Breaking: All Health Republic plans (Group and Individual) ending on 11/30. according to early reports the healthcare Co-Op Health Republic NY will be shutting down Nov 30, 2015. New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.
TIMELINE:
Oct 28th – Utah Healthcare Co-Op shutting down end of 2015. This sis the 5th Co-Op to shut down
June 2015 – With a spike in rate increase of 15-20% for 2016 to reflect unexpected high costs of new 200,000 membership the most affordable health plan was experiencing difficulties. The insurer reported $130 million in losses during its first 18 months of operations, according to financial filings, even as it enrolled more customers than any other insurer. DFS did allow for a 13 percent increase in the second year and a 14 percent increase heading into 2016. Both were lower than what Health Republic requested, though, and were not enough to save the struggling insurer.
May 2015- Health Republic was dealt its death blow when it became clear that the Affordable Care Act’s risk corridor program would not be fully funded, said one source familiar with the company’s finances. A report from Standard & Poor’s in May said the program had only 10 percent of the funds needed to make payments.
Summer 2013 -Health Republic had borrowed $265 million to begin operations.
New Insurance Risk Corridors paid for by a combination of both consumer insurance premium surcharge tax of 2-3% and Health Insurers is suppose to reclaim capital to those that are less profitable. Health Republic was owed approximately $147 million but was told by the Centers for Medicare and Medicaid Services to expect less than half that according to sources.
Regrettably, we all suffer when an Insurer exits the market. Furthermore, it will be a while again when Federal funds earmarked to start a low cost affordable health plans will materialize again. We are pulling for neighboring co-op Health Republic of NJ and hope this trend discontinues.
Our agency will be working closely with our clients to mitigate this exposure and transition smoothly for Dec 1, 2015. Individuals on the Marketplace can contact the New York State Department of Financial Services Consumer Hot Line with questions regarding Health Republic by calling 1-800-342-3736. The Hot Line hours are weekdays (Monday through Friday) from 8:00 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 1:00 p.m.
Please Click here to read the full Press Release from NYDFS.
Stay posted, more news to follow. Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us info@medicalsolutionscorp.com today.
November 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
2016 plans and prices will be available for preview the third week of October, 2015.
December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.
If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Marketplace Special Enrollment Period.
Penalty: The uninsured penalty rises to $695 or 2.5% of your income, whichever is higher.
Coverage start dates
If you enroll before the 15th of any month, your coverage starts the first day of the next month. If you enroll after the 15th of the month, you’ll have to wait until the month after that for your coverage to start. So, for example, if you enroll on January 16, your coverage would start on March 1.
Enroll using our online comparison shopping tool for both on and off-Exchange Marketplace to be released next week. Email us or Contact us at (855)667-4621.
Oxford has released an affordable new plan for 2016 and not a moment too soon. With the recent exit of popular Health Republic of NY, Health Republic NY is Shutting Down, the market is starving for an affordable option.
Today’s largest networks with in-network only GOLD are priced at $9,000/single annually. They typically are accompanied with $50 copays and non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 15% IN SAVINGS. For example, an Oxford Liberty HMO Gold is $745 vs Oxford Metro Gold $650.
In 2015 Oxford’s Garden State Network originated the same game plan of offering a third network in addition to FREEDOM and LIBERTY. After all what good is a large network when one cannot afford to visit Providers? The third network answers the call for access to Providers with half the copays priced at approximately $1,500 less.
All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists. Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Mt Kisko Medical Group are NOT in the network.
The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Jeb Bush, running for the Republican presidential nomination, put out a detailed health proposal yesterday. The Bush campaign says the former Florida governor’s plan, in broad terms, would accomplish three goals: promote innovation, lower costs and return power to states.
Under Bush’s plan, individuals could get higher tax credits for purchasing health insurance and would be allowed higher contribution limits on health savings accounts for out-of-pocket expenses. He also would overhaul the regulations imposed by the Food and Drug Administration to help spur innovation in the healthcare industry and would put limits on malpractice lawsuits. And he would put caps on federal payments to states and create a “transition plan” for 17 million people “entangled” in Obama’s Affordable Care Act.
Bush also proposes to limit the tax-free status of employer-provided health insurance, an idea labor unions fiercely oppose.
Here are some key points to consider:
It would repeal and replace Obamacare.
Bush wants more people to have catastrophic coverage.
Bush would repeal the so-called Cadillac tax
Instead limit the Employer tax-free health benefits at $12,000 a year for an individual and $30,000 for a family.
ACA Marketplace and Employer Health Plan Cost Comparison
Are you ready for 2016 Individual Open Enrollment? The #1 question we get form individuals is am I better off staying on the individual plan or joining my small employer group plan?
Starting Nov 1, 2015, the 3rd anniversary of Obamacare’s ACA Marketplace begins. Continuing through 2018, several new parts of the Affordable Care Act that affect costs and benefits will be rolled out. The remaining provisions will take effect against a backdrop of new patterns in health care spending and trends.
A frequent Employer question is how do costs compare on the ACA Marektplace vs. Employer Health Plans. The infographic from the Commonwealth Fund point out that the premiums are more favorable when factoring low income premium subsidies. In order to even the scales, an individual must earn $23,500 for a net subsidized premium of $125/month (click Kaiser calculator). This number represents 60% of marketplace enrollees. The same $125/month contribution amount represents 55% of employer health plans.
One positive point is that U.S. health care spending has slowed in the past few years. In a recent 16-month period, nearly 23 million Americans have enrolled in the Affordable Care Act, while almost 6 million people lost coverage. Research from Rand Corp. finds that of the newly insured:
42 percent are covered through employer-sponsored plans.
29 percent are enrolled in Medicaid.
18 percent have health coverage in individual marketplaces.
Take a look at the infographic:
2016 Open Enrollment Deadlines:
November 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
FYI2016 plans and prices will be available for preview the third week of October, 2015.
December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.
If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Marketplace Special Enrollment Period.
Penalty: The uninsured penalty rises to $695 or 2.5% of your income, whichever is higher.
Coverage start dates
If you enroll before the 15th of any month, your coverage starts the first day of the next month. If you enroll after the 15th of the month, you’ll have to wait until the month after that for your coverage to start. So, for example, if you enroll on January 16, your coverage would start on March 1.
Enroll using our online comparison shopping tool for both on and off-Exchange Marketplace to be released next week. Email us or Contact us at (855)667-4621.
BREAKING: The young Co-Op start up of 2014 will be shutting down Dec 31, 2015. With membership totals approx. 200,000+ the early exit comes as a shocking surprise despite their recent losses and 15-20% rate increase approved for 2016.
On Friday, a joint announcement came from the state Department of Financial Services, the Department of Health and the federal Centers for Medicare and Medicaid Services (CMS), with DFS directing Health Republic to cease writing new health insurance policies and begin an orderly wind-down of business.
“Given Health Republic’s financial situation, commencing an orderly wind down process before the upcoming open enrollment period is the best course of action to protect consumers,” said Anthony Albanese, acting superintendent at DFS. “Moving forward, we will work closely with New York State of Health and federal regulators to help ensure continuity of coverage for Health Republic’s customers.”CMS officials said decision was made after state and federal agencies determined it was likely Health Republic would become financially insolvent.
According to recent announcements Health Republic of NY was exiting the small group and individual markets for Mid-Hudson, Albany, and Utica/Watertown regions. These counties include: Albany, Columbia, Delaware, Dutchess, Essex, Greene, Hamilton, Oneida, Orange, Oswego, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster, Warren, and Washington. The reasoning was the high delivery costs driven by Provider consolidation, see https://healthrepublicny.org/media/2563/faqs-service-area-reductions.pdf.
With recent exits for Insurers such Atlantis, Emblem Health/GHI and Empire blue Cross the transitions were handled differently. Some allowed groups to see their plan through renewal anniversary date or end of year. Further announcements are expected on transition of coverage.
Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us info@medicalsolutionscorp.com today.
Breaking News: NSLIJ, and Brooklyn’s Maimonides Announce Strategic Partnership on Wednesday. Both side shave been in talks since February.
Eventually North Shore-LIJ and Maimonides will fully integrate, “in a phased approach that will begin immediately,” the two jointly announced Wednesday. In the meantime, both institutions maintain their independence and separate governance structures. Lynam said there was no specific time frame for full integration.
Maimonides gets much-needed cash — tens of millions of dollars — for capital and operational investments. That will help it compete with Presbyterian-backed Methodist and Langone-backed Lutheran. North Shore-LIJ gets its first real foothold in #Brooklyn, one of the most competitive health care markets in the nation. But it does so without the commitment that a full-scale merger would entail. An affiliation agreement also protects North Shore-LIJ from unknown liabilities related to the Federation of Jewish Philanthropies, a malpractice insurer that covers Maimonides and several other hospitals
North Shore-LIJ has made strategic partnerships and acquisitions before. For North Shore-LIJ, the relationship means it has a hospital or hospitals in every borough as well as blanketing Westchester and Long Island. North Shore-LIJ, the country’s 14th largest health care system, owns 19 hospitals. In the city that includes Lenox Hill Hospital in Manhattan, Staten Island University Hospital, and, in Queens, Forest Hills Hospital, Long Island Jewish Medical Center, Cohen Children’s Medical Center and Zucker Hillside Hospital, a behavioral health center.
They are also actively insuring members today in the Downstate NY area under the CareConnect NSLIJ holding company. With important advantages under ACA and mindful of delivering value the insurance arm is priced affordably. In fact they had lowered their rates 15-20% for 2015 and and industry low 3.3% for 2016.
A fun visual transit infographic highlighting the benefits of public transportation by Credit Donkey. With NYC Transit Benefit Mandate for 2016 Employers with 20 or more full-time employees in New
York City must sponsor for full-time employees a pre-tax qualified transportation benefit program (excluding parking subsidies). It would mean that an estimated 450,000 more New York City-based employees will have access to the commuter tax break. That’s in addition to the 700,000 who already get the break.
Despite the requirement this visual highlights the inherent win-win of riding public transit. Furthermore, Employers exempt form the mandate such as smaller Employer or outside NYC ought to consider this as a benefit per at work. IMPORTANT: The popularity of the benefit for Employers have been a budget neutral perk that is offset by payroll tax savings. After all, the Employer is not required to fund the Transit/Parking only sponsor the plan.
Tax Savings:
The way the pretax commuter tax break works is employees exclude their transit commuting costs from their taxable wages up to the $130 monthly limit (there’s a separate $250 monthly limit for parking). If you’re in the 40% combined federal and state bracket and you put away $130 a month pretax salary to use for transit, you save $624 a year. This also saves the employer money because the employer doesn’t pay payroll taxes of 7.65% on every dollar set aside by employees pre-tax.
$130 transit maximum
EE Savings @ 40% tax bracket = $624/year
ER Savings (FICA) = $119/year
$250 parking maximum
EE Savings @ 40% tax bracket = $1,200/year
ER Savings (FICA) = $230/year
Next Step:
If you want your employer to add commuter benefits—so you’re eligible for the tax break–petition your HR department, and specifically ask for the pretax commuter benefits program (why wait until 2016?). To learn more about the NYC Transit Mandate, please visit the official website of the City of New York.
To start a Transit benefit within 24 hours contact us today (855) 667-4621 or info@medicalsolutionscorp.com. Ask us about our enterprise payroll.
MMS, Inc. in partnership with BenefitMall adds allCheck ACA compliance tool!
Want to know how to easily calculate your FTE’s ( Full Time Equivalents)?
Not sure if you need to provide the Notice of Exchange?
Unsure about your Health Care Tax Credit Eligibility?
Want to get an idea what your overall ACA compliance obligations might be?
Let MMS inc. and allCheck do the work. How? Its simple. Download the input sheet, complete and we will crunch the numbers and send you a customized report just like the sample! Please call us 855-667-4621.
This law is new and constantly evolving. We (and everyone else) are still processing the thousands of complex provisions. The calculations here will change based upon your input, and is meant to be an educational tool for you to use in understanding how healthcare reform may impact your business. We recommend you work closely with your broker and local counsel to receive the most accurate and up-to-date information.
The rate requests for 2016 marked the first year in which insurers could rely on actual data from exchange enrollees. In many cases, insurers participating in exchanges in other states requested double-digit rate increases. New York is the second-largest state to receive final approval of its rate requests. Earlier this week, California insurance regulators approving an average rate increase of just 4 percent.
To the relief of customers of industry leader Oxford/UnitedHealthcare the rate increase for groups will be 3.9 to 6.5%. Importantly, the rates are a collective average and may range depending on one’s particular health plan. Additionally, Helath Insurers can opt to tweak or remove plans. Reminder: be sure to check back again our site in 30-60 days. Rates will be posted upon Health Insurer’s release. Also 2016 Individual Exchange Marketplace opens Nov 15th.
Individual Market
On average, insurers requested a 10.4 percent increase in health insurance rates for 2016 in the individual market. DFS reduced that average increase more than 30 percent to 7.1 percent – which is below the approximately 8 percent average increase in health care costs.
Starting on January 1, 2016, New York will add a new Basic Health Plan a.k.a ” Essential Health Plan” to the plans that can be purchased by lower income New Yorkers through NY State of Health. Households at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) will have no monthly premium for the Basic Health Plan. Those with slightly higher incomes at 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will have a low monthly premium of $20 for each adult.
The Basic Health Plan will provide the same covered services as other plans offered on the Marketplace. The Basic Health Plan has no annual deductible and lower copayments, making health care even more affordable for hundreds of thousands of New Yorkers. For example, a person who earns about $20,000 a year and uses moderate health care services including an inpatient hospital stay, prescription drugs and doctor’s visits, will pay about $730 a year for premiums and out-of-pocket costs under the Basic Health Plan in 2016 as compared to about $1,830 in 2015 if they were enrolled in a Qualified Health Plan.
Small Group Market
On average, insurers requested a 14.4 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase by 32 percent to 9.8 percent. A number of small businesses will also be eligible for tax credits that would lower those premium costs even further.
2016 Small Group Rate Actions – Overall Summary
Company
Requested
Approved
Reduction
Aetna Life
23.87%
21.47%
-2.40%
CDPHP HMO*
-19.84%
-19.84%
0.00%
CDPHP UBI*
16.56%
16.56%
0.00%
Emblem HIP*
29.74%
29.74%
0.00%
Empire Assurance
8.70%
3.40%
-5.30%
Empire HMO
9.21%
4.37%
-4.84%
Excellus*
13.90%
10.00%
-3.90%
Health Republic*
20.00%
20.00%
0.00%
HealthNow*
8.06%
0.66%
-7.40%
Independent IHA*
-15.60%
-15.60%
0.00%
Independent IHBC
-6.19%
-6.19%
0.00%
Managed Health
5.60%
3.94%
-1.66%
Metro Plus*
-0.81%
-0.81%
0.00%
MVP Health Plan*
7.28%
6.36%
-0.92%
MVP Services*
16.71%
15.90%
-0.81%
North Shore LIJ*
3.27%
3.27%
0.00%
Oxford OHI
13.61%
6.75%
-6.86%
Oxford OHP
10.58%
3.90%
-6.68%
United UHIC
18.79%
11.61%
-7.18%
All Companies Combined
14.41%
9.80%
-4.61%
You may view the DFS press release, which includes a recap of the increases requested and approved by clicking here.
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Health Republic NY Shutting Down Nov 30
the pretax commuter tax break works is employees exclude their transit commuting costs from their taxable wages up to the $130 monthly limit (there’s a separate $250 monthly limit for parking). If you’re in the 40% combined federal and state bracket and you put away $130 a month pretax salary to use for transit, you save $624 a year. This also saves the employer money because the employer doesn’t pay payroll taxes of 7.65% on every dollar set aside by employees pre-tax.
