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Empire Health Insurance Company

Dino Christoforakis
Dino Christoforakis

Editor in Chief & Licensed Insurance Agent.

Empire Health Insurance Company is a Blue Cross Blue Shield company. Their HMO, Direct HMO, and Medicare Advantage HMO products have earned them Excellent Accreditation status from the National Committee for Quality Assurance. Founded in 1934 in New York City, where it is still headquartered today, Empire Health Insurance Company has 5 million members and over 38,000 company accounts. Statistically, they retain 93% of their company client base with a 91% customer satisfaction score.

Read through this review of Empire Blue Cross Blue Shield Health Insurance Company, check out the Empire Health Insurance reviews left by real customers at the bottom of this page, and then leave your own review of Empire BCBS if you are a policyholder.

Once you have completed perusing the Empire Health Insurance reviews then be sure and enter your zip code into the box on the sidebar of this page to compare health insurance quotes from top health insurance providers online.

History of Empire BCBS Health Insurance

After Associate Hospital Service (AHS) was founded in 1934, United Medical Service (UMS) was established in 1944. In 1974, these two companies merged to form Blue Cross Blue Shield of Greater New York. In 1966, Empire HealthChoice and Empire HealthChoice Assurance were created. Later in 2005, WellChoice, the parent company of Empire Blue Cross Blue Shield, was acquired by WellPoint, which created the largest health insurance provider in the United States.

This acquisition formed over thirty-five million members nationwide. 2007 introduced Empire Prism, which are health plans for small to medium sized businesses. Life insurance was added by Empire Blue Cross Blue Shield in 2009, making it a full service benefits provider.

Local network providers service 28 eastern and southeastern counties in the state of New York and 10 counties in New Jersey and Connecticut. Through local Blue Cross and Blue Shield plans, all members have access to participating providers nationwide and worldwide.

It is important to note that Blue Cross Blue Shield is similar to a nationwide franchise and is not a true nationwide company. There are many different health insurance companies that pay a licensing fee to use the BCBS trademark and operate in a specific locale. Click here to read the full Blue Cross Blue Shield Health Insurance Review.

Empire Blue Cross Blue Shield Individual Health Insurance

Child Health Plus is available in select counties of New York State, New Jersey, and Connecticut. Children under 19 years of age who qualify for the plan receive in-network benefits with over 65,000 providers and 147 hospitals. Financial support for coverage may also be available.

Healthy New York is a plan for individuals and sole proprietors in select counties of New York, New Jersey, and Connecticut. Necessary health services are available with Empire’s network of 65,000 providers and 147 hospitals, and emergency care is always accessible at the nearest doctor or hospital. Optionally, a prescription drug benefit is obtainable.

Direct Pay HMO/POS offers dual benefits. The plan is a traditional HMO (Health Maintenance Organization) that offers the choice of a POS (Point of Service) if a member goes out of the network. As is standard with an HMO, a Primary Care Physician (PCP) will provide for your care or refer to you a specialist when needed. As with the Healthy New York plan, emergency care is always accessible.

Direct Pay HMO is a standard Health Maintenance Organization plan. Members choose a PCP for their basic and preventive care and then receive referrals for specialists when needed. By having a PCP you have the added benefit of maintaining your medical history. Hospital admissions must be arranged and special services do require pre-certification. All services must be within the HMO network. Pharmacy benefits are included along with in-patient coverage and emergency care.

Tradition PLUS Hospital is hospital coverage for members and their dependents. It covers hospital related costs, including inpatient hospital protection with 365 days paid in full. Also included are maternity care, newborn hospital care, outpatient chemotherapy, radiation therapy, physical therapy, and Skilled Nursing Facility Care.

Empire Blue Cross Blue Shield Group Health Insurance

HMO is a traditional HMO plan with low out-of-pocket costs and access to over 65,000 providers and 147 hospitals in participating counties in New York, New Jersey, and Connecticut. Typical HMO plans require that you stay within the network, see your primary physician, and get referrals for specialized care.

Empire’s Direct HMO plan is the same as the traditional HMO plan above with the exception that members are allowed to choose a network specialist without a referral.

Direct POS gives members full range of in-network benefits with no claim forms, although full out-of-network coverage is available. Low out-of-pockets costs are made possible by requiring members to have a PCP, but members are not required to get referrals for specialists within the network. The same network of 65,000 providers and 147 hospitals applies.

DirectShare POS (SM) is the same plan as the Direct POS plan, with the additional benefit of allowing members to manage their own healthcare costs with in-network doctors.

The PPO plan is the freedom of choice plan. In addition to the Empire network, members have an extended network of doctors and hospitals through BlueCard PPO providers, giving access to 668,000 physicians and 8,500 hospitals. Coverage is nationwide with in and out-of-network benefits. No referrals are needed and members can help manage their costs with in-network doctors.

Empire’s EPO and national EPO plans have nationwide coverage with over 668,000 doctors and 8,500 hospitals through Empire’s network as well as through participating BlueCard network providers. Although only in-network benefits apply, referrals are not needed.

Empire Total Blue (SM) is a Consumer-Driven Health Plan (CDHP). Members are in control of their health costs and healthcare decisions. Referrals are not required and nationwide coverage gives members access to both Empire’s network and the BlueCard network, which consists of 668,000 physicians and 8,500 hospitals. The plan carries a higher deductible which gives members a lower monthly premium. The plan utilizes Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA) whether they are employee or employer funded.

Empire BCBS Medicare Health Insurance

Empire offers both Medicare Advantage and Medicare Supplement plans, which are intended to provide members with up to 100% basic Medicare benefits and additional hospital and medical coverage that is not typically provided by Medicare.

MediBlue (SM) HMO is a Medicare Advantage HMO plan with no or low monthly premiums depending on the plan. Medicare prescription drug coverage is also available. Members will receive access to doctors and hospitals in the counties of Westchester, Ulster, Sullivan, Suffolk, Schenectady Saratoga, Rockland, Richmond, Rensselaer, Queens, Putnam, Orange, New York, Nassau, Kings, Dutchess, Bronx, and Albany.

MediBlue Total Solutions is a Medicare Advantage HMO for eligible low income individuals in the Westchester, Suffolk, Rockland, Richmond, Queens, Nassau, Kings, and Bronx counties.

MediBlue PPO is a Medicare Advantage PPO with direct access to providers in and out of the network. Medicare prescription drug coverage is also available under this plan, which can be obtained in the Westchester, Suffolk, Rockland, Richmond, Queens, Nassau, Manhattan, Kings, and Bronx counties.

MediBlue SmartValue (SM) is a Medicare Advantage Private Fee for Service plan where members can go to any licensed doctor who provides Medicare services and is willing to accept the terms and conditions of the plan. Members are not required to have a PCP or get referrals for special care. Medicare Part D prescription coverage is included in this plan, which is only available in Sullivan County.

MediBlue (SM) Medicare Supplement plans, sometimes called Medigap, is available to help pay for out-of-pocket costs for Medicare services that are not covered by Medicare, such as deductibles and copayments. There are twelve standardized Medicare supplements that vary by company, but typically Plan A covers the basics while Plans B through L cover a variety of additional expenses as well, such as emergency health care or skilled nursing facilities. Empire offers Plans A, B, C, F, H, K, and L. The monthly premium and out-of-pocket fees will depend on the plan.

To be eligible for Empire’s Medicare supplemental plans you must be a resident of New York State living in one of the 28 counties that are within Empire’s service area. You must also be 65 years of age or older, although some states will consider participants under 65 years of age if they have a disability or are in the end stages of renal (chronic kidney) disease. Applicants must be enrolled in both Medicare Part A and Medicare Part B. Medicare supplement plan benefits cannot be used along with a Medicare Advantage plan.

Compare Empire Health Insurance Quotes

Empire Health Insurance Company offers many different individual and group plans in addition to supplemental Medicare plans. Utilizing the Blue Cross Blue Shield network in addition to its own large network allows Empire Blue Cross Blue Shield to offer a myriad of plans with varying costs and benefits. In order to find a plan that fits your medical needs and financial budget, enter your zip code above and start comparing Empire health insurance quotes with quotes from many top health insurance companies. Why not take a minute, since you’re already here, and use the quote tool now?

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