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1 Empire Dual Advantage (HMO SNP) H X
2 Freedom I (PPO) $20/$50 $40/$75 H X Medicare limiting charges apply. Customer Service: Provider Service: Services provided by Empire HealthChoice Assurance, Inc. an association of independent Blue Cross and
3 Plus (HMO) $20 $50 H X
4 Empire MediBlue Select (HMO) $20 $50 H X
5 WM3A A4 Essential (HMO) $10 $40 H X
6 Freedom I (PPO) $20/$50 $40/$75 H X Medicare limiting charges apply. Customer Service: Provider Service: Services provided by Empire HealthChoice Assurance, Inc. an association of independent Blue Cross and
7 Freedom II (PPO) $10/$30 $35/$55 H X Medicare limiting charges apply. Customer Service: Provider Service: Services provided by Empire HealthChoice Assurance, Inc. an association of independent Blue Cross and
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