CITY OF NEW YORK 2021 OPEN ENROLLMENT - EMPIRE BLUECROSS BLUESHIELD - CUNY
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Empire BlueCross BlueShield City of New York 2021 Open Enrollment
City of New York offers three Empire
BCBS plans for active employees
1. Empire BlueCross BlueShield/GHI-CBP Hospital Plan
• Empire Hospital Coverage
2. Empire Blue Access Gated EPO
• Medical Plan with broad Local Network
3. Empire EPO Plan
• Medical Plan with National PPO Network
2
Empire BlueCross BlueShield/GHI-CBP Hospital Plan
This plan consists of two components:
Empire BlueCross BlueShield, an Anthem company, offering benefits for services provided at hospital and out-patient facilities.
GHI, an EmblemHealth company, offering benefits for medical/physician services
Access to hospitals under the
expansive National and You also have the option of
$0 Monthly Premium
International provider network. using hospitals outside of the
This allows you to visit any network for an additional out -
hospital that participates with of- pocket cost
Blue Cross or Blue Shield.
$300 individual copay per 20% coinsurance to a maximum
$150 ER copay per visit (waived
hospital admission/$750 of $200 per person per/ per
if admitted to the hospital
maximum individual copays per calendar year for outpatient
within 24 hours)
calendar year procedures
Things to know about your Hospital Only Plan • You will be issued two ID cards, Empire BCBS and GHI/Emblem. • Care Management Program- Provides a team of registered nurses, supported by clinical experts to help you during stressful times when having health issues. They are your health care advocates with the goal to understand your needs from all angels, and help you get the best care possible. • WINFertility Program- Provides 24/7 access to Nurse Care Managers who can answer your questions, help you find providers and listen to your concerns while you're trying to get pregnant. • ER Copay is $150 but if you are admitted to the hospital overnight then that copay is waived. A Inpatient cost share of $300 per admit will apply. • The plan benefits run on calendar year, for example you will not pay more than $200 for any/all outpatient procedures for January 1st through December 31st. • As an eligible Blue Cross Blue Shield member, you have access to the international network for emergencies when traveling outside the Unites States, Puerto Rico or the U.S .Virgin Islands. Blue Cross and Blue Shield Global Core can help you find providers and get your services covered. Please visit www.bcbsglobalcore.com or call 1.800.810.BLUE (2583) or collect at +1.804.673.1177 for assistance. • Additional questions, visit www.empireblue.com/nyc or call 1-800-433-9592
Empire offers two EPO plans , what is the difference ?
Blue Access Gated EPO EPO
Provides a large local As a Gated plan you will
Provides one of the No referrals needed $250 copay per hospital
network of physicians need to select a primary
$300 copay per hospital largest national from your primary care admission / $625 per
and hospitals in New care physician in order
admission/per person networks of physicians physician to visit a maximum per
York, New Jersey and to be referred to a
and hospitals. specialist. person/per calendar
Connecticut * specialist year
Durable Medical Durable Medical
Equipment and $100 copay per
Equipment and $0 copay per admission 210 days covered for
Prosthetics covered at admission for Skilled Unlimited hospice care
Prosthetics covered at for Skilled Nursing hospice care
50% Nursing
100%
Premium contribution - Premium contribution –
See 2021 Health Plan See 2021 Health Plan
Rate sheet Rate Sheet
*Available only to members residing in the following counties:
New York-Albany, Bronx, Clinton, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland,
Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington and Westchester. New Jersey-Hudson, Union, Sussex, Passaic, Monmouth and Bergen. Connecticut-Fairfield
and LitchfieldThings to know about Empire’s EPO plans – In network benefits only
24/7 Nurseline WIN Fertility
Live Health Online
(Telemedicine)
Additional questions regarding these plans, visit www.empireblue.com/nyc or call customer service
numbers for Blue Access Gated EPO (833-924-1055) and for EPO plan (800-767-8672)Appendix • For additional information on Empire BlueCross BlueShield plans, please visit www.empireblue.com/nyc • Have questions regarding how to enroll and the cost of plans ? Please refer to your local union website or the OLR website https://www1.nyc.gov/site/olr/health/healthhome.page
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