Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.

Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 2.2% 1.3% N/A ‐0.6%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.7% 2.8% 1.9% 1.4% 0.0%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.8% 2.7% 1.8% 1.3% ‐0.1%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 3.6% 2.7% N/A 0.8%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐2.6% 1.9% 0.9% 0.4% ‐0.9%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 8.4% 7.4% N/A 5.4%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.1% 5.1% N/A 3.2%

Empire Gold Blue Access EPO 35/10%/5850 N/A 7.7% 6.7% N/A 4.8%

Empire Gold EPO 1000/10%/5000 3.6% 8.3% 7.3% 6.8% 5.4%

Empire Gold EPO 1500/10%/7000 3.6% 8.4% 7.4% 6.8% 5.4%

Empire Gold EPO 25/0%/6000 1.9% 6.5% 5.5% 5.0% 3.6%

Empire Gold EPO 35/10%/5850 4.0% 8.8% 7.8% 7.2% 5.8%

Empire Gold EPO 500/20%/7350 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold Blue Access EPO 35/10%/5850 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Gold Blue Access EPO 500/20%/7350 0.7% 5.2% 4.3% 3.8% 2.4%

Empire Gold PPO 1000/10%/5000 N/A 15.7% 14.7% N/A 12.6%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 14.4% 13.4% N/A 11.3%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 5.4% 4.5% N/A 2.5%

Empire Platinum EPO 15/0%/3500 1.9% 6.5% 5.6% 5.1% 3.7%

Empire Platinum EPO 5/0%/2600 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.9% 3.7% 2.7% 2.2% 0.8%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 16.8% 15.7% N/A 13.6%

Empire Platinum PPO 250/10%/5250 N/A 15.7% 14.7% N/A 12.6%

Empire Platinum PPO 5/0%/2600 N/A 14.8% 13.8% N/A 11.7%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.1% 5.1% N/A 3.2%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 7.3% 6.4% N/A 4.4%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.8% 5.8% N/A 3.9%

Empire Silver EPO 1500/30%/7350 2.3% 6.9% 6.0% 5.4% 4.0%

Empire Silver EPO 2500/30%/7500 3.5% 8.2% 7.3% 6.7% 5.3%

Empire Silver EPO 2700/30%/5000 w/HSA ‐1.3% 3.2% 2.3% 1.8% 0.4%

Empire Silver EPO 2750/30%/7350 3.9% 8.6% 7.6% 7.1% 5.7%

Empire Silver EPO 3000/0%/5250 w/HSA 3.0% 7.7% 6.7% 6.2% 4.7%

Empire Silver EPO 3000/30%/7350 3.9% 8.6% 7.6% 7.1% 5.6%

Empire Silver Blue Access EPO 1500/30%/7350 8.0% 12.9% 11.9% 11.3% 9.8%

Empire Silver Blue Access EPO 2500/30%/7500 1.0% 5.6% 4.6% 4.1% 2.7%

Empire Silver Blue Access EPO 2750/30%/7350 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 10.5% 9.5% N/A 7.5%

Empire Silver PPO 3000/0%/5250 w/HSA 10.1% 15.1% 14.0% 13.5% 12.0%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.9% N/A N/A 17.5% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.1% 2.3% 1.4% 0.9% ‐0.5%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 5.5% 10.3% 9.3% 8.7% 7.3%

2019 Plan Name

3rd Quarter

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFSl, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan.

Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 2.2% 1.3% N/A ‐0.6%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.7% 2.8% 1.9% 1.4% 0.0%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.8% 2.7% 1.8% 1.3% ‐0.1%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 3.6% 2.7% N/A 0.8%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐2.6% 1.9% 0.9% 0.4% ‐0.9%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 8.4% 7.4% N/A 5.4%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.1% 5.1% N/A 3.2%

Empire Gold Blue Access EPO 35/10%/5850 N/A 7.7% 6.7% N/A 4.8%

Empire Gold EPO 1000/10%/5000 3.6% 8.3% 7.3% 6.8% 5.4%

Empire Gold EPO 1500/10%/7000 3.6% 8.4% 7.4% 6.8% 5.4%

Empire Gold EPO 25/0%/6000 1.9% 6.5% 5.5% 5.0% 3.6%

Empire Gold EPO 35/10%/5850 4.0% 8.8% 7.8% 7.2% 5.8%

Empire Gold EPO 500/20%/7350 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold Blue Access EPO 35/10%/5850 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Gold Blue Access EPO 500/20%/7350 0.7% 5.2% 4.3% 3.8% 2.4%

Empire Gold PPO 1000/10%/5000 N/A 15.7% 14.7% N/A 12.6%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 14.4% 13.4% N/A 11.3%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 5.4% 4.5% N/A 2.5%

Empire Platinum EPO 15/0%/3500 1.9% 6.5% 5.6% 5.1% 3.7%

Empire Platinum EPO 5/0%/2600 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.9% 3.7% 2.7% 2.2% 0.8%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 16.8% 15.7% N/A 13.6%

Empire Platinum PPO 250/10%/5250 N/A 15.7% 14.7% N/A 12.6%

Empire Platinum PPO 5/0%/2600 N/A 14.8% 13.8% N/A 11.7%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.1% 5.1% N/A 3.2%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 7.3% 6.4% N/A 4.4%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.8% 5.8% N/A 3.9%

Empire Silver EPO 1500/30%/7350 2.3% 6.9% 6.0% 5.4% 4.0%

Empire Silver EPO 2500/30%/7500 3.5% 8.2% 7.3% 6.7% 5.3%

Empire Silver EPO 2700/30%/5000 w/HSA ‐1.3% 3.2% 2.3% 1.8% 0.4%

Empire Silver EPO 2750/30%/7350 3.9% 8.6% 7.6% 7.1% 5.7%

Empire Silver EPO 3000/0%/5250 w/HSA 3.0% 7.7% 6.7% 6.2% 4.7%

Empire Silver EPO 3000/30%/7350 3.9% 8.6% 7.6% 7.1% 5.6%

Empire Silver Blue Access EPO 1500/30%/7350 8.0% 12.9% 11.9% 11.3% 9.8%

Empire Silver Blue Access EPO 2500/30%/7500 1.0% 5.6% 4.6% 4.1% 2.7%

Empire Silver Blue Access EPO 2750/30%/7350 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 10.5% 9.5% N/A 7.5%

Empire Silver PPO 3000/0%/5250 w/HSA 10.1% 15.1% 14.0% 13.5% 12.0%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.9% N/A N/A 17.5% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.1% 2.3% 1.4% 0.9% ‐0.5%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 5.5% 10.3% 9.3% 8.7% 7.3%

2019 Plan Name

3rd Quarter

coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com     <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD> Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your group’s current

region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

DFS Website: www.dfs.ny.gov/healthinsurancepremiums United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed. Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on <RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

30-day Comment Period

You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.

Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 3.0% 2.0% N/A 0.2%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.9% 1.9% N/A 0.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.0% 3.5% 2.6% 2.1% 0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.0% 3.5% 2.5% 2.0% 0.7%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 4.3% 3.4% N/A 1.5%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐1.9% 2.6% 1.7% 1.2% ‐0.2%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 9.2% 8.2% N/A 6.2%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.9% 5.9% N/A 4.0%

Empire Gold Blue Access EPO 35/10%/5850 N/A 8.5% 7.5% N/A 5.6%

Empire Gold EPO 1000/10%/5000 4.3% 9.1% 8.1% 7.6% 6.1%

Empire Gold EPO 1500/10%/7000 4.4% 9.2% 8.2% 7.6% 6.2%

Empire Gold EPO 25/0%/6000 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Gold EPO 35/10%/5850 4.8% 9.6% 8.6% 8.0% 6.6%

Empire Gold EPO 500/20%/7350 4.1% 8.8% 7.8% 7.3% 5.9%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold Blue Access EPO 35/10%/5850 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Gold Blue Access EPO 500/20%/7350 1.4% 6.0% 5.1% 4.5% 3.1%

Empire Gold PPO 1000/10%/5000 N/A 16.6% 15.5% N/A 13.4%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 15.3% 14.2% N/A 12.1%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 6.2% 5.2% N/A 3.3%

Empire Platinum EPO 15/0%/3500 2.7% 7.3% 6.4% 5.8% 4.4%

Empire Platinum EPO 5/0%/2600 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.1% 4.4% 3.5% 3.0% 1.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 17.6% 16.6% N/A 14.4%

Empire Platinum PPO 250/10%/5250 N/A 16.6% 15.5% N/A 13.4%

Empire Platinum PPO 5/0%/2600 N/A 15.7% 14.6% N/A 12.5%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.8% 5.9% N/A 3.9%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 8.1% 7.2% N/A 5.2%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 7.6% 6.6% N/A 4.7%

Empire Silver EPO 1500/30%/7350 3.0% 7.7% 6.7% 6.2% 4.8%

Empire Silver EPO 2500/30%/7500 4.3% 9.0% 8.1% 7.5% 6.1%

Empire Silver EPO 2700/30%/5000 w/HSA ‐0.5% 4.0% 3.1% 2.5% 1.2%

Empire Silver EPO 2750/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver EPO 3000/0%/5250 w/HSA 3.7% 8.4% 7.5% 6.9% 5.5%

Empire Silver EPO 3000/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver Blue Access EPO 1500/30%/7350 8.8% 13.7% 12.7% 12.2% 10.7%

Empire Silver Blue Access EPO 2500/30%/7500 1.7% 6.3% 5.4% 4.9% 3.5%

Empire Silver Blue Access EPO 2750/30%/7350 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 11.4% 10.3% N/A 8.3%

Empire Silver PPO 3000/0%/5250 w/HSA 10.9% 15.9% 14.9% 14.3% 12.8%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 14.8% N/A N/A 18.3% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐1.4% 3.1% 2.1% 1.6% 0.3%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 6.2% 11.1% 10.1% 9.5% 8.0%

2019 Plan Name

4th Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

3 Huntington Quad. 1st Fl. Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan.

Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 3.0% 2.0% N/A 0.2%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.9% 1.9% N/A 0.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.0% 3.5% 2.6% 2.1% 0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.0% 3.5% 2.5% 2.0% 0.7%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 4.3% 3.4% N/A 1.5%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐1.9% 2.6% 1.7% 1.2% ‐0.2%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 9.2% 8.2% N/A 6.2%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.9% 5.9% N/A 4.0%

Empire Gold Blue Access EPO 35/10%/5850 N/A 8.5% 7.5% N/A 5.6%

Empire Gold EPO 1000/10%/5000 4.3% 9.1% 8.1% 7.6% 6.1%

Empire Gold EPO 1500/10%/7000 4.4% 9.2% 8.2% 7.6% 6.2%

Empire Gold EPO 25/0%/6000 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Gold EPO 35/10%/5850 4.8% 9.6% 8.6% 8.0% 6.6%

Empire Gold EPO 500/20%/7350 4.1% 8.8% 7.8% 7.3% 5.9%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold Blue Access EPO 35/10%/5850 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Gold Blue Access EPO 500/20%/7350 1.4% 6.0% 5.1% 4.5% 3.1%

Empire Gold PPO 1000/10%/5000 N/A 16.6% 15.5% N/A 13.4%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 15.3% 14.2% N/A 12.1%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 6.2% 5.2% N/A 3.3%

Empire Platinum EPO 15/0%/3500 2.7% 7.3% 6.4% 5.8% 4.4%

Empire Platinum EPO 5/0%/2600 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.1% 4.4% 3.5% 3.0% 1.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 17.6% 16.6% N/A 14.4%

Empire Platinum PPO 250/10%/5250 N/A 16.6% 15.5% N/A 13.4%

Empire Platinum PPO 5/0%/2600 N/A 15.7% 14.6% N/A 12.5%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.8% 5.9% N/A 3.9%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 8.1% 7.2% N/A 5.2%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 7.6% 6.6% N/A 4.7%

Empire Silver EPO 1500/30%/7350 3.0% 7.7% 6.7% 6.2% 4.8%

Empire Silver EPO 2500/30%/7500 4.3% 9.0% 8.1% 7.5% 6.1%

Empire Silver EPO 2700/30%/5000 w/HSA ‐0.5% 4.0% 3.1% 2.5% 1.2%

Empire Silver EPO 2750/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver EPO 3000/0%/5250 w/HSA 3.7% 8.4% 7.5% 6.9% 5.5%

Empire Silver EPO 3000/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver Blue Access EPO 1500/30%/7350 8.8% 13.7% 12.7% 12.2% 10.7%

Empire Silver Blue Access EPO 2500/30%/7500 1.7% 6.3% 5.4% 4.9% 3.5%

Empire Silver Blue Access EPO 2750/30%/7350 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 11.4% 10.3% N/A 8.3%

Empire Silver PPO 3000/0%/5250 w/HSA 10.9% 15.9% 14.9% 14.3% 12.8%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 14.8% N/A N/A 18.3% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐1.4% 3.1% 2.1% 1.6% 0.3%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 6.2% 11.1% 10.1% 9.5% 8.0%

2019 Plan Name

4th Quarter 

Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

3 Huntington Quad. 1st Fl. Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com   <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD> Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your group’s current

region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 0.7% ‐0.2% N/A ‐2.0%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 0.6% ‐0.3% N/A ‐2.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐3.1% 1.3% 0.4% ‐0.1% ‐1.4%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐3.2% 1.2% 0.3% ‐0.2% ‐1.5%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐5.4% ‐1.1% ‐1.9% ‐2.4% ‐3.7%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 6.8% 5.8% N/A 3.9%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 4.6% 3.6% N/A 1.7%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.1% 5.2% N/A 3.3%

Empire Gold EPO 1000/10%/5000 2.1% 6.7% 5.8% 5.2% 3.8%

Empire Gold EPO 1500/10%/7000 2.1% 6.8% 5.8% 5.3% 3.9%

Empire Gold EPO 25/0%/6000 0.4% 5.0% 4.0% 3.5% 2.1%

Empire Gold EPO 35/10%/5850 2.5% 7.2% 6.2% 5.7% 4.3%

Empire Gold EPO 500/20%/7350 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Gold Blue Access EPO 25/0%/6000 ‐2.2% 2.2% 1.3% 0.8% ‐0.6%

Empire Gold Blue Access EPO 35/10%/5850 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold PPO 1000/10%/5000 N/A 14.0% 13.0% N/A 11.0%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 12.8% 11.7% N/A 9.7%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 3.9% 2.9% N/A 1.1%

Empire Platinum EPO 15/0%/3500 0.4% 5.0% 4.1% 3.5% 2.1%

Empire Platinum EPO 5/0%/2600 1.1% 5.7% 4.8% 4.2% 2.8%

Empire Platinum Blue Access EPO 15/0%/3500 ‐2.3% 2.2% 1.2% 0.7% ‐0.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.1% 14.0% N/A 11.9%

Empire Platinum PPO 250/10%/5250 N/A 14.0% 13.0% N/A 10.9%

Empire Platinum PPO 5/0%/2600 N/A 13.2% 12.2% N/A 10.1%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 4.5% 3.6% N/A 1.7%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 5.8% 4.8% N/A 2.9%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 5.3% 4.3% N/A 2.4%

Empire Silver EPO 1500/30%/7350 0.8% 5.4% 4.4% 3.9% 2.5%

Empire Silver EPO 2500/30%/7500 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.7% 1.7% 0.8% 0.3% ‐1.0%

Empire Silver EPO 2750/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver EPO 3000/0%/5250 w/HSA 1.5% 6.1% 5.1% 4.6% 3.2%

Empire Silver EPO 3000/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver Blue Access EPO 1500/30%/7350 6.4% 11.3% 10.3% 9.7% 8.2%

Empire Silver Blue Access EPO 2500/30%/7500 ‐0.5% 4.0% 3.1% 2.6% 1.2%

Empire Silver Blue Access EPO 2750/30%/7350 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 8.9% 8.0% N/A 6.0%

Empire Silver PPO 3000/0%/5250 w/HSA 8.5% 13.4% 12.4% 11.8% 10.3%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 12.3% N/A N/A 15.7% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐3.5% 0.8% ‐0.1% ‐0.6% ‐1.9%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 3.9% 8.7% 7.7% 7.1% 5.7%

2019 Plan Name

1st Quarter

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

DFS Website: www.dfs.ny.gov/healthinsurancepremiums United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed. Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

Enclosure

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on <RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 0.7% ‐0.2% N/A ‐2.0%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 0.6% ‐0.3% N/A ‐2.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐3.1% 1.3% 0.4% ‐0.1% ‐1.4%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐3.2% 1.2% 0.3% ‐0.2% ‐1.5%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐5.4% ‐1.1% ‐1.9% ‐2.4% ‐3.7%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 6.8% 5.8% N/A 3.9%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 4.6% 3.6% N/A 1.7%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.1% 5.2% N/A 3.3%

Empire Gold EPO 1000/10%/5000 2.1% 6.7% 5.8% 5.2% 3.8%

Empire Gold EPO 1500/10%/7000 2.1% 6.8% 5.8% 5.3% 3.9%

Empire Gold EPO 25/0%/6000 0.4% 5.0% 4.0% 3.5% 2.1%

Empire Gold EPO 35/10%/5850 2.5% 7.2% 6.2% 5.7% 4.3%

Empire Gold EPO 500/20%/7350 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Gold Blue Access EPO 25/0%/6000 ‐2.2% 2.2% 1.3% 0.8% ‐0.6%

Empire Gold Blue Access EPO 35/10%/5850 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold PPO 1000/10%/5000 N/A 14.0% 13.0% N/A 11.0%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 12.8% 11.7% N/A 9.7%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 3.9% 2.9% N/A 1.1%

Empire Platinum EPO 15/0%/3500 0.4% 5.0% 4.1% 3.5% 2.1%

Empire Platinum EPO 5/0%/2600 1.1% 5.7% 4.8% 4.2% 2.8%

Empire Platinum Blue Access EPO 15/0%/3500 ‐2.3% 2.2% 1.2% 0.7% ‐0.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.1% 14.0% N/A 11.9%

Empire Platinum PPO 250/10%/5250 N/A 14.0% 13.0% N/A 10.9%

Empire Platinum PPO 5/0%/2600 N/A 13.2% 12.2% N/A 10.1%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 4.5% 3.6% N/A 1.7%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 5.8% 4.8% N/A 2.9%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 5.3% 4.3% N/A 2.4%

Empire Silver EPO 1500/30%/7350 0.8% 5.4% 4.4% 3.9% 2.5%

Empire Silver EPO 2500/30%/7500 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.7% 1.7% 0.8% 0.3% ‐1.0%

Empire Silver EPO 2750/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver EPO 3000/0%/5250 w/HSA 1.5% 6.1% 5.1% 4.6% 3.2%

Empire Silver EPO 3000/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver Blue Access EPO 1500/30%/7350 6.4% 11.3% 10.3% 9.7% 8.2%

Empire Silver Blue Access EPO 2500/30%/7500 ‐0.5% 4.0% 3.1% 2.6% 1.2%

Empire Silver Blue Access EPO 2750/30%/7350 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 8.9% 8.0% N/A 6.0%

Empire Silver PPO 3000/0%/5250 w/HSA 8.5% 13.4% 12.4% 11.8% 10.3%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 12.3% N/A N/A 15.7% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐3.5% 0.8% ‐0.1% ‐0.6% ‐1.9%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 3.9% 8.7% 7.7% 7.1% 5.7%

2019 Plan Name

1st Quarter

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

30-day Comment Period

You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 2.2% 1.3% N/A ‐0.6%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.7% 2.8% 1.9% 1.4% 0.0%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.8% 2.7% 1.8% 1.3% ‐0.1%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 3.6% 2.7% N/A 0.8%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐2.6% 1.9% 0.9% 0.4% ‐0.9%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 8.4% 7.4% N/A 5.4%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.1% 5.1% N/A 3.2%

Empire Gold Blue Access EPO 35/10%/5850 N/A 7.7% 6.7% N/A 4.8%

Empire Gold EPO 1000/10%/5000 3.6% 8.3% 7.3% 6.8% 5.4%

Empire Gold EPO 1500/10%/7000 3.6% 8.4% 7.4% 6.8% 5.4%

Empire Gold EPO 25/0%/6000 1.9% 6.5% 5.5% 5.0% 3.6%

Empire Gold EPO 35/10%/5850 4.0% 8.8% 7.8% 7.2% 5.8%

Empire Gold EPO 500/20%/7350 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold Blue Access EPO 35/10%/5850 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Gold Blue Access EPO 500/20%/7350 0.7% 5.2% 4.3% 3.8% 2.4%

Empire Gold PPO 1000/10%/5000 N/A 15.7% 14.7% N/A 12.6%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 14.4% 13.4% N/A 11.3%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 5.4% 4.5% N/A 2.5%

Empire Platinum EPO 15/0%/3500 1.9% 6.5% 5.6% 5.1% 3.7%

Empire Platinum EPO 5/0%/2600 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.9% 3.7% 2.7% 2.2% 0.8%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 16.8% 15.7% N/A 13.6%

Empire Platinum PPO 250/10%/5250 N/A 15.7% 14.7% N/A 12.6%

Empire Platinum PPO 5/0%/2600 N/A 14.8% 13.8% N/A 11.7%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.1% 5.1% N/A 3.2%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 7.3% 6.4% N/A 4.4%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.8% 5.8% N/A 3.9%

Empire Silver EPO 1500/30%/7350 2.3% 6.9% 6.0% 5.4% 4.0%

Empire Silver EPO 2500/30%/7500 3.5% 8.2% 7.3% 6.7% 5.3%

Empire Silver EPO 2700/30%/5000 w/HSA ‐1.3% 3.2% 2.3% 1.8% 0.4%

Empire Silver EPO 2750/30%/7350 3.9% 8.6% 7.6% 7.1% 5.7%

Empire Silver EPO 3000/0%/5250 w/HSA 3.0% 7.7% 6.7% 6.2% 4.7%

Empire Silver EPO 3000/30%/7350 3.9% 8.6% 7.6% 7.1% 5.6%

Empire Silver Blue Access EPO 1500/30%/7350 8.0% 12.9% 11.9% 11.3% 9.8%

Empire Silver Blue Access EPO 2500/30%/7500 1.0% 5.6% 4.6% 4.1% 2.7%

Empire Silver Blue Access EPO 2750/30%/7350 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 10.5% 9.5% N/A 7.5%

Empire Silver PPO 3000/0%/5250 w/HSA 10.1% 15.1% 14.0% 13.5% 12.0%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.9% N/A N/A 17.5% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.1% 2.3% 1.4% 0.9% ‐0.5%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 5.5% 10.3% 9.3% 8.7% 7.3%

2019 Plan Name

3rd Quarter

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice.

You can contact Empire for additional information at: Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 2.2% 1.3% N/A ‐0.6%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.7% 2.8% 1.9% 1.4% 0.0%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.8% 2.7% 1.8% 1.3% ‐0.1%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 3.6% 2.7% N/A 0.8%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐2.6% 1.9% 0.9% 0.4% ‐0.9%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 8.4% 7.4% N/A 5.4%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.1% 5.1% N/A 3.2%

Empire Gold Blue Access EPO 35/10%/5850 N/A 7.7% 6.7% N/A 4.8%

Empire Gold EPO 1000/10%/5000 3.6% 8.3% 7.3% 6.8% 5.4%

Empire Gold EPO 1500/10%/7000 3.6% 8.4% 7.4% 6.8% 5.4%

Empire Gold EPO 25/0%/6000 1.9% 6.5% 5.5% 5.0% 3.6%

Empire Gold EPO 35/10%/5850 4.0% 8.8% 7.8% 7.2% 5.8%

Empire Gold EPO 500/20%/7350 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold Blue Access EPO 35/10%/5850 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Gold Blue Access EPO 500/20%/7350 0.7% 5.2% 4.3% 3.8% 2.4%

Empire Gold PPO 1000/10%/5000 N/A 15.7% 14.7% N/A 12.6%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 14.4% 13.4% N/A 11.3%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 5.4% 4.5% N/A 2.5%

Empire Platinum EPO 15/0%/3500 1.9% 6.5% 5.6% 5.1% 3.7%

Empire Platinum EPO 5/0%/2600 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.9% 3.7% 2.7% 2.2% 0.8%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 16.8% 15.7% N/A 13.6%

Empire Platinum PPO 250/10%/5250 N/A 15.7% 14.7% N/A 12.6%

Empire Platinum PPO 5/0%/2600 N/A 14.8% 13.8% N/A 11.7%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.1% 5.1% N/A 3.2%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 7.3% 6.4% N/A 4.4%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.8% 5.8% N/A 3.9%

Empire Silver EPO 1500/30%/7350 2.3% 6.9% 6.0% 5.4% 4.0%

Empire Silver EPO 2500/30%/7500 3.5% 8.2% 7.3% 6.7% 5.3%

Empire Silver EPO 2700/30%/5000 w/HSA ‐1.3% 3.2% 2.3% 1.8% 0.4%

Empire Silver EPO 2750/30%/7350 3.9% 8.6% 7.6% 7.1% 5.7%

Empire Silver EPO 3000/0%/5250 w/HSA 3.0% 7.7% 6.7% 6.2% 4.7%

Empire Silver EPO 3000/30%/7350 3.9% 8.6% 7.6% 7.1% 5.6%

Empire Silver Blue Access EPO 1500/30%/7350 8.0% 12.9% 11.9% 11.3% 9.8%

Empire Silver Blue Access EPO 2500/30%/7500 1.0% 5.6% 4.6% 4.1% 2.7%

Empire Silver Blue Access EPO 2750/30%/7350 1.3% 5.9% 5.0% 4.4% 3.0%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 10.5% 9.5% N/A 7.5%

Empire Silver PPO 3000/0%/5250 w/HSA 10.1% 15.1% 14.0% 13.5% 12.0%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.9% N/A N/A 17.5% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.1% 2.3% 1.4% 0.9% ‐0.5%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 5.5% 10.3% 9.3% 8.7% 7.3%

2019 Plan Name

3rd Quarter

coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com   <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD> Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your group’s current

region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

DFS Website: www.dfs.ny.gov/healthinsurancepremiums United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed. Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on <RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: < Region> New 2019 plan name: <2019 Plan Name> If approved, the percentage change to your group’s premium:

<Rate Increase >*

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_JAN-MAY_filing0517

30-day Comment Period

You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com     <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD> Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your group’s current

region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 0.7% ‐0.2% N/A ‐2.0%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 0.6% ‐0.3% N/A ‐2.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐3.1% 1.3% 0.4% ‐0.1% ‐1.4%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐3.2% 1.2% 0.3% ‐0.2% ‐1.5%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐5.4% ‐1.1% ‐1.9% ‐2.4% ‐3.7%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 6.8% 5.8% N/A 3.9%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 4.6% 3.6% N/A 1.7%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.1% 5.2% N/A 3.3%

Empire Gold EPO 1000/10%/5000 2.1% 6.7% 5.8% 5.2% 3.8%

Empire Gold EPO 1500/10%/7000 2.1% 6.8% 5.8% 5.3% 3.9%

Empire Gold EPO 25/0%/6000 0.4% 5.0% 4.0% 3.5% 2.1%

Empire Gold EPO 35/10%/5850 2.5% 7.2% 6.2% 5.7% 4.3%

Empire Gold EPO 500/20%/7350 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Gold Blue Access EPO 25/0%/6000 ‐2.2% 2.2% 1.3% 0.8% ‐0.6%

Empire Gold Blue Access EPO 35/10%/5850 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold PPO 1000/10%/5000 N/A 14.0% 13.0% N/A 11.0%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 12.8% 11.7% N/A 9.7%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 3.9% 2.9% N/A 1.1%

Empire Platinum EPO 15/0%/3500 0.4% 5.0% 4.1% 3.5% 2.1%

Empire Platinum EPO 5/0%/2600 1.1% 5.7% 4.8% 4.2% 2.8%

Empire Platinum Blue Access EPO 15/0%/3500 ‐2.3% 2.2% 1.2% 0.7% ‐0.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.1% 14.0% N/A 11.9%

Empire Platinum PPO 250/10%/5250 N/A 14.0% 13.0% N/A 10.9%

Empire Platinum PPO 5/0%/2600 N/A 13.2% 12.2% N/A 10.1%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 4.5% 3.6% N/A 1.7%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 5.8% 4.8% N/A 2.9%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 5.3% 4.3% N/A 2.4%

Empire Silver EPO 1500/30%/7350 0.8% 5.4% 4.4% 3.9% 2.5%

Empire Silver EPO 2500/30%/7500 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.7% 1.7% 0.8% 0.3% ‐1.0%

Empire Silver EPO 2750/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver EPO 3000/0%/5250 w/HSA 1.5% 6.1% 5.1% 4.6% 3.2%

Empire Silver EPO 3000/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver Blue Access EPO 1500/30%/7350 6.4% 11.3% 10.3% 9.7% 8.2%

Empire Silver Blue Access EPO 2500/30%/7500 ‐0.5% 4.0% 3.1% 2.6% 1.2%

Empire Silver Blue Access EPO 2750/30%/7350 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 8.9% 8.0% N/A 6.0%

Empire Silver PPO 3000/0%/5250 w/HSA 8.5% 13.4% 12.4% 11.8% 10.3%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 12.3% N/A N/A 15.7% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐3.5% 0.8% ‐0.1% ‐0.6% ‐1.9%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 3.9% 8.7% 7.7% 7.1% 5.7%

2019 Plan Name

1st Quarter

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

DFS Website: www.dfs.ny.gov/healthinsurancepremiums United States Postal Service:

NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY 12257

If you choose to submit comments to DFS, please include the following information:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed. Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date. Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on <RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

*Subject to DFS approval. Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 0.7% ‐0.2% N/A ‐2.0%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 0.6% ‐0.3% N/A ‐2.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐3.1% 1.3% 0.4% ‐0.1% ‐1.4%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐3.2% 1.2% 0.3% ‐0.2% ‐1.5%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐5.4% ‐1.1% ‐1.9% ‐2.4% ‐3.7%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.1% 1.2% N/A ‐0.7%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐4.0% 0.4% ‐0.5% ‐1.0% ‐2.3%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 6.8% 5.8% N/A 3.9%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 4.6% 3.6% N/A 1.7%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.1% 5.2% N/A 3.3%

Empire Gold EPO 1000/10%/5000 2.1% 6.7% 5.8% 5.2% 3.8%

Empire Gold EPO 1500/10%/7000 2.1% 6.8% 5.8% 5.3% 3.9%

Empire Gold EPO 25/0%/6000 0.4% 5.0% 4.0% 3.5% 2.1%

Empire Gold EPO 35/10%/5850 2.5% 7.2% 6.2% 5.7% 4.3%

Empire Gold EPO 500/20%/7350 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Gold Blue Access EPO 25/0%/6000 ‐2.2% 2.2% 1.3% 0.8% ‐0.6%

Empire Gold Blue Access EPO 35/10%/5850 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.8% 3.7% 2.8% 2.3% 0.9%

Empire Gold PPO 1000/10%/5000 N/A 14.0% 13.0% N/A 11.0%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 12.8% 11.7% N/A 9.7%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 3.9% 2.9% N/A 1.1%

Empire Platinum EPO 15/0%/3500 0.4% 5.0% 4.1% 3.5% 2.1%

Empire Platinum EPO 5/0%/2600 1.1% 5.7% 4.8% 4.2% 2.8%

Empire Platinum Blue Access EPO 15/0%/3500 ‐2.3% 2.2% 1.2% 0.7% ‐0.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.1% 14.0% N/A 11.9%

Empire Platinum PPO 250/10%/5250 N/A 14.0% 13.0% N/A 10.9%

Empire Platinum PPO 5/0%/2600 N/A 13.2% 12.2% N/A 10.1%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 4.5% 3.6% N/A 1.7%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 5.8% 4.8% N/A 2.9%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 5.3% 4.3% N/A 2.4%

Empire Silver EPO 1500/30%/7350 0.8% 5.4% 4.4% 3.9% 2.5%

Empire Silver EPO 2500/30%/7500 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.7% 1.7% 0.8% 0.3% ‐1.0%

Empire Silver EPO 2750/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver EPO 3000/0%/5250 w/HSA 1.5% 6.1% 5.1% 4.6% 3.2%

Empire Silver EPO 3000/30%/7350 2.4% 7.0% 6.1% 5.5% 4.1%

Empire Silver Blue Access EPO 1500/30%/7350 6.4% 11.3% 10.3% 9.7% 8.2%

Empire Silver Blue Access EPO 2500/30%/7500 ‐0.5% 4.0% 3.1% 2.6% 1.2%

Empire Silver Blue Access EPO 2750/30%/7350 ‐0.2% 4.4% 3.4% 2.9% 1.5%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 8.9% 8.0% N/A 6.0%

Empire Silver PPO 3000/0%/5250 w/HSA 8.5% 13.4% 12.4% 11.8% 10.3%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 12.3% N/A N/A 15.7% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐3.5% 0.8% ‐0.1% ‐0.6% ‐1.9%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 3.9% 8.7% 7.7% 7.1% 5.7%

2019 Plan Name

1st Quarter

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_JAN-MAY_filing0517

30-day Comment Period

You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change.

Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan.

Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle - 1st Flr Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBC_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 3.0% 2.0% N/A 0.2%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.9% 1.9% N/A 0.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.0% 3.5% 2.6% 2.1% 0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.0% 3.5% 2.5% 2.0% 0.7%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 4.3% 3.4% N/A 1.5%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐1.9% 2.6% 1.7% 1.2% ‐0.2%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 9.2% 8.2% N/A 6.2%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.9% 5.9% N/A 4.0%

Empire Gold Blue Access EPO 35/10%/5850 N/A 8.5% 7.5% N/A 5.6%

Empire Gold EPO 1000/10%/5000 4.3% 9.1% 8.1% 7.6% 6.1%

Empire Gold EPO 1500/10%/7000 4.4% 9.2% 8.2% 7.6% 6.2%

Empire Gold EPO 25/0%/6000 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Gold EPO 35/10%/5850 4.8% 9.6% 8.6% 8.0% 6.6%

Empire Gold EPO 500/20%/7350 4.1% 8.8% 7.8% 7.3% 5.9%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold Blue Access EPO 35/10%/5850 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Gold Blue Access EPO 500/20%/7350 1.4% 6.0% 5.1% 4.5% 3.1%

Empire Gold PPO 1000/10%/5000 N/A 16.6% 15.5% N/A 13.4%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 15.3% 14.2% N/A 12.1%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 6.2% 5.2% N/A 3.3%

Empire Platinum EPO 15/0%/3500 2.7% 7.3% 6.4% 5.8% 4.4%

Empire Platinum EPO 5/0%/2600 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.1% 4.4% 3.5% 3.0% 1.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 17.6% 16.6% N/A 14.4%

Empire Platinum PPO 250/10%/5250 N/A 16.6% 15.5% N/A 13.4%

Empire Platinum PPO 5/0%/2600 N/A 15.7% 14.6% N/A 12.5%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.8% 5.9% N/A 3.9%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 8.1% 7.2% N/A 5.2%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 7.6% 6.6% N/A 4.7%

Empire Silver EPO 1500/30%/7350 3.0% 7.7% 6.7% 6.2% 4.8%

Empire Silver EPO 2500/30%/7500 4.3% 9.0% 8.1% 7.5% 6.1%

Empire Silver EPO 2700/30%/5000 w/HSA ‐0.5% 4.0% 3.1% 2.5% 1.2%

Empire Silver EPO 2750/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver EPO 3000/0%/5250 w/HSA 3.7% 8.4% 7.5% 6.9% 5.5%

Empire Silver EPO 3000/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver Blue Access EPO 1500/30%/7350 8.8% 13.7% 12.7% 12.2% 10.7%

Empire Silver Blue Access EPO 2500/30%/7500 1.7% 6.3% 5.4% 4.9% 3.5%

Empire Silver Blue Access EPO 2750/30%/7350 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 11.4% 10.3% N/A 8.3%

Empire Silver PPO 3000/0%/5250 w/HSA 10.9% 15.9% 14.9% 14.3% 12.8%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 14.8% N/A N/A 18.3% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐1.4% 3.1% 2.1% 1.6% 0.3%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 6.2% 11.1% 10.1% 9.5% 8.0%

2019 Plan Name

4th Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice.

You can contact Empire for additional information at: Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2018. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 3.0% 2.0% N/A 0.2%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 2.9% 1.9% N/A 0.1%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐1.0% 3.5% 2.6% 2.1% 0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐1.0% 3.5% 2.5% 2.0% 0.7%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 4.3% 3.4% N/A 1.5%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐1.9% 2.6% 1.7% 1.2% ‐0.2%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 9.2% 8.2% N/A 6.2%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 6.9% 5.9% N/A 4.0%

Empire Gold Blue Access EPO 35/10%/5850 N/A 8.5% 7.5% N/A 5.6%

Empire Gold EPO 1000/10%/5000 4.3% 9.1% 8.1% 7.6% 6.1%

Empire Gold EPO 1500/10%/7000 4.4% 9.2% 8.2% 7.6% 6.2%

Empire Gold EPO 25/0%/6000 2.6% 7.3% 6.3% 5.8% 4.4%

Empire Gold EPO 35/10%/5850 4.8% 9.6% 8.6% 8.0% 6.6%

Empire Gold EPO 500/20%/7350 4.1% 8.8% 7.8% 7.3% 5.9%

Empire Gold Blue Access EPO 25/0%/6000 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold Blue Access EPO 35/10%/5850 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Gold Blue Access EPO 500/20%/7350 1.4% 6.0% 5.1% 4.5% 3.1%

Empire Gold PPO 1000/10%/5000 N/A 16.6% 15.5% N/A 13.4%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 15.3% 14.2% N/A 12.1%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 6.2% 5.2% N/A 3.3%

Empire Platinum EPO 15/0%/3500 2.7% 7.3% 6.4% 5.8% 4.4%

Empire Platinum EPO 5/0%/2600 3.3% 8.0% 7.1% 6.5% 5.1%

Empire Platinum Blue Access EPO 15/0%/3500 ‐0.1% 4.4% 3.5% 3.0% 1.6%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 17.6% 16.6% N/A 14.4%

Empire Platinum PPO 250/10%/5250 N/A 16.6% 15.5% N/A 13.4%

Empire Platinum PPO 5/0%/2600 N/A 15.7% 14.6% N/A 12.5%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 6.8% 5.9% N/A 3.9%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 8.1% 7.2% N/A 5.2%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 7.6% 6.6% N/A 4.7%

Empire Silver EPO 1500/30%/7350 3.0% 7.7% 6.7% 6.2% 4.8%

Empire Silver EPO 2500/30%/7500 4.3% 9.0% 8.1% 7.5% 6.1%

Empire Silver EPO 2700/30%/5000 w/HSA ‐0.5% 4.0% 3.1% 2.5% 1.2%

Empire Silver EPO 2750/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver EPO 3000/0%/5250 w/HSA 3.7% 8.4% 7.5% 6.9% 5.5%

Empire Silver EPO 3000/30%/7350 4.6% 9.4% 8.4% 7.9% 6.4%

Empire Silver Blue Access EPO 1500/30%/7350 8.8% 13.7% 12.7% 12.2% 10.7%

Empire Silver Blue Access EPO 2500/30%/7500 1.7% 6.3% 5.4% 4.9% 3.5%

Empire Silver Blue Access EPO 2750/30%/7350 2.0% 6.7% 5.7% 5.2% 3.8%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 11.4% 10.3% N/A 8.3%

Empire Silver PPO 3000/0%/5250 w/HSA 10.9% 15.9% 14.9% 14.3% 12.8%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 14.8% N/A N/A 18.3% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐1.4% 3.1% 2.1% 1.6% 0.3%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 6.2% 11.1% 10.1% 9.5% 8.0%

2019 Plan Name

4th Quarter 

coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ. 30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com <Date> <Group Name> <LINE_1_ADRS_TXT> <LINE_2_ADRS_TXT> <GrpCity>, <GrpState> <ZIP_CD>

The proposed premium rate changes described in this letter are for plans that will renew during 2019. They do not affect your upcoming 2018 renewal.

Re: Notice of Proposed 2019 Premium Rate Change

Product Name: <PROD_MRKTG_NM > Health Insurance Oversight System (HIOS) identification number: <HOISID>

Dear Group Benefits Administrator: Empire is filing a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Changes The chart below shows the requested percentage change to the premium rate for the plan that you offer your employees in your rating region. If approved, this rate change will apply to your <RNWL_DT> renewal.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

Please note that the final, approved rate may differ because DFS may modify the proposed rate. In addition, while we try to provide you with the most accurate information possible, the final approved rate may differ based on the benefit plan design and other features you select on renewal. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes we are making in 2019 to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

What You Need to Do Please share the enclosed memo with your employees who are enrolled in the <PROD_MRKTG_NM > health plan. We recommend that you provide any additional information with this notice, such as expected changes in employee contribution levels, that may help your employees better understand this notice.

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice.

You can contact Empire for additional information at: Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS, by visiting the DFS Website or via standard mail as follows:

United States Postal Service: NYS Department of Financial Services Health Bureau – Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you choose to submit comments to DFS, please include the following information: 1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your HIOS identification number, which is <HOISID>

Written comments submitted to DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change We have prepared a plain-English summary that provides a more detailed explanation of the reasons why a premium rate change is being requested. You can find this information at the following websites:

Empire website: empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differ from the requested rate noted above, you will receive final rate information at least 60 days before your 2019 renewal date.

Your business and your employees’ health and well-being are important to us. Thank you for choosing Empire for your employee health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Enclosure Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517

Empire BlueCross BlueShield PO Box 1407, Church Street Station New York, NY 10008-1407 empireblue.com

<Date>

IMPORTANT: Notice of Proposed 2019 Premium Rate Change Product Name: <PROD_MRKTG_NM >

Health Insurance Oversight System (HIOS) Identification Number: <HOISID>

Important News About Your Empire Health Plan We have filed a request with the New York State Department of Financial Services (DFS) to approve a change to your group health insurance premium rates for 2019. New York Insurance Law requires that we provide a notice to you when we submit requests for premium rate changes to DFS. DFS is required by law to review our requested rate change. DFS may approve, modify or disapprove the requested rate change. Proposed Premium Rate Change

The chart below shows the requested rate change for the plan offered by your employer. This rate change request (if approved by the DFS) takes place on your annual renewal date, which is on

<RNWL_DT>.

Your group’s current plan: <PROD_MRKTG_NM > Your group’s rating region: Your group’s rating region is based on your

group’s current region of operation New 2019 plan name: <2019 Plan Name>

Your group’s rating region is based on your group’s current region of operation. Please contact Empire if there is a discrepancy.

REQUESTED RATE CHANGE BY REGION* Effective January 1, 2019 upon renewal

*Pending DFS approval

The details of who pays your plan’s premium cost are between you and your employer. So, any percentage change in the amount you and your employer contribute to your premium cost may be different from the percentage listed above. Why We Are Requesting a Rate Change The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. The rates also reflect coverage changes to some deductibles, copays, coinsurance, benefit limits, and/or annual out-of-pocket maximum amounts. DFS’s views of these matters may differ.

Region 1:  Region 3:  Region 4:  Region 7:  Region 8: 

AlbanyMid‐

HudsonNYC Upstate Long Island

Empire Bronze Blue Access EPO 5500/20%/6700 w/HSA N/A 1.5% 0.5% N/A ‐1.3%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA N/A 1.4% 0.4% N/A ‐1.4%

Empire Bronze EPO 5500/20%/6700 w/HSA ‐2.4% 2.0% 1.1% 0.6% ‐0.7%

Empire Bronze EPO 5500/35%/6700 w/HSA ‐2.5% 2.0% 1.0% 0.5% ‐0.8%

Empire Bronze Blue Access EPO 5500/35%/6700 w/HSA ‐4.7% ‐0.3% ‐1.2% ‐1.7% ‐3.0%

Empire Bronze Blue Access EPO 7900/0%/7900 N/A 2.8% 1.9% N/A 0.0%

Empire Bronze Blue Access EPO 7900/0%/7900 ‐3.3% 1.1% 0.2% ‐0.3% ‐1.6%

Empire Gold Blue Access EPO 1250/20%/4000 N/A 7.6% 6.6% N/A 4.7%

Empire Gold Blue Access EPO 1350/0%/3000 w/HSA N/A 5.3% 4.4% N/A 2.5%

Empire Gold Blue Access EPO 35/10%/5850 N/A 6.9% 6.0% N/A 4.0%

Empire Gold EPO 1000/10%/5000 2.8% 7.5% 6.5% 6.0% 4.6%

Empire Gold EPO 1500/10%/7000 2.9% 7.6% 6.6% 6.1% 4.6%

Empire Gold EPO 25/0%/6000 1.1% 5.7% 4.8% 4.3% 2.9%

Empire Gold EPO 35/10%/5850 3.3% 8.0% 7.0% 6.5% 5.0%

Empire Gold EPO 500/20%/7350 2.6% 7.2% 6.3% 5.8% 4.3%

Empire Gold Blue Access EPO 25/0%/6000 ‐1.5% 3.0% 2.0% 1.5% 0.2%

Empire Gold Blue Access EPO 35/10%/5850 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Gold Blue Access EPO 500/20%/7350 ‐0.1% 4.5% 3.5% 3.0% 1.6%

Empire Gold PPO 1000/10%/5000 N/A 14.9% 13.8% N/A 11.8%

Empire Gold PPO 1350/0%/3000 w/HSA N/A 13.6% 12.6% N/A 10.5%

Empire Platinum Blue Access EPO 15/0%/3500 N/A 4.6% 3.7% N/A 1.8%

Empire Platinum EPO 15/0%/3500 1.2% 5.8% 4.8% 4.3% 2.9%

Empire Platinum EPO 5/0%/2600 1.8% 6.5% 5.5% 5.0% 3.6%

Empire Platinum Blue Access EPO 15/0%/3500 ‐1.6% 2.9% 2.0% 1.5% 0.1%

Empire Platinum PPO 15/0%/3500 80th Percentile FAIR Health N/A 15.9% 14.9% N/A 12.8%

Empire Platinum PPO 250/10%/5250 N/A 14.9% 13.8% N/A 11.8%

Empire Platinum PPO 5/0%/2600 N/A 14.0% 13.0% N/A 10.9%

Empire Silver Blue Access EPO 1500/30%/7350 N/A 5.3% 4.3% N/A 2.4%

Empire Silver Blue Access EPO 2500/30%/7500 N/A 6.6% 5.6% N/A 3.7%

Empire Silver Blue Access EPO 3000/0%/5250 w/HSA N/A 6.0% 5.1% N/A 3.2%

Empire Silver EPO 1500/30%/7350 1.5% 6.2% 5.2% 4.7% 3.3%

Empire Silver EPO 2500/30%/7500 2.8% 7.5% 6.5% 6.0% 4.5%

Empire Silver EPO 2700/30%/5000 w/HSA ‐2.0% 2.5% 1.6% 1.1% ‐0.3%

Empire Silver EPO 2750/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver EPO 3000/0%/5250 w/HSA 2.2% 6.9% 5.9% 5.4% 4.0%

Empire Silver EPO 3000/30%/7350 3.1% 7.8% 6.8% 6.3% 4.9%

Empire Silver Blue Access EPO 1500/30%/7350 7.2% 12.1% 11.1% 10.5% 9.0%

Empire Silver Blue Access EPO 2500/30%/7500 0.2% 4.8% 3.8% 3.3% 1.9%

Empire Silver Blue Access EPO 2750/30%/7350 0.6% 5.1% 4.2% 3.7% 2.3%

Empire Silver PPO 2700/30%/5000 w/HSA N/A 9.7% 8.7% N/A 6.8%

Empire Silver PPO 3000/0%/5250 w/HSA 9.3% 14.2% 13.2% 12.6% 11.1%

Empire Silver PPO 3000/0%/5250 w/HSA 80th Percentile Fair Health 13.1% N/A N/A 16.6% N/A

Empire Bronze Blue Access HMO 5500/35%/6700 w/HSA ‐2.8% 1.6% 0.7% 0.2% ‐1.2%

Empire Gold Healthy New York Blue Access HMO 600/0%/4000 4.7% 9.4% 8.5% 7.9% 6.5%

2019 Plan Name

2nd Quarter 

30-day Comment Period You can contact us or DFS to ask for more information or submit comments to DFS about the proposed rate changes. The comments must be made within 30 days from the date of this notice. You can contact Empire for additional information at:

Email: premiumratechange@empireblue.com Telephone: Small Group Contact Center, 1-866-422-2583 Mail: Empire BlueCross BlueShield

Small Group Call Center (SG Prior Approval) 3 Huntington Quadrangle – 1st Floor Suite 104S (South) Melville, NY 11747

Comments or requests for more information on the proposed rate change may be submitted to DFS by visiting the DFS Website or via standard mail as follows: DFS website: www.dfs.ny.gov/healthinsurancepremiums

United States Postal Service: NYS Department of Financial Services Health Bureau — Premium Rate Adjustments One Commerce Plaza Albany, NY, 12257

If you want to submit comments to DFS, please include the following:

1. The name of your insurer, which is Empire 2. The name of your Empire benefit plan as shown on your Empire ID card 3. Indicate you have small group coverage 4. Your Health Insurance Oversight System (HIOS) Identification number, which is <HOISID>

Written comments submitted to the DFS will be posted on the DFS website with all your personal information removed.

Plain English Summary of Rate Change Empire has prepared a plain English summary that explains in more detail the reasons why a premium rate change has been requested. You can find this information at the following websites:

Empire website: www.empireblue.com/priorapproval DFS website: www.dfs.ny.gov/healthinsurancepremiums

Notice of Approved Premium Rate After DFS approves the final premium rate, which may differe from teh requested rate noted above, you will recevie final rate information at least 60 days before your 2019 renewal date. Thank you for choosing Empire for your health benefits plan. Sincerely,

Lawrence G. Schreiber President, New York Commercial Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. EBS_Jun_filing0517