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NYS 2021 Final Rates Approved    

NYS 2021 Final Rates Approved    

by | Aug 14, 2020 | group health insurance, healthcare, individual health insurance, NY News, Small Business Group Health

NYS has approved 2021 health insurance rate requests yesterday. Small group rates increase 4.2% and 1.8% for individuals.

  1. As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2021 Rate Requests.  Despite only 3 months of mature claims data experience for 2020  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 63%.

The 2021 small group rate increase was the second-lowest ever approved at 4.2% vs  2020’s approval of  7.9%. This reflects 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% last year in the individual market nationwide.

Rate Factors

The state noted that the premiums increase main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of  11.4% in the small group market.  DFS cut the weighted average requested rate increases by 63% for 2020, saving small businesses over $565 million.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small businesses, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example. Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

Small-Group Market

Final Small Groupo Rates NYS 2021

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NYS 2021 Rate Requests

NYS 2021 Rate Requests

by | Jun 8, 2020 | group health insurance, healthcare, individual health insurance, Small Business Group Health

The NYS 2021 Rate Requests filings were released today.  The total weighted average increase request was 11.4% for  Small Group Market with some citing Coronavirus as necessitating higher premiums next year.That figure is heavily influenced by the request of UnitedHealthcare’s Oxford, which has recently controlled about half the market and requested an 13.6% increase.  The total weighted Indiv market request is an 11.7%.

Background:

Health Insurers have been meeting the COVID-19 challenge by paying 100% for diagnosis and treatments at no cost to the consumers. Additionally, health insurers have been advancing cash payments to hospitals while also absorbing sustained premium losses. 

This early filing request deadline request requirement is not an Obamacare requirement.  As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year.

A spokeswoman for the state Health Plan Association said insurers have worked to control costs, which have been driven up by rising prescription drug prices and state mandates that require coverage of certain services.

In the small-group market, national insurers such as UnitedHealthcare’s Oxford and Empire Blue Cross have requested 13.8% and 16.6% rate hikes. Recent start-up, Oscar Health has requested a 29.1% increase. Disappointingly, the google-backed health insurer has been a leader in health technology and had supposedly righted the ship with new plan designs.

Fortunately, the localized hospital-owned network such as Healthfirst has requested a modest 5.5% increase. This is consistent with last years 4.7% increase and their inflation busting average of 5% last 3 years. Similarly, the Fishkill-based, MVP Healthcare, is asking for only a 4.1% hike which is even lower than their 7% for 2020. MVP has averaged a stable 6% increase last three years. 

Conclusion

Final rate approval are expected in early August. The past rate reductions averaged 10-50% savings. Last year, plans asked for an average increase of 9.2% and NYS 2020 Final Rates Approved at a 7.9% increase. 

Defined Contribution Choice:  Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange or a PEO.  This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.

To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.

Resource

  • For a custom analysis detailing YOUR upcoming 2019-2020 renewal please 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.  
  •  See Health Reform Resource

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

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Return to Work Plans and COVID-19

Return to Work Plans and COVID-19

by | May 14, 2020 | COVID-19, group health insurance, healthcare

Return to Work Plans and COVID-19

As COVID-19 unfolds, the importance of a properly deployed Return to Work is reviewed and in place with contingencies.

Echoing the sentiments of public health officials, a return to normalcy won’t be like flipping a switch, but rather a gradual effort. In preparation for reopening your business and asking employees to come back to work, it’s imperative that your company thoughtfully constructs a return to work plan for its employees to keep everyone healthy and safe following the COVID-19 pandemic.

 Things To Consider Before You Open

1. Make sure your workspace is thoroughly cleaned with CDC recommended cleaners
2. Check with state and local health codes for your type of work in light of COVID-19
3. Create health and safety protocols for your work environment 
4. Train your staff on new work and health protocols as it relates to COVID-19
5. Implement paid sick leave if you don’t have it already for sick employees

Returning to Work and Benefits Eligibility Considerations

Eligibility

Employers should first determine whether the plan document addresses furloughs, rehires, or unpaid leaves of absence.  It may be time to check and update existing Employee Handbooks. 

Premium Payments

The employer may recoup the cost of any missed contributions during the period the employee was furloughed without pay.  Employers should check state wage and hour laws, as some states have limits on what can be deducted from an employee’s pay.  

Restoring Previous Election

When more than 30 days have elapsed between an employee’s termination and rehire, the cafeteria plan may (by design) allow a new election or require the old election to be reinstated.

ACA and FMLA Considerations

For special unpaid leaves of absence (such as leave under the FMLA and USERRA), the employer has two options for crediting hours. One option is to exclude the period of special unpaid leave from the applicable measurement period. The other option allows employers to credit the employee with hours equal to the average hours worked during weeks not part of the unpaid leave.

Employers who furlough employees without terminating employment will need to make careful determinations as to whether employees need to be credited with hours of service under the applicable look-back period. The failure to correctly credit hours could cause the employer to misclassify employees as not full-time and cause penalties under the ACA employer shared responsibility rules. Careful records should be kept so that the employer knows each employee’s status as full-time or not full-time during each month of 2020 in order to be prepared for ACA reporting that is done in early 2021. Employers may wish to go ahead and credit employees with hours service during the furlough period. While this would be one way to avoid penalty under employer mandate rules, the employer should get the carrier’s

What Happens If Your Employees Get Sick?

  • Send them home immediately if they aren’t already working from home.
  • Advise them to contact their doctor immediately.
  • Advise them to keep their direct report updated on their status.
  • Deep clean the office if the employee has been there during the last 14 days.
  • Notify Human Resources to send information on how to self-monitor and self-quarantine at home.
  • They should not return to the office until symptoms are gone for 72 hours, without the use of symptom-reducing medication.

What do I do if an employee tests positive for coronavirus?

  • If they learn of this while in office, send them home immediately.
  • Notify all office employees of the exposure and send them home.
  • Deep clean the office.
  • Close the office for 14 days.
  • Identify and notify any employees from other offices who may have visited the office in the last 14 days.
  • Advise all employees to self-monitor for 14 days, and to reach out to a doctor if they start to exhibit symptoms.
  • Notify Human Resources to send information on how to self-monitor and self-quarantine at home.
  • Advise employees to keep in contact with their direct report.
  • Require a doctor’s note that verifies the employee is no longer sick, contagious or COVID-19 positive before they can return to work.

Continued Safety

Once back at work employees with symptoms should understand the importance to stay home and get tested and have a plan if an outbreak occurs again. Remember, reopening your business after the COVID-19 pandemic isn’t as simple as opening your doors. You’ll need to carefully evaluate each step of your reopening and gradually ask employees to return to work.

The next phase of responding to the COVID-19 pandemic involves reopening your business. While this task may seem daunting, we’re here to help. Understanding your health benefits well is the key to helping your employees get the right health care when they need it. If you’d like to find out more about how you can get better benefits so your employees use them when they need to, we’d like to show you how. Please contact us using form below or info@mecialsolutionscorp.com or 855-667-4621.

 Resources

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below.

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To Test or Not to Test: That is just one of many critical questions

TIME:  Friday, May 15, 1:00 P.M. EST

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COVID-19 has dramatically affected the world and created new hurdles for businesses in virtually every industry. To meet this challenge, Optum has built a practical Return to Workplace approach for employers.

DISCUSSION  presenters discuss the issues defining (and redefining) the workplace in the age of COVID-19, including:

  • Testing, re-testing, and quarantine management – all top of mind with employers as they consider how to open for business
  • What employers should think about as employees return to the workplace
  • A framework for building an effective return to work approach

 

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Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

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COBRA Rule Changes

COBRA Rule Changes

by | May 10, 2020 | COBRA, COVID-19, group health insurance, healthcare

COBRA Rule Changes

 

The Departments of Labor and Treasury has issued a final rule that creates an extension of timelines for employees due to COVID-19. These new rules apply for 60 days after the announced end of the declared National Emergency. This 60-day period is now called the ‘Outbreak Period’. See new model general and election notices for continued health coverage under COBRA. 

COBRA

Current Rules:

Employees impacted by a COBRA qualifying event have 60 days to elect COBRA, and 45 days thereafter to make payment for coverage retroactive to their last day of coverage.

A participant actively enrolled in COBRA has 30 days from the first of each month to make payment for continued coverage.

New Rules:

Initial election period is extended to 60 days from the last day of the ‘Outbreak Period’.

Actively enrolled COBRA participants now have 30 days from the last day of the ‘Outbreak Period’ to submit retroactive premium payments.

These Federal rules only apply for groups 20 or larger, each state has its own continuation rules for employers with less than 20 employees.

Our Recommendation:

Please notify your COBRA Participants and adjust your required notifications.We are automatically notifying all our COBRA Administration Clients and Participants of these brand-new Federal Rule changes.Employers are ultimately responsible for all COBRA rules, including notification requirements.

HEALTH INSURANCE

Current Rules:  

Employees have the right to enroll under 3 situations only:   

  1. When initially hired, subject to the company’s waiting period.
    2. At open enrollment, which normally coincides with the plan’s renewal date.
    3. When there is a life qualifying event (i.e. marriage, birth, etc.); the employee can enroll within 30 days of the qualifying event.

New Rules:

  • Employees with a Qualifying Life Event now have up to 30 days after the end of the ‘Outbreak Period’ to submit the request for retroactive enrollment.
  • The Special Election Period Allowance currently applies to Medical Insurance coverage only.

Additional New Rules:

  • Employees who previously opted out of coverage may now be able to join the employer’s plan. This is subject to carrier discretion. Call us for the particulars.
  • Health carriers continue to allow furloughed employees to remain eligible for coverage even though for many this does not meet their minimum eligibility guidelines.

Examples

Example One: Electing COBRA

Individual A works for Employer X and participates in X’s group health plan. Due to the National Emergency, Individual A experiences a qualifying event for COBRA purposes as a result of a reduction of hours below the hours necessary to meet the group health plan’s eligibility requirements and has no other coverage. Individual A is provided a COBRA election notice on April 1, 2020. What is the deadline for A to elect COBRA?

Answer – Individual A is eligible to elect COBRA coverage under Employer X’s plan. The Outbreak Period is disregarded for purposes of determining Individual A’s COBRA election period. The last day of Individual A’s COBRA election period is 60 days after June 29, 2020, which is August 28, 2020.

Example Two: Special Enrollment Period

Individual B is eligible for but previously declined participation in, her employer-sponsored group health plan. On March 31, 2020, Individual B gave birth and wants to enroll herself and the child into her employer’s plan. The open enrollment does not begin until November 15. When may Individual B exercise her special enrollment rights?

Answer – The Outbreak Period is disregarded for purposes of determining Individual B’s special enrollment period. Individual B and her child qualify for special enrollment into her employer’s plan as early as the date of the child’s birth. Individual B may exercise her special enrollment rights for herself and her child into her employer’s plan until 30 days after June 29, 2020, which is July 29, 2020, if she pays the premiums for any period of coverage.

The information provided on this website is intended for informational purposes only.  Millennium Medical Solutions Corp. does not offer legal or medical guidance.  Those with legal or medical questions should seek appropriate assistance from a licensed professional.  Stay up to date by signing up for Newsletter and Coronavirus Dashboard below.

 

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Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

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

Study: Single Payer Aftermath

Study: Single Payer Aftermath

by | Dec 8, 2019 | group health insurance, Health Care Reform, healthcare, Hospitals, MEDICARE

As Americans learn more about proposed new government-controlled health insurance systems – like Medicare for All, the public option, Medicare buy-in and other similar one-size-fits-all systems – a new study on teh aftermath of Single Payer by KNG Health Consulting is providing a glimpse into the real-life consequences these systems could have on American families. 

50% of Americans would give it thumbs up according to Kaiser Family Foundation. That majority support turns to opposition once people learn Medicare for All would ban private insurance. Turns out 70% of Americans are also satisfied with their employer-sposnored health insuarnce.   The plan grants the federal government a monopoly on health insurance — no private insurers or employers would be permitted to pay for health benefits.

Many Americans would understandably switch from private insurance to the public option. As they did so, hospitals and doctors would raise prices for the privately insured to compensate. Insurers would be forced to hike premiums in response, to cover providers’ higher payment demands. That would compel even more individuals to switch to the public option.

Some employers would surely do the same, dropping their benefits programs and encouraging their workers to enroll in the public plan. Indeed, a recent study from KNG Health Consulting found that Medicare for America — a proposal that would transfer everyone who does not receive coverage through an employer to a government-run plan — would cause one in four workers to lose access to employer-sponsored insurance by 2023. More than half of employees at small businesses would lose their employer-sponsored coverage under Medicare for America.

Download Full Study
Among the most startling findings, Medicare for America could force one-third of American workers off of their current employer-provided health care coverage, also known as employer-sponsored insurance (ESI). 

 

The KNG study on “Medicare for America” points to an unaffordable new government-controlled health insurance system that reduces Americans’ choice and control over their care.  Whether it’s called Medicare for All, Medicare for America, Medicare buy-in or the public option, Americans would pay more and wait longer for worse care.

And instead of addressing rising health care costs, the study finds that this new government-controlled health insurance system “would increase total health care spending, with the largest spending increases occurring among those who already had public coverage through Medicare or Medicaid.”

 

Hospitals would lose. Approximately 5,000 community hospitals would lose over $151 billion under a Medicare for All system, according to a recent Stanford University study. Robert Pollin — an economist at the University of Massachusetts Amherst and supporter of Medicare for All — estimates that 2 million jobs across hospitals, health care facilities and the insurance industry could disappear.

According to CBO (Congressional Budget Office) that Medicare for All could “lead to a shortage of providers, longer wait times and changes in the quality of care.”

Ultimately, the public option would be the ONLY option. The insurance market can’t function unless all the players in the market are operating by the same rules.As Seema Verma, administrator of the Centers for Medicare & Medicaid Services, rightly put it, “The public option is a Trojan horse” for Medicare for All.

So which one is it?  An added public option that doesn’t have to compete or really one costly government option? Both options seem to fall short of their ideals.   

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2020 Oxford Metro Network NY

2020 Oxford Metro Network NY

by | Oct 28, 2019 | group health insurance, healthcare, Small Business Group Health

2020 Oxford Metro Network NY

Oxford has expanded on their successful Oxford Metro Network plan released in 2016. For 2020 the network has expanded 15% in NY and added NJ network last year.  In 2019 most Metro plans stayed flat and  for 2020 increasing single digits.

Oxford Metro Network:

The NY network has grown to approx. 13,000 Primary Care Providers, 32,000 Specialists and 85 hospitals.  Furthermore, the Oxford Garden State network has been added as well onto the Metro Network.  The Garden State network alone has access to 24,900 physicians and 67 hospitals.

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 Caremount, formerly Mt Kisko Medical Group,  are NOT in the network.

Value:

Today’s largest networks with  in-network only GOLD  are  priced at  $12,000 /single annually. They typically are accompanied with $50 copays and  non-office exposures of $1,000 deductibles and coinsurance percent in network. By comparison, the new Metro network is approximately 25% smaller than NY Liberty network with up to 16% IN SAVINGS.  For example, a popular Oxford Liberty HMO Gold  is $910 vs.Oxford Metro Gold $770.

New 411 Plans Added 2020 new oxford plans

Innovative plan intended for the moderate user. Enhancements include four $5 PCP Copays, one $25 Urgent Care and one $25 Specialist Copay. The tier 1 Rx copays are only $5.The average family copay savings is $250/year. The network uses Liberty network.

The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network. Rates for Gold level plan are approximately 35% discounted. Want to learn more about Healthy NY? Schedule a 1-on-1 RSVP today.

Additional Features: 

  • MyUHC.com – member portal
  • Gym Reimbursement – Sweat Equity –Annual reimbursement $400 members and $200 dependents. now eligible age 13+ dependents qualify for reimbursements
  • Telemedicine – Virtual doctor visits on myuhc.com
  • Real appeal – a personalized weight loss program
  • Quit for Life – a tobacco cessation program
  • Enhanced customer service

DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze

Oxford Metro FAQ. Click Here

Drug Formulary: Click Here

Group Sample Rates:

2020 Metro, Freedom, Liberty prices

 

 

 

 

 

 

 

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