by Admin. | Oct 19, 2011 | healthcare, Healthy NY, NY News, Small Business Group Health
As reported by Crains, the Healthy NY program will be undergoing significant cuts. Beginning January 1 2012, the high deductible health plans (HDHP) option will only be offered by Healthy NY.
With rates averaging 30% below market and reasonable benefits such as $20 Office Copays this was an important safety net for NYS Small Businesses. Since its inception 10 years ago the program has enrolled approx.180,000 members covering small groups, sole proprietors and working individuals. The program is not Medicaid and allows members to keep their Doctors and enroll in private insurance EPO/HMOs such as Empire Blue Cross, Oxford, Emblem GHI etc. One of the reasons the program is 30% less expensive is that the state has a pooled stop loss fund that reinsures health care companies. This fund has been underfunded with rapid growth and stagnant funding the past 3 years.
Currently, the less expensive Healthy NY HIgh Deductible Plan is $1200/single and $2400/family. Outside of preventive care, members must self insure on the entire deductible including Pharmacy. The good news is that this plan is a qualified HSA (Health Savings Account) and can be reinsured by members. For healthy members the HSA unspent money is not use it or lose and can be rolled over year to year.
Existing Healthy NY groups can still keep their plans as long as long they qualify. However, Healthy NY only allows 1st of the month effective date with only an 11.1.11 and 12.1.11 still available to prospective new groups looking to lock in the regular Healthy NY.
To view current Healthy Benefits and rates click here. For more information or to enroll Contact us today.
by Admin. | Oct 19, 2011 | Healthy NY, NY News, Small Business Group Health, Uncategorized
Healthy NY FAQ
The goal of the Healthy NY program is to promote and provide affordable insurance coverage to eligible small businesses that are not currently offering health insurance coverage to their employees. It is also available to eligible uninsured working individuals and sole proprietors. Listed below are some frequently asked questions by small employers about the Healthy NY Program.
This program does not allow employers to participate if they have “provided” group health insurance to their employees in the past year. Under what circumstances is my business considered to have “provided” group health insurance?
An employer is considered to have “provided” health insurance if the employer arranges for group health insurance and contributes more than $50 (or $75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester counties) per month per employee towards the premiums for coverage. If an employer has merely arranged for health insurance coverage for employees but has not contributed more than the previously noted amounts, then the business may still be eligible for Healthy NY.
What if my business has provided other health insurance during the past twelve months, but the insurance had limited benefits?
If your business has provided other insurance during the past twelve months, but the coverage included only limited benefits (for example – only medical benefits or only hospital benefits, but not both) then your business may still be eligible for HNY.
What if my business has not provided group health insurance coverage in the past twelve months, but some of the employees have been covered through other sources, like their spouse’s employer plan?
The coverage of individual employees through other sources does not affect a small employer’s eligibility to participate in the HNY program.
I have 5 employees. One is enrolled in Medicare and two others receive health insurance through a spouse. The remaining two employees wish to enroll in Healthy New York. Is my business eligible?
Your business would be eligible because the three employees who have other coverage count towards satisfying the minimum 50% participation requirement.
Why is this program available only to small employers who did not provide insurance during the twelve months preceding application? Doesn’t this penalize the “good guys” who struggled to maintain coverage for their employees over the past few years?
HNY was designed to target those individuals who were completely uninsured. These so called “crowd out” provisions of the legislation are also designed to ensure that employers and individuals do not drop existing coverage in favor of this new product.
If my business offers family coverage through Healthy NY, does my business have to contribute towards the cost of the premiums for my employees’ dependents?
No. Employers are encouraged to share in the cost of the Healthy NY premium for their employees. However, there is no requirement that the employer contribute towards the cost of dependent coverage.
Can my business offer Healthy NY coverage to my employees’ families?
Yes, the employer may choose to offer coverage for dependents through the HNY program. Qualifying dependents include dependent children up to age 19 and full time students up to age 26. However, it may be financially beneficial to employees to obtain health insurance coverage for their children through New York’s Child Health Plus program, rather than Healthcore. For more information about Child Health Plus, contact New York’s toll free hotline at 1-800-698-4543.
Is there a re-certification process?
Yes. On an annual basis, employers participating in the HNY program are required to submit a re-certification that attests to their continued eligibility for the Healthcore program. The employer’s health plan will notify participating employers of when this re-certification is due and will provide them with the necessary forms.
What if my business qualifies for HNY and things change? What if I hire more employees and it brings my workforce total over 50? What if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would the coverage then be terminated?
Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of HNY coverage. However, HNY requires an annual re-certification process at which time your business’ eligibility would be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that the wage levels set forth in the eligibility criteria for the HNY program are increased annually to account for inflation.
Can my business offer coverage to part-time and seasonal workers?
Yes, employers may offer coverage to part-time and seasonal workers who work less than 20 hours weekly, but they are not required to do so. If they choose to offer coverage to these employees, the employer may choose to contribute toward the cost of their premium but is not required to do so.
Can I count the wages of part-time and seasonal workers in determining if my business is eligible for participation in the Healthy NY program?
Yes, the annual wages of part-time and seasonal workers may be included for the purpose of determining an employer’s eligibility if the employer also extends coverage to part-time workers.
Which employees must be offered Healthy NY coverage?
Small businesses must offer HNY to all employees working more than 20 hours weekly and earning $40,000 or less annually.
My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthy NY?
Students who are graduating from high school or college who are aging off a parent’s policy may be eligible for HNY if they meet the other eligibility guidelines of the program.
If I do not qualify for Healthy NY, are there other affordable health insurance products available?
Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit Millennium Medical Solutions Corp.
by Admin. | Sep 1, 2011 | Health Care Reform, Health Care Refrom, healthcare, Hospitals, NY News, Tax
Ever Wonder why in a Metropolis of 25 Million there are maybe 5 insurers left?
New York Taxes – As published with the NYS Insurance Dept.
New York adds more insurance taxes than any other state in the country. These consist of both direct taxes and a number of “hidden” taxes amounting to a total of over $4.1 billion in taxes passed on to our customers in the form of higher premiums. These taxes include:
• NYS Premium Tax- this 1.75% tax is on all HMO and insurance contracts and is projected to raise $353 million for the State in 2010. Empire alone pays $103.9 million to the State in premium taxes (this amount includes a special surcharge for customers in the MTA service area).
• Covered Lives Assessment- this “hidden tax” is a charge on all fully and self insured “covered lives” and raises, statewide, projected to raise $1.16 billion for the State in 2010. Empire alone will pay about $296.2 million in covered lives assessments in 2010. The purpose of the Covered Lives Assessment is raise funds for a variety of state programs and for the state Budget. The Assessment is included in claims costs for purposes of calculating the MLR.
• HCRA Surcharge- this is a 9.63% surcharge on all hospital discharges projected to raise $2.33 billion in 2010. Empire alone will pay approximately $379.4 million to the State in HCRA surcharges in 2010. The purpose of the HCRA Surcharge is to raise funds for a variety of state programs and for the state Budget. The Assessment is included in claims costs for purposes of calculating the MLR. NYS Insurance Department “332” Assessment- while this assessment is legitimately intended to fund the cost of the Insurance Department’s regulatory activities there is a “hidden tax” whereby a large portion of the revenue generated by the assessment is used to fund other programs funded not directly related to insurance regulation and is projected to raise $270 million from New York’s health insurers and HMO’s in 2010. Empire will pay the state $57.9 million in 332 assessments for 2010.
Each of these taxes is increased regularly by the State and contributes significantly to annual increases in rates. The competition in the health insurance industry is already at a dangerous low level. Negotiating with insurers has become an overwhelming challenge in the large group market.
by Admin. | Aug 31, 2010 | latest health insurance news, NY News
So how does your Health Insurance Company rank? Click here to find out.
“Each year, NYSID and DOH receive complaints about health insurers from consumers and health care providers. After reviewing each complaint, the State determines if the health insurer acted appropriately. If the State determines that the insurer did not act in accordance with their statutory and contractual obligations, the health insurer must resolve the problem”
According to the report, a better rank means that the health insurer had fewer upheld complaints, relative to its size. If the ratios are the same, the health insurer with the largest premium is ranked higher.
As usual the leading insurers with the most market share rank in the middle. The #1 insurer based on membership, Empire Blue Cross, received # 6 ranking. Highly regarded Aetna got # 8. Using this as a gauge, highest ranked insurers such as MVP, Independent Health and Community Blue (Healthnow) ought to be the way to go. As an example, local Mid Hudson Valley privately owned MVP had 117 complaints with just 7 upheld or 6%.
The numbers would suggest that the smaller size of an insurer the better they are at customer service and reducing complaints. This is unfortunately contrary to what we are seeing in the industry. Health Net has existed the northeast recently, GHI and HIP merged to form Emblem, Oxford was taken over by United Health Care and Empire is owned by Anthem and no longer a non profit. We are seeing recent examples of this turned outside the region as well. Moody’s, New York, points to recent notifications that Blue Cross Blue Shield of Delaware, Wilmington, Del., signed an affiliation agreement with Highmark Inc., Pittsburgh, and that HealthSpring, Nashville, Tenn., agreed to acquire Bravo Health, Baltimore.
So how does an MVP afford to invest in technology and new products? Regulators may frown on the big boys from swallowing them up but its a good guess that new affiliations with similarly sized small companies will be shaping the future landscape of private Health Care.
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by Admin. | Apr 23, 2010 | healthcare, Hospitals, NY News
Just a heads up on a topic that will be all too familiar going forward. We see this as a trend and not the exception. As hospital systems have consolidated in reaction to negative market condition and increasing costs of doing business. But size is better when it comes to negotiating with insurers. We are seeing profitable hospitals asking for 15% rate increase form prior years. They can do this because insurer network marketability is on the quality and size of network.
Current News:
Aetna: Effective 4/5/2010, Beth Israel Medical Center – Petrie Division, Beth Israel Medical Center – Kings Highway Division; Long Island College Hospital; New York Eye & Ear Infirmary; and St. Luke’s Roosevelt Hospital Center – Roosevelt Division, and St. Luke’s Roosevelt Hospital Center – St. Luke’s Division (the “Continuum Hospitals”) were terminated from the Metro NY Aetna network. The hospitals will remain participating and will be accepting In Network Rates until the end of the cooling off period on 6/5/2010.
Continuum had almost lost United/Oxford Health Net in march and Empire or Wellpoint last Spring.
Empire Effective 4/1/10 has lost Stellaris Health Network in Westchester. Those hospitals include Phelps Memorial, Lawrence Hosp, White Plains Hosp, and Northern Westchester Hosp. They were asking for double digit increases for each year of a mutli-year contract, which would have had to be passed on to our members in the form of higher premiums. Our Empire clients will be covered in those facilities for emergencies, as well as services that have already been pre-authorized and approved.
A released Empire Fact Sheet of the contract termination is available
While this happened somewhat in prior years things usually were worked out at 11th hour after a cooling of period. Whats troubling now is that there is little common ground to stand on. We believe in the short term they will get reworked as both Mammoth Corp need each other but this will be a serious concern worth watching.
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by Admin. | Nov 17, 2009 | group health insurance, NY News
NY State is trying to tack on additional taxes on health insurance. They’ve already quietly added a sales tax for the 1st time earlier this year.
According to NY POST Article NY eyes $1B tax slap on health
“I STRONGLY OPPOSE ANY ADDITIONAL HEALTHCARE TAXES OR HEALTH INSURANCE ASSESSMENTS AS PART OF THE DEFICIT REDUCTION PLAN (DRP), SINCE THIS WILL RAISE HEALTH INSURANCE PREMIUMS FOR CONSUMERS”
Here’s a list of officials and legislators to contact with the simple message above:
Executive Chamber:
Governor David Paterson – (518) 474-8390
Lt. Governor Richard Ravitch – (518) 474-4623
Senate Leadership:
Senator John Sampson (Democratic Conference Leader) – (518) 455-2788
Senator Carl Kruger (Finance Committee Chair) – (518) 455-2460
Senator Tom Duane (Health Committee Chair) – (518) 455-2451
Senator Neil Breslin (Insurance Committee Chair) – (518) 455-2225
Upstate Senate Caucus:
Senator David Valesky (Vice President Pro Tem) – (518) 455-2838
Senator Darrel Aubertine – (518) 455-2761
Senator William Stachowski – (518) 455-2426
Senator John DeFrancisco (Finance Committee Ranker) (518) 455-3511
Long Island:
Senator Craig Johnson (518) 455-2622
Senator Brian Foley (518) 455-2303
Senator Dean Skelos (Minority Leader) (518) 455-3171
Hudson Valley:
Senator Suzi Oppenheimer (518) 455-2031
Assembly Leadership:
Speaker Sheldon Silver (518) 455-3791
Assemblymember Denny Farrell (Ways & Means Chair) (518) 455-5491
Assemblymember Richard Gottfried (Health Comm. Chair) (518) 455-4941
Assemblymember Joseph Morelle (Insurance Comm. Chair) (518) 455-5373
