September 26, 2011


Streamlining the EmblemHealth
ConsumerDirect Product Portfolio

To meet the evolving business needs of today's marketplace, EmblemHealth will be streamlining its existing Consumer Direct EPO and PPO product portfolio. Selected Consumer Direct plans will be discontinued and replaced with ones that have a more relevant benefit design and cost-sharing structure. These changes will take affect at renewal* (for small groups/sole proprietors) beginning with January 2012 renewals and continuing through year end. The replacement coverage is comparable to Consumer Direct EPO and PPO benefits.

Transition to Replacement Coverage

Unless you advise us otherwise, affected small group Consumer Direct customers currently covered under one of the discontinued plans will be enrolled automatically into an alternative Consumer Direct plan. These groups will also have the option to purchase any EmblemHealth plan offered in the small group market upon their renewal.

Please refer to this chart to view the key differences and replacement plans for the Consumer Direct options.**

Customer Notification

We are also including a sample of the communications that summarize the benefits and features of the new replacement plans. We will mail letters to affected groups (with a copy to the broker) notifying them of their plan's discontinuance at least 90 days in advance of the effective date. This will provide ample time to evaluate the replacement plans and consider alternative EmblemHealth plan options. The following communications will go to affected groups/sole proprietors and members:

Groups that are not in one of the transferring Consumer Direct plans will continue to receive the same benefits for medical and pharmacy that they receive today, and will receive a renewal letter approximately 60 days prior to the renewal effective date.

We are committed to refining our product portfolio and offering plans that feature attractive benefits at the most competitive price points.

We look forward to continuing to work closely with you to best serve our customers and your clients. If you have any questions about the product discontinuance, please contact your EmblemHealth representative.


  *All Calendar Year Consumer Direct HDHP plans will be discontinued on January 1, 2012 and will have the corresponding renewal effective date.

** Rates are subject to approval by the New York State Insurance Department.

We are discontinuing these plans for existing customers pursuant to our group contract and New York State Insurance Law.