Select Page
NYS 2023 Final Rates Approved

NYS 2023 Final Rates Approved

by | Aug 18, 2022 | group health insurance, Health Care Reform, healthcare, Individual Exchanges, NY News, Small Business Group Health, United Healthcare

Yesterday, NYS Dept of Financial Services approved 2023 health insurance rate requests yesterday. Small group rates increased by 7.9% and  9.7% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –2023 NY Small Group Carrier Rate Filings.  Despite only 3 months of mature claims data experience for 2022  health insurers’ original requests were noticeably above the average of 16.5%/individuals and 19% for small groups. For example, regulators last year approved average rate increases of 3.7% for individuals and 7.6% for small group plans. Over 1.1 million New Yorkers are enrolled in individual and small group plans impacted by the rate increases, the state agency noted.  

The recent COVID-19 surge irony reflected a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% in recent years years. That said, in an anticipation of spikes in claims submissions + overall inflation, a larger than average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial wellbeing of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ health care costs and the economy, held insurers’ profit provisions to a historically low 0.5%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 6% rate increase approval for next year. This is a sharp reduction from the original 16.8% request in part by disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

Small Group Market   

Almost 850,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 16.5% in the small group market, which DFS cut by 52% to 7.9% for 2023, saving small businesses $632.4 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

DFS SMALL GROUP MARKET RATE ACTIONS   

NYS DFS Approval 2023 Health Insurance Rates

*Indicates the Company will offer products on NY State of Health Marketplace in 2023.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

 

 

 

Put You & Your Employees in Good Hands

Get Started

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

Employer Sponsored Health Plans Generate 47% ROI

Employer Sponsored Health Plans Generate 47% ROI

by | Jul 6, 2022 | group health insurance, healthcare, Small Business Group Health, Wellness

Health insurance is expensive, and we’ve all asked ourselves, “Is it really worth what I am paying?”. For employer-sponsored health insurance, the answer is a resounding YES it is. For every dollar employers spent on health insurance-related costs, they get back $1.47 according to a new study from Avalere Health. This figure in fact is expected to grow to 52% by 2026 from 47%.

The U.S. Chamber of Commerce commissioned the Avalere Health employer study that used publicly available data from the Bureau of Labor Statistics and the Congressional Budget Office to estimate the return on investment employer-sponsored health insurance provides employers with 100 or more employees.  Improved employee productivity, reduced direct medical costs, and tax benefits were the primary aspects that generated benefits for employer-sponsored health plans. Employers who offered employer-sponsored health coverage and wellness programs had healthier employees and spent less on direct medical costs, Avalare found.

The Numbers

Share of Benefits by Component as % of ROI for ESI

Employee productivity reflects the reductions in absenteeism and lost productivity after receiving employer-sponsored coverage. These productivity increases contributed an estimated $275.6 billion in employer benefits in 2022, or 53.3% of all benefits. By 2026, this is expected to rise to $346.6 billion or 55.9 percent of total ROI.

ROI of some of these key components includes $275.6 billion from improved productivity in 2022 and $346.6 billion in 2026, $101 billion from a reduction in direct medical costs in 2022 and $108 billion in 2026, and $119.2 billion or a 23% ROI from tax benefits in 2022 and $139.7 billion in 2026.

Employer-Sponsored Insurance(ESI) offerings can positively influence prospective employees’ decisions to join firms, reducing employer recruitment and vacancy costs. The study’s model assumes that 9% of individuals decide to accept a certain position based on ESI. The analysis estimates that firms with 100 or more employees derived $141M in employer benefits in 2022, growing to $167M in 2026.

Similarly, ESI positively affects the retention of employees. Avalere’s analysis estimates $20.3B in employer benefits from improved retention in 2022 and $24.3B in 2026.

Conclusion

The study finds that industries where firms generally made greater investments in ESI tended to result in larger ROI. Also, since costs associated with turnover and recruitment are positively associated with wages, Avalere estimates higher ROI in higher-wage industries. On the flip side of that same coin, lower ROI was associated with industries that typically have a lower investment in ESI and wellness programs, lower wages, and lower employee participation in ESI and wellness programs.

The full report including the methodology can be found here.

For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

Study: Employer-Sponsored Health Insurance Produces +47% ROI

Newsletter Sign Up Now

Learn how our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get Started

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

Oxford Liberty National Network Changes

Oxford Liberty National Network Changes

by | May 18, 2022 | group health insurance, United Healthcare

Oxford Liberty National Network Changes

Starting with September 1, 2022 plan effective dates, Oxford members of a Liberty Network plan will have the UnitedHealthcare Core Network for out-of-area coverage. They will no longer use the UnitedHealthcare Choice Plus Network for national network access. This change applies to all Oxford Liberty members. 
 

UnitedHealthcare Core Network Overview 

  • The Core Network has 90% physicians and 93% of hospitals overlap with the Choice Plus Network
  • The Core Network includes 895,806 physicians and health care professionals and 5,001 hospitals. 

Click here for the Core Network Availability Map

What this means for New York and New Jersey Oxford members enrolled in a Liberty Network plan

  • The out-of-area network for New York and New Jersey situs businesses with Oxford Liberty Network plans will change from the UnitedHealthcare Choice Plus Network to the UnitedHealthcare Core Network effective September 1, 2022 for new business and upon renewal for existing business
  • In states where the UnitedHealthcare Core Network is not available, Oxford Liberty network members will have access to the full network that mirrors the UnitedHealthcare Choice Plus Network
  • Liberty network access within the Oxford tri-state service area remains unchanged

Provider search

As always, please confirm a provider’s participation in the health plan network prior to seeking care. You can do this online, on myuhc.com, or by calling the phone number on their health plan ID card. Please note:

  • Members should sign in to myuhc.com® to search for Oxford Liberty Network providers
  • Upon renewal, beginning with September 1, 2022 plan effective dates, Core Network providers will appear in the provider search tool when Oxford Liberty members look for out-of-area providers
  • Non-members and affected members whose plan has not yet renewed will also be able to perform a search for Liberty with Core providers prior to September 1, 2022

New Cards

New Liberty Member ID with COREAll Oxford Liberty Network members will receive new member ID cards indicating UnitedHealthcare Core for out-of-area network access.

We will continue to share additional communication tools as they become available from Oxford. 

 
 Learn more about how we are successfully helping navigate SMB for 25+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

Newsletter Sign Up Now

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get Started

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

by | Oct 12, 2021 | group health insurance, Health Care Reform, Small Business Group Health

A little-known requirement but most important under Affordable Care Act (ACA) is for Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods, and that plans can only be offered to applicants that live in, work in, or reside in the plans’ service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees, but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. This was even more evident in 2019 with the ACA’s federal Individual Mandate non-compliance penalty reduced to $0.00.

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

Newsletter Sign Up Now

For more help with the Special Open Enrollment Window contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get Started

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

HSA vs FSA

HSA vs FSA

by | Feb 1, 2021 | group health insurance, healthcare, HSA, Tax

HSA vs FSA

With High Deductible Health Plans (HDHP) funding trending in the recent decade, there are helpful tax-advantaged savings tools that can help employees out. But just how many employees understand the difference between an HSA(Health Savings Account) vs an FSA(Flex Savings Account)?

Facts:  Only 11% could correctly identify all HSA attributes which may explain why 33% of employees enrolled in an HDHP have not opened up an HSA according to the JAMA Network website published in July 2020.

Below is a simplified chart comparing HSAs vs FSAs.

It pays to fund an HSA

Some people who are eligible for HSAs don’t participate or don’t max out their contributions, because they don’t fully understand how these plans work. But if you pass up the opportunity to capitalize on an HSA.

Currently, you can contribute up to $3,500 per year to an HSA as an individual, and up to $7,000 for a family. If you’re 55 or older, you can put in an extra $1,000 on top of whichever limit applies to you. Also, know this: Sometimes employers fund HSAs on their employees’ behalf, so see if that’s a benefit you’re entitled to. Though the sum your employer puts in will count toward your annual limit, it’s effectively free money to help you tackle the potentially monstrous cost that is healthcare, both now and in the future.

If you still are unsure which savings plan best suits your small business, contact your licensed insurance broker for advice. To download this entire document as a PDF, click here: Open Enrollment eBook

Is your HSA compliant?  Which pre-tax qualified HSA, FSA, HRA spending card is right for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.  Stay tuned for updates as more information gets released.  Sign up  for the latest news updates.

This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

 

 

Contact Us

 Learn more about

 Liability Protection  •  Employee Benefits  •   HR Consulting

(855) 667-4621 or email us at info@medicalsolutionscorp.com

Contact

PEO Pros and Cons

PEO Pros and Cons

by | Nov 16, 2020 | group health insurance, healthcare, HR, PEO, Small Business Group Health

When choosing the right PEO, especially when it comes to human resource management, you should ensure that they offer basic HR services like benefits, payroll, and compliance.

Pros of PEO

1. Flexible, scalable:

Bundled HR solution covers you as you grow.  i.e. Compliance changes based on # of employees. The HR Platform can handle 10 as well as 200 employees. The benefits scale up as you do. You are able to include value-added services as you grow.

2. Access to “Big-Company” infrastructure and benefits

  • More health care benefit options for employees and their families mean:
    • Attract high caliber talent in your industry
    • Retain your best employees
  • 401(k) and retirement planning 
  • Top-rated voluntary benefits and discount programs
  • HR technology platform for administering benefit plans

3.  Access to HR expertise

  • Support for payroll and employee needs.
  • HR and Human Capital consultants.
    • Benefits administration
    • Employee issues
    • Strategic HR planning:  Interview Traning and Permanence Management Reviews, etc. 
  • Ensure HR compliance with local, state and federal laws.

4. Shifting and sharing of liability

  • Workplace safety
  • Sexual Harassment
  • Employer Practices Liability Insurance
  • Affordable Care Act compliance
  • COVID and New regulations

5. Value

  • Time Saver:  You get back valuable time from doing redundancies. The average PEO client saves 10 hrs/month. 
  • Benefits Savings:  The average client saves 15-40% on medical benefits alone.   The national networks and robust benefits are also value-added. 
  • Savings on Workmans Comp. 
    • PEO’s are pay as you go WC. This means if you downsized in light of COVID you receive an adjusted lower rate the following month and not end of the year. 
    • PEO’s may be able to place hard to write Workmans Comp. Ex: Construction Industry
  • State Unemployment:  Since you are sharing in a larger company’s SUTA rate the rates are generally lower with lower fluctuations. If during COVID a company had high turnover their SUTA rate can jump much higher than a PEO. 

PEO Cons

1. Wrong PEO Selecting a PEO for the wrong reason(s): should be considered a long-term strategy, not a short-term fix.  Some PEOs may charge a percentage of salary instead of a clear per employee per month cost.  

2. Employers fear the loss of control Even though you will still be running your small business and making day to day decisions, the PEO will become the co-employer of your staff.  PEOs do NOT have control over your salary. You control who you hire/fire.  You decide on benefits eligibility waiting periods, plan selections, and employer contributions. The PEOs deal with HR responsibilities and risks, saving you countless hours and many headaches, but do not take away your independence.

3  System limitations   Because the PEO is a business as well, and has to meet it’s own deadlines, they may request certain payments upfront. This may mean a fundamental shift in your cash flow because there will be consequences for being a week late with your payroll taxes.

4. It is NOT for every small business depending on your industry and demographics you may or may not be the right for a PEO. While the vast majority of clients are indeed enjoying benefits savings for some groups the costs may be even higher than small group health insurance. Addiotnaly, some companies can develop above-average very high risk and become too much of a liability burden for the PEO and the client can be moved to a higher risk category. The very advantage of a PEO can make it a disadvantage – they can underwrite.  

Summary

Before you consider hiring a Professional Employment Organization, you should first find out what is a PEO so that you can know exactly what to expect from it. With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well. 

If you are looking for an insurance solution for your business, go to our website and check out our business insurance solutions. Do not hesitate to contact us for more information.

 RESOURCE:

PEO What are the Stats?

What is a PEO?

 

 

Put You & Your Employees in Good Hands

Get Started

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP.