For Employer Groups of 2-49 Employees
Plan	High Option	Moderate Option	Low Cost Option
	BlueChoice   HMO 2	BlueChoice   HMO 6	BlueChoice    HMO 9
Rates for the Hudson Valley counties of Ulster, Sullivan, Greene, Putnam, Dutchess & Orange Counties. Effective untill 6/30/04
Single	$446.03	$428.67	$402.58
Family	$1233.41	$1184.80	$1112.49
Rates for Westchester, Bronx, Kings, Queens, New York City, Nassau, Richmond, Rockland & Suffolk Counties Effective untill 9/30/2004
Single	$414.13	$392.08	$353.58
Family	$1110.41	$1050.88	$947.29
In Network Benefits
Office Visits	$10 Per Visit	$20 Per Visit	$25/40 Per Visit
Hospital	$0 No Charge, Unlimited	$0 No Charge, Unlimited	$500 copay
Outpatient Surgical	No Charge	No Charge	$75 copay
Mental Health Outpatient	$25 for up to 20 visits/yr	$25 for up to 20 visits/yr	$25 for up to 20 visits/yr
Mental Health Inpatient	$0 No Charge For up to 30 Days	$0 No Charge For up to 30 Days	$500 copay For up to 30 Days
Emergency Room	$35 Waived if admitted	$35 Waived if admitted	$75 Waived if admitted
RX Generic/Brand/NF	$10$20/$40 Participating Pharmacies	$10/$20/$40 Participating Pharmacies	$10/$20/$40 Participating Pharmacies
NO Out of Network benefits
Single Deductible	None	None	None
Family Deductible
Coinsurance
Lifetime Max./Member
Available Riders	Vision, Dental	Vision, Dental	Vision, Dental
This chart is presented for illustrative purposes only. Please refer to each plan's respective literature and contract for detailed information regarding plan benefits, copayments and exclusions.

These are only a few plans that Empire has,  There are also PPO plans that allow you to go out of the network and see any doctor you choose, but of course, with the additional freedom comes additional premium costs.  Empire also has a Direct Connection HMO that does not require referrals in the network as well as a new $20 co pay which will bring down the cost a little bit.