3000/0%/5250 w/HSAEmpire Silver EPO 3000/30%/8150Empire Silver Blue Access EPO 1600/30%/8150Empire Silver Blue Access EPO 2500/30%/8150Empire Silver Blue Access EPO 3000/0%/5250 w/HSAEmpire Silver Blue Access EPO 3000/40%/8000Empire Silver Blue Access GEPO 4000/40%/7350Empire Bronze EPO 5100/30%/6850 w/HSAEmpire Bronze EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 6850/0%/6850 w/HSAEmpire Bronze Blue Access EPO 8150/0%/8150Empire Bronze Blue Access GEPO 6500/40%/8150Region .4%Region 3:Region 8:Region 4: Region 2%6.8%6.6%2.9%1.5%3.5%0.4%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 ChangeThe requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, achanging pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in2020 to some deductibles, copays, coinsurance, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters maydiffer.Services 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.
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 – 1st FloorSuite 104S (South)Melville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or viastandard mail as follows:DFS Website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsUnited 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: www.empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate informationat least 60 days before your 2020 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,Alan J. MurrayPresident & CEOServices 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.
Empire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date IMPORTANT: Notice of Proposed 2020 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 2020. 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 2020 plan name: PROD MRKTG NM Your group’s rating region is based on yourgroup’s current region of operation 2020 Plan Name Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Services 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.
2020 Plan Name2nd QuarterEmpire Platinum PPO 20/0%/3500 80th Percentile FAIR HealthEmpire Platinum PPO 500/10%/6500Empire Platinum PPO 5/0%/2500Empire Platinum EPO 5/0%/2500Empire Platinum EPO 20/0%/2500Empire Platinum Blue Access EPO 20/0%/4600Empire Platinum Blue Access GEPO 250/10%/3000Empire Gold EPO 25/0%/7000Empire Gold EPO 35/10%/7000Empire Gold EPO 1250/20%/5000Empire Gold EPO 1000/10%/7000Empire Gold PPO 1000/20%/5500Empire Gold PPO 1500/10%/4000 w/HSAEmpire Gold EPO 2000/30%/7900Empire Gold Blue Access EPO 25/0%/7000Empire Gold Blue Access EPO 35/10%/7000Empire Gold Blue Access GEPO 40/30%/6000Empire Gold Blue Access EPO 1400/0%/3000 w/HSAEmpire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair HealthEmpire Silver PPO 3000/0%/5250 w/HSAEmpire Silver PPO 3000/20%/6850 w/HSAEmpire Silver EPO 1600/30%/8150Empire Silver EPO 2100/30%/6850 w/HSAEmpire Silver EPO 2500/30%/8150Empire Silver EPO 3000/0%/5250 w/HSAEmpire Silver EPO 3000/30%/8150Empire Silver Blue Access EPO 1600/30%/8150Empire Silver Blue Access EPO 2500/30%/8150Empire Silver Blue Access EPO 3000/0%/5250 w/HSAEmpire Silver Blue Access EPO 3000/40%/8000Empire Silver Blue Access GEPO 4000/40%/7350Empire Bronze EPO 5100/30%/6850 w/HSAEmpire Bronze EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 6850/0%/6850 w/HSAEmpire Bronze Blue Access EPO 8150/0%/8150Empire Bronze Blue Access GEPO 6500/40%/8150Region .4%Region 3:Region 8:Region 4: Region 2%6.8%6.6%2.9%1.5%3.5%0.4%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.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 that your employer selects on renewal. Also, the final approved rate may differ becauseDFS may modify the proposed rate.Why We Are Requesting a Rate ChangeThe requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, achanging pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles,copays, coinsurance, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.Services 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.
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 – 1st FloorSuite 104S (South)Melville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or viastandard mail as follows:DFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsUnited States Postal Service:NYS Department of Financial ServicesHealth Bureau — Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY 12257If 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: www.empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rateinformation at least 60 days before your 2020 renewal date.Thank you for choosing Empire for your health benefits plan.Sincerely,Alan J. MurrayPresident & CEOServices 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.
Empire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date Group Name LINE 1 ADRS TXT LINE 2 ADRS TXT GrpCity , GrpState ZIP CD Re:Notice of Proposed 2020 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 2020. 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 2020 plan name: PROD MRKTG NM Your group’s rating region is based on your group’s currentregion of operation 2020 Plan Name Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Services 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.
2020 Plan Name2nd QuarterEmpire Platinum PPO 20/0%/3500 80th Percentile FAIR HealthEmpire Platinum PPO 500/10%/6500Empire Platinum PPO 5/0%/2500Empire Platinum EPO 5/0%/2500Empire Platinum EPO 20/0%/2500Empire Platinum Blue Access EPO 20/0%/4600Empire Platinum Blue Access GEPO 250/10%/3000Empire Gold EPO 25/0%/7000Empire Gold EPO 35/10%/7000Empire Gold EPO 1250/20%/5000Empire Gold EPO 1000/10%/7000Empire Gold PPO 1000/20%/5500Empire Gold PPO 1500/10%/4000 w/HSAEmpire Gold EPO 2000/30%/7900Empire Gold Blue Access EPO 25/0%/7000Empire Gold Blue Access EPO 35/10%/7000Empire Gold Blue Access GEPO 40/30%/6000Empire Gold Blue Access EPO 1400/0%/3000 w/HSAEmpire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair HealthEmpire Silver PPO 3000/0%/5250 w/HSAEmpire Silver PPO 3000/20%/6850 w/HSAEmpire Silver EPO 1600/30%/8150Empire Silver EPO 2100/30%/6850 w/HSAEmpire Silver EPO 2500/30%/8150Empire Silver EPO 3000/0%/5250 w/HSAEmpire Silver EPO 3000/30%/8150Empire Silver Blue Access EPO 1600/30%/8150Empire Silver Blue Access EPO 2500/30%/8150Empire Silver Blue Access EPO 3000/0%/5250 w/HSAEmpire Silver Blue Access EPO 3000/40%/8000Empire Silver Blue Access GEPO 4000/40%/7350Empire Bronze EPO 5100/30%/6850 w/HSAEmpire Bronze EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 6850/0%/6850 w/HSAEmpire Bronze Blue Access EPO 8150/0%/8150Empire Bronze Blue Access GEPO 6500/40%/8150Region .4%Region 3:Region 8:Region 4: Region 2%6.8%6.6%2.9%1.5%3.5%0.4%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 ChangeThe requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, achanging pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in2020 to some deductibles, copays, coinsurance, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters maydiffer.Services 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.
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 – 1st FloorSuite 104S (South)Melville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or viastandard mail as follows:DFS Website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsUnited 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: www.empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate informationat least 60 days before your 2020 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,Alan J. MurrayPresident & CEOServices 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.
Empire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date IMPORTANT: Notice of Proposed 2020 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 2020. 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 2020 plan name: PROD MRKTG NM Your group’s rating region is based on yourgroup’s current region of operation 2020 Plan Name Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Services 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.
2020 Plan Name2nd QuarterEmpire Platinum PPO 20/0%/3500 80th Percentile FAIR HealthEmpire Platinum PPO 500/10%/6500Empire Platinum PPO 5/0%/2500Empire Platinum EPO 5/0%/2500Empire Platinum EPO 20/0%/2500Empire Platinum Blue Access EPO 20/0%/4600Empire Platinum Blue Access GEPO 250/10%/3000Empire Gold EPO 25/0%/7000Empire Gold EPO 35/10%/7000Empire Gold EPO 1250/20%/5000Empire Gold EPO 1000/10%/7000Empire Gold PPO 1000/20%/5500Empire Gold PPO 1500/10%/4000 w/HSAEmpire Gold EPO 2000/30%/7900Empire Gold Blue Access EPO 25/0%/7000Empire Gold Blue Access EPO 35/10%/7000Empire Gold Blue Access GEPO 40/30%/6000Empire Gold Blue Access EPO 1400/0%/3000 w/HSAEmpire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair HealthEmpire Silver PPO 3000/0%/5250 w/HSAEmpire Silver PPO 3000/20%/6850 w/HSAEmpire Silver EPO 1600/30%/8150Empire Silver EPO 2100/30%/6850 w/HSAEmpire Silver EPO 2500/30%/8150Empire Silver EPO 3000/0%/5250 w/HSAEmpire Silver EPO 3000/30%/8150Empire Silver Blue Access EPO 1600/30%/8150Empire Silver Blue Access EPO 2500/30%/8150Empire Silver Blue Access EPO 3000/0%/5250 w/HSAEmpire Silver Blue Access EPO 3000/40%/8000Empire Silver Blue Access GEPO 4000/40%/7350Empire Bronze EPO 5100/30%/6850 w/HSAEmpire Bronze EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 5500/30%/6800 w/HSAEmpire Bronze Blue Access EPO 6850/0%/6850 w/HSAEmpire Bronze Blue Access EPO 8150/0%/8150Empire Bronze Blue Access GEPO 6500/40%/8150Region .4%Region 3:Region 8:Region 4: Region 2%6.8%6.6%2.9%1.5%3.5%0.4%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.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 that your employer selects on renewal. Also, the final approved rate may differ becauseDFS may modify the proposed rate.Why We Are Requesting a Rate ChangeThe requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, achanging pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles,copays, coinsurance, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.Services 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.
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 – 1st FloorSuite 104S (South)Melville, NY 11747Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or viastandard mail as follows:DFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsUnited States Postal Service:NYS Department of Financial ServicesHealth Bureau — Premium Rate AdjustmentsOne Commerce PlazaAlbany, NY 12257If 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: www.empireblue.com/priorapprovalDFS website: www.dfs.ny.gov/consumers/health insurance/health insurance premiumsNotice of Approved Premium RateAfter DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rateinformation at least 60 days before your 2020 renewal date.Thank you for choosing Empire for your health benefits plan.Sincerely,Alan J. MurrayPresident & CEOServices 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.
Empire BlueCross BlueShieldPO Box 1407, Church Street StationNew York, NY 10008-1407empireblue.com Date Group Name LINE 1 ADRS TXT LINE 2 ADRS TXT GrpCity , GrpState ZIP CD Re:Notice of Proposed 2020 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 2020. 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 2020 plan name: PROD MRKTG NM Your group’s rating region is based on your group’s currentregion of operation 2020 Plan Name Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.Services provided by Em
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 health insurance premium rates for 2020. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS.
