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NYS DFS 2024 Rates Approved

NYS DFS 2024 Rates Approved

Earlier today, the long-awaited NYS Dept of Financial Services approved 2024 health insurance rate requests. And it was worth it with small groups stabilized.  Small group rates increased by 7.4% and  12.4% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers. Despite only 3 months of mature claims data experience for 2023  health insurers’ original requests were noticeably above the average of 22%/individuals and 15.3% for small groups.

State Department of Financial Services officials asserted the rising cost of medical care — including in-patient hospital stays and rapid increases in drug prices — continued to be the main driver of health insurance premium increases. The final approved rates for 2024 would keep health insurers’ profit provisions at 1%, state officials added, noting they sought to limit those returns in light of ongoing inflationary pressures harming consumers. That said, in 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 well-being 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’ healthcare costs and the economy, held insurers’ profit provisions to a low 1%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 4.7% rate increase approval for next year. This is a sharp reduction from the original 15.5% request in part to 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 800,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 15.3% in the small group market, which DFS cut by 52% to 7.4% for 2024, saving small businesses $607 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   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Indicates the Company will offer products on the NY State of Health Marketplace in 2024.

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. PEOs 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 a difference for your small business please contact us at [email protected] or 855-667-4621.

 

 

 

 

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Get Covered NJ and American Rescue Plan Act

Get Covered NJ and American Rescue Plan Act

Get Covered NJ and American Rescue Plan Act and the Extension of COVID-19 Special Enrollment Period

Governor Murphy announced an extension of the COVID-19 Special Enrollment Period for Get Covered New Jersey to May 1, 2021.

Special Enrollment Period Effective Dates:

  • Enroll by March 31, coverage effective April 1
  • Enroll by April 30, coverage effective May 1
  • Enroll by May 15, coverage effective June 1

The American Rescue Plan – Additional Financial Relief 

The new COVID-19 relief bill, the American Rescue Plan Act of 2021, will reduce health insurance premiums by providing more financial help to eligible consumers who purchase a plan through Get Covered New Jersey. These changes will make coverage more affordable at many income levels:

  • Increases in financial help (Advance Premium Tax Credits or APTC) for all eligible consumers. The amount of financial help is based on household income just like before, but has increased at every income level. Families making less than 150% of the Federal Poverty Level (FPL) – or $19,140 a year for an individual or $39,300 for a family of four – will be eligible for near zero-dollar premiums under the new law.
  • New financial help for higher incomes. Previously, financial help was not available for households making more than $51,040 for an individual or $104,800 for a family of four. The new law ensures that no family spends more than 8.5% of their income on health insurance premiums. This means many individuals who previously did not qualify for financial help from the federal government may now see more affordable premiums.
  • Financial help for unemployed. Additional financial help may be available for anyone who has received unemployment benefits in 2021

For more details visit the Get Covered New Jersey COVID-19 webpage at:

https://nj.gov/getcoverednj/findanswers/covid19/

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at [email protected] or (855)667-4621.

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Top 7 Health Trends for 2021

Top 7 Health Trends for 2021

Health Tech trends had been diverted last year due to the impact of the COVID. Yet the emerging results are very real and for 2021.  

What do you think the defining healthy living trends of 2021 will be? Here are a few to keep your eye on.

Distanced and Digital

1.   Telemedicine. Virtual doctor’s appointments were already catching on before the pandemic began, and they’re most likely here to stay. Some visits will still need to be done in person, of course, but don’t be surprised if others, like therapy sessions and quick check-ins, stay digital. The adoption rate has skyrocketed in part because of convenience but also low cost. During the first quarter of 2020, the number of Telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019.  See – Preparing for a Telehealth Visit.

2.  Ditching the Gym. As social distancing remains a part of life, many people are skipping the gym for good. Everyday routines now include exercising outside as much as possible or turning to apps and videos to find quality solo or group workouts. Health Insurers have doubled down on member gym rewards and expansion to ages as young as 13. Additionally, attending classes has been also recognized. For example, Oxford Health Plans sponsored  Chelsea Piers Fitness Virtual Classes.

3.  Genomic Breakthrough.  Scientists have already made many advances in treatments of killer diseases, including Duchenne muscular Dystrophy, heart disease, and cancer. Due to breakthroughs in this field, we’re likely to see accelerated development of forms of treatment known as “precision medicine,” where drugs can be customized to match the genetic profile of individual patients, making them more effective, as well as less likely to cause unwanted side-effects.  Just imagine custom prescriptions based on your genetics.

4.  Data and Artificial Intelligence analytics.  The coronavirus pandemic has shown us that there is a willingness to share our personal data when the benefits to our health are clearly communicated. This has been proven by track-and-trace systems that have reliably kept infection levels in check in some regions (though less so in others). This will be particularly important from a financial point of view. The coronavirus pandemic has been costly for the healthcare industry, with revenues falling by 50% in the US due to patients avoiding hospitals and surgeries. This will lead to an increased reliance on AI-driven prediction tools to forecast where resources can be used most efficiently. Insurance providers will also step up their use of advanced predictive technology to better understand risk and more accurately set premiums.

Mindful Living

5.  Prioritizing mental health. A stressful 2020 placed mental health needs in the spotlight. As a result, many individuals, families, and workplaces feel more comfortable discussing this essential topic. Expect to see a continued focus on stress relief, honest communication, coping techniques, and more.  To be sure Yoga has been widely recognized under the gym rewards. 

6.  Thoughtful cooking and eating. You’ll also probably see a continuing emphasis on sustainable and locally sourced food. This means more home and community gardens, creative and collaborative cooking, and supporting your favorite restaurants by ordering takeout. Overall, in 2021 we’ll be more aware of food sourcing and quality than ever before. People have become more comfortable cooking healthy meals as a health measure and nice savings. 

7.  Future Planning

After managing so much uncertainty these past few months, preparing for the future has become more urgent. Estate planning, exploring your life insurance options, and taking advantage of your health coverage are all continuing priorities.

We also offer personal line insurance such as renter’s policies, home insurance, and life insurance.  

 

Top Health Trends for 2021

Learn how our PEO Partnership can help your group please contact us at [email protected] or (855)667-4621.

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President Signs $2.3 Trillion Stimulus CARES Act

President Signs $2.3 Trillion Stimulus CARES Act

President Signs $2.3 Trillion Stimulus CARES Act

Visualization of the CARES ActPresident Donald Trump signed a $2 trillion bipartisan stimulus package Friday that is intended to address the threat of economic disaster posed by the coronavirus pandemic.

The largest stimulus in U.S. history stimulus package aimed at resuscitating the economy following several weeks of severe, acute economic downturn.  Senate and House passed the bill unanimously after a week. The following are the healthcare related provisions:

Hospitals

Hospitals will receive the $100 billion in federal assistance they initially requested be in the FFCRA along with a 20 percent bump in Medicare payments for treating COVID-19 patients. Experts expect rural hospitals to be hit especially hard during this pandemic, since they already operate on thin margins with limited staff.

Insurance Companies

Unlike the providers, insurers were not so lucky. Carriers requested an emergency fund to offset losses from the pandemic, including premium subsidies to help fund temporary COBRA coverage, but received nothing.

The bill expands coverage beyond what was in last week’s Families First bill by requiring health insurers to pay for coronavirus testing beyond those that are FDA-approved to include those provided by labs, state-developed tests, and any other tests approved by HHS.

Telehealth Expanded to HSA (Health Savings Accounts)

Accessibility for telehealth is also expanded. High deductible health plans with HSAs may now allow pre-deductible coverage for telehealth and other remote services, as well as allowing the use of HSAs for the purchase of over-the-counter medications without a prescription. In the past, the HSA Deductibel would have to first be met.

OTC items bought with pre-tax funds

After the Affordable Care Act, over-the-counter (OTC) drugs and medicines required a prescription in order to be eligible for reimbursement from an HSA, FSA or HRA. The CARES Act would allow individuals enrolled in these pre-tax accounts to pay for OTC drugs and medicines without a prescription. This action helps to reduce additional strain from an already overwhelmed healthcare system. This is a permanent chang

Surprise Bills

Very limited action was also taken to address surprise medical bills. Under the CARES Act, all health insurance plans would reimburse a COVID-19 test provider at the in-network rate put in place prior to the breakout. If the provider is out of network, the health plan is to fully reimburse the provider based on the provider’s own “cash price” which must be made publically available while the public health emergency is still declared. Providers that do not post their test price publically could be fined up to $300 a day. States like NYS in 2015 and NJ in 2018 have already passed Surprise Medical Bill Laws.

NYS

Will the Empire State see relief with the passage of the CARES Act? Governor Cuomo is not so sure, claiming that the $3.8 billion New York will receive is “a drop in the bucket as to need,” and that a previous House bill would have given his state $17 billion. Cuomo’s budget office predicted on Tuesday that state revenue losses could be as high as $15 billion.

Additionally, NYS Department of Labor received over one million calls from recently unemployed individuals in a single week, while the country as a whole reported 3.3 million jobs lost. The governor had already implemented several executive orders and moratoriums to provide relief for New Yorkers, including a 90-day pause on evictions as well as a halt on both medical debt and student loan debt collection. This week, the governor announced that utility companies will postpone rate increases that were set to go into effect on April 1.

State Funding

The bill also provides $150 billion for state and local governments, as states quickly burn through their own funding. Several states anticipate they will face multibillion-dollar budget shortfalls. New York’s budget office, for example, anticipates state revenue losses could be as high as $15 billion. The massive stimulus package also includes:
  • $200 million to be invested in telemedicine
  • $30 Billion for education funding
  • $25 Billion for public transit
  • $17 Billion for small businesses
  • $10.5 billion for the Pentagon, including $1.5 billion to deploy the National Guard
  • $10 billion Treasury loan for the Postal Service

SMB Relief

The 800-page Act includes many provisions to help small and medium-sized businesses (SMBs). It will provide $350 billion worth of loans to SMBs. Note: 
  • Small business interruption loans

    This is in addition to the Small Business Administration (SBA) Economic Injury Disaster Loan program, which provides loans up to $2 million and is available to SMBs in all 50 states. 

    Small businesses, non-profit organizations, sole proprietorships, and self-employed individuals with 500 or fewer employees per location are eligible for loans up to $10 million. The maximum interest rate is 4%.

    The loan can be used to provide:

    • Payroll
    • Mortgage or rent payments
    • Utility payments
    • Healthcare premiums
    • Other debt obligations

    Any portion of the loan used for payroll and existing debt obligations will be eligible for loan forgiveness for an 8-week period from the beginning of the loan, given they can maintain the equivalent number of full-time employees through June.

    Organizations that have already laid off workers due to the pandemic will still be eligible for the loans and loan forgiveness if they rehire their staff members.

    Portions of the loan used for payroll issued to workers who earn over $100,000 will not be forgiven.

    The stimulus legislation states portions of the loans used for covered expenses will convert to grants, but interest will still have to be paid.

    Loan forgiveness is reduced proportionately to any reduction in workforce or wages compared to the prior year.

    Businesses that receive funding under the “Paycheck Protection Program” are not eligible for the SBA EIDL loans.

  • Any portion of the loan used for payroll and existing debt obligations will be eligible for loan forgiveness for an 8-week period.

  • The Act also provides a refundable payroll tax credit equal to 50% of “qualified wages.

  • Qualified individuals will receive up to $1,200 per person (or $2,400 for married filing jointly) with an additional $500 per child. The benefit decreases by $5 for every $100 in income over $75,000 and will not be paid to single taxpayers who make $99,000 (or $198,000 for married filing jointly).

  • Federal Income Tax Returns normally due on April 15 will not be due until July 15, 2020.

  • The Act extends unemployment benefits from 26 weeks to 39 weeks. The benefit amount is calculated under state law, plus $600 in federal funding per week up to 4 months. It will also waive the one-week waiting period.

  • It also provides unemployment benefits for self-employed workers and contractors.

The legislation is surprisingly vague on exactly how the money will be distributed, although most of those who have been working to shape it assume that HHS Secretary Alex Azar will likely have a major role to play.

The information provided on this website is intended for informational purposes only.  As more details emerge, we will continue to update this article. 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.

Learn how our PEO Partnership can help your group please contact us at [email protected] or (855)667-4621.

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HRA Final Rules

HRA Final Rules

On June 13, 2019, the Departments of Labor, Health & Human Services and Treasury released final rules concerning Health Reimbursement Arrangements (HRAs).  The 497-page rule includes the creation of two new types of HRAs, the “Individual Coverage HRA” and the “Excepted Benefit HRA.” 

Advantages of the Individual Coverage HRA

  • Funds can be used to reimburse the employee’s premiums for an individual health insurance policy.
  • Reimbursements made to employees do not count towards the employee’s taxable wages.
  • The employer can choose to roll-over unused amounts into the following year.
  • Coverage can be offered to different classes of employees (e.g.; full-time, part-time, seasonal, salaried, hourly)
  • An offer of the Individual Coverage HRA represents an “offer of coverage” under the employer mandate, however, contributions must meet affordability guidelines. The IRS will release further guidelines regarding this later.

Individual HRA restrictions: 

  • An offer of an Individual Coverage HRA cannot be made to any employee that is offered a traditional group health plan.
  • If an offer of coverage is made to a class of employees, there is a minimum class size that is required. Size is typically 10% of that specific class of employees. For example, if an employer has 200 employees, a minimum of 20 employees would have to be in a specified class.
  • Contributions can be in any amount that the employer chooses, but contributions must be consistent for all employees in a specified class.
  • The employer must provide notice of the Individual Coverage HRA to employees.
  • The employer must be able to substantiate that the employee is enrolled in an individual plan or Medicare (model notices are available).
  • The employer must notify employees on an annual basis that the individual health insurance is NOT subject to ERISA.

The final rule also created the “Excepted Benefit HRA” which, starting in January of 2020, will permit employers to finance additional medical care. Employees can use the HRA without having to be enrolled in the group’s traditional health plan. 

“Excepted Benefit HRA” include:

  • The annual contribution is capped at $1,800.
  • It must be offered in conjunction with a group health plan, but there is no requirement for the employee to enroll in that plan.
  • The “Excepted Benefit HRA” cannot be used to fund group health or Medicare premiums.
  • It can fund premiums for dental, vision, or short-term limited duration insurance.

Effective Date:

Employers who want to offer the “Individual Coverage HRA” for January 1, 2020, can do so but employees will need to enroll in an individual plan during the 2019 open enrollment period (November 1, 2019 – December 15, 2019). 

If you have any questions or would like additional information, please contact us at 855-667-4621 or [email protected].

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NYS 2019 Final Rates Approved   

NYS 2019 Final Rates Approved   

NYS 2019 Final Rates Approved    

NYS has approved  2019 Final Rates last Friday. Small group rates will increase 3.8% and 8.6% 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 –NYS 2019 Rate Requests.  Despite only 3 months of mature claims data experience for 2018  health insurers’ original requests were noticeably below average 7.5% for small group and 24% for individuals.  Ultimately NYS reduced this request substantially by approximately 50%.

Experts are concerned over the long term effects. Example, the Individual  mandate was removed last December by Presidential order. Without the Mandate anyone can drop insurance without penalty.  A comparable take away for similar auto insurance industry would be something like this -Drivers ought not be mandated to buy auto insurance as its a profit scheme by Insurers. While a popular decision this will hardly bend the curve long term and reduce competition.  Furthermore, the new order of Selling Across State lines makes NYS most unwelcoming.

OTHER STATES

Insurers have been filing to sell Obamacare plans that will go into effect in 2019, and in some states they appear to be pricing in for the fact that the mandate is going away next year. Other states are seeing mild increases, but that is in part because they saw significant hikes for the previous year.

Insurers have concluded that fewer people will enroll without the mandate than otherwise, so in some places they are pricing their plans higher based on the assumption that sicker people will be left behind, which will increase medical costs for those left. It is well worth pointing out that in recent years the loss federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.

How are neighboring States doing?

In NJ, not that bad.  Last year the average increase were 5.5% for small groups and some popular plans such as  Horizon Blue Cross Blue Shield’s  OMINA  increasing only 4.8% increase.   This year the increase is only 5.2.  Other insurers offering EPO and HMO plans in the individual market for 2019 include Oscar Health and Oxford Health Plans.

With individual mandate repeal fewer people will buy health insurance raising the prices for those who do. NJ Banking and Insurance Department officials said premium prices would have increased, on average, by 12.6 percent.

For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases last year.  The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year: The proposed average small group rate increase request is a 10.22 percent and ranges from -5.0 percent to 21.1 percent. This compares to the average increase request of 18.06 percent requested last year.The proposed average individual rate increase request is 12.3 percent and ranges from -10.9 percent to 31.0 percent. This compares to the average increase request of 25.51 percent requested last year.

Final plan rates in New Jersey & CT will be finalized and released in the fall, state officials said. ACA open enrollment begins Nov. 1

  • Trend: Trend is a factor that accounts for rising health care costs, including the cost of prescription drugs, and the increased demand for medical services.
  • Uncertainty in Washington:
    • Removal of penalty for individual mandate: The elimination of the penalty means that individuals who are typically younger and healthier would have no inducement to participate in the insurance pool, which could further destabilize the market. Lack of participation shrinks the pool and increases the cost of insurance to the remaining members.
    • Short-duration health plans and Association Health Plans: Still pending are final federal regulations on non-ACA compliant short-duration plans, which may have implications for the ACA risk pool. Also, Connecticut along with other state insurance regulators, are awaiting clarification from the federal government on new federal regulations allowing association health plans, which could further shrink the ACA risk pool.

 A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.

Finally, a tax on health insurance premiums has been reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested for 2019 and for  2019

SMALL GROUP MARKET VS.  INDIVIDUAL MARKET

Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit. Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see –  Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.

The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a 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 are lower for small group plans than individual markets.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at [email protected] or (855)667-4621.

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