Major Changes to NY Empire and Oxford plans for 2017

logos for blue cross and oxford

Empire Blue Cross Network Changes-

  1. EPO/PPO (i.e. “BlueCard”) –this is Empire’s best-in-class legacy BlueCard network
  2. 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.
  3. 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.