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Update: Oxford/United and Montefiore Health Systems Still Split

Update: Oxford/United and Montefiore Health Systems Still Split

Recently, UHC/Oxford and Montefiore Health System had split effective January 1, 2021.  Since that time there have been state-required cooling-off period and ongoing talks on resolution but that has not yielded a positive outcome yet. 

According to Oxford, Montefiore patient claims are deemed as out-of-network. 

  • Montefiore’s physicians will be out-of-network for all employer-sponsored and individual plans, including Oxford, as well as our Medicaid plan, effective January 1, 2021.

  • Montefiore’s hospitals will be out-of-network for all self-insured commercial plans, effective January 1, 2021.

  • Our members enrolled in fully insured commercial plans as well as our Medicaid plan will continue to have in-network access to Montefiore’s hospitals until March 1, 2021.

Montefiore Hospitals & Health System

Facility NameCounty
Montefiore Hospital (Moses Campus)Bronx
Children’s Hospital at MontefioreBronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical CenterBronx
Montefiore Wakefield Hospital (Wakefield Campus)Bronx
Burke Rehabilitation HospitalWestchester
Montefiore Mount Vernon HospitalWestchester
Montefiore New Rochelle HospitalWestchester
Montefiore Nyack HospitalRockland
Montefiore St Luke’s Cornwall HospitalOrange
White Plains HospitalBronx
Montefiore Hutchinson CampusBronx
Montefiore Medical GroupWestchester
Montefiore Medical Specialists of WestchesterWestchester

 

Neighboring Hospitals

Facility NameCounty
Bon Secours Community Hospital
BronxCare Hospital Center
Garnet Health Medical Center
Good Samaritan Hospital of Suffern
New York Presbyterian Hudson Valley Hospital
New York Presbyterian Lawrence Hospital
NYC Health + Hospitals Jacobi
NYC Health + Hospitals Lincoln
NYC Health + Hospitals North Central Bronx
St. Anthony Community Hospital
St. Barnabas Hospital
St. John’s Riverside Hospital
Westchester Medical Center
Orange
Bronx
Orange
Rockland
Westchester
Westchester
Bronx
Bronx
Bronx
Orange
Bronx
Westchester
Westchester

Leading Health Insurers 

2021 Empire Blue Cross Blue Shield
2021 EmblemHealth 
2021 Healthfirst Plans
2021 New Oscar Circle Plus

Both sides need each other as both are market leaders in their fields. It is our hope and most of our clients that they get this resolved soon. In the meantime, please bookmark our site for the latest updates.  And do reach out to us and learn the steps that you can take to smoothen this temporary roadblock.

Resources:

KeepMontefiore.Org

https://www.uhc.com/montefiore

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

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Gov Signs NJ Health Insurance Tax Effective Jan 2021

Gov Signs NJ Health Insurance Tax Effective Jan 2021

Gov Signs NJ Health Insurance Tax Effective Jan 2021

Gov. Phil Murphy signed a law Friday that imposes a 2.5% tax on health insurance companies that will help pay the premiums for people who rely on the marketplace created by the Affordable Care Act to shop for coverage.

The Department of Banking and Insurance would levy a 2.5% tax on insurance companies based on the amount of money collected in premiums. The proceeds — estimated at about $200 million — would be deposited into the Health Insurance Affordability Fund and used to subsidize the cost of insurance for people who earn no more than four times the federal poverty level. For example, a single person earning a maximum of $50,040 and a family of three earning $86,880 would qualify.

An estimated $77 million of the tax money collected will bolster the state’s existing reinsurance program to cover high-cost claims and lower premium costs in the individual market.

Much like the Health Insurance Tax (HIT) on Insurers under the ACA, it is expected to be passed on to Employers and Consumers. The New Jersey Business and Industry Association testified against the bill while it was making its way through committee, arguing it would “increase costs on businesses and nonprofits, large and small, which have continued to offer health benefit plans during the current COVID-19 pandemic while struggling themselves to remain afloat.”

Prior Actions:

NJ Expands Disability and Leave Benefits COVID-19  –Mar 30, 2020 

NJ to Start State-based Exchange  – Mar 29, 2019

New Jersey Enacts Individual Health Mandate – Jun 12, 2018 

No More Surprises – NJ Surprise Medical Bill Law – Jun 3, 2018

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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.

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

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NJ Emergency Grace Period for Insurance Premiums

Guidance Follows Executive Order; Requires Emergency Grace Period of at Least 60 Days For Health Insurance Policy Holders & at Least 90 Days for Auto, Homeowners, Renters and Life Insurance Policy Holders

TRENTON — The New Jersey Department of Banking and Insurance today directed insurers to provide financial relief to residents and businesses, as New Jerseyans suffer financial hardship due to the COVID-19 pandemic. The guidance issued to regulated entities follows Executive Order 123 signed yesterday by Governor Phil Murphy extending grace periods during which certain insurance companies, including health insurers, life insurers, and property and casualty insurers, will not be able to cancel policies for nonpayment of premiums.

The executive order requires a minimum 60-day grace period for health and dental insurance policies, and a minimum 90-day grace period for life insurance, insurance premium-financing arrangements, and property and casualty insurance, which includes auto, homeowners, and renters insurance. 

Following the Executive Order, the Department directed health and dental insurance carriers in the individual market, small group and large group markets to provide a grace period for premium payments of at least 60 days. The department directed issuers of life insurance policies, property and casualty policies and insurance premium finance companies to provide a grace period for payments of at least 90 days. Consumers must contact their insurance company to take advantage of the emergency grace period and to discuss options to pay their premiums over time after the grace period ends.       

“We know that many New Jerseyans are facing financial hardship due to the unprecedented COVID-19 emergency. These actions will allow residents and businesses a grace period on premium payments for health insurance policies, as well as homeowners, renters, life and auto insurance. I want to thank Governor Murphy for his steadfast commitment to ensuring New Jerseyans continue to be protected by their insurance policies during this period, and that they receive the financial relief that they need,” said Department of Banking and Insurance Commissioner Marlene Caride. “I also want to thank the industry for providing financial options to policy holders that will ensure they maintain coverage, and for working in cooperation with the department as we implement these measures.”       

The Department of Banking and Insurance is directing carriers in the individual, small group and large group health insurance markets to:

  • Provide a 60-day grace period to pay insurance premiums and continue paying claims during this period; allow policyholders to amortize any unpaid payments over the remaining policy period (for example, if six months are remaining, the policy holder must be given the option to pay the unpaid premium in six installments in addition to the regular monthly premium);
  • Provide those with individual health plans obtained through the federal Marketplace, and receive subsidies, up to a 60-day grace period with claims paid and additional flexibility;
    Waive late payment and fees otherwise due, and not report late payments to credit reporting agencies;
  • Refrain from cancelling any policy or contract for nonpayment during the emergency grace periods, and not seek recoupment from any policyholder for any claims incurred during this emergency grace period; and 
  • Waive certain rules that as a result of the COVID-19 emergency could serve as a barrier to coverage for employees and employers.

    The Department of Banking and Insurance is directing property and casualty carriers to:

  • Provide a 90-day grace period to pay insurance premiums and continue paying claims during this period; allow policy holders to pay premiums not paid during the 90-day period over the remainder of the current policy term or in up to 12 months, whichever is longer;

     

  • Waive late payment fees otherwise due, and not report late payments to credit rating agencies;
  • Ensure that late payments during the 90-day period are not considered in any future premium calculations at any time (i.e. applicable late payments should not be counted for any rating, pricing, tiering attributes, etc.); and

     

  • Permit the grace period to be applied to all installment payments, including renewal down payments, provided that the insured provides notice to the insurer that they wish to continue coverage. 

    The Department of Banking and Insurance is directing life insurance carriers to:

  • Provide at least a 90-day grace period to policyholders or certificate holders to pay life insurance and annuity contracts premiums; allow premiums not paid during the 90-day period to be paid over the course of the following year in up to 12 equal installments;

     

  • Waive late payment fees otherwise due, including any interest permitted, and refrain from reporting late payments to credit rating agencies, during the 90-day period; and

     

  • Extend to 90 days the period to exercise policyholder and contract holder rights and benefits under life insurance and annuity contracts.

The guidance also directs carriers issuing Medicare Supplement plans and insurance premium finance companies to provide grace periods and repayment over a period of time. The Department directed all carriers to, in addition to posting information on their websites, provide each policyholder with an easily readable written description of the terms of the extended grace period offered pursuant to the Department’s guidance. 

 Resource: 

Bulletin – Health Insurance – Individual Market
•   Bulletin – Health Insurance – Small Employer Market
•   Bulletin – Health Insurance – Large Employer Market
•   Bulletin – Health Insurance – Medicare Supplement
•   Bulletin – Property and Casualty Insurance
•   Bulletin – Life Insurance

 

 

This document is designed to highlight various employee benefit matters of general interest to our readers. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional.

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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Disability Insurance: New York vs. New Jersey Infographic

Disability Insurance: New York vs. New Jersey Infographic

Comparing NY’s Disability Benefits Law (DBL) and NJ’s Temporary Disability Insurance (TDI)

From our preferred DBL Partners, ShelterPoint

Do you need to stay on top of the differences between the statutory short-term disability programs in New York and New Jersey?  It may seem hard to keep track of the details, particularly since there are many scheduled changes for New Jersey’s disability program in 2020.

New York vs. New Jersey: How Does Their Statutory Disability Insurance Coverages Compare?

Our handy infographic illustrates the similarities and differences between New York’s Disability Benefits Law (DBL)versus New Jersey’s Temporary Disability Insurance (TDI) with the latest information you need to know for 2020. This visual guide gives you a side-by-side look at each program, ranging from eligibility, and qualification periods to rates/premiums and maximum employee contributions.

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NJ to Start State-based Exchange

NJ to Start State-based Exchange

Governor Murphy announced that the state will seek to run its own ACA marketplace in 2021 to allow greater control over its health insurance market. New Jersey took this step to “protect New Jersey from actions taken by the Trump Administration to roll back the hard-fought protections afforded by the ACA,” according to Governor Murphy.  

Running a state-based exchange will give the state more control over different aspects of the market. These aspects include having control over the open enrollment period, having more access to data, the ability to conduct targeted outreach, and allowing user fees to fund exchange operations, consumer assistance, outreach and advertising.

New Jersey has already passed a few laws that have decreased average rates by 9.3% in 2019. The laws include an individual mandate, a reinsurance program, and legislation that protects consumers from surprise balance billing. The individual mandate’s penalty is related to the average cost of a bronze plan in New Jersey, and will be assessed on state tax returns. The revenue collected from this penalty will go into state funding for the reinsurance program. The reinsurance program was approved by CMS in August 2018. The reinsurance program reimburses insurers for 60 percent of the cost of claims over $40,000, up until claims reach $215,000. 

New Jersey is also proposing codifying major ACA provisions into state law. The protections the Murphy Administration is looking into codifying include: 

NJ’s announcement that they will run a state-based exchange comes at a time when President Trump’s Administration has declared that it backs a full invalidation of the ACA. This position furthers the earlier decision by the administration when the Justice Department argued that there were only grounds to strike down the ACA’s consumer protections. 

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