Empire Blue Cross Network Changes-
- EPO/PPO (i.e. “BlueCard”) –this is Empire’s best-in-class legacy BlueCard network
- Blue Priority – full BlueCard hospital network with a narrowed practitioner (doctor) network when in Empire’s 28-county service area. Plans are non-gated with National BlueCard access for folks living and traveling outside of NY. Most of Northwell doctors now are non-participating in the Blue Priority Network. Doctors were just notified in November. The change does not impact BlueCard and/or Pathway networks – Northwell doctors and hospitals still participate in both of those.
- Pathway – narrowed hospital and practitioner network limited to Empire’s 28-county service area (though this network has grown to be fairly comprehensive, missing really only Memorial Sloan Kettering & SUNY Stonybrook)
Oxford Health Plan important Changes:
- Many of the gold plans had 1st dollar coverage for basic radiology that is now subject to the deductible and then a copay.
- Some gold plans had an increase in the Emergency Room Copays from 300 to 400
- Some had a generic Rx copay increase from $10 to $15.
- Many plans have increased Maximum out of pockets and increased deductibles.
- Oxford has added a non-gated Metro option in gold and silver with a 3rdtier Rx instead of the 50% coinsurance to the $800 max that is on the other Metro gated products. (at renewal) be Embedded and not Non Embedded, so someone in a family only needs to hit the single deductible before coinsurance kicks in. Last year the full family deductible had to be hit before coinsurance kicked in.
- Most important to note is that the difference in cost between a generic and name brand will no longer go towards your Maximum Out of Pocket as of your 2017 renewal.