2020 Empire BCBS Small Business Health Update

2019 was a year of transition and rebuilding at Empire BCBS in the small group market. New Senior Management came in with a lot of industry experience and set out to improve their small group portfolio in addition to streamlining their operations to become more fluid and easier to work with.

New for 2020 – Empire BCBS rolls out new Connection Network

The Empire Connection Network includes national blue card access we all know and love! In addition to the connections network, Empire has rolled out what they are calling the “Whole Health” solutions. Whole Health packages their competitive medical portfolio as well as their competitive Ancillary offerings.

Empire’s EPO/PPO Network continues to boast one of the largest and robust networks in the NY area while offering national access with the Blue Card network.

Empire Blue Access Network, which was new to the market in 2019 replacing the old Blue Priority network, is back this year and by no means is this a micro network. The Blue Access network is approx. 92% of the EPO/PPO network and as of 1/1/2020 Memorial Sloan Kettering is in network as well. The only major provider group missing is the Caremount Physicians (Mt. Kisco Medical Group) and Stony Brook University hospital. Empire has also upgraded the RX formulary for these plans, all Blue Access plans will now use the larger Traditional RX pharmacy as opposed to the Select pharmacy all plans had last year. While this network offers the Blue Card network nationally, Gated plans require members to have a PCP in NY, so this network would NOT be a good fit for out of state employees if the plans are gated.

The Empire Connection Network, which is new for 2020, is approximately 70% the size of the EPO/PPO network which also includes national access with the Blue Card Network. This product was created to compete with the Oxford Metro, Oscar, HealthFirst and Emblem plans with similar network restrictions. This network includes Northwell Health System, Hospital for Special Surgery, and NY Presbyterian. The following hospital systems are NOT participating – NYU (which includes Winthrop), Memorial Sloan Kettering, Caremount Physicians, Stony Brook and the Long Island Health Network which is made up of the Catholic hospitals on Long Island, most notably St. Francis.

Empire is offering 67 small group plans this year across all 3 of their networks. Empire rates Long Island separate from the 5 Boroughs and Westchester and interestingly where some carriers rate Long Island higher usually due to the Northwell system, Empire is rating Long Island approx. 2% lower than the other rating areas due to competitive contracting.

Also included on all the Empire plans for 2020 is a very robust Empire Health Rewards program with a Gym Reimbursement of up to $400 for members, spouses and dependents over 18. There are also reimbursements available for smoking cessation, completing Preventative Wellness exams, Flu Shots and completing reward incentives.

Empire has also rolled out a new RX Platform which they own, Ingenio RX. With the transition to their own PBM (pharmacy benefit manager), Empire is confident they can deliver a new value. The move to their own PBM is in tune with their Whole Health approach. With line of insight into the pharmacy and medical benefits, Empire BCBS can make clinical decisions based on a more complete view of the members health.

Click here for more information on Empire BCBS Small Business Health Plans. You can also compare all carrier networks and search for providers with this link as well.

Peak Advisors is a NY health insurance broker serving NY, Long Island, and NYC for over 29 years. For quotes and information please complete our small group information form to get rates and to discuss options for your small business.